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Home My WebLink About0330 REGENCY DRIVE - Health �i3o �e�enr�� Yh .7n . �� o4q V- LjO CATION n SEWAGE PERMIT NO. 3�0 Deco dl(',L V/fir V L=AG E 4 ��/` I N S T A LLER'S NAME i ADDRESS ' O _ GJo loin' 9r e U I L D E R OR OWNER 1?1 Gh and Lor)Q DATE PERMIT ISSUED DATE COMPLIANCE ISSUED //�� / �1 � I \ !,(wLu ��`� Z� ' r Fx$ .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ................................OF..........................._...._......--------------------............................... Appliration for Di-spoil al Workii Tlw mi rn.rtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S�jem at UC zip me ui�i of �'1 25 6s AI,t..Ls- �/ ),CC ..Y...........__.................. .. ................... ! ...........--- ---........... .................. •Loca'on•Address Lot No. ..... G.�� 1 .... -----_ ... .I!"-Pam...._. Owner Address �--..---- ----�i.;Z_G' Installer Address Type of Building Size Lot...`:9.. ._61)...Sq. feet Dwelling—No. of Bedrooms..........:... .........................Expansion Attic ( ) Garbage Grinder ( ) pay Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ...._.... d -•----.••---------------- w Design Flow............................................gallons per person per day. Total daily flow..............................._............gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by--------------•---------••-------------•------•--------------•----------- Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ •---.....•-•-•---------------'.....••-••••-•••-....••..............•••••-••-••-•--•--------------••......................................................... 0 Description of Soil.....................................................................................................................................-.................................. x c, 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 TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been rs's"lied by th oard ealth. gn1� ------------------------ ----/t/-D .,..... ApplicationApproved By....... ��-- - -----------•-•--.........•..----------•--•----------------------------•••--- --_......... --- ---- --•-•---- Date Application Disapproved a following reasons:.....__ ..._.. ..._ ..............•__•.______.............__......._...__._____._....._........._-•••----......... ! _._. ._------- !9y------_.. Date PermitNo...................................................... Issued........................................................ Date N .,.......... ..----�~ - Fm$............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................0 F............................•.........--------------------------I.................... Appliratinn for Disposal Murks Tnnotrnr#inn 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ......... -»y._ ................ .......... - .. ..................-----.......--------•----•----------------------....�.-•----------•---•-- (^ Loca'on-Aedress ors Lot Now ..... .-C..l Si ........ .:... C1_r.1 - Vic,, 1 ld �e"G c i r • -r ..................... .......................r -------- Owner Address �� - - a "LL `Ca ,<u C V,� y�_..1._:t.= �� -7'/ ................................ ............................................... Installer Address Type of Building Size Lot.... - 6»d_._Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'k Other—T e of Building .. No. of persons............................ Showers — Cafeteria Q' Other fixtures ...................................................... ------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..............-..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ------------------------•--------------------------•--....--------------._.......................•--........-----------._....-------•--........----•---.•••-- 0 Description of Soil.......................................................•-------------------......---------------------------------------------- ................................... W U ---------•--------------------••-•-•-----------........------------•---•-..........-------------•---------•------------.._...-•--------•------.....•-••-------------------------...---•-----•-•-•--•---- w x ----•--•----•--------------------------•-••--•--------•-•--•------------•---•-----•--------------•---•--•----------------------------------------•----------•-•--------•----••--------------•----•••---- 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 TITiZ- 5 of the State Sanitary Code—Theundersigned_further agrees not to place the system in operation until a Certificate of Compliance has been issued by the��d 9f Pealth. newer-•e �� ---------•---•--------•- s ApplicationApproved By............. ----- " -----.....-•-•--------•-----•••-------•------•-•---.......__ -------- Date Application Disapproved,from% e following reasons------------------------------------•----...-•----.......------------........................................... -•-•-•..............•-•----•---------------......----------•-•----------------------------........................=................................................... ............................. Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... -- Qwrrtifiratr of Tomphaurr THlSCE -TIFY, That te^Individual Sewage Disposal System constructed ) or Repaired ( ) by...... :�� -r ....... ......... r .r f-� c ll at........ '.... . C .. ... !�_ / ''JI"�� has been installed in accordance with the p�ovlsions of TI T IZ ,5 o&The State Sanitar?Cothe application for Disposal Works(eo tt' �i-o n Permit No•-_- e /----------- ---- dated-�...- � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G 11 BJAR_ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. >>J DATE.................................................... 3 •.. inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................OF.................I..................I................................................ No..+._... .. �. FEE........................ Rapp f- wv,6 �nnotr n �eruti# Permissionis Eby gra ed....""....----- ........----•---------------•-� -------------------•--------------........-----...--------...---- .._. to Construct ( or - i. ) �n Individual Sewage Disposal System atNo..---•-•--•---........G_....._ �..1.... -- ---.--- ...._•••--...... Street as shown on the application for Disposal/Works onstru ion Permit No...... _. ........ Dated.......................................... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �•w a 2 5 s w i 1 ` I k'', w E —A- S.F. p. to .0 C) ilTOTA Y /Pr �p✓� �gp � rii t F t�� • �L.L`Mr O ��'Y� P p_p��rr� �p � W! +; i tsar rt as �S Alt OfiLLIAM C. 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