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Home My WebLink About0022 MANOR WAY - Health a� YY�an �y l�J��..� G�� / - -- -- I � (� � 12F� 7 - -- --- -- --- �. - i No. Fps .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .... ......................OF...................................... ...............-----------------------.......... Appliratiun for Disposal 19orko Tuntrnrtiun Pumit Application is hereby made for a Permit to Construct, ( ) or Repair ( ) an Individual Sewage Disposal System at: _ �'r fta�g.. �A... C 1 a�url16. ------------------------------------------ ---- ------------------- -- ----.. IQcat -Ad res or Lot No. Address Installer Address Q Type of Building Size Lot lJ_�__._____Sq. feet V Dwelling—No. of Bedrooms-::_--_I� ..............Expansio ttic ( ) Garbage Grinder (L-Y p., Other—Type of Building ............................ No. of persons----- -------------------- Showers Cafeteria ( ) f4 Other fixtures .......................••--..... --- w Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/v®_gallons Length................ Width..__._.__._.__. Diameter..... th.__ ... x Disposal Trench—No..................... Width................ otal Length__.___._.___.._.._._ Total leaching area____:46, sq. ft. Seepage Pit No. Diameter................... eth below inlet..`._.._._.._ Total leaching are 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---------------------._. (3� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--.__-_--_____-___-.--. a' O Description.of Soil...S A+ , ................................•---------------------------------------------. x U ---•-------------------------------------•-••-•••---•-•-••-•••••-•-••-•--•-••-••--•----........•----•----•-••-••---•------------•---- ---•--••----------•------•---------------------------------------- w UNature of Repairs or Alterations—Answer when applicable.---------------------------------------------------------------------------------------_-_-_- •----------------------------------•-----------•--•------••-------•--•-•------••-•--......•----•--------•-•---•-----•----•------.•...-••----------------------•---------------------------------------- Agreement The undersigned agrees-to install the afore scribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitar. C de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued by the b d lth. Signe / lz L Dat Application Approved By............ . -- -------••--- --- ------ /6� ----- --� ��- 2� Date Application Disapproved for the following reasons:.................................... ---------------------------------------------------------------------------------------------•-.._........_ ---------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued.------------------------------------ •--.----- Date 3W No .. .•••• FEE..., .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OR HEALTH ..................... ..................O F.............................-........................................ ....... Application for Dispoo l Works (nongtrurtion Vantil Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /p 1 f v,jt i ;.,�..�.C:?Ll 1r.ic.. , ..... ........................ .... . ... a.....__ ! ______ ____________________________________ ...._.......__..._. ocation Address,,,,, / or Lot No. ....................................... e54 I Owner Address W a •_•'-_-..i.......::.......:... ................................. ................................................................................................. Installer Address III Type of Building 00, Size� Lot,,, ..:.'c ------------- feet aDwelling—No. of Bedrooms--------, .......... .....___.___Expansio Attic ( ) Garbage Grinder ( ' aOther—Type of Building ____________________________ No. of persons---- ............... Showers ( -" ) — Cafeteria ( ) dOther fixtures ......................................................_..._..••----------------------------------••----•---•..._..-•------•-------------.....-•--•-. W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacitj.! 02°__gallons Length---------------- Width------------.... Diameter--------------.. Depth--.-_-______-_- x Disposal Trench—No..................... Width-__-_______--..-._- Total Length.................... Total leaching area___. _._____ , sq. ft. 3 Seepage Pit No......:�........... Diameter._4.t"._4"_...... bepth below inlet.... Total leaching are. __ -----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- aTest Pit No. 1....� _.....minutes per inch Depth of Test Pit____________________ Depth to ground water---...__-_-__...____---- �L4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to.ground water------------------------ a -------------•-----•--------•--•••••--•••----••------------•......•-••••....--•-----••••-••-•-•••-•......................................................... ODescription of Soil--�t_ _#=t ---------------------------------•--.._....-•--------------------------------------------------------------....-------------------------_------ x 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 Sanitar de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by thXbD d alth. Signed" 4- � Z Z. Dat Application Approved BY--------- � . . - -----• - --�7 -- Date Application Disapproved for the following reasons--------------------------------- --------------------- ......................................... ....................... Date PermitNo........................................................ Issued----------------------- -----------................... TM Date THE COMMONWEALTH OF MASSACHUSETTS t .�. f BOARD O-F '.,HEALTH • t r r r rr#ifA�ratr of Tomplittata T�HI S!IS TO C TIFy' 't the I ividual Sewa e Disposal System constructed ( ) or Repaired ( ) by = -'' . �£, c � 'aa- `.= "- --------------------•-------•-------••-- _ f ! try dl s Installer r 0 at- -- � ;,•a::..__...-- has been installed in accordance with the provisions of Article o T,he State Sanitary Code as descfribed jxl the application for Disposal Works Construction Permit No THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector-------------------------------------------•------------------..._......•-•....••. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No._2•-- FEE f Permission is 'ereby granted , ...........t. --.... t� �°�'a ` ................................. to Constru , ( or Repair (f . an Individual: Sewage Disposal System l' - ----- as s A licat` for is osal Works Construction P No. "` � P Date i .� _� Board of Health DATE . --...-••---------••-•-•......-••--••••- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS