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Home My WebLink About0047 WEST TERRACE - Health (3) �l�I (,�e:S�- Tern , CQ�- r .No.--•--7641. F'Es.... . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � N.............OF.-.-. ff. -- --�-----...-•-----------............--------- Appliratiou for Uiipuual Workii Tontitrurtiuu Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ()c) an Individual Sewage Disposal System at: y'T_....... r . .T ------------------------------ ------- ---��P ......................... •- - Lo tion-Address or Lot No. .......-------- - ----------- Owner Address Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling X No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers Cafeteria ( ) Q, Other fixtures .......................................... WDesign Flow____________________________________________gallons per person per day. Total daily flow-----------:................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________________ Depth................ x Disposal Trench-No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W ,a Test Pit No. 1_---------------minutes per inch Depth of Test Pit.................... Depth to ground water_-____-________________- fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ................................................................ •----------------------------------- ---------•---------•--•-•-------------------------------- 0 Description of Soil.........................................................................................-----------------------------------------------------------------....._•---_.. x V ---•-------------------•--•-------------••----------------------------------------------._.-...-------••-------------------------------•---._.-----------------------------------•----•--•--•----•----- W x ------------------------------------------------------------------------------------ --------•---------------------------------------------------------••---•-------••-•------------------•.._...._...._ U Nature of Repairs or Alterations—Answer when applicable.___` dP�9A_._.__Ol,P___torf''_____t✓ ___._L9ba______..__. ---..........'?- �'-'-'------.W-io P.Y' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by the bo rd_ 1 alth. Signed •---------•.Ll d 2-L/-o d ----•---••------------- ----._.........-------•- Date Application Approved BYC) ------------•-----------•-•••-- .......... Date Application Disapproved for the following reasons:...............................................................................^-............................... -----------------•-•--••-------•----•---...--•-•-•-----•----...-•-•----------•-------------•-•-----------------------------------------------------------------------..--------------------------------- q Date PermitNo...........�f..!_.4-)—....................... Issued..................................................... Date No..... --!'.gZ.-.. Fxs....'30......... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------ --......bt zi...e:.............OF..... - .E; f?y c...-----------...-----------------.......---------- Appliratilan for Uiiploii al Works Touts ra tion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: _ o. »..C_......-• �ion✓SAddress v< C i �7 or fjnCi Lo�(t ... ------- ------O---------------- ••- -----•--------------------•------ ---- Owner s r�l�•...r..i../-i-- Address Installer Address QType of Building Size Lot............................Sq. feet Dwelling x No. of Bedrooms........:-................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers Cafeteria ( ) Q' Other fixtures ----------------------------•--- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________________ Depth................ x Disposal Trench—No_ ___________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test-Results Performed by.......................................................................... Date........................................ aTest Pit No. 1________________minutes per inch Depth of Test Pit____________________ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ --••-•-•--•----•-------•--.._.__--•-•-•---•---__...---•------------------------------------------•---•---•-••------------•--•---------•----------. --------- 0 Description of Soil---------------•---------------------._._......-•---.....-----._...----•----------------------------------------------------•---....----------------------------•------- x U ---•--•----------------------- ----•--•--•----•-••-•--•---------------------------------•---•--------------•------•-----------------------•-----•-------------------........._---••--•-----••-•-------. W ................-------------•--•-------••----------•--------------•-------------------••---------------•-------------------------------------•---•-•---•••--••--••••---•--•-----•--•-••-----••.....---- VNature of Repairs or Alterations—Answer when applicable.___ _ ______ % ."."`_____.........:'_.__i0::'...__._______.. ..............-.............................................................................................................................................................. .......................... Agreement: } Th', undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar of health. Signed---- ...................................................... F Date Application Approved B `l - -- ' .. .. r -•---------•-------------- ••----••--�_ =-�-�-`•--- Date Application Disapproved for the following reasons:-----•-----------------------------=-------------------•------------------------------------------._...-----•-- .............................................................=...........................................-••--•---------------------------------•---•--•----•---•----•---•----•----------•--•----•------ Date PermitNo........... ......................... Issued Issued----------•-----------------------•---•---•-----...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v 4} s rr3G_C ..........................................OF......................................_......_..................................................... Trdif iratr of �rrnt tli nrr THIS IS TO CEJ?TIFY, That the Indivilual Sewage Disposal System.constructed ( ) or Repaired ( ) / //< Ci---••-----��j/S S Ts"�rC`�i ^_...... f".:---•"L 'L -=-----------------•--•------•--.......__..._.._..........---....--------...._.: by----------- Installer ---------•-- ------------ - --------------------•---•-------••-••-•---••---•----------------_------------ has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... _-_ ._<;L,__________ dated______________ ________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT:BE3C0RU:EDAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.--•...... =-=--•�. �J-----•-------•-----....-•---------------- InsPec � .---•--------•. --------------------------...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _// No... ,�...(p. FEE..... ................ Bispos al Work.5 Tonatra ilan rrnti# Permission is hereby granted-----------! �G.��f'''-•---____---------•----------------------------•-------•------•--•---------•---.___-_--•---____I._...------- to Construct *1 or Repair ( ) an Individual Sewage Disposal S stem A� atNo...................... .-_._A_41/- ' -,-----7:t;^� -•-•--------. �N�-K�............................................................ Street as shown on the application for Disposal Works Construction Permit No.?O.'�ezvf% Dated........................................... ��aPoVealth--•--•----••-•--------•-•---•-•-•---...» oar DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS