HomeMy WebLinkAbout0059 FURLONG WAY - Health 59-Furlong Way
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LOCATI.OKI ' 5EWO,C,E PERMIT UO.
VILLAGE YlIz1<2e-19-7�
IMSTNLLER 5 W&ME � ADDRESS
BUILDER 'S Q [TIE �- ADDRESS
DOTE PER"IT 155UED - - - - - - -
D ATE COMPLI &MCE ISSUED : - - -
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
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............OF....... .. .... ........ ... ._.......... ...................................
Appliratinn -for Uhipwia1 Workfi Tonstrnrtinn Vatnit {
Application is hereby made for a Permit to Construct (Y`3or Repair ( ) an .Individual Sewage Disposal
System at:
cr/Y ......AieA/....---.......................................... ------ z ...............................................................
Location•Address or Lot No.
dphzy...LL!/! -----•-••-------------------------------•--•-•----- ----p�Q---._ e.....----
p p� Owner Address ,�/�
a � ------CA.e . .....................•---._--------------- --- -• ------•----•-••---------•---•-••-•------•----------.--------.-----•----1000 ---
Installer Address
d Type of Building Size Lotlj:�,/V_.� .....Sq. feet
---_---._-Ex Expansion Attic Garbage Grinder
Dwelling—No. of Bedrooms._.____-�___________________ _ p (h`�j g )
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
P4 Other fixtures ------------------------------
W Design Flow............................................gallons per person per day..Total daily flow--------------------------------------------gallons,
WSeptic Tank—Liquid capacityfP?p_gallons Length................ Width.-_--....._.._.. Diameter................ Depth---.--_--.-._..
x Disposal Trench—No..................... Widt i..--_.-_-___ _ Tota th_. . ...._ Total leaching area....................s ft.
P g g` q'
� 1
SeepagePit No.__.__ Diameter__ ________________ ep e ow n e ___........`_.._._. Total leaching area.__....____.___..sq. ft.
f-----------
z Other Distribution box ( ) Dosing tank ( ) Q)s 4 `tom
aPercolation Test Results Performed by........................................................... ... Date-----_--_---_--------------------------.
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...__--._----.-.--_-__--
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-_-..---------__--_--
P4
----....--•-- --------------••----------• .........................................
.........•-------•------........----•--
O Description of Soil .Ge ._..... .a . ••---- . --- �'---- -- -- r
q P
I ...
t n
- -------- ---------------------------------------------------- ------------------•--------
VNature 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 Article XI of the State San it'
ode—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has n issued by o ealth.
Sign ------------------------- A-----��
Date
,/
Application Approved By------- �. •--•---- -- --d � ------ •-- ................. - --1/0_.._ 0 __7`
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------------------•-------------------
•-------------------------------------------------------------------------------------------------------.-----------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
A�1 ar^
T
r.
No........ ........ Fiza.....Z4.............._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
---------- - t-----------OF........ 1.1 �1-d..(:......`A...l...
Appliration -for Bigpoottl Vorkti Tomitrurtion Vrroiit
Application is hereby made for a Permit to Construct (,�-)or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
..• / ................................................................. ... � .��'%�.'.'..'
Owner Address
a - ---.. --------
Installer Address
Q Type of Building Size ----Sq. feet
Dwelling-No. of Bedrooms-----------
...................................Expansion Attic (IV41 Garbage Grinder (X")
Other-Type of Building ____________________________ No. of persons............................ Showers ( ) - Cafeteria ( )
Other fixtures -----------
w Design Flow............................................gallons per person per day. Total daily flow.......................................-----gallons.
P4 Septic Tank-Liquid capacity.4-h :�ggallons Length---------------- Width................ Diameter................ Depth.._.------------
xDisposal Trench-No- -------------------- Width_--______.._;C__�,T, oDta/L,,� gti-_./_...�___._.. Total leaching area-------------------- ft.
Seepage Pit No......./ Diameter___/('. ..._. e t '`' '
� ,-.-•--------- � `� p�i l�1ow inlet�..f..--- -- 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...-----------------_-
LT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......-------------_-. -
11
O Description of Soil -f`" ' � __ =1: '.. _... ..-- ....
t
cx.� ------------ J . ... �> - - n-_ f 1 f _ Cc. - 7�__J_ _ .._..
----
w ----------------------& - t•�----- ' -=f---'"' '='' ���r
VNature 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 Article XI of the State Sanitary,Code-The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en issued by fkr !,bar ?of-health.
Signed= �'�' . .......................be•
- - -
Application Approved By ... r «f .... ---------------
Date
Application Disapproved for the following reasons:----••-------............................................ .....................................................
..............................................------------------------------------....................•----•...._...---••-------------•--------•--•----•......-------•---••----------...--------•.--•--
Date
PermitNo......................................................... Issued.....................................................--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF,�HEALTH
�prtifiratr of f�ott��rli�ta�rp
THl . IS TO CE T 'Y, T at the 'ndividual Sewage Disposal System constructed ( r Repaired ( )
by-----��I�- .vz. ------�- ----�.�----------------------- - --------------------- ------ ------------------------------
/ InstaYle
3---
at VC
/per�=�j 1 has been installed in accordance with th provisif Attic 'I of The tate Sanitary Code as dCescribed in the
application for Disposal Works Construction Permit No------�--,2-5-/......... dated.-----.epl.-.16'.-7�...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.--r . -� ���� =� -------•----••-• Inspector A
THE COMMONWEALTH OF MASSACHUSETTS
C_7�)
BOARD OF HEALTHz o F ...... ... . ...................... �J
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�- ...... ...... ��... 4
No------------ ---• •-- FEE...0.. ............
�i��o,�tt ork,� �oo�tr�trtioit �,,�rmit
Permission is hereby granted - --- ------(---------4 `-r/ !/�/r - ------------------- -------------------..----
to Cons", uc ,( Lr Repair ( ) an Individiial Sewage Dispo al ZSXtem
at No ._ � ' .. ..•--. s ki.. .-l.G� *- -��- ......................
Stre-as shown on the application for Disposal Works Construction P mi/No.____ %% Dated------------------------------------------
-� ��'�✓� =-----------------------
DATE. ` l Board of Heath
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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