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Home My WebLink About0132 BAY ROAD - Health I L O CAT I001 '9�d5l j f-e o (1 (Y SEW A G E PE RMI.T NO• �J `r -7 - VILLAGE _ � IP f M • 00-1 " . INSTA LL,ER NAME i ADDRESS 4 - rCv s 7 IUILDEIt OR OWNER 9 DATE PERMIT ISSUED _ DATE COMPLIANCE ISSUED 1!t i' ' � 9- �% is i `� � �' ,� � .� �o - r �� , �Q ��;�� No._ / �,/�� - • � � 3� , � .............. ..... THE COMMONWEALTH OF MASSACHUSET TS _ B0* HEALTH . SUBJECT gTpp--O rAfP�PROVAL/AOrFq�ggg . SS-- r t 11E'l E V �•�. !r—��JI1.7 4ldiV Cw €)id ApplirFation for U44paii al Works mitrurtion Prrmit Application is hereby made for ermitA to Construct ( or Repair ( ) .an Individual Sewage Disposal Syst ...: .. .` at: ` y-- - ..... . b �........... ................. i.:... .................. ................. ...................................................................... .'—moo atio�ddress or Let No. � I, d ssOsn _ aa Inw Address _ Type of Building Size Lot. 1.11Wl......Sq. feet U Dwelling—No. of Bedrooms...............:................ Expansion Attic Showers( ) ge Grinder ( )Other--Type of Building ............................ No. of persons .on (Gajb Cafeteria ( ) a' Other fixtures ................................. W Design Flow............................................gallons per person per day. Total daily flow----------� 0................._gallons. WSeptic Tank—Liquid capacity.Ems' 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 ( ) aPercolation Test Results Performed by..••--------------------•----............-•-••------•---------..._...-.._. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit................--.. Depth to ground water........-----........... (i Test Pit No. 2................minutes per inch Depth of Test Pit-- Depth to ground water.........--........----. O Description of Soil :�. .. ------------------------ .-----------. �;( --•-------------------------•-------•-----------------•-------------•---•---------•--••--------•--------------•------•--------••-----••----•----------••-•-•-•-••-•--•-----••-•---------._.....---...... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .Agreement: The undersigned agrees to install the aforedescribed Individual"Sewage Disposal System in accordance with the provisions of TITS 5 of the State—Sanitary C—o"d The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d b the b iealth. Signed.................................... --............ .............................. ------------ ..........�x f ate Application Approved By. ...;. '•-•- .............................'y� �- / ... ate Application Disapproved for the following reasons------------------------•---...------•--....-----------••-----------------------...--...-•-...--------.....------ ........................•----------•---.......--......---------------•--------••------•---•---------...•.----------------------•-------------•------------•---•--------•------------••-•-------••------- Date PermitNo......................................................... Issued-....................................................... Date • S .\ F�$.... _............_. THE COMMONWEALTH OF MASSACHUSETTS BOARD--OF HEALTH ...................... tZ ....._.__.................._..._.... Alipliratiou for Uiipastal Works Tvitstrurtivat runtit Application is hereby made for a.Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System.at: -- ��, l .. --...... ...... .__.-0 C 77 -- • -------------- ------------^--- or Lot -- •-------------•------------- *------------ r Location-Address �t.3r•. lit R--2 a __ ... .....-� .�...... =_�r•--�•-------••-•-----------------------------------•---•-•--------•---- Owner Address ..----------•••••-•-....... . r--- `..................'......=•..-�--•--.........--•- ............... 1\1 Installer-- Address r^ Type of Building Size Lot.��__ f .U.2......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a4 Other—Type of Building .............. No. of ersons....__........_.._......____ Showers .P g -------------• P ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------------•-------- W Design Flow............................................gallons per person per day. Total daily flow..._....:":.� tr✓_..._._......__....gallons. WSeptic Tank—Liquid*capacity r t%Z rigallons Length................ Width................ Diameter---------------- Depth................ Disposal sposal Trench—No. .................... Width................._.. Total Length.................... Total leaching area... ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil......! ---....... rfl fifl...// '.- qc_,lo•- "C> -l-_•.------ -- ................ } Z `I ( . C. h) ... fi i._k r l r-:"t}... •.." ..ft.�....^.---...�_.......................................!'� `^' i'S"`"g'_t ____________ _---•I------------ .............r , W M .._.....---•...................................................................................................................•----•........_................_......_...__.................---......... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------•---------------...---------------------------------------...-----.....----------------------------------------------------------------------------------------••-------•--.......--.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:T T s:;:. p 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 board`of,health. / Signed..........l............ -: ...:- ' t Date./.._.... Application Approved By. == -r= = % y v ��_Z_ v/,`� r i ate Application Disapproved for the following reasons:--• •-----•-------------------------------•------...-------•------------------.........-•-•---•-•--....-- ------•-------------------------------------•----•--••-•------------.....--••-•--•-......-•------........---........---•------•-----------...-----------------•--•-•-•---•-----•-...-----•------•-•----- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS - BOARD,-OF--HEALTH .............I......I.....................O F..........................................0=: .......:)l......................... ,� w1untifiratp of Toutplittatrr THIS�IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by . ` -- = ..._.......:.•-••............. .........• ••----..........._.------- --------- -------------------••----------------. (I Installer b— at f1r I � - k,-L � has been installed in accordance with the provisions-d TTTIZ j f(The State Sanitary Code as described in the application for Disposal Works Construction Permit No-----�.? 2 ---- dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................ l ... Inspector.......: '......................................... THE COMMONWEALTH -OF MASSACHUSETTS ----- _ _- BOARD-OF HEALTH I u ..I.... ..... .......... ............................................................ No... .............. . FEE...`-...----........... Disposal Works ITAa4rudiiari rrmit Permission ish ereby granted---- -_"-..."!T, c •---....._... !...?-:.-------•------------------------------------------------------------ to Constructor-Repair an-Individual Dispost: yste at No. / b - .n ym ` .....•----------------------•---.....-------•-------------------------------------------------------•--------------...........--..•- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... / ...........................................- � 1 ....__.... -- •. / Board of Health DATE.__�1.- - _�7---------------------------------------------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS T+ rL b00% � L�--wazum� w�his �4 45 t. lz ss g } SF ftor � I 1� d /J 09 Q ` r r jit ' . 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