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HomeMy WebLinkAbout0023 IRONWOOD ROAD - Health (3) pr os�- o��7 Ga-ru % t 7 L CATION SEWAGE PERMIT NO. VILLAGE INST A LLER�'S NAME m ADDRESS ® UILDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED _. „... .• d. `, , . iC �� z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /. ..............OF. - .... ........................... , ppliratilau for Uispoiial Workii Tonstrurtion rautit Application is hereby made for a Permit to Construct ( 41-ror Repair ( ) an Individual Sewage Disposal System at: / 07- ......................... .�...._...... --..............•-• . - f�l_�!_1.... Location-Address or Lot No. F.... 1... JQ,��---••-•f�----N��tJ-----• . ............ ._.......... Owner Address W a ................ .. .-••-----. (� Inst r Address UType of Building Size Lot_ ®,r_® .....Sq. feet Dwelling—No. of Bedrooms..................... ...................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons__-...........G---------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ---------------------------------------------------------------------------------------------------------------------------•---•--------............. W Design Flow............................%I—.__gallons per person per day. Total daily�flow....................e.�a ........ WSeptic Tank—Liquid capacity/ ..gallons Length_ Width' 0._.._ Diameter---------------- Depth.=.....4 .. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-------.--�------ Diameter.,/ -__ Depth below inlet......C........... Total leaching area. q. -��--�-------s tt. Z Other Distribution box (V__� Dosing t nk ( ) '—' Percolation Test Results Performed by---i�✓O�L.? ! ..__S� !% /!_4 • •- -_ - ----------- a Y Date Test Pit No. 1.....4Z-------minutes per inch Depth of Test Pit...,f.Z._........ Depth to ground water......... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .................••------•--•••--••--••--------......-•---------•-•---•....................P--.............................................................. 0 Description of Soil..... ........S!2�!V��--........: O Ct�......4�a.................................................................... U ----------------------------------------•-••------------------------------•-•--------------...------•------------------------------------------- W 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 iITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hK bDeFn issue y th oard of liealt i n � ` Application Approved 'BY a--rfoMllowing p= /-- Date ------------ Application Disapprove or reasons----------------------------•---------------------------•------•-----------------................................ .............................................•.....•••••----.....-••-•--•------------......-•------•--•---...--••--•-••-••-••--------•--------••-•---------•-••---••-•-----••-•------•-•------•...._. Date PermitNo......................................................... Issued....................................................... Date No. --------------------- Fa$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r✓-Lv�.Y.. ................OF.....;5 i7 _.... ApplirFa#ion for Uiupmtal lgorkii Tongtrortiuo ramit Application is hereby made for a Permit to Construct ( k--nor Repair ( ) an Individual Sewage Disposal System at: o TZ1 / _.. � Lo�alwn-Address or Lot No. �---TH .:r..... h?✓ _. ... f .�sN�w ............. .....•--.... -----•--•.........---•---- ,Address Address rW-a . •................... ....................................•.... --•---.....----------.•...------......----•------------•--------�--------•-----•--•-------•---- In ller Address Q of UType of Building Size -----Sq. feet Dwelling—No. of Bedrooms........................�..........___.__.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ________-__---------------- No. of persons........_._.._fit......... Showers ( ) — Cafeteria ( ) alOther fixtures ..:.........................--.----------------•------------------------------------------•-----•--------------------------------------------.-----. W Design Flow............................—I— ..gallons per person per day. Total daily flow.._................_%3,30........gallons. WSeptic Tank—Liquid capacity/0-09_.gallons Length__`6".. Width 4.W.. Diameter................ Depth.3_'!�... x Disposal Trench—No.:....!............. Width.................... Total Length.................... Total leaching area....................sq. ft. ; ee a e Pit No.--.____-__�__,__- Diameter../.V.._(a*--- Depth below inlet...... ....... Total leaching area..- _� S p g p g ��.' q. tt. Z '...:Other Distribution box'( Dosing tank ( ) ' Percolation Test Results:- Performed by....jl�!�71T&..._SCT! �'+�,._.��. ....... Date__..�._ .._B _.._._._.. a , � Test Pit No. 1___:-;Z _-_-_-minutes per inch Depth of Test Pit----/2.......... Depth to ground water-----7!�...... Test Pit,No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil..... U .................................--•--------------------•---•---------------•----... W ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ...................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ......................................r................................................................................................................................................................. Agreement: The undersigned agrees to instaJJ the . foredescribed Individual Sewage Disposal System in ac rd., ce with the provisions of T ITIZ 5 of ate nitary Code:— he u. rsigned furth agr�jes not.t 1 e e system in operation until a Certificate , "e has is, of Signe -•••-•--------------------•---------...-------•--•...--------•.---- ----------•••--- -•••----•-- Date ApplicationApprove B ...........................-------------•.........-------------•----------------------.......... Date Application Disapproved for the following reasons:................................................................................................................ .................••.........---•------•-------•------•-•----...-------•-------•-----•--------•••--••------•---------••--•-•-•••-••----------•---------•••-•------••-•----------•---•................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH e ..........................................OF...................... ......... OF...................... ......... ........ .............................f Y /" ` V tttr of S �LER idual Sew is s ys in constructed ( o Repaired ( ) by----•----------••--•--•-••--••.............................................................. -- '..:...._._..: ....... st er .1� ..----..................... .. ..............----•-----•- In �___ at.............................................................................................................................................................. has been installed in accordance with the provisions of TIT1` 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------.._..................... THE ISSUA C F THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL/FUACTION SATISFACTORY. DATE...-2. ..I --.................................................... Inspector........... -••--......_...-----•-----------•---•--............._........---.---•- THE COMMONWEALTH OF MASSACHUSETTS . f 40 BOARD OF HEALTH .................... ..................OF............................................................. ; ..... No......................... FEE ....... .......... Aiu ,uurt� Permission is hereby g ed..... -- .. .•---••--•-= . -•---••... .. *. .. . ................ to Construct ( ) or Repair ( ) an In ividual Sewa Disposal S sy t a� atNo................................................................................................................... ............................................... Street as shown on the application for Disposal Works Construction Permit ....... ............ Dated.......................................... •------------------------------------------- ......-.......------------------•------•--••----.......... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �,.,.,..,. .a._. , .._.,,...._......._. __._......._.,.,........-... _...__.___._.._._...._____..,.___.._._._...,.,.._..W... ..,_-__...... ....... .... ... ..._._._. ....._.,,.._ ._.._._w...___._ ..._,._-__- �.,.,�_...... ......,.... .....,__.- .r- .._.. ___.... ,ram /4 O�O _. .. - d'Vd7" To .S'GA,'7�.E' I EL. . } D ._ F/N/S.W CjRgOE OYErQ /i/S7 e9aA'J• - 3•_© F'/N/SN GE'A7OE OV SE.a T/C 7,QPA/C ' ., ,. .• -.�.C- _. .. .. It ld l`..%!•, .-% ../p. .. _ '.. /�'v M/n/ CO►�ER /2 " .��F'ECf7S T CONG. OR M ^'10.P7- TO COA/CRET'E COVER d, �� r •. I.�'~ BEG OI✓ C.p.�7 L7E fl V. W T. /O O L B S. ou 7-4 E 7- F-�fF�E L EVEG t V f O.P Z M/N• „ . a o p o.. 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