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Home My WebLink About1019 IYANNOUGH ROAD - Health lho/9 Z yaar a�J-l-, d?oa6 i � � �. � 2 _. ��s �� ,, 1 ... 7;� ", 9) #,, e " . No.._........L?. .�I. �`j '� � Fizz..., r .................. vQ,W(jV J E�rCOMMONWEALTH OF MASSACHUSETTS / BOAR® 0!Y HEALTH ..-.......0 F........... .......�..../�..1':_'.. .....---••--••---.._........... ApplirFation for Diopos al Works Tnnlitrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at: � t Loc ion-Address �.�.� or Lot No. owner Address ,, a ` t.�Z- %..... .......... Installer Address Type of Building Size Lot-----. feet ,.., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p`1, Other—Type of Building ............................ .No. of persons--_-.z7•__--__•___-___ Showers ( ) — Cafeteria ( ) Other fixtures ---•--•-•-------------------- WDesign Flow....�7......x........�4.___gallons per person per day. Total daily flow................_ .�. _..........gallons. WSeptic Tank—Liquid capacity.«DOgallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------i2-.......... Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing to � 7 Percolation Test Results e� Performed by..... G�rr ' .7 ......---•- ate...1�----� •-----�---------... 1 Test Pit No. 1......__1_.....minutes per inch Depth of Test Pit.................... Depth to ground water.__:k '�� 0-4 Test Pit No. 2................minutes per inch Depth of Test Pit...................... Depth to ground water........................ a ............................... -•-•--••--.......--•- • --- ------------ ........................ O Description of oil--- ._... L`.1..� .. ..... . .. � �........Y--l3-.......... Z � �--��' _ .. .....................•--•-.... x -•-----------------•---•------------------------•-•--------------...---•----._.....----••-----•-- •--------•--•-•--------•-------•-•---•••-------------••-----•---••......•--•-•--•••-. --------•------- U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. ....................-r.............................................. ----------•--•--------------------------------••---------•--------•••------•--•---•--•-------------•-------•-------•-••.......••.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLEj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the board of health. ned.- =!�i? . ................................ l ate Application Approved By............ �l ... . Date Application Disapproved for the following reasons:------....-•---•-•-•-------•------------•-------------•-••-----••---------------•--------••---•--•--......---••- ---------- 4 Date Permit No......... �7 �.....?. ---••CiD._.... Issued_--- Date Date w C-77 �/ ..,✓r/ No..........a. . F�$...a� .....r ............... THE COMMONWEALTH OF MASSACHUSETTS +_... ,„��➢ R„R9 BOARD O HEALTH Wit.. OF.:...:..... .. ..:: ". ............................................. Apphration for Uhip sFal Workii (foustrurtivat ILerutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Svstem at .... . .............' !ha#.�:►::. .----'-'--- "•"..... •" ......_ "'+ ' ............ ..................... Lo ion-Address or Lot No. --- Owner .rw ddress a •ttt1.� ..`...... .. _ 11 .i y Installer Ad ress d Type of Building Size Lot._S_,Z,;. dQI..Sq. feet U Dwelling—No. of Bedrooms....................................._......Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ I o. of persons.....2ii _______________-,Showers ( ) — Cafeteria ( ) ad Other fixtures --------------------------------------------------•------------•----•--. -•-- ...-----------•-•-•---•- W Design Flow__:471......!�......._ _�r___._gallons per person per day. Total daily flow _____.1 4.1e�__:_...____gallons. WSeptic Tank—Liquid"ca.pacityt% _gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No ........... Diameter..................... Depth below inlet.................... Total leaching area..... ...__sq. ft. Z Other Distribution box ( ) u;: Dosing to Percolation Test Results Performed by... - .:. Date...!'j`&� '_�__�:___.___.__.. Test Pit No. 1... ...___minutes, inch Depth`<of Test Pit �._::________•_ Depth to ground water _ TWest Pit No 2______ _______minutes per inch Depth of Test Pit........... _.Depth to groundwater _.______.______.. P4 ' ....... ... ... D Description of. oil + 44 W ---=--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------•---. UNature of Repairs or Alterations—Answer when applicable -----------------------------------------------------------------•-=----------------.....--•........----.....------------------------•-----------------•------------._...------------._...--•--•-------• Agreement The undersigned agrees to install the aforedescribed Individual.Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate'of Compliance has been is ed.by the board of health. gne ..... .... Date fi tlly Application Approved BY............ ....... - ----------: --h - 7- - Date Application Disapproved for the following reasons:_............................................................................................................. ----------------------------••---•------------............................................................ ...---..---•----------------------------------------------...------------------------------ ,e, ._ .. •----------------'--- Date •---- "T-•-- - -. Issued_-----1 �._.._7_' 7 Permit No. v _ Date_ r THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH " `� .......................OF . '1' ......*............................................., Trrtifirate of ToutpliFanrr THI' IS CERTI Th the4ndivioual Sewage Disposal System constructed (�r Repaired ( ) bY-------- .... >��:# :....:. ...... -� ............................................... - rInstaller ] m r d�- has been installed in accordance with the provisions of � of The State Sanitary Co e as describ d in the application for Disposal Works Construction Permit No ---1-7-/�---------------- dated.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY DATE...--- 7' 7 Inspector ,Y Ce�% = THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N . ..... •-----... FEE ._.J Dispo's 194" uxks�&_ ts w.n proof Y g Permissio is reb granted..... x°_ __ __. _ _ "^ .. __ ___ _____________ , , . to Constru ( ) or Rep ( an Individu Sewage > osal S stem at No."-`_ id- ,P'.0� ."^�1 ------ .__._...� ' Street�e - as shown`on the application for Disposal Works C nstruction Perm>t ... Dated.._ 7 ,,. � t B4ard of Health DATE...( . ...............- '-----....=-•-----=' ................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS _ ::.,•.'Yd„'+.•. ,r,!YF:vh`.:b+,lYfl9»+�eRRa„Jr_MfR.�. ..,LIY+Ma%rtaM✓„»n`�'.+E,:n-e.!'nlb.4lni^±.",{»,aM'.w.•++"-s...A ,e niu'1-. Y.-i+,�wwa.pe�-+azmr •s�',,.y.�. t,�r,n�.~�»w�ra+vwararvvi-war..*•na.+sr..,wa',.v-:'..,r...<rw.+,erww.+-uv. —a .,,..»,- n. 1 rW_.-xi. M�'•v, ar-_R>.+w.t, ," v.Rkav '�Y.u„�•`.4Yl er.,-,...x.Y.<...r, s.::,.._<.._, ,.w-iakvNwP�6fr^ .-ss-.-.xwr-..t,..r. 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