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Home My WebLink About0417 REGENCY DRIVE - Health 1-7 t�qelix�-W, )*MA . LOCATION SEWAGE PERMIT NO. VILLAGE INSTA, LLER'S NAME 6 ADDRESS ® U I L D E R OR OWNER DA T E P ERMIT ISSUE D 0 p DATE C01'APLIANCE ISSUED Rear O,� H o�S e 0`t N `o O N • No y . '. ...... Fss.4 ............. THE COMMONWEALTH.OF I IASSACHUSETTS '- BOAR® OF HEALTH o�.✓off.................OF......... /7. rI, '.L��.�. . .........__........ Appliration for Dispaii al Workii Tonstrnrtion ramit Application is hereby made for a Permit to Construct (tom) or Repair ( ) an Individual Sewage Disposal System at: # ------ --------- ..........�...---..... ---- ... .........--------------..: ---------- L c on- ess or Lot.N ................ .___h! ,Y.. . ..... »_ ..............------. ....9.7..5....... '"�°� ---- . Owper .--.-..Address_ w ,................ .. ._...tn.---......----- ----------------- �C3 r n J.W...)_.r9. .................. . ,.a ------•. Installer Address Type of Building Size Lot. . .1. _Q-----Sq. feet �. Dwelling—No. of Bedrooms.........3.............................Expansion Attic N Q Garbage Grinder ()14? '_l Other—T e of Building No. of persons............................ Showers (Q a YP g ----•-----•----••--------- -----••�4) — Cafeteria (� P4Other fixtures ..--•.. _ �.---...D. tk--------------------------------------------------- ------...------------------. Design Flow-_y2.J'-J0,.D.. ....--..gallons per person per day. Total daily flow.....3.3-�........................gallons. Septic Tank—Liquid capacity/Qo49.gallons Length................ Width................ Diameter.............._. Depth................ w Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by----------------------------- -- --- Date.................... Test Pit No. 1_... ,...__.minutes per inch Depth of Test Pit---1.2.......... Depth to ground water-___,................... Lt, Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ •----------------------------------------------------------------------------------------------•-.--........................................................ O Description of Soil------....-- ---------------------------------------•---•------•... x 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 iI'i U 5 of the State Sanitary Co The undersigned furth agrees not to place the system in operation until a Certificate of Compliance has bee > s d by?)boaWl Signe -----• -• ....-••-••----•---•••................... .......... ----------•----------•---------- .-- Application Approved Vor ... . ---- ••.......-•----------------------------•......••--................._. ---------------------------------------- Date Application Disapprove ......Date.............. ............ PermitNo........................................................ Issued....................................................... 1 No.. FEs, ll_............ THE COMMONWEALTH OF MASSACHUSETTS rr BOARD OF HEALTH .../..owN................OF......... .. .�" Apptiraa#ion for Disposal Works Tonstrn.rtiun Vrrmit Application is hereby made for a Permit to Construct (V"') or Repair ( ) an Individual Sewage Disposal System at: ....1. :�,�. .,�;?,r..._CJ.�1 ,� s.��. ....../ie .......... �.---....... ....---•--. ---•--.... . Location-Address i + or Lot o. • r . . .... - .. `. �. ................... � !¢/.N__.,�. .._ t f r_9 ...M'4 r ),Owner Address ....... ..A....---- 0..r�.N------------------------------------------•-•-- ------JO-A-e2v----------I A,$.5...... Installer Address UType of Building Size Lot Z.- -�....Sq. feet Dwelling—No. of Bedrooms.............3..........................Expansion Attic (/ p) Garbage Grinder (N1) a4 Other—Type of Building ....................I...... N°am of ersons.............:_............. Showers �NO) — Cafeteria (VO) Other fixtures ..---•-•2'+-f..... 7•........,,.A'•.....•- W Design Flow...- __i�.r _�'��iP....gallons per person per day. Total daily flow........ ..........gallons. WSeptic Tank—Liquid'capacity/B.O_f1...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 ( ) 1' Percolation Test Results Performed by Date------------------- a Test Pit No. I....I_.........minutes per inch Depth of Test Pit.... V....... Depth to ground water.._.._........... _____ frq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 0 -- - -------------- •--------------------- ----- -------------------------------------........I'll................. O Description of Soil...s4l... x W ----•---------------------------------------------------------------------------------------------------------------------------••••:--------••••-•--•-••-••••••••••-•••••...-------••••......-•----_•-- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•------------------•---------------------.....----------------------------...------..........--------------•-----------------------•---------------•-------------------------•••-------•----•..� t Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Cjde ' e undersigned furtl:e green not to place the system in operation until a Certificate of Compliance has beenby th 9,and,r lSigned----•----•......--•....................•-....•---•-•....----•-••------•-••......-•-- ••----•-•--�1--3.. Date Application Approved By'_:... .-•!�'� ---------------------------------------------------------•-------- Date f;/ a following reasons-------------------------------------------------------------•------------------------•--- ---------......---- Application Disapprove ............................................/------•-••••.....--•-•-•-•-••••---------••--•---••-•-••................................................................................................... Date PermitNo......................................................... Issued_...................................-----••--•••---------•- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF MEALTH r... :: ....OF........................ <..t.....-........... ...................... Trrtifiratr of TuntpliFanrr THIS IS TO �CERYFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) I - by............................. -------=-.... --•_ ems_, _ --------•-•-•-•----.-----'•------------------------------------•----------------_----- /0_Instaii� `_ at......................--•. r''7-�......_.-.--��r� /� /�=��jj --------- .... has been installed in accordance with`the p�'ovisions of TITLE 5 of The State Sanitary Code as de' ,rib in xhe application for Disposal Works Construction Permit No........ _! —�,P................. dated........._....._../_��.- _._..../........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE.THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................................... �..---------•••---•-••---- Inspector...........1 ..... F THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALII:L— FEE........................ Disposal 1911rho Tnnstrnr$taa,�prattt Permission is hereby granted................. = ....................................... to Construct ( ) or Repair ( /an Ind 'dual gage Disposal System at No.................. � ✓ — �� Street �-- -•-•--• ------------------•- as shown on/theapicati n for Disposal Iorks Construction Permi :.................. Dated.._.......................-............... ------------•-- •-•... ................•--••••------••-•--••-•--•.....-•-......•-•••-......_.Board of Health DATE--- --••-••••-•--•-•........---•--••........--•--------•-•-- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Z o r— Z- 0. eti ins v� N l 60 V ° ' Tw ` • ��L oQ. fv� �o1'h��•o� q L 10 J� ° / V k, � �� o• P�OT oL..�l� �I • C,ra. RICHARD��,�� AL ANA IX \\`� • ;i BAXTE JONES i , Rom. No.2yU,ld Nu. : �;4! • 1 �IsTE��o"` cra \'�. :- � .�E6/STE-+�E.a.C.�4it/d,� ..St-�F'✓�r�C� it :.U�ty�"�a � ��.'�' G?STE,�✓/�L� �