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Home My WebLink About0722 SANTUIT-NEWTOWN ROAD - Health - _ c�z��-y� - -- \ � � — �c ��i I � •� � 3 7S � _ ERMIT IJO._ LO_CLET-10KI SEWQ.C,E_P _ - VILLAGE -- IMST_QLLE "s -1 & . E_ __ADDRESS - -- - - - - BUILDER 5 Q-&V AE ADDRESS DtICTE PERMIT ISSUED _— D D.TE COMPLIAMCE I G� -1 / � �fi ;4 �, No..---.-S17.3.... Fizic .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD r1P �EA TH -- -------OF.:........k... .. . . ................ Appliration -for Disposal Works Tomitrurtion Prruid Application is hereby*made for a Permit to Construct or Repair (�an In vidpal Sewage Disposal dr I t System at: 0.),1V ...........................l.............................7;... ................................................ a � I&.. ...... L ation-Address or Lot No. ........ ............. ......................................... ................................................. .. .......................... es;................ ... 0 e e s ---- . ..... ;. ......... . .. .. ... ... .......... ........ ..... ............................... 20 Installer Address Type of Building Size Lot_L-_'.1-C_,t-_e--------Sq. feet U X<_1 Dwellingt?No. of Bedrooms.___3....................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons...._....._....__._.__ Showers Cafeteria ( ) Otherfixtures ---------------------------------------------------------........................................................................................... Design Flow. .........................................gallons per person per day. Total daily flow...............................:------------gallons. P4 Septic Tank—Liquid capacity------------gallons Length________________ Width.____........__. Diameter__.__.........__ Depth....________._.. Disposal Trench—No. ..................... Width.... Total Length__._....._._ Total leaching area--------------------sq. f t. __.t__&pt below inlet--6. Total leaching area------- ........._sq. it. Seepage Pit No--------------------- Diameter..... h z Other Distribution box Dosing tank aPercolation Test Results Performed by......................................................................... Date....................................... Test Pit No. 1----------------rninutesperinch Depth of Test Pit_.__________-._____- Depth to ground water-.__--_.__._-_._______.. rzq Test Pit No. 2................minutes per inch Depth of Test Pit___..___............ Depth to ground water_-._.--_______.__.__:__. a+ -- ------- - --- ------- ---------------------------------------------------------------------------*---------*----*------------------------------------- 0 Description of Soil------- z ------------------------------------------------------------------------------------------------------------------------------------- U .......................................7------Z.2.................................................................................................................................. ------------- ................................................................................................. -------F - ------------- - U Nature of R5 ps e ap, icaj)airs-,qr Alteratjo —Answer wh ble..-.. ........... .. ......... ........o-D........ _��e----------- _c .......... ... -----------------7----------------- ---------------- --------- --------- -- -------------I-------------------------------------------- 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 iss d by e oa he kt SigS ig ... . ... ---------------------------------------------------------------------- ................. Date Application Approved By------- --------- .... .. ..."44 L��---------------------- ... Date Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------------------------- ......................................................................................................................................................................................................... Permit No......................................................... Issued.._... .Date ....... Date ——------------------------------------ No.. a Fig. . ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH / .1 Applirtttiun -fur 43iupuittf Work,6 Tonitrurtion Vermit Application is hereby made for a Permit to Construct ( ) or Repair (�-4 an Individual Sewage Disposal System at: Yt tom). l & ?� r:a-j . 7- c� - -- ...... --•-------------•----------•-------- --•-•- ------------------------- Locationon•--Addr-ess or Lot No. ` r yf Owner f ' Address i�j� , :!✓. _` v�h ��* t_.i.� /:. 'j �i�./Z YLr1. A7 mil'�...11 ............/...........................•-•-•....._........................................... .......----........._........... -----•�--......------------• •-.......................... Installer Address Type of Building Size Lot-. --------Sq. feet Dwelling l'No. of Bedrooms----- _-----------------------------------Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ---------------------------- No. of persons.:=_J._..................__ Showers ( ) — Cafeteria ( ) 0.1 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-__-__f_yl----- Depth below inlet__-�_��-` Total leaching area..... ------------sq. fI. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---- -------------------••--------.-------------------------------•------- Date........................................ Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...-_--..--.---.---__._. (4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..._.--.-__._-.---_----- 9 •---------------j -----•------------------------------•------------••--•---....--------•-------•......................................................... O Description of Soil-------- <y .� �Xe - x ---------------------------------------------------------------------------------------------------------------------------------------------- U ------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------- --------------- ---------------------------------------------------------------------------------------------------------= _ ------------------------------- U Nature of P,epairs or Alterations—Answer when,applliicable--.- ........�- Uv r ,----t� - .!1 t✓------rf : /-------------------------------- ---------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI 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' Signed.- � 'r.$�r�f _ 0----- �-L --- f / Date Application Approved BY - 5'L`''-1`-___1._.�.✓�i rr f.l !/ // X/ Date Application Disapproved for the following reasons:.......................t/-_-_ _.. --•-------••------------------------------------------• ----•------- ------------------------------------------------------------------------------------------------------•------••--•-•--•---------------------------•--- --------- - Permit No......................................................... Issued......... - - ---- ----------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF--HEALTH—,,, _ Ir wrtifirttte of T"JiM littur.r THIS IS TO CERXIFY,yTh:�t e Individual Sewage Disposal System constructed ( ) or Repaired -- ------ ----- InstallIr has been installed in '&e6ordance with the provisions of Article XIof The State Sanitary Code as described in the application for Disposal Works Construction Permit No----' �_. T _�_,3___-.---- dated... /)-=_-2.. ._'_..�...'....... THE ISSUANCE OF THIS CERTIR TE SHALL NOT BE C R ARANTEE THAT THE SYSTEM WILL UNCTION SATISF ORY. DATE7�- Inspector -•- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ft�..............OF..........,<... .? -�.................................. 4'L . .. sue= No.--------.u_ ,<� FEE---- -............. Dinvu£tt. . ttxk,q QTuY�j�",turt'ion Vrrmit Permission is hereby granted---------(_1_UZi�_;_efZ1....... �:. ,_ ` to Construct( ) or Repair ( an Individual Sgwage Dispos`�1 Systm j l� y' j Street _ as shown on the application for Disposal Works Construction�Pjermi No. __ ,:/ _ D/ated__ ��.._" ..._ %.. .................. 7 ------------ Bo.,'* of Health DATE----/C.)_"`.................I---------------------------------------------• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS