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HomeMy WebLinkAbout0186 SETH GOODSPEED'S WAY - Health __ ___ _ _ _ _ _ _ ►aa/ Oq'-7 No..... �.1 ........ -'' Fss.. s.. ............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® ®F HEA T ............. -GC .. .......OF..... . .. . I A hutiu for Dhi us�a�� r tt� # 1 Works Tuu,strurttuu ramit Application is hereby made;for a Permit to Construct ( or Repair ( ) an-Individual Sewage Disposal C,,1 System at..... ._.�. ..... _.:.... : ram..,.Z��.-... .._._ .............. ..r ...._ .. Lo Address Lot No. Own PzeLot s r WW1 .... ..... ........ ... ..... .. ......... •...... ............................ .............. ................ Installer s Type of Building S __� �G®0_.71, Sq. feet _a Dwelling—No. of Bedrooms........ ...............................Expansion Attic ( ) Garbage Grinder ( ) W Other—Type'of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -n- — -............ ---------------------- W Design Flow............ ... .....................gallons per person per day. Total daily flow.............0.2.0..0_..._............gallons. WSeptic Tank—Liquid capacity/ llons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No.................. idth._.___.... .._..._ Total Length._. -_..... ..._. Total leaching area....................sq. ft. 3 Seepage Pit No...__fd'-._ ter......... th Total leaching area._->_P.S—..sq. ft. Z Other Distribution box ( 64 Dosing tank Percolation Test Results Performed by._. ,------------------------------------------------------- Date....l? ,_l Test Pit No. 1................minutes per inch l5epth of Test Pit.................... Depth to ground water....................... (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �...... Description of Soil r - - _ - ................ x �..� ... S' -- 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 TITLE 5 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. Sig . ..... ••--...... .. f/ �� Date Application Approved By........ -,�' .....�!/� - .... -- /z-,7rJ_-7- ---------- Date Application Disapproved for the following reasons-----------------------------•--------------------...-----------------------.................................. --••---•-•------------------------••......-----------------------------------------...-------------------'----------------------------.................................-............-................... Date Permit No......................................................... Issued----.1�_`�_`? ._.. Date • THE COMMONWEALTH OF MASSACHUSETTS �F - T BOARD OF HE AL . ......OF..... ... .:..:. Appliratiun for Uiipus ai Workg Tonstrurtinn ramit Application is hereby made for a Permit to Construct (4, or Repair ( } an Individual Sewage Disposal System at a- Lotion-Address ... •. .,.,. ..---•-------- ------- ........-'``f------....-•-•--. -------------------- A ........._..... • ✓ Gf 1)Owner /f Y �Jdress t .... ..... ...... . .......... - ............................... ... ... F Installer ��'� ". � Address Type of Building Size Lot._l �r --------Sq. feet Dwelling—No. of Bedroo ....... ...............................Expansion Attic ( ) Garbage Grinder ( ) a - Other—Type of Building ............................ No. of persons............................ Showers ( )' — Cafeteria ( ) dOther fixtures ---- -�-----------------•---•----'-------------------------------------......................................................... Design Flow............: ......................gallons per person per day. Total daily flow............ 0..................gallons. 9 Septic Tank x Disposal Trench—No c..pacity�! adthns LengthTotal Length-idth................Tootal leaching area._-�epth_.....sq_ ft. 3 Seepage Pit No. .............° ' ._..._-- th Total leaching area---;S.P-��'=:..sq. ft. Z Other Distribution box ( ✓) Dosing tank ( � Percolation Test Results Performed by_.T ----------------- --------------. Date.... ` .z...A Z.-'AK Test Pit No. I................minutes per inch bepth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth..of Test Pit.................... Depth to ground water,........................ rA _ , D .................. Description of Soil .."t �-- • ....... - ---------•--•------------- --- - .. _.. .. fit..... ��- -� � ....................... V W V Nature of Repairs or Alterations—Answer when applicable...........:................................................................................... -------•-------------------•--•---••--......_._..------•--•------------.......•------•-••••••••--••----••---------•----------------••••--------••••--------------...---•------------.....••--....-•---- Agreement i The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 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. ASig ------.- .. •�! .__ �l_ .7 ` Date Application Approved By. y .:. ... -.-7y..Date Application Disapproved for the following reasons:-------•-----------------------•----------------------. ................•---........--------•-------•-----------...-------•---•--••-••.............._..---------•'---...---------•--------•-----•-•--•----------------------•--------------------•--------•---... Date PermitNo......................................................... Issued_......................................-----------_.... Date ' ,. THE COMMONWEALTH OF MASSACHUSETTS BOARD JQF HEAL H d �'�r:.....O F.....: ...... ...a. f�rrifirtt#r of f�u�t i�.nrr THIS I TO CERTIFY, Th t t " Ind i dial Sewage D> po 1 System octed ) or Repaired ( ) In er at.......... . ............................... has been installed in accordance with the provisiof s of T� 5 of 'ehe State Sanitary Code as described in the application for Disposal Works Construction Permit No.__.__.._._P.?Ye..........:....... da.ted_._/,7 a..'_�_______......_.__.._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------------------•------.............--------•----•-------• Inspector---•------••-•--•-------------------------...........-•••--•---••--•••-............. THE COMMONWEALTH OF,MASSACHUSETTS! ''''''������ BOARD HEALT .............. .. ..OF.... .. 4. ... �.....�_ No........ .�f-%._..... FEE iS ... TPermission i ereby granted---------------------------------- --=--------- -_.--:- .._..... %J.. to Construc or Repair Individual Se age Disposo System s� c •-----.---- ---.--. ---- .... Street � ° as shown on the application for Disposal Works Construction mit Dated.......................................... /DATE �� - / Board of Heal (� ...-----•. FORM 1255 HOBBS IN WARREN, INC., PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR* QUALITY ORIGINALS) I M -A-= 7 DATA f ► .F ,1 ir• t ��.ik. = ��c�✓ ISc; % * 45�� 6.PC7 �j 3S �of L);L -- � I C>C?O G .L ✓CIS-�•/A•t..� ACE--A _ l�jC� �-J-F. � TANK 7 � I �5err rr ti1 vs��.c._ cc, •s7- Tc,i'L.L- L'e-�IGKI = 425 G•P•i::>. N 'rlo F'ur., i J�rCD -n1 it ;,J T.'a-t E t"�� SAAIQ are L". 1 ALI Z3 � e f 54-7141 I Tor rwu =icoo.o Lc-A,y '1'Po I oc<> ItJb: :A son r�j V15r. t►N. 64 l. qG.'1 •. -max 96.4 I.V. T'AW►C 1000 NV. Iliv. 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