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Home My WebLink About0235 EBENEZER ROAD - Health a 35 Cb entz ex goo,d1 �s hex it i l l e� A - 19� - 03,5 - ----- --- — - No......................... Fu�,C ...................... THE COMMONWEALTH OF MASSACHUSETTS OAR® HEA ��f1e A.V43firatinn -fur Uiivgiitt1 Vorko C owitrurtion Vrrntit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Se age Disposal yr,System 3 .. ;.. G' �-1 `Loc i Addr or Lot No. . ........... ..... ................ -•- ...... ......--- e Owner C Address W - - '.. Installer Address �3 UType of Building Size Lot.,0,._A(.4`...Sq. feet �-+ Dwelling—No. of Bedrooms......0!2.�..........................-----Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures . --- ... •-------------------------------------------------------------------- W Design Flow........ ........................gallons per person per day. Total daily flow........ .0----------------gallons. W Septic Tank—Li uid ca acit�� gallons Length---------------- Width.-___------_-_ Diameter................- Depth................ x Disposal Trench—No. .................... . i..._....... -------- Tot th........._..._._.... T�eacharea_...G _sq. f t. Seepage Pit No.•--Z-�a ------------- e .w t t- - _ " area-.--------------_sq. ft. Z Other Distribution box ( Dosing tank ( ) d6 C�/'�l l -/g•- 71,, Percolation Test Results Performed bY.......................................................................... Date-----"-"------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit---------------_.... Depth to ground water..._"-__.___.._".----... f: Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.__._..__._"-"_---_--- fYi -------------•---•---------- - ----------------------- O Descri tin of Sp7_ - ' I Jd�.. K 1 :6 x '- ---- ------------------ c.� /� � lv_.-_/�.-_Zr Diu ------ 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 witli 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 oard o health. Vig ...------.it... I�f f/ ......•---------- ----- Application Approved B Date ` l� r Date Application Disapproved for the following reasons----------------•--••---"--------"---------------------•-----•--•-•---------------•--------------------------•-- .............................. ..........•----------------•--------.....-----------------.....-----'• --•----------------------------------------------•---------------------------------------.----- Date PermitNo........................................................ Issued........................................................ Date No......................... .......... ................. THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH -.... ... ..................OF.............-..........................._.................---................. Applirtttion -fur Uhywittl Workii C omitrurtiou Perutit Application is hereby made for a Permit to Construct (if) o'R pair ( ) an Individual Sewage Disposal System at: ........---•----------------------•••--......--•--••---••-•••..._...................._••--•------ ........-••-••-•••----•••-•---•--••••••-----.....•----••--•••••-•••--•-•----•--..........._...... Location-Address e or Lot No. .tom.fl.....c..s'.+.....,.. Owner / Address of _ a .......................................................'___........._......__.._ Installer Address Q Type of Building � � Size Lot_.�-- _.%�� Sq. feet -------------- U Dwelling—No. of Bedrooms.....'```................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.................._--------- Showers ( ) — Cafeteria ( ) Other fixtures ----- -------.:f. --__ W Design Flow--------- `,j.......................gallons per person per day. Total daily flow......... 1-_-_------.....gallons. 1/e'11(� 9Septic "Tank—Liquid capacity___---___--_gallons Length................ Width..._............ Diameter_----....-.---_- Depth................ Disposal Trench—No..................... Width_-_-__--_-__---_-_-. Total-Length ............... Total-leaching`area__-_- sq. ft. Seepage Pit No.....1--_ --Diameter.......'.'.......... Depth li 1 W inlet s-' _" Total-lea ing 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-----------.......... ... (4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.--_-.---.--.------.-. W ---------•--. -------------------------------- ----- - ---- x Descry ti1ri/of S��l '�-... -'�-= 4 f- ------------ ---- ------.�- • mac. ----- U --------------1----------- --—�'Li�r� U` r� 0 / G%G � =G�� U.-.�2_-_. ._.._Llh�.lre' 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 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 of,health. ----•-------------------------------•--• --- ----------•-----------•----- ----•----•---------------------- I i A�gn.e Application Approved By.....:"----- . G/ Date Date Application Disapproved for the following reasons:-.-------------------------------------------------------------------------------------------------------------- -•---------------------•----•----•--•-------•----------------------------•••--•-••-•••-------•--•-•-••••------......----------.-------------------•-----•---------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD �OF HEALTH (Irrtif irtttle rrf TlImplittttr.e THIS IS TO.CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) ------------------------------------------------------------------------ -----------•----•--•-•-••----•-••-----•••----•--••----•----------------•-•-•---------••••-•-- .+Installer -- � 11 has been installed in accordance with the provisions of Art"�� XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...........�JeL............... dated..... ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT,J9N SATISFACTORY. DATt ....... �� Inspector. ............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD (OF HEALTH 74 I , .............................fir ' OF........... r_ t+ i. No.--• • 3L FEE �i��tt�tt� nrk� (>rnrt�trttrti�tt hermit Permission is hereby granted----------. .................................. to Construct ( "')sor Repair ( ) an Individual Sewage Disposal System,' -`- -- -'-- ----------- --------- t Street as shown on the application for Disposal Works Construction P r it N _._ _ � _...__.. Dated___ L..................- _ ---• ------ Health t ' . ., oarof DATE-------------------------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS A. Dj t - toot �� Lfc�G�-! `f-�r `-.��,`��-?:`-��`• error�: DsTeetv(L.La M4SS t '_' t 'C► := i T F4,4.-r T i.! 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