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Home My WebLink About0008 GENERAL PATTON DRIVE - Health f ' +1 I i i N SMEADI KEEPING YOU ORGANIZED No. 12134 2-153LGN SL)STNABLE FORESTRY A1 MIN.RECYCLED AM INITIATIVE CONTENT10%f-M CertiffeeSourcing POST-CONSUMER xnnmafi ro9rem.org SR01290 MADE IN USA GET ORGANIZED AT SMEANOM -(� -- -2-` �� d� !-`/�P��C��'-tic J �c�,�C G j �/ - �- G ................... THE COMMONWEALTH OF MASSACHUSETTS BOA RDff HEALT . .......... --- -------OF...... ............................................................ .. . Appliration -for Tomitrurtijan Prrutit Application is hereby made for a Permi o Construct or Repair (111'*"an Individual Sewage Disposal S em at: ....... .. . ........ .... ... ..... --- -------------- ........ ........ ................. .................. .................... Add s do or Lot o. --------- ....... - - ---- -------- ... ... . .. ................. ......... ............. . . ................. ne Addre .......... . .. .... . ......... .. ........ ............................. .......... ... .......... ........ .. .. ...... ......................... nstaller Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms______________________________ __ _Expansion Attic Garbage Grinder ( ) Other—Type of Building ---------:.................. No. of persons.._____..__-_._.._.___._-___ Showers Cafeteria ( ) Otherfixtures .........................................................--------------------------------------------------------------------------------------____ Design Flow -----------1;---- . allons per person per day. Total daily flow--------------------------------------------gallons. 7------------ Septic Tan4_1_iquid capacityft-&A---tWlons Length________________ Width--__._-_-.-_. Diameter__.--_ Depth.--..__-__.._... x Disposal Trench— A , eaching area---------- ---------------------- Width__.______------ n th ------ ----------sq. f t. a.Ott 0 4 eptlii el 0 4.4 Seepage Pit No------.............. Diameter_/_!��_i_.�' -_'. leaching are. -----------------sq. f t. Other Distribution box Dosing tank Percolation Test Results Performed by-------------------------------------------------------------------------- Date-------------------------------I--------- Test Pit No. I----------------minutes per inch Depth of Test Pit_.__________________ Depth to -ground water-..____..___-_._--._.... �, Test Pit No. 2----_----------minutes er inch D of Test Pit..c /e Pit.....-.._..____._.._ Depth to ground water__._....._--___-__-_---. ---------------- ------ .. .............................................................................................................. 0 Description of Soil------------- -- --- ---- - --------- ------------------------------------------------------------------------------------------ ------------------------ U ----------------------------------------------------------------------------------------------------- . ..... ..0_ --......—... -----------*----------------------------------------------- ------------------------------------------------------------------------------------------- ------- 7 ----- ------------------ p - 2--------------------- U Zature of Repairs p?Altetions,—Answer wh plicable----—-- ......... ------------------------ al - --- -- ---------------------- -------- -------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance 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 h bee sue oard of health. Signed- - - A------- - --------------------------------------------------------- Da-t................ eo .. Application Approved By 7-- ........... ate te Application Disapproved for the following reasons:.................................... ................................................................ .......................................................................................................................................................................................................... Date PermitNo........................................................ Issued------_' ....e ........------------ Du e ---—----------------------------------------------------------------------------------------- No..... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD HV.L4, .........OF�.....4.p. .........:........................... ................................ A.VVItration -for Ditipmal Works Tomitrurtion Prrutit Application is hereby made for a Permi 0 Construct or Repair (A01 an Individual Sewage Disposal SLIAem at: ... . .... ....... -------- ......... ................ ................-- Add s or Lot o. .......... ..... . ........ ------ .. Addre A. .... . ......... . . .. ........ ............................ .......... ------- ........... ---- -- ...................... nstaller Address Type of:Bui ding. Size Lot.................... ..........Sq. feet J 4 .-Dwelling—No. of Bedrooms------------- ------------------------------Expansion Attic Garbage Grinder Other—Type of Building -------------------------- No. -of persons--------------------------- Showers Cafeteria y al Other fixtures ------------------------------------------- ......... --------------------------------------------------------------------------------------------- Design Flow +.........gallons per person per-'day. Total daily flow..................................... ---gallons, Liquid capacity/Rc- r4 Septic T-11tV—- - ----------------------- _4_7?� allons Length________________ Width-__._-.._.-.._:. Diameter................ Depth--______.._. x Disposal Trench— Width... p_��_ _L I �o 7------------ � of �eachingarea--------------------sq. ft.' J)t F"O R� .1 leaching area------------------sq. ft. t� Seepage Pit No.___._1k� Diameter: 01i ... h eo .. ............... Da --- ---- p eo Other Distribution box (I) Dosing tank ( ) Percolation Test Results Performed by---------I--------:------------------------------------------------------- Date---------------------------------------- Test Pit No. I----------------minutesperinch Depth of Test Pit.................... Depth to ground water-__-________._____-__--. f14 Test Pit No. 2................minutes per inch De of Test Pit_._.._.__.__.___.___ Depth to ground water.......___.____-__:__--. ..... .... ---------- - -------------- ...6----------------------------------------------------------------------*------------------------------------- 0 n of Soil:._______-__- - ......... Description . ...................................................................................................................... �4 AA*. ---14-- -------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ ---------- -------------- -------------------------------------------................. --- -- -- --- ---------------- ----- 2------------------- • -------------------------------------------------- U ture of --------- --------------- LRepairsr Ite Answer ble_'_&1ations ---�;.T_.t4ll... I Dw 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 undersigfied further agrees not to place the system in operation until a Certificate of Compliance h bee' s oard of health. Signed- - ----------- .......................................... - -- ---------------------- D. .... ......Application Approved By.. ate Application Disapproved for the following reasons:------------------------------------- ------------................................................. ......................................................................................................................................................................................................... Date Permit No-------------_-- . . . . Issued.... 7----/4/------------ Dat THE COMMONWEALTH OF MASSACHUSETTS BOARDHEALTH ..................OF.... ........ W.Vatifiratr of Tompliaurr rk T J TO T Y, hat the I'MlVidual"Stwage Disposal ffiS,N-tw constructed ),,or Repaired( b, . . ..... .. . .... . ....................... ........................................ ... ....................... 7 .. ......... .. stallft has been installea"'iri accordance with the provisions of Artic;e XI of T e State Sanitary Code s descyi bedin the Y application for Disposal Works Construction Permit No.____ - _5...................... dated' Ayd THE ISSUANCE OF THIS, CERTIFICATE SHALL NOT BE:CONS I T RUED I AS A GUARANTEE. THAT-THE HE SYSTEM WILL,FUNCTION SATISFACTORY: DATE--------- .................................--------............................ Inspector-------------------_-N—z:,:......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9V HEALTH ...... .. OF..... F. 42 Na_:.. ....................... FEE...2............. Involi. �rkil UrffvnXrrmft Permission is hereby granted ------- .. .... --------------_..................................... ,1 11111111 ------------------7 to .*,-'6 n-str --- -------- '00 C, _jjkt. j or di; u-'A'ew sporsal tem- atNo._!�� .. .. ..... ------------------------- ------ Str. .... -- -- ----- --- --------- - st t di ... .... . .. a pica ion or I No...... e ----- ... .....as shown on the 1i ti f Disposal Works Construction in ...... --- ------- --- --- --- - -- --- Boar of Healt DATE. . . ................ ... ............. FORM 125 HOBSS & WARRE INC.. PUBLISHERS