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Home My WebLink About0023 WINTERGREEN CIRCLE - Health (2) 233 Wintergreen Circle Ostery Ile T A = 119 063 ^ ^ e ^ u o o ' , I ' N ._8: .6�� Fps. d................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H A TH _ � �3 j . -.. .......-..oF....... ..._/. --------------------------------- ' 'L Appltration for Dhipviial Works Cfnnuitrurtinat Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: jQ..jL.A // AL?�-ox e e4,, (V /V- 07 o ation- d s or Lot No. -- ..... -..._ .�.� -.................•------....,... ............... ./ .... �� .� ........ s A ner - ems. �( Address / ._... -• o�.f_..'1--!�....................................... .................. F/..Q./ld�..... -.--.-----•--••-• Installer Address Type of Building Size Lot...A%. �.Sq. feet V Dwelling—No. of Bedrooms... Attic ( ) Garbage Grinder ( ) Other—Type T e of Building p� yp g _f11llly.e........... No. of persons____________________________ Showers ( ) — Cafeteria ( ) . � Other fixturesy.� 0"R- � A e.-----------------------------•--...-•----------------......-------- ................................. W Design Flow.? - ----- - .....__gallons per person per day. Total daily flow____-__-. aa.... p�s. WSeptic Tank—Liquid capacity.l.00.0..gallons Length________________ Width................ Diameter................ Depth................ x Disposal Trench—No. _ _. W i _,@ ---------•----_ Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. ZOther Distribution box ( ) Dosing tank ( ) V E" / W Percolation Test Results Performed by....l�Ax_�" 2... . ...................................... Date.... 1.4 Test Pit No. 1..,e_'.L......minutes per inch Depth of Test Pit------/.L/...... Depth to ground water._t►�r.;u.C�_....__. fi, Test Pit No. 2.. -__..._._minutes per inch Depth of Test Pit.___.�........_._.._. Depth to ground water.....0.)............... a ---•-------------------------------•------••----•-••----•--•---••-----------•-....---•-•------......---........--•--..........-------•---------.....-•-••-•-- ODescription of Soil........... ..-.z-�... _9�. ---•------...c� - :----------� ' -------------------------.--.--.------------- V -------------------------- 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 TI'HE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued b e boarpr of health. Signed----- --------- ---------------------------------- Date Application Approved BY ✓._ ----•--------•----------- -----�� X� ....... . Date Application Disapproved for the following reasons---------------•--...------....-------------------------------•--------------------------------•----------....._. -•------------------•-•---••----------••---------------------...---.........----------........----------.._.....--•--•--=------------------------------------------------------------------------........ Date Permit No......................................................... Issued../ y � Date N((p------------ FEE ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ IV N..e�At.�...1.0.................................................................................OF.......t � e- Appliration for UtoposZ11 Works Tonotrurtion thrmit Application is hereby made for a Permit to Construct or Rep,air an Individual Sewage Disposal System at: -71- . OL '0 'Z ---kl-1,& �01"- 161 A P —> ........................ ........... ---------------------------------- ------------------------------------------------------------------- Add s Lot No........... ......... .... ......... Addres s ........................................ .................. .................................. Installer Address Type of Building Size Lot.........Y_��.Sq. feet U `'Dwelling—No. of Bedrooms____________________.2.............. E.'N,. xpansion Attic Garbage Grinder Other—Type of Building A!fie__........... No. of p*e4ons............................ Showers Cafeteria Other, fixtures ................................. -------............................ ----- ................ ............................. Design Flow.#Y.'.�.....cr..VS).........._..gallons per person per day. Total daily flow...........Ilia....t.—Wf X.).....gallons. 1:4 Septic,Tank—Liquid*capacity. ... ...el..g llons Length___............. Width................ Diameter---------------- Depth....___......... W T Disposal Trench—No. W 1h , "&e-e---- T4aWng ................... Total leaching area....................sq. ft. 7�p Seepage Pit No_____________________ Diameter...._----------- Depth below inlet....... .......... Total leaching area............--....sq. ft. Other Distribution box Dosing tank Percolation Test Results Performed by._..BKX.Tek...�..&14................................. Date.... A ..;'...........I................. as Test Pit No., Le— ........minutes per inch Depth of Test Pit....../1"...... Depth to ground water_.A,'A.#0A*........ fest Pit No. 2__�� minutes per inch Depth of Test Pit___-- .......... Depth to ground water........................ ...........................................................................7................................................................................ 0 Description of,�soil........... ..............4?...VAIL'..41.1rb........... ............................................. .......................................................................................................................................... ....................................................... U . . 'j, ............................................................................ ...............L--------------------7------7-------- .................................................... - U Nature of Repairs or Alterations—Answer when applicable._................................ ............................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Se'w&ge Disposal System in accordance with the provisions of TLITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued b noar of health. Signed..... . ..... .... ................................................ ............................... Date Application Approved By -------- 1 F. Date _ty� Application Disapproved for the following reasons:................................................................................'....r ........................ Da te PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF...... —,.................................................. ...if ........... Tatifiratr of Toutpliatur . .THIS_JS_T010ERT1IE That-the Individual Sewage Disposal System constructed �_—A�®r Repaired by.............nivLO.h .. ----_-N------ .......................................................................................................................................................... Installer/ at.......................... ... has been installed in accordance 1;;7ith the provisions of TI7,J.F— f The State Sanitary Code as described in the Of Z7 1 application for Disposal Works Construction Permit N _.k.40.......... dated--- .............................. THE ISSUANCE OF THIS CERTIFICATE SHALL T BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. ............1...1 ........................................... Inspector...................... ............................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD 0,FHEALTH .1 A/.... 4 .............OF.... .... .......................... FEE,7_4)............ Diapoaal VorV ipgtrw w tiott rrAft Permission is hereby granted..'J", .... .... ...... ................................................................................................................. to Construct or Repair an Individual Sewage Disposal System, 0-11 ............2..................................... el. --------at No... —Street as shown on the application for Disposal Works Construction Pe it No...................... Dated........_.__.__............_............_. Lm_ ........................ Board DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS •/� 1✓tom_Y t�i�1 �i i'� l-1--� �/l„� l h-+ t r.,��'�C,,'�„�a t< � -...,. i t ,f r•� t t / LC-- +IP11,Mtlr`f �"(�-�'T—IC. TA>,t1L = � U,r tSC -!� !•L.Cc'i F..;'•r�. � e / 41 + iil5P0<AL" F'IT - U;c_ (v 3 I i r(yC-W,&LL AV-G- •. t Z 7 pr r 4o r E zZ) .. SCfi, 7K TOTAL_ ��5161.! = 4-43&-T>D. 4Z1 ool ?�f _ ToTA •1�,, PErlGDLQTI:?t_S �/JT•E: 1��iU �4...ktltJ �f•' Il�:�y. �L r.%t.��l..•, � - -'n1 7- t�7 U`� U - for FUV c 100.0 �r >OiL 4'PD� lid;". �- 1��,�. G•AL. +I�'�,At J .. Gam. ya,S ►,�,�'` ,,N.�} GAL• 4�,J, ��1 1 •%1 C LErc+4 P�T s G. C�(ZTti= E.tC� C1Ja." Pt.. ! c:,t� r t t- Tlt f�. /r TO�TPPU`��.117��•�- r-5�,o.v u �C:t. �::�I�t ��n�\�,t-�` `J W t 11� ,1 {-1` �{ V4� t_I+-,� .��" "'F"'r -•�r a►.,� S��-t�,nct�, t}"'c-QtJ;�C��-+.ITS ot; -rNc�: 4.. -TowtJ cat= of 6-1GT ItJ�t-C'J',�t=`_I sr,�c_�/�=�{ � T+�c� c.Fsr-;r-r"�, �,t-IGE:.JI.D A.NI�t_.1 G,'�.f`_t�r� J •-� v i.Z'. f',t _ lJ=,lr+' t�.t l�(=_1 i_i'.Nt{'•i