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0140 SETH GOODSPEED'S WAY - Health
w&J - -- Oa bci �; No.......... 7 .............................. THE COMMONWEALTH OF'MASSACHUSETTS BOARD is v � ................... ...._.._OF...... Appliration -for 'Mipatin't Workii��tuitrurtion Vrruift : Application is hereby'made for a Permit to Construct or Repair an Individual Sewage Disposal system ...... ....... ................. ......... --- ....................................................................... C-L a*;i.-.-.,A ss-- ............/alz� ............. ------ . ...... ........ ..................... ................................... ---------- Owner...................6� - .rV ........ ------------- --------------------------------- igztA�---------- Installer Address U Type of Building Size Lot-- .1.4 5 _7--7.....Sq. feet Dwelling—No. of Bedrooms..........;�------------------------------Erxpansion Attic Garbage Grinder ( ) PL, Other—Type of Building ---------------------------- No. of persons-.-_-___---_-_______--___.-_ Showers Cafeteria ( ) Otherfixtures e7r��_ --------------------------------------------------------------------------------------------------------------------------- Design Flow---------J_:_V-------------------------gallons per pet-son per day. Total daily flow--------------Z.....1.7----a----------_-_--gallons. P4 Septic Tunk—Liquid capacity 0_V_-_10g--af1ons Length________________ Width................ Diameter-----_--------- Depth------_--.----- Disposal Trench—No. .................... V kith...................�. al Length-----_---_-- .....;4tal leaching area--.-_.--------------sq. f t. Seepage Pit No..../.05:00' ���tal leaching area--- ft. Other Distribution box Dosing tank Percolation Test Results Performed by------- ---------------------------------•-•--•--------•-..._-----•--.---- Date--------------------------------------- a Test Pit No. I----------------minutes per inch Depth of Test Pit..................... Depth to ground water_--------------------- Test Pit No. 2----------------minutes per inch Depth of Test Pit.--_-_--_____-___--_ Depth to ground water...........------:_----. --------------------^--------- .......... ----- _/..... 0 ------ ------- . ................. . Descro S% ---- --rS,.......... U . ...... /---- ------ ----------- ------------------------------------------ ------------------------------------- ......................................................................7--------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when aP plicable----------------------------------------- ---------------;------------------- ----------------- , ----------------------------------------- ..........:................................:...............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 y t boar of health Signe ........ . ... ................... A . .......... ---------- Application Approved By------- .. . . ....... ..... .. . ------------ .......d _zz Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- ................................................... ------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo.......................................................... Issued......................................................... Date y 1 ............................. THE COMMONWEALTH OF MASSACHUSETTS .>r BOARD OF HEALTH _ Applirtttion -for Uhipasttl Morks Tonitrnrtion Prrotit Application is hereby'made for a Permit to Construct v__<OrRepair ( ) an Individual Sewage Disposal System at:, i� _•j Location-Address Owner/ Address v Installer ` /! Address vType of Building (! Size Lot.... ..._.-7.7-----Sq. feet Dwelling—No. of Bedrooms--- -------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons Showers Cafeteria � YP g p __ ( ) — ( ) Otherfixtures --- -----------------------------------------------•---•-•------------------------------•--------•-•----_-------------------___________---- W Design Flow.......... r�_________________________gallons per person per day. Total daily flow____________............................................gallons. Septic Tank—Liquid capacity''_ gallons Length___________ ___ Width-------......... Diameter_-.---.......... Depth.____---_-.----- xDisposal Trench—No........... ....... Width ___-__-___-_---__ Total Length ..- ..Z.... Total leaching area--------------------sq. ft. Seepage Pit No.... -'��'!'_ Dae��inet �"�________�D pt1Pbelow inle't.1 �`�"'�' Total leaching area----.-._.-_ __-_sq. 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.-_-----_-_._--_--__.. Q'+ ---. f /+ + Descriptio Soi -" c y Gar' " ' 1i--! - ---- . 1� "' •. . .......... �!� ••---•--- •------------- W �` U Nature of Repairs or Alterations—Answer when applicable.-.-_-........:..:...._..____._.__.... --------------,------------------.---------------------- ------------------------------------------- d *. Agreement; The undersigned agrees to install the aforedescribed Individual Sewage'Disposal System in accordance with the provisions of Article YI 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. J _ Signed` �,. iii1- ` -5Ile X �I, - -- --- ---- Application Approved By - -------- -------s-- � ---�-- Date Application Disapproved for the following reasons------------- -•---•------ ..............................................................-................--••----•-•-------•----------------------•-••---•---...--•-•----•--••---------------...-------- ---•-•------------•••---- n Date Permit No. Issue_--•---•---•---•-••-•--._...... ............................................ Date r•. THE COMMONWEALTH OF MASSACHUSETTS S BOARD OF HEALTH � ............y. .• ',rr-^►ti•- ....OF..... i"-`xt......... .fir.......... (r1prxtifirttte of T"amplianir .-,'� THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed `(, ) or Repaired ( ) /j ,- ......JAL /''ll.r .......✓.....,.... bY--•--_..._ . /.. ................ •---------•----•_-•. •-•• ••. -•-------_•-•--•-••----•-••------•- -r� rt r� Installers ......................................................... has been installed in accordance with the provisions of :A a XI of The State Sanitary Codes dperi�l eA4n the application for Disposal Works Construction Permit NJ .'' r+ - - ----------- dated.----_ ------ r�--_..%.__._......------• THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE© AS A GUARANTEE THAT THE SYSTEAA4L FUNCTION SATISFACTORY DATE.g$ ..........................--'- --------=` �-._� Inspector _., �• � � <- THE COMMONWEALTH OF MASSACHUSETTS 7 _ BOARD OF HEALTH 1 _f OF. 's�/.IS:�Gi:C7".��' — FEE .............-----..............•... ............................ _ . No---------- --------- Permission is granted_.-___ _________H___o f/o-�'t....r�--1t--r--ti-�-/--�-t-----�---.r---r••-u--•t--i-t--------•••-•------'•-•------ -................. to Construct or Repair an Ind-ivid-ual Sewage Disposal System.................................... l at No ✓ , Street C as shown on the application for Disposal Works Construction Per o_________ _______ _ D ,C ..................................7 . ------------- ------ - - --- - -- -- ------------- Board of H Ith ' DATE...............................-----------------------------------------•-•-•• FORM 1255 HOBBS-& WARREN. INC.. PUBLISHERS 1 ij f: 4-► N ul10 Nj »1rOt11�D. .1_EA C V,A P t T W +' C.>=e.T%P%ar) LbT' FVT \-�,4�1 i CMIZTtFY T$ 4Ar THE FOUtADAY1QN S"0,AJ .! Pt-AQ iZ t'c2E+.1G t4i--eEo&4 GCUMPL�(S wiTN TWG SIVSL(WC-- AWtD Se'rl3ACV- W1=4UIZEME"Ty OPTNe O T . • REG1Sre=1Z�t� LAt.1p SUQ.vGYo2S TNtS Pt_AW IS LIOT ESASE'ta 064 AW OSTUZV%L-' G- o �1rtAS5 114, rptlMEt-iT SUQVC-*-If TNc_ t3PC:-5f--;C'4 5i4oW 0 APPU CA."T KbT Bn USC-.o TO C)e:TCCMtgt^ 1-O-r LlWia-5 J°i ' {;, E. Zf .1...