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Home My WebLink About0062 MILNE ROAD - Health i No-Z --- FxE...�, THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH z 1,.. ...OF........ . ...:. . . . .. . .. . ........----- Applir4tion -for lkiipviial Workii Towitru41 rt- u Vantit Application is hereby mad for a Permit to Construct or Repair anndividual Sew age Disposal System at: ........................................................... L ess or Lot No. •r - -- ----•- •-• ----•-----•••-•---•• •-- --------- O ` Address W Inst er Address dType of But di tg/ /� Size Lot............................Sq. feet U Dwelling �—No. of Bedrooms. ------- �/% ----Expansion Attic ( ) Garbage Grinder ( ) 0 -11 Other—Type of Building ____________________________ No. of persons-_______.____.______________ Showers ) — Cafeteria ( ) a' Other fixture _____ d --- ------ -_------ W Design Flow__ _________________ _____ __ gallons per person per day. Total daily flow.._...._.___ __ _.gallons. WSeptic Tank Liquid capacity gallons Length---------------- Width................ Diamet r------ Deptla-____._._.__... x Disposal Trench— __________ Wi th__._...... t',en /._._____ Total leaching -area....................s ft. Seepage Pit N ... Diameter 1pt below let____________________ Total leaching area------------------ ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date--------------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water..__-____________._.__.- �, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-..--------------------- --------------•--•------------- 4-: 0 Description of Soil--------- ------------------------•--••• -¢ t------------ x b . ---------------- ----------------------------------------------------------------------------------- - - - -------- V 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 rd of health. Date/� Application Approved BY �� - �C -c/-_7 Application Disapproved for the following reasons---------------------------------••-•-• •- ..................................................................... --••-•••-••••••••••••••-•..__....•••-••---•-••---•--------------•---------•---------••-•-----•••••-------••- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS i , 9-3 BOARD OF ALTH ....OF...... .............................. rttf- ate V f nr ialtrr THIS IS TO CERT e In idual age p S-stem constructed ( ) or Repaired ( ) .L nstall at. '.. ---- has been installed in accordance with the rovisions of Ar icl XI of The State Sanitary Code as1 scribed in t e application for Disposal Works Construction Permit No.----: -�----------•-- dated.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA ISF'AjCTORY. DATA✓.---•-•----- •/ ice' --................ Inspector. ----- Y �._�_--------- -- -----------------------------------------L� _-1__----- No...Z........in........... Fizic ;:wz.................- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... .. . ..... V.........OF Appliration -for Ui!ipoiial Workii Towitrurtion Vrruift I'll Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 4-3 �. ....................................................... ............... ... ....... ------ ........ ------- LotNo fooq`ea dress or............ ..... .............. .................................................................... "I W Address .................................................................................................. ............... .................................................................................. Installer Address 11 Type of Building,- Size Lot............................Sq. feet U Dwelling-!?No. of Bedrooms__:....... -------I _-_--Expansion Attic Garbage Grinder PL4 Other—Type of Building __.......................... No. of persons_...____----______-_-____-.- Showers Cafeteria Other fixtures ------- -------------------------------------%------------------------------------------------------------ ----------- Design Flow________________________ ;.gallons per person.-per day. Total daily flow..__._.._._. .___ .....gallons. gallons. Showers gallons Length________________ Width..._........._.. Diameter__.--...._.-.-__ Depth._..------------ P4 Septic Tank-74-Liquid capacity 1,21-,7�1 Disposal french—N ---------- --- Width------------_------ Total Length._......_..._.__..__ Total leaching area--------------------sq. f t. Seepage Pit No-____-_- ---- Diameter/zt�_V Depth below inlet____________________ Total leaching area------------------S(l. ft. Other Distribution box Dosing tank Percolation Test Results Performed by------------------- ----------------------------------------------------- Date--------------------------- ------- Test Pit No. I----------------rninutesperinch Depth of Test Pit._..._..____...__... Depth to ground water---I-------------------- (4 Test Pit No. 2--------_-----minutes per inch Depth of Test Pit.---_---________-___ Depth to ground water.__--.-.---_---._----.-./---------- ----------------------------------------------------------------------------------------------- 0 Description of SoiL------------------------------------------_1--- rz- ------------------------------------------------------------------------------------------- X ----------------------------------------------------------------------------------------------------- ------------.................................. -------------------------------------------------- IJ .... ---------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------.......................... U Nature of Repairs or Alterations—Answer when applicable.----------------- -------------------------------------------------------_---------- --------- --------------------------------------------------------------------------------------------------------ir,--------- ------- ----------- 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 - �- r"am_. Date 07----------------------------------------------------------------------------Approved By------ . ...................... Date Application Disapproved for the following reasons:----------------------------------------- ----------------------------------------------------------------- ......................................................................................................................................................................................................... Date PermitNo------------------------ .......................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... ........................... fit T9I'S RC hat th i Disposal System constructed or Repaired by---- --------------- ........i...... ---------- --------------- ------------------------------------------------------------------------------------------------------------------------------ at ------ ------------------------------------------------------------------- is been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nb;.__. _�—------------------------- dated----- ............ ;EQUANCE, OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE W -OISFACTORY. W F Xbijif(ak S 7 -Z; DATE............... ............................................................ lnsp� . ... ...... -------------------- ....... ------------------- 100", THE COMMONWEALTH OF MASSACHUSETTS BOARD 0, HEALTH OF ....... .................... A01. ......................... FEE-_.2................ Permissignjis aere grante ----------_....................... .................................................................. to u Con;� C; Renpai an' fndi4idual/SewAge-Disposal System 5a a, ...... ...... kj --------------------------- ---------------------------------------------------- I Street s s n & ap rn ation for Disposal Wo structio T, t 0-------------------- Dated _ .............. --- --- --- -- --------------- ------------------------------- DATE....... ....................................................................... FORM 1255 HOBBS &-WARREN. INC.. PUBLISHERS I Cl (- . I I I i 1 c� co Zo' 4z' /iI'L5.> vAL. � / i l 1Z 314 I I *CALM DRAWN BY DATE APPROVED BY DRAWIP40 NUMBER F{•� AL•AN[N! AN 8485 FORK MDR 10•.S.A. G AfC01T[Cft'fTA00A•D IOR• *94• Cg I , i i �3 i o� i �LL � f • I,ao D 1 S Q1PSt.� tOh� 'A YL -� m 0 f I f ! 1 44 �� 1 I i �'X1S�INCz C�SSPODL t { J j I f I I � i