HomeMy WebLinkAbout0040 IRONWOOD ROAD - Health (3) j
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LOCATION SEWAGE #
VILLAGE_ Co4,,j ASSESSOR'S MAP & LOT 6S6 bb�--Q y
INSTALLER'S NAME & PHONE NO. 3J: 065(6\1 771--1014
SEPTIC TANK CAPACITY I,pa �41id S
LEACHING FACILITY:(type) ?4,4s (size) 606y414,s e&,G
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
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DATE PERMIT ISSUED: 1 Z -S - q 9
DATE COMPLIANCE ISSUED: 00
VARIANCE GRANTED: Yes Not/
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No.. - O L! FEs..... a ........_
THE COMMONWEALTH OF MASSACHUSETTS
¢ BOARD QF�HEALTH
.....OF_............. ��Jul. ��. -..._...
Appliration for Disposal Works Tonstxnrtinn Permit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at_.... .... �......_. .�.:.------
••..... rz .y:... ... ........... ....
ion ddress or Lot No.
.................. �._. .... .
.. ..... ..... ............... . --............................................
' Owner '- Address
W
...................... ....... .. ........ . .._.•----._........--.---....-- ....... L ..... ........._.....
Installer Address ��//�
Type of Building Size Lot. _7.?>r ...Sq. feet
Dwelling—No. of Bedrooms------------------- ---------------------••Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons.................... ... Showers —
C4 YP g P ( ) Cafeteria ( )
W Other fixtures ...............................:...
- -----------------------------------------------
=--------------------
Design Flow........... � ........... gallons per p pet day. Total daily �ipw............. ?.' ?. _.........gallons.
WSeptic Tank—Liquid capacit .gallons Length..(,.... Width: /'.o... Diameter................ Depth.S.-
x Disposal Trench—No..................... Width.................... otal Length.................... Total leaching area.................-sq. ft.
Seepage Pit No...... -- Diameter..... Depth below inlet. :.. . Total leaching area..:
Z Other Distribution box (� Dosing tank ( /� f
� �j
~" Percolation Test Results Performed by...._.....�',,.: ..(,�� .........a4................. Date......L.'_........._,. .._....L
Test Pit No. 1.,�„__ inutes per inch Depth Test Pit... . _. .._. Depth,to ground water.._.. .._0;V, ...
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-• -- ----.. . -- .--
O Description of Soil.. -- -..� ...............••-••-----------••••-
.__...
V -----------------
------------------------------
----..------•----------------------
•-------
•--------------.--.---- .-.-....---....•--•--••--... .......
•-• ----
VW ••----••-••-•--------- --•--------••---•••--•-•-•••-..._.....--•--•--•••-------••-•----._...-•-••-•--•-•---------•-•-----•-•-•_•--•----•••--•••-•----......-•---•...............7...._....--•--.........
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 LITL U 5 of the State Sanitary Code- The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss ed by the board O . .
--- _ _. health y
Signed- .. �l��Jd(�
.... . j Date
d
Application Approved By.......... � s�cr.. m=. ... ........
Date
Application Disapproved for the following reasons:......................:..............•...___._....._.__....__.........•...._.__...........................---
...................................... .............................................._...-•----•--•-•••----•................._................. . ...--•-•-..
Date
—
. =� .:Permit No....
................ Issued------••--.-•-• --•----•----.......................
r
No.... ...... ._ FEs............. ........._
THE COMMONWEALTH OF MASSACHUSETTS fl
7 / OBOARD` OF HEALTH
..---... ... ..!'S ` ....OF..... ..., l � J-.............................................�"
t r
Appliratiou for M-4putittl Workii Tomitruidiaan thrutit
Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal
System at: �
................__....
/ ... :..% 4 �...........
/ '�:/�
1. �a�,iion-A as b� t/V[�uit�Y��or Lot No. .........................
................_.... .,..- ..._.... ......_... ...••-•--••••-••-•---•.........._..........................
W Owner Address
.. - �P. ....._ ... ... ........... ..._.. .....
Installer Address
Type of Building ? - Size Lot....... .... ..:.:... ...Sq. feet
► Dwelling—No. of Bedrooms................. .....................Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Building ..._...... No. of persons.......................... Showers
YP g ------------------ P -- � ) — Cafeteria ( )
Q Other fixtures -----••... �' ----------------•-•----------....•---•--------••---
.---
W Design Flow........:...........1...r/ :gallons per pegson•p�-day. Total daily flow.......... ? l .............gallons.
WSeptic Tank—Liquid capacity/_�._�.�"gallons Length.Q.-�._.•. Width.. 6... Diameter................ Depth�.. -...`
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No.-----.�.....-..... Diameter....... Z fi:... Depth below inlet---. !�. Z.__ . Total leaching area... �s sq. ft.
z Other Distribution box (X) . Dosing tank ( ) c
a Percolation Test Results Performed by-_-......_ _. . ... ..?................................ Date..._..................o.................
Test Pit No. L.Z...r�.minutes per inch Depth of Test Pit... ..._ Depth to ground water.... `....
f4 Test Pit No. 2................minutes per inch Depth'of Test Pit.................... Depth to ground water........................
PG :_ -•--•------------------------•------.-•---•--
�- - ----------------•-------------------.... ------...---------..........._......-•••••-•......
O Description of Soil...r____...��_....."�....d.a
x
x ••••-•-•••-•-••-••-----•••-••--........-••-•---...-----•-••-•-••-•--•--••------•-------•••-•--•----•-•-••-•••--•-•---•.............•......•-•••-••-••••-••-•-••••••-•-•---..........••.._._....-•--_....
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 TITIf 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 board o health.
Signed.._..Q)...............
..(...................fi ( ................7�..."..p..a ............
.....
O / Date
Application Approved By......... --........!s:�a.- ...... ....................•--••- ---•--. ------.- -.�.-.....-�'L.
Date
Application Disapproved for the following reasons:-----•--•-----•...............••----------------------••......-•••-••-••••.---......_......••.........•••..._..
---•------•..................•-••-----....--••--••--•--•-•--....-•---•----........-----.........---.............---.........----•-•-------•-----------------•---.....-•-------.........•-•............_
Permit No.....� .................•-- Issued-----•---------.....-_.-•----•---...-.....Date
a , ._......
Date
--------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/ ..::.........OF.................P .........................
(9rrtifiratle of Toutphattrr
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by........................`�- . 5=----------n. C F ......-----•--------•-----•-------.•......----•---•---•--•------...----•----•-----....-----------••-•-----..................--
" Installer
{
at...........1 -............ ....1�t'---------------------------•-----•--....--•---..........................--•-•----
has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No....... '-.-7 ._?_.... dated.__............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. � _lam/
DATE............. ,�i ._....... Inspector......................................� .--------........................---
v ti .-.---•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
2 t' ��
No.....15............. FEE....--.................-
�i��u�ttl urk� �un�lrttrtiun rrutit -
Permission is hereby granted.------......�5.-Win....- h --•-----------------•-----------------------••--•-•--•----•-...........
to Construct O' or Repair ( ) an Individual Sewage Disposal System
atNo..••--••..•••• / 7.....Z2 'r , .vet .....UK,------ ..............................................................
Street � ,
as shown on the application for Disposal Works Construction Permit No..,.._ .__ .t_____. Dated......—..................................
e.— Board of liealt6
DATE...--•--------•--•---------•................�:.................................
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