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Home My WebLink About0686 IYANNOUGH ROAD - Health ��`"` .� - �� - �t � � i r� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HE LT ..�. —,VPL..........OF..... . ... .. -•----•---------•--• Apli iration for deposal Works Tonsttrnr$inn Vrrmil Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: j . . . ................��i 1.�_ . -••---•--•-•-••-•-•------..----- Locatio ddresV o Lo . o. )ype -- ---•---••"" -------•--'__. .._-••--•-•• --------+c-""'•--'--'-• ----'-•---"'- -- •-----•__________________________________ ---- -------O e �Insta er Address of Building Size Lot_________------------------Sq. feet U Dwelling No, of Bedrooms________________________________ _Expansion Attic Garbage Grinder ( ' ) aOther—Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( ) Q' 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____________________ Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by------------------------------------------------------------------------- Date---------------------------------------- 1-4 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ (� Test Pit No. 2................minutes per inch Depth of Test P t.................... Depth to ground water________________.____._. ---------------_--- ------------•---•-----•----------•-••---------------------------------------------------- 0 Description of Soil------ --------------------------------------------------------------------------------------- x W ------------------------------------ ..................................................=•-•••-•••-•-•--•------••------------- - U Nature of Repairs or Alterations—Answer when applicable.__:___ ... ______- ----- --------- -- - ---- - ---- n 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 issued by the board of health. Signe . -- Date Application Approved By / �! !1- - ----------------- �� - --� ate Application Disapproved for the following reasons:---•---•-------••--•---_-----------------------------------------•------- / Date Permit No---- _-_ .............................. Issued.__ l� 2 Dat ti No........................ Fmc 2.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F H LTH ............OF. . . . .. ....... ...................... Appliration for Utgposal Worbs Toniitrurtion Permit Application is hereby made for a Permit to Construct ct or Repair an Individual Sewage Disposal a :Syst t 'A _ -------- -- --- ----..................................... ..................1",� ...... -2z Locationddres;V or 0. ----------- /.......... .......W;........................... ... AKrel.------------------------------------------ ..........................................::�............. Installer Address . ............ ......... Lo U ZZyvpe of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder aOther—Type of Building ------------:............... No. of persons---_--------------------- Showers Cafeteria Other fixtures ..... ------------- ---------------------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow--------------------------------------- ....gallons. 9 Septic Tank—Liquid capacitv------------gallons Length................ Width---..-.-_.-.-_- Diameter__.-_.._-..... 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 ( ) 1.4 Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit_...._..........._.. Depth to ground water------------------------ L14 Test Pit No. 2----------------minutes per inch Depth of Test it.................... Depth to ground water---_._--------_-__------ ve;--------------- --------- !. - --- --- ------------------------------------i *-----------------------*------------------------- 0 Description of Soil-------%J—145". ... ., ......---------------------------------------------------------------------------------------- W .................................. ...................................................................................................................................................... U --------------------------------------------------------------------------------------------------------------------------- ------------ 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 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 issued by the board of health. S' A 1"7 ign?.............. ................................................................ -- -----Date-------- --------- Application Approved By------ 4 r :2— ....... ... ............. .... .. ...... ...... ate te Application Disapproved for the following reasons:...............................;-------------------------------------------------------------------------------- .............................................................................................................................................................------------------------------------------ Date PermitNo......................................................... Issued- ................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALTH , ,........OF......... LP................ QWrtifiratr of TlImplitturr TqIS I-S,,TO CERTIFY/ T t the YIff ividual Sewage Disposal System constructed or Repaired ------------ . .................................... .................................................................................................... by- .... .. . Installer at .......... ------ ---- - ------------------------------------------------------------------ has been installed accordancewith the provisions of Article XI of The State Sanitary Codt? as described in the application for Disposal Works Construction Permit No----------------------------------------- dated ---- ------- .............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAPANTEE THAT THE SYSTEM WILL FUNI;TION 5AT[SfACTORY. ......................... DATE------------e ..... Inspector---/e - ------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 H E A L'T:�,_ ......... ... ...........OF .. , ............................. 4 a.4- No.--- FEE....12............... irlat1 � , (ion turti Permit Permission is hereby granted-- . ............... _e ...................................................................... to Construct (/ ) or Repair n,A?Individual Sewage Disposal System at - --------------------------------------------------------------- ----------------------------- No t as shown on the appljicati'o'n for Disposal Works Construction Permit' 0 ✓A --------------------------- /',--------------- ------ ------------ Board of Health j- --- ----7000- 17 DATE--- ------------------------------------------- FORM 1255 '0. & WARREN. INC.. PUBLISHERS .................. 0�