The URL can be used to link to this page

Home My WebLink About0048 FORTES WAY - Health V-��QA-e-o )i ' f Y Pciawdaffae CutLess File Folders 48420 Tops-Products.com/Pendaflex MADE IN USA 30%PCF P4 No......5_51.. Fx$............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... . .. ._ ..............OF..................................... ................................................... ApVtiration, for Uhipwial Morks Toustrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sem at �P S ..7Y / .. .......................... ............................. --------------.----•--..-. ati . n-Add Tess .or.Lot No. ............................. /. ..f........................................ ......`................................ Address ............•.. ..................•---- Own .......... .........................��...''....:............................................... ....✓-.. ..... .....Z,.,y�............ AZ� W Installer Address Type of Building 3 Size Lot............................Sq. feet aDwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building .........................6. N of persons_..___.'...___......_..._. Showers ( — Cafeteria ( ) Pa Other fixtures ' G OL -------------------- W Design Flow............................................gallons per person per day. Total daily flow......................................_-----gallons. WSeptic Tank—Liquid capacity , ...�..gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench/—,,�Nppo..................... Width_._..... _._...... Total Len gth.................... Total leaching area....................sq. ft. Seepage Pit Ncl, _.� vDiametenj&�. �'-..e. 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_____--___ t� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' .................................. -------------------------------------------------------------------------- -...... -------------------------- -------------------------- ........•------------ ODescription of Soil--------------------------------•-------------..---.....-------•----------------....------------------------------------------------------------------------------------ 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 XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasjben isl by t bo of h Signed ......... ................�......--- -D- atc ApplicationApproved By--------------------------------------------------------------------------------------•----------. ........................................ Date Application Disapproved for the following reasons:-............................................................................................................... ------------------------•-•-•--------•---•--------------------------••--------------....••-------------------------------------------- --•-•--•-----•-------------•-----...._..-----...---••----••------ Date PermitNo......................................................... Issued........................................................ Date 1� - •__ _ .. ... .. .____---------------------------------------------- ---- - -- - - No........................ Fmm............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ..................... Off'.........:................. Applirativit fur Dfi_qpasal Workii Toustrurtion Urrvad Application is hereby made for a Per.-nit to Construct or Repair an Individual Sewage Disposal System at: ............ 4 .................. ................................................ ... ..... .;Zt?.... ..... Location-Address Aor t 0. ry .............................. 94e..................................... ...............................................d.................................................. f4 ........................................... ... . Owne7, . dress ..3 L�/'/ Installer Addr U t� Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......................................_Expansion Attic Garbage Grinder PL4 Other—Type of Building -------------------------.__ No. of persons-_- Z............ Showers Cafeteria ..Other fixtures . 4... .......... .1 01 4�t r 11.. t _�_ ---------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity./O.—,,�.?,- allons Length................ Width-__--__._-._--__ Diameter..........._..__ Depth................ Disposal Trench—No. .................... Width..............._._.. Total Length..._..__.__......... Total leaching area....................sq. f t. Seepage Pit --- Depth below inlet.................... Total leaching area...'...............sq. ft. Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date--------------.......................... Test Pit No. I................minutes per inch Depth of Test Pit.-__-___-_--___--_.- Depth to ground water________ w Test Pit No. 2................minutes per inch Depth of Test Pit.______............. Depth to ground water..__.___._......__..__. P4 ----------------*-----------------**---**""*--------*--------------------------------**....*-------------------------*-----------------***....*............. 0 Description of Soil........................................................................................................................................................................ U ....................................................................................................................................................................................................... W �i -----------------------------------------------------------------------------------------.............................................................................................................. 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 issK(d by the board of health. Signed,) .......... :�/Da/lc� ApplicationApproved By..................................i ... .......................................................... ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _0 F .1L.............. ......... Tfffffiratr of TlImpffiturr THIS IS TO CERTIFY,. That the Individual Sewage Disposal System constructed or Repaired by..........................................W_�......k------------ ---------------------------------------------------------------------------------------------- Installer at..................... ....................... ----------------- ................................................... -------------- has been installed in accordance with thell)rovisions of Article X1 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------- ------------------ dated........... :114;------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------ ....... ............................................ Inspector..... 4.�4. ....... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ......... IL ..0'd ....... F . ....................... ...... No.......j.. ..... FEE.. Uigpnmt Permission is hereby granted.........:nZ ............................................................... .............. ....... to Construct or Repair Q- an Individual Sewage Dispo sal System at No........ A ..........(:��.gw ' I �. ; j';........... . ...............................�'.i...� Y'.'- ........................................... i r Street as shown on the application for Disposal Works Construction Permit No..................... Dated....._,?4 :.... 2.1L...... ............... Board of Flealth DATE-............ ..... ....? J.�....................................... FORM !255 HosB.s & WARREN, INC., PUDLISHERS No.°�=- ` .... F�a........................... THE COMMONWEALTH OF MASSACHUSETTS �®A R®. i-I Ede T H - ----------OF...... .........I..................• Appliratijau for Raposal Workfi Toustrur#inn VertuitApplication is hereby made for a Permit to Construct ( ) or Pepair ( n Individual Sewage Disposal Sy st •--�ls •••• __ l-•-• ..._V_ r ��d.� �.-J •• ation- ress ..... ..-• -- •- N ... f..... ... f-� o Owne Addre W � ............................................. ........................................ ....................................... .........................................................ry Installer Address U Type of Building,/ Ex Size Lot. q feet Zff Dwelling—No, of Bedrooms............. . pansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building ............................ No. of persons_________________________ Showers — Cafeteria Other fixtures ________________________ _ = -------------•-------- W Design Flow..............._1_f ..___.,__.. gallons per person per day. Total daily flow.............3..� ___..........gallons. WSeptic Tank'—Liquid capacityl___._____gallons Length................ Width................ Diameter................ Depth................. x Disposal Trench—No_____________________ Widt _____._.___ �-,T Length_.____..j___._._._ Total leaching area....................sq. ft. Seepage Pit No._Z_________________ Diameter• G�f'Depth below inlet_.._.�i_.......... Total leaching area._��.d_ -5q. ft. z Other Distribution box ( ) Dosing tank ( ) 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....................... - P4 -----•-- --------------- ----•--------------•••-••--•••-•--•--•-•-•-••-••-•...-•-•••••.._.....•---•----• ................... ....... •----------------- O Description of Soil........ r_ x U -----------•-----------•-----•----••----•---------•---•-••-------------------•---.--..---•----------------------•'----•----•- 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. Si ne ! "ate ..... Application Approved By... ._---- ---L�C/li1 _--------_--- �� ` ,6� Date Application Disapproved for the following reasons:...................(_/_______-___________-_-___________________..._..____________•_______._.______.__.......___._ ----------------------------•------•----------------•-•---------•----•--------------.......------------••.---------------------'--------- .............................................................. Date PermitNo.......................................................... Issued...u .Y Date No.s? -_.............._. Fps............................ THE COMMONWEALTH OF MASSACHUSETTS BOA RD�PF H EAI�TH _ 1! .... Applirat vit for Diipsat Marks Towitrurtioaa Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ),.an Individual Sewage D�•tsposaI System at n, ! f; ,y - a �� L canon t1t�rc s � � _A � No. _4.41- ' � ,�,� ,4„_,'.-.4 ?`.,_...-" � �Co�t'�f�'��ys+t� <� F . W Own e i Addrep a ....................................................... ••---•-••-•---.._......._........... ................ ................................................ ................................ Installer Address UType of Building�s Size Lot___________________........Sq. feet 1-+ Dwelling- No. of Bedrooms....•.......................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of.persons............................ Showers — Cafeteria �a —Type g-"-""--•""---••.................."---""•• P ( ) ( ) Other fixtures - •-----•---•-------------------------------------------------•----------------._...--•----•------------- W Design Flow_________________�__:.A...............gallons per person per day. Total daily flow..._.._._.___Z__ ........._....gallons. WSeptic Tank—Liquid capacity/e'�?�Ygallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width___.._.__.____.l._.T, 1 Length_._..___._._____.._ Total leaching area...... __._______aq. ft. . . � Seepage Pit No._:f_________________ Diameter__]-._...._.'`�. D�t� below inlet_.__. ___._..._..__ Total leaching area__.=..._�...rt:'sq. ft. z Other Distribution box:( ) Dosing tank ( ) Percolation Test Results Performed bv.......................................................................... 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 ..._....4:............ F'__._........................._...._._._.....'.____.___..............._......_._.__ __ xDescription of Soil........ V .............""-•"--•----"-•---•-••"-"•"•"....._._._..._..--•--•--". ----•.._..------"--•-----------"---------------•--•----------------------------•--------------------..__..._"-"""-••----"--"••. W tr j 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 issued by the board of health. Signed ------------- ate Application Approved By... 'f__ �� /.d'......... •'• ! '''.'• 4 'r �� s� Application Disapproved for the following reasons:....................°�..._._...__...._.._._....__-___.._..._...---_._______ •_______:__Date--___•............... .............."--------•--•---------•-----------------•-----••-----------"....-"-•---••----•-------------...---------------••----•-----------------------------"------------"----"""--••"---•---••-"-"--" Date PermitNo......................................................... Issued---4�•1¢ ` ........................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF.. HEALTH r �....,�..:: `?�.. .....oF.............. Trrtifiratp of Tootphattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b jni tllrt........L:4_i. ._.+_----" '°-•--z` -----'.. •....... . .........•,.•.•-"..-----•-•---•--•--.-.'-----"-"•"----•-.-•---________ has been installed in accordance with the provisions of Article XI'of Thf State Sanitary Code a5,despribed in the application for Disposal Works Construction Permit No.__•..................c dated.......CH. ------ .......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .. I Z r f DATE. .. ................................................ Inspector o. .�°"r�.:t :.. ........................................ THE COMMONWEALTH OF MASSACHUSETTS � - BOARD, qF HEALTK 3'4 Zx AIA °�{N'f r9;,;.•m' s` / �fi ""` r^r' a.r+l' No.......r......... ........ FEE.A.........-•--•-- �io�ro��t� �dor�� at�trortiott f prottt Permission is hereby granted.._.._r .: ....................... to Constru ( ,)�o Repair ) n Individual Se��t ge D> posal Syteti�f 6__________________ atNo._. . .... ...:....� ...�:.! .✓�,f . �t - - -'•: --...__.......,.............. jr...... ,... Street .... as shown on the application for Disposal Works Construction Permit No...� i _•.. Dated._.._. =r`J........................ t Boas d of rHcalth '' J DATE...... ......................... FORM 1255 HOBBS tk WARREN, INC.. PUoLISHErS