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Home My WebLink About0085 ANGELL ROAD - Health � Arw�ek h�A . ��s i n ut am , tea`odn rp�v3ws i LOCAT-11:0-N SEW�,C;E PERMIT 1J0. Ir7 � No......................... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F H ALTH 40,14,4V OF. .. .............................. . .... . ... Appliration -for Uhipoiial Morks Tonstrurtion Pruift Application is hereby made for a Permit to Construct or Repair (�7an Individual Sewage Disposal System at: -Alu — 4- %.n4! L .......------C .i........... ------------------------------------------------------------------------------------------------- -----71 Lo3t*ion,Address or Lot No. L 'e ..................................... A� ..U_ar� .................................. ............................................................. owner rA�S ........... ....... ....................................... ... S-Q rl................... f--k------- Installer Address Type of Building Size Lot............................Sq. feet U DwellingZE�'go. of Bedrooms-—- -----------------------------------Expansion Attic Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons...____________.____...._.._ Showers Cafeteria ( ) Otherfixtures ..................................................................................................................................................... Design Flow---------------------------------------------gallons per person per day. Total daily flow____-_________.__._._.....____. __-_-_-.-_--gallons. P4 Septic Tank—Liquid capacity............gallons Length________________ Width..__..._........ Diameter__-_----_..-____ Depth_._....___._.... Disposal Trench—No- --------------------- Width___..._....__.._.... Total Length__________________-. Total leaching area....................sq. f t. Seepage Pit No..................... Diameter__...._._.........._ Depth below inlet_.._.....____.__._._ Total leaching area------------------sq. f t. Z Other Distribution box ( ) Dosing tank ( ) . aPercolation Test Results Performed by.......................................................................... Date-----___-------------------------__----- Test Pit No. I----------------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........................ P4 ........................ --------------------------------------------------------------------*--------------------------------------------------------------- 0 Description of Soil........................................................................................................................................................................ x U ......................................................................................................................................................................................................... ........................................................................................................................................................................................................ U Nature of Repairs or Iterations—Answtr when applicable.... Gam__-__- -/-------- ...C—.0tZ......... f-2r.. -—------ -------d:`•7-el-----------= ------------------------------------------------------------ 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 issued by the f Ith.a____ - ----------------------- Date Application Approved By------- - =- . .............................................................................. ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo........................................................ Issued.._ ... .. ....................... Date ....................... ---------- No........ .................... .... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH................OF..... .............................. A;jVfirafton -for IN-4potia1 Narks Towitrurtiatt Vrruift Application is hereby made for a Permit to Construct or Repair (� an Individual Sewage Disposal System at: .......... .......... .....-)........Z -f- -C...&& ............_................................................................................................. ..... ... Z Location.Address or Lot No. 4.. .................................... .................................................................................................. Ow er P dress ...................... ..... ... . .........../. ..... tu................ ..... .... --------- Installer Address U Type of Building Size Lot............................Sq. feet --'N- -Dwelling4— o. of Bedrooms_ ................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons....--..---_--..._.---...... Showers Cafeteria ( ) 04 Other fixtures ...................................................................................................................................................... W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity------------gallons Length---------------- Width..----.......... Diameter_.......---.---- Depth................ Disposal. Trench—No. .................... Width--_----.--------.--- Total Length-.----_---.-._------ Total leaching arca....................sq. f t. Seepage Pit No..................... Diameter.----__-.--_-_-.--.- Depth below inlet.................... Total leaching area------------------s(l. f t. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date--------------.......--................. Test Pit No. I----------------minutesperinch Depth of Test Pit.................... Depth to ground water...-----.----........... 4.1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--.---------.-----. P4 ............................................................................................................................................................. 0 Description of Soil........................................................................................................................................................................ x U ......................................................................................................................................................................................................... ---------------------------------------------------------------------------------------................................................................................................................ U Nature of Repairs or Alterations—Answqr when applicable.-..././ ..... ........1-6.1 ------------------------------------------------------------- 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 issued by the board Xf1th. O ;Z Signed"4`,.A-.�.Q).... . ... ............. ............. ........... ----------7S Date ApplicationApproved By.................................................................................................. . ...................... ................. Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date Permit No. Issued. `� ------------**------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Kew ....... . ..........*...OF..... ... .................................. Trdifiratr of TIMphaurr �qIS IS TO CERTIff, That the Individual Sewa, Disposal I System constructed or Repaired V by.... ....... .. ...... ........................................................... stiller at....... . ..... . ........................................................ has been installed in accordance with the provi ns of Artjit-TV-XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-- .............. ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE UARANTEE THAT THE SYSTEM VIALL FUN,;TION-SATISFACTORY. 7,S A a DATE------........................................................................... Inspector--.. ................ .... _U p ............ $. .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD RF HEAV. H No.....2.j��.... .... .............OF..... ............................. FEE..Z............... D�,AS AAUAl Marks Tlon#trurfton Vrrmit Permission is hereby granted...... .......49.6.�_ ............................................................................... to Cons e*!, Sew F ys PP 41'an Indi idu Sewage 'sp S t atNo.-- ........... ---------------------------------------------------------- St'rect as shown on the ap plication for Disposal Works Construction P it N� ated.... ......... C_.V D z,�Wlle ..�.......................... DATE--- 7.JS........................................... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS