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Home My WebLink About0059 POINT ISABELLA ROAD - Health CHI- 11 5"1a- LO-CATION SE �7CE PERMIT N0. VILLAGE INSTALLER' NAME & ADDRESS B U I'L D E R OR OWNER �. 01A bV ®�J e e DATE PERMIT ISSUED l'4 7e DAT E COMPLIANCE ISSUED S_i3-77 k-Av�c». N cu a � 6 b 7) s s OU Fss.... ...:. �.._ THE COMMONi44EALTH QF MASSACHUSETTS BOARD OF HEALTH ...........OF.......................................................... Apphratintt -for Bi, vaoal Works Tatuitrurttvtt Vrrnift Application is herebymade for a Permit to Construct (t/j or Repair ( ) an Individual Sewage Disposal Vstem at: ---- ---- ----........ --------------------------------------------------------- - Location--Address ............. .................... •...j ef v � o`® � ..............LN� . Address Owarr C ------------ 0-4 Inste Address d Type of Building Size Lot.... feet v Dwelling No. of Bedrooms............... _.-_.Expansion Attic Garbage Grinder aOther—Type of Building _________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfi. es --------------------------------------------------- ----------------------------------••--•-----•---------------------------------•---------------- -- -- ---------�1 -0_1 ns r erson per day. Total daily flow.----J�f�W Design Flow. P P / Y Y ...................................gallons. WSeptic "Tank—Liquid capaci Length..._._...i ... Width....V_........ Diameter................ Depth................ x Disposal Trench"—No. -------------------- Width----- ------- Total Length-----------f....... Total leaching area--------------------sq. ft. Seepage Pit No........I.......... Diameter___________________ Depth below inlet---- ________..--- Total leaching area..L--@/....sq. ft. Z Other Distribution box (/" ) Dosing tank ( ) aPercolation Test Results kerforwed by..._..........-�•zy .. _._ Date------------------------------------ . Test Pit No. 1__ ''__mtnutes per me epth of Test Pit...:................ Depth to ground water_' L11 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------------------- ---- O Description of Soil----------- :e x ----------------Z44 . = ".... U W 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is u d b e board of health. Signer - �/..., Z3— 7 ---•• ---------------- - --- - --- Application Approved BDate Date Application Disapproved for 2--following reasons:................................................................................................................ ---------------------------------------------------------------------------------------------------------...----------------....------------......------------------------------...•--------------•---•-- Date PermitNo. ........................................ Issued........................................................ Date -No.,...�'.. ........... _ Fmc......�G'.... -- THE COMMONWEALTH QF MASSACHUSETTS ` BOARD OF HEALTH ............. ... ._ _._.._....:....OF..................................... . --- • -----....................------ Appliration -fur R,ipuiittl Works Tomitrurtion Prrutit Application is hereby made for a Permit to Construct (too� or Repair ( ) an Individual Sewage Disposal i System at: ...............��e -l'----• ...--• ........ ........... 9 7'............................................ A`J'•.S ,i� Location-Address r Lot No. vss v ........................................................./lam --- -•---- /� . vl� ............. Own Address W ---••..... ...........-.:�.....'"- ................................ ` �!/f /Y .................................................... ---.......r-...j......_.....mJ...__ Installer Address U Type of Building Size Lot....j/l_//l/� __ Sq. feet Dwelling—No. of Bedrooms---------------- -------------------------Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ .No, of persons.......................... Showers ( ) — Cafeteria ( ) W Other fi_ es ------- ------ W Design Flow.................. ------------_! U-. a n� r person per day. Total daily flow-----1�j-lJ-----------•-----.--- ----gallon~. WSeptic Tank—Liquid capaci ,. , a n Length.-" -- --_ Width------ Diameter---------------- Depth-----........... x Disposal Trench—No. .................... Width... : _------- Total Length-------------------- Total leaching area-----------_--------sq. ft. ' Seepage Pit No.-___--._f_____---__ Diameter............... .... Depth below inlet____?____.____.._ Total leaching , �_._a ____sq. it. z Other Distribution box (/ ) Dosing tank (. ) aPercolation Test Results &rfqrtd by----------------------------------------------------------- ___ Date--------------------------------------- Test Pit No. L._: utes per tneh. Depth of Test Pit Depth to ground water__. '- ..co . .- . . rs•I Test Pit No. 2-----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-----.--------- -..__. P4 %-/----------------------------------------------------------------------------------- Descriptionof Soil----------- -5�N ---------------= ---------------------------------------------------------------------------------------------------------------------- ---------------------------- 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 Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until�ta Certificate of Compliance has been issued b tie board of health. Signed"' --- ............................../ Z3 7'� Date 4plicationApproved By--------------------------------------------------------------------------------------------------- Date Application Disapproved for the following reasons:----•--------------•---•---------------•------------------------------------------•-_:__--•-•-----•-••-•------- •..............................•--• ------• ..........................................................................................-------------------------------••----------_•---- Date PermitNo-----------' ........................................... Issued---------------_--- ................................ Dattee THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH Qlrrtif iratr of f�ompliaztrr THIS IS TO CERTIFYa That the Individual Sewage Disposal Systemm constructed ( aired ( ) bY. - = r► Installer •_9__ at----------------------•-------•------------•--•---•--------------•------•-•-•---•---•••--••--••-- ---- •--•--•--•-••-•---.. ---------------------------------........................ Ilas been installed in accordance with the provisions of Article of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--_- -_---.�_______________________ dated-.-._�!`_,�_---___---................. THE ISSUANCE OF THIS CERTIFICATE"�SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY: DATE------s -� 77> Inspector --------------------------------------------------------------•- THE COMMONWEALTH OF MASSACHUSETTS. _ BOARD OF HEALTH OF.........::........................... - No.---•------------•-••---- - - FEE-------•----::.:.._..... Dispaiittl ,urtion 't ,�0 ,� Permission is hereby granted-----------!_.,_ "_______r -_- ._._ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No-------- -'=-7--------- ------•--•-• • =................... .....-.. ---- ............... =,.. i r' J - - -----------------•• --------------------------------------------------------- Street as shown on the application for Disposal Works Constructi4onn-lit. 1 t... - -- --- - --- - ------ ' Board of It ATE...... /70 t /Ij� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS /( - rf 6 _, i h ......// 'fit . 90. 0i ' ri fa Q ' p 1 if N 'gip, e z.►�' j S z5 X �•i a h —!Z (Av WATO-) TEST r _ V c /1 CERT%FtEI? PLOT PLAN I-dCATtoW Co-rulT eAY 5140%P.S t t SCAI.�71' =1 -A.g0rT, DA,'TE ROV. trs,MI4 c R T i F y Tµ AM TVA E SH owr q ;��'A of r.+ h41_Rea+4 COM ¢t,Ys Wxro -r}4E 5tC»t.lNC t�L �t.1 RE�£R NCE AH o SLTBACK RsoutREmeti-cs. OF 'T t �.n cr;�..3 TOWN OF $xRPA$Tlaf$LE. a ht Y C .1.3 .era 1' C +` L �} ��16Tc LNn jV su2�l�. 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