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Home My WebLink About0181 CAP'N LIJAH'S ROAD - Health (3) J r� � I 04 THE COMMONWEALTH OF MASSACHUSETTS 19 BOAR® ,FOF HEALTH ......................u'.......Q.....OF........... q-.!v� PI_................................... Allp iratinn for Diipniitt1 Worka Tonotrnrtinn ramit - Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .........o"-'--- ---•=----•--C .�.�..........g .1� ..'—x.�'-..''� ........ 01.t. ..R. .._....- Location-Address or Lot No. 11� . 13.... 0'`��....--- lu :........ Nr> c��.g Owner Address w K�v N N Vie ` ? .... 2 � � ......... s �3L 1--------------------------- Installer Address � Type'of Building ` Size Lot___________________________S q. feet U Dwelling—No. of Bedrooms....... ___________________ .Expansion Attic 00 Garbage Grinder ( y' Other—T e of Building ... No. ofpersons_.,.-3.................. Showers — Cafeteria a' Other fixtures ................................. . w Design Flow......A Q......................... gallons per person er day. Total dailyflow......330.......................... Ions. Septic Tank—Liquid capacitylIDO......gallons LengthP!&..._. Width__�T . Diameter----6 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 Percolation Test Results Performed by------------------------------------•------------------------------------- Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--__..__•__-____--____-- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-___-______---•-..--___- --••----------------------•-----------------•-••....................----............-----•----................................................................ 0 Description of Soil.......................................................................................................................................................................... x U .............=........................................................................................................................................................................................... --------------- ---------------------------------------------------------------------------------••:-------------------- ------------------------------------------------............. U Nature of Repairs or Alterations—Answer when applicable_________________ ____ l4t.P2-_-___._...____._...__......._..__..__.........__...__. --------------------------•--------•-----------------------•-----------------•------.....----•-.•---•---.......-••------••-•------••----•--•---•---••----••---......................................... Agreemene. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TI APU 5 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--•-)Ae ......!.5 _ ............... ....... ..8— ............ Date r.. Application Approved By......--•----------------•-----•-•-----------------------------------.......---•-------•------_.. ........................-............... Date I' Application'Disapproved for the following reasons--------------------------------------------------------------------------------------------------------------- -------------------------------------•••••••••-----••--•----••-•----...•---•---•--------------------••--------••-•••••-------------------------•-----•---•------••----••----•--•----•-----•------------- Date PermitNo.......S ko----------------------•--•----......... Issued-....................................................... h Date No..A.64--------- Fini....................C) ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .71;.��....Pid.....OF........ ...t._2k................................... Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct or Repair ( 110'a"n'-Individual Sewage Disposal System at: ................................ .........klt� ILL.L................................................ Location-Address D(Z,UOV�ot No.01,01 Vm�lk�A_ nao— V............................K0 ...............)—C;!v.............. ........ ........tts................................................................ Owner Address <1 )IQ H 1- 'aft Vtw%"Tf-%L .......... ........ Installer Address Type of Building Size Lot............................Sq. feet U oms-------�3...............................Expansion Attic 0 Dwelling—No. of Bedro Garbage Grinder �-4 CLI Other—Type of Building .............. No. of persons.._.,.:5.................. Showers ( .4 Cafeteria Nf:� PL4 Other fixtures -------------------------------- -------------------------------------------------------------------- Design Flow......Pq........................ :510 '0.....gallons per person Vr day. Total dapy flow...... gallons. 04 Septic Tank—Liquid'capacity!I!P......gallons LengthA... Widtl............Z.- Diameter----6-------- Depth_._.._.___...... Disposal Trench—No..................... Width.................... Total Length......_......_._.... Total leaching area....................sq. f t. 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.._.................._... Test Pit No. 2................minutes per inch Depth of Test Pit._.............__... Depth to ground water.................I....... ............................................................................................................................................................. 0 Description of Soil.........................................................................................I................................................................................ x '"------------------------------*--**.......*---------------------------------------------------------**------------------------------------------------------------------------***--------*-------- ...............................................................................................................*---------- - --------------------------------------------------------------------U Nature of Repairs or Alterations—Answer when applicable................. i&...................................................... ...................................................................................................................................................................................................... Agreement': The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 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....... . ......im------- ---------- ....................... ................................ Date ApplicationApproved By................................................................................................. ........................................ Date Application Disapproved for the following reasons:.........................................................................;...................................... ..........................................................................................................................................................................V............................. Date PermitNo....... ---------------- IssuedL....................................................... .Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. .........OF........r:...... . ji .................................................................... Tntifiratr of Tontpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired y-------------------_ ! I------------------------------------------------------------------------------------------------------------------------ b - .........HJ�.C.. 4nstaller at.......4o.i.....Z?....... ±r.lv I . ......... ......................................... has been installed in accordance with the provisions of TITLE 5 of The State,Sa'hitary Code as described in the application for Disposal Works Construction Permit No........... ............................. dated_--............_....__...__..___.........._..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL N SATISFACTORY. DATE C_( 1>1 '4 ...........�t!IJJCTIQ Inspector---- 671 AT ..................................................................... r---- ....................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C",0,0 JA?.� ....VV......OF.. .................................................................... ya No...._ ........ FEE.......4................ Disposal orks Tonligmtton prrmit Permission is hereby granted..............al ............Nc ................................................................i to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst4m 1Z, atNo................................................................................................................................................................................................. Street as shown on the application for Disposal Works Construction Permit No.__57.60..... Dated-------9.-..4P Cf.......... ................... ..................... ......................................................... Board.of Health DATE----------- .................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS