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Home My WebLink About0043 HIGH POPPLE ROAD - Health _... �`�"tie+ �� 5..�'eI'� '`i � � �✓�' 's �e l No, 4210 1/3 BLEB 1 % - a a a LO-C AT.I O.N_ __ __ _ _ 5EW Q-CZE _PERMIT MO. VILLAGE _ 1 Sfa TALLER�S__IJ�NIE__�-_Q,D_DRESS_ _DQTE_.PERMIT _15SUED '—_— Wl 7 _ _ D.ATE. COMPLI&KICE ISSUED : 4�- e = r 6 9 n A vJp ` k No......................... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ........ .O F't ... .7--------......................... Appliration -for Riip oal 30orko Towitrurtiott . rrotit Application is hereby made for a Permit to Construct ( ) or Repair ( n Individual Sewage Disposal System at: .......... t....... a .. ............... Location-Address or Lot No. -------..... er ddress......OD44'te............. ----..... Installer 1Cddress Type of Building Size Lot............................Sq. feet, Dwelling— drooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOth —Type of Buildin ___________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------------------------------------------ W Desi n w................................ ..........gallons per person per day. Total daily flow............................................gallons. WSep is Tan —Liquid ca . tv------------gallons Length---------------- Width---------------- Diameter................ Depth................ x Dis osal Tr ch o. .................... Width.......--!•......_ tal Length.................... Total leaching area--------------......sq. ft. See age Pit o..................... Di ame p elow inlet-------------------- Total leaching<tre:t------------------sq. ft. z Oth r Dist i tion box ( �an Pert ation est Result Pe�fo med y--------------------------------------------------- ...................... Date---------------------------------------- st Pi 1 . ------- ------- a ut s per inch Depth of "Pest Pit____________________ Depth to ground water-..______-___.__..__ (s, Tes No. 2........ .....minu es per inch Depth of Test Pit.................... Depth to ground water__._-.._________-_-_---. W --------------••----------------------•------------------------------------------------------------------------------- ------------------------------------- ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x U ------------- --------------------------------------------------------------------------r----------------------- /_..... -,-�-- `''�- -- ------------------- U Na u ccf Repairs or Alterations—Answer when applicable..__._._all------ x... !✓______ ! C _____________________ _ e 's..Wj ------=--- ---------- - --------- 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 de *geed fur a ree to pla the sy em in operar_ion until a Certificate of Compliance has been ' e ( - Signedc------ ------ - ---------- •--. ......... --- ---• ---------------- . i Da te ApplicationApproved By.................................................................................................. ........... --------------------------- Date Application Disapproved for the following reasons________________________________________________________________________________ _______________________________ --------------------•-------------------------------------------------.....-••----------------•----------....•---------........-•••--•-----------......--•-----------...-------------_._...-------------- Date PermitNo......................................................... Issued..' " 7') --... .................................- Dat r i � i i � t ��w� 1 it 1 t � _ 1 1 o e 0 r _ e i D 0 D D {P D �_�� —rl �� `t', ll i -.! ` 1 '�-\ ��'=_"� -�,,-� � �'' z \� Y' r �, t - No�t3..�.. Fes$. ........-......_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. E.................................... Appliratiou -fur R-gpoottl Works Totw4rurtiou Vrruiit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System-fat: .- -� '4 I 1 , ---------------- 5 Location-Address or Lot No. rV Owner Address «jr �.C._f4< {--{.._-.. ..:...... !d'1�f"- -------- ------ -------.....---•- Installer Address Q Type of Building Size Lot............................Sq. feet Dwellin r—oN-o-of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOtl i —Type of Build'g�__________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QOther fixtures ...... -----------------------------------------------... --.-...-_--.-------•--•------------_-.-_------.•----.---------------------------------•-------- Desi'gn Plow......................... ... gallons per person per day. Total daily flow-__________-__--. .......................gallons. W l. , Width---------------- Diameter------ --------- De1 Atli..---•-----_.... W Septic Tank—Liquid�calyaclty_� ............ gallons Length_______________ x Disposal TC�est No. .................... Width......:^-----_�-T.otal Length.................... Total leaching area--------------------sq. ft. Setage P ______________ Diameteh�......_.......4epthbelow inlet.._._............... Total leaching area--.-.-..-.--__--.sq. ft. Othiier Disox (_-�--- �t st gua (� aPercolatiosults- Perf med by----- -- ------------------------------------------------- -. Date----------------------------------------Test P . 1----------------riiinu s per inch Depth of Test Pit.................... Depth to ground water...----..-----.._..----- (_, Test-$it No. 2........�---_minu es per inch Depth of Test Pit.................... Depth to ground water------------------------ -----------------------------------------------------••--•--------------------------•---•---..------......................................................... 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x U ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W , x -------------- -------------------------------------••---...•--•----•--•......•-••--:-------•------ --.........-------------------- - =- ---- r U N of Repairs or Alterations _�—Answer when applicable....._. �----- .._.�-!....___ ... . _ ..f ...................... ------- 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,, T e`und signed further agreesfno to place the sys(em in operation until a Certificate of Compliance has been>i'sue y th b .ard-ofi�heal'r Signed ..c ............-- �------ - - -__ ... ......��%._/..,_ Date / ApplicationApproved By-------------------------------------------------------------------------------------------------- --------.----- ---------- Date Application Disapproved for the following reasons:................................................................................................................ ••--•--•••-•---•••--•----••------------------•------••-----•---------------------•-•--••----•------------------------------------------------------------------------------------------------.......... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH �............0F...... . .44W,.� .....:.. ....... ............... (Intif iratr of 111111ontplitturr b T S I'S TO`C c'TIFY, hat the Individual Sewage Disposal System constructed ( ) or Repaired Y d 1A Gf - Installer �. . • •..•• has been in6talled in accordancet4ith the provisions of Articlq XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---e✓...._..14-4_------------- dated:...._..`Zc`�1.:=..��............... 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 Off HEALTH f ..........1 / .....OF....... .. r'LrJ...r......---............---------... No........ .. . ..... FEE...2... Binpoa ttl Ivor; ii n mi rurtiolt rrrmit g v-- 'S � t/ ----------------------------------- Permission is herebyranted_______.�. ... . �! _ I- to Con t uct ( ) or Rep it ( ) an Individual Sewage Disposal�ylstem f . f Skr et _ - as shown on the application for Di posal Works Construction r t No,/:. _ /j . Dated'_.__ _:��....__ .. f � 7 , ` oard of Health DATE 9!n - --- -------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ,o , SEEN 4,C4E-P_E.R.MIT U- -0, l.l�l_ST Q.L l_E R-S-IJ-�►.Nl- -A-D DRE S�S 5 U 1_ -D E=R S Kl-&-►-E -A D D R.E-SS 13 l4i ,