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Home My WebLink About0028 JANICE LANE - Health (2) zs �-� ��,�� sot-a�� No............Alt/ ar� 4 .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH --------_---OF. ....... ................ Appliration for llsposal World Tonstrurtion rprmit Application is hereby made for a Permit to Construct l�or Repair an Individual Sewage Disposal ystem at: ........ ....... ............ .......... ]�;.K.............................. 4 `.7D cation/ or 0 ddress _74 ------ 4? .............. Z01 .20-M. /J�. ... ss -nl ... ......... . .. ...4 . ................ ............ Installer Address Type of Building Size Lot-_9A.7�......Sq. feet 01— �—F Garbage Grinder ( Dwelling—No. of Bedrooms-1--------4;.?...........................Expansion Attic Other—Type of Building IV0C?..D........ No. o _V persons__._....Is----_-------- A veers Cafeteria (t...... v . ........................................ Other fixturesA9W,..... e W_---- Design Flow............................................gallons per person �_e�d_!y. Total da� 9ow--------------------------------------------gallons. .4 _1 1Z,!0 ank—Liquid capacity/o"--gallons Length---- N, .. Diameter________________ Dej),th-- -------- Septic T, No------I............ Width.zu- -------- ---- a Disposal Trench Total Length__A.$'... Total leaching area_____J-661O.-sq. ft. Seepage Pit No_____________________ Diameter........._._.._..... Depth below inlet-------------------- Total leaching area--------- --------sq. f t. Z Other Distribution box (X) Dosing tank ( ) 0_1 Percolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ f14 Test Pit No. 2................minutes per inch Depth of Test Pit..__.___....__...... Depth to ground water------------------------ 9 ............. 0 --------------- Description of Soil 1.0- ; $r W-Ai..I :�............. ....... ;S) --------------------------------------------------------------------------------------------------------------------------------*---------------*------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee"ssued by ths-bloard ol�V/fihlthh, 4/ ,V ........ ........ Signed,��_�__ ---------------------- ---------------(_ Dat Application Approved ................. --------------- -------- B Z yoel� ----- ................................................ Dale Application Disapproved for the following reasons:----------------------------------- ............................. .........................................................................................................I............................................................................................... Date Permit No....49.2y_,................................... Issued---- ---73-----_----- Date - --------------------------- ------------------------------------------ Vz No.---------- .. i , FED ... .j ........... '. .f THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -/ -------------_OF...... tf�/€� Applirotion for DisposalMorks Tonstrurtion jjrrmit Application is hereby made for a Permit to Construct (v'�or Repair ( ) an Individual Sewage Disposal System at: / • s� k;� -------------------- ------ •• ------------------------------------------'••.. or ocation.Addreesssn /j ,n ' + �� tf�f�L�/ Lot No* ��E� ! Address/�J / a IJ FFf-- �j L' � v r '-"(----�a`�7 j-----------• �1. (� ............. ..: t� f ��f� Installer Ad ress U Type of Building Size Lot. S feet .` J" q Dwelling—No. of Bedrooms...........pZ._.. ...e,?-------Expansion Attic ( Garbage Grinder ( ) p., Other—Type of Building xko-D--------- No. of persons........ Showers ( ) Cafeteria ( ) Other fixture S/6— �.� .Ir------=;----.4r91r: ifr /--------------6-5 - ----•- ----------•---------------- W Design Flow............................................gallons per person per day. Total dail flow............................................ P4 Septic Tank—Liquid capacity -._gallons Length.__,`. Width- 11-. Diameter_________._____ Depth._- W. Disposal Trench—No.-----/............. Width.�,0..__.___ Total Length._, .'_._.. Total leaching area-----1��t_�,3...sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date-------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_..__-____-__--_:----.-. t=, Test Pit No. 2-------------...minutes per inch Depth of Test Pit-------------------- Depth to ground water--..-______-___--__-.--- P' ------------------------------------------------M i-----------•...... _ 1, O Description of Soil ._.,� ! f��. � rF r ,r` ...7 1 ----- - ------- --------- -------- ------ W ----------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ----------------------------------- V Nature of Repairs or Alterations—Answer when applica.ble..........................................................................:..................... ---------------------------•------------------------------------.......-------------•--•--------------------•-•------•---......_....._... -------------•-------------•--------------------------------- 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 bee issued by the board o health. i Signed-- - - - =-sl'�- ---------- - � --------------- ---'.`-- •,7 Date Application Approved BY_1 - - ✓+f-�o ,p- '�`'`z'-7 t--------------•- ---•------ `-�•7.2-33---..... J� Y Date Application Disapproved for the following reasons:................................................................................................................ ----------------------------------------------------------------------- -------------------------------------------------------------------- Date Permit No.---- `_ r'� Issued.----- - ? •�,tt -- - ............ .7- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................../2!rw�c......OF........ f , x ..5. alb.-................................. ' (9rdif iratr of (fontplittnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ]() or Repaired ( ) by :------ J4-��; ,4 V ��G'- ,p Installer has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal.Works Construction Permit No------ q----- �dated _A.. -__ ._....._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED,AS A GUARANTE THAT THE SYSTEM WILL FUNCTION-SATISFACTORY. DATE---- =" =, / Inspector--- ------ A! . //--Gta V / THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF...............d/ .l .s �..... _........ > J T. /........................... �� `� FEE........................ Rapaiial Norkii (lIonsirurfion erntit Permission is hereby granted----------jif-----:� y--------Z-x _-' °�`� "��i •---------------------•--------............................. to Construct ( or Repair ( ) an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No------,y __%U_. Dated____ !_ _?__ -_.a-_ _••----- ---------------------------------------- --- ---------- ------------•------------------------------- DATE------------------------------------------------------------ Board of Health,•{�f';�,� . Tom"�,AG A)GU Are FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ,�