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Home My WebLink About0580 POPONESSETT ROAD - Health WZ �� vz.. LOCATIONS SEWAGE PERMIT NO. Loy VILLAGE Co��>r I N S T A LLER'S NAME & ADDRESS �75= 3 6 1 R U I L D E R OR OWNER r DATE PERMIT ISSUE=D DATE COMPLIANCE ISSUED �� . , 3b � �v�/'D��SSc-7T /�� .. "` THE COMMONWEALTH OF MASSACHUSETTS SUBJECT TC 7-bo.4 -°0a` �AR6��TA�LE Cl�r:10tI lL i3t BOARD OF HEALTH RYA--jply C®MMISSIOA Appliration for Biiipusttl Workii Tonstrn.r#ion ami# Application is hereby made for a Permit to Construct (U�or Repair ( ) an Individual Sewage Disposal System at _...... .......... - - �.f..� ... c�---- ----......---•..............----•--------- ....:......... ----- ---- •....... Location-Address or Lot N . ..�1 .ca ....._..---•••-••-•--------•-------•--•....... ..... hl a - ............ Address s ------------------------------------------- Installercz.n_ -----------•-----.....------•--- . .......n� �-- Address Type of Building Size Lot.3AP..C..........Sq. feet U Dwelling—No. of Bedrooms...____________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons....._....3.............. Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. W Design Flow.......110.............................gallons per person per day. Total daily flow.....3 1:0..................._._._..gallons. WSeptic Tank—Liquid capacity(d.Op..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No............I....... Diameter...........&...... Depth below inlet.................... Total leaching area_ .�)..5.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results ormed by.. Date Test Pit No. l hey . ._.- i es per inch Depth of Test Pit....l._�.)........ Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil...-- .......a :--•---•-••------------•----------•----- --•---•-- ---------------------•-•---............-----•--- x w UNature 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 TITIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificat f Co a s n issued by the board of health. Date Application Approved By............. ........... ... ........� IDatel Application Disapproved for the f l wing reasons:....................................................... ._....._...__ .........-•---•..............................•--•----•-•---------•--.....--•-----------------•------•---••-•-••-•----........................-•••--••--•-•••••--•-•-•--...-••-•-•--•••--....•-•••-...... Date PermitNo......................................................... Issued....................................................... Date -------- ---- - .......................... THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH J:4 ........................___..._..__........_........ ;:i _;;y Appliratilin for. spoottl Works Toostrurtioo,- rm_i#., Application is hereby made.for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: .. ..........._.......................:....._...._........................................... .............................._........................_......._._................................ Location-Address or Lot No. ;5_0_1............................................................ . _____.-•••••--....._......____._______..... ..__............................_____......... O ner Address W - ........... ..o.�_�s '......----------...-------•-------,•---- •_____-_-------- ......_.......... ...- ........ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons____________________________ Showers a YP g --------•----•-------------- P ( ) — Cafeteria ( ) 04 Other fixtures ---------------------------------------•---•----------••••---••-----••----••••-•------------••-•--....•-••-•••-••-••-•-•-•-••-....--••••-------_••••- WDesign Flow......._....................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth_.______.___.__. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 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........................ fxq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W •-------------------------------------------------------•------.....----._._............----................................................................. ODescription of Soil........................................................................................................................................................................ x .--•-------------------------------•---------------••-•------------•-----•-------•--••-•--•----•----•----------.-..-------•-----....---------...-•-----•----•----•--••-•------------------------------- UW ........................---............................................................................................................................................................................. 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 TIT11 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation.until a Certificate of Co plian-e has been issued by the board of health. Application Approved By•-•••••--•-- - •---•••• - -------• .. ....................... ...... Date Application Disapproved for the f o wing reasons---------------------------------•--•-----•--•-------------------•-----------•---•-•••••----•-•--••••---•--- - ...•--------------------------------------------------------- Date PermitNo......................................................... Issued_....................................................... Data THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................................I.......OF........................................I............................................ (Irrtif iratr of Toutpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............................................................................................ .----•-------..._..................---•-------•------•----............--------••-•-----• ...... Installer at............................................................................................................................................................................... has been installed in accordance with the provisions of TITLE 5 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.......... .+ - ............................................. Inspector_. ( IM ..... ---•--................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ S- 1 1 1 ..........................................OF......---................._.--•------•-•---._......__............---......... F No..................... .��-+. .... Disposal Works Tonstrurtion rrmi�`...._:.........:..,. �, Permiss>on z hereby granted.............. -•---..4_...--•-•-....................................................... ...... to Construct of Re air (, ) an Individual Sewage UDisposal SSys atNo._. ... 4 .. ------------------ ......................................................... Street as shown on the application for Disposal Works Construction Permit No_____________________ Dat ____________________________-__________-_- 1r ••- - / Board of Health DATE------------ ------------•----?��{ .................................... FORM 1255 A. M. 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