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Home My WebLink About0125 MELBOURNE ROAD - Health (2) 1 a5 �1e1 brume �O, 1Ds l � � r ,~� | x / -- \ b� � ��o | _ ° ` ~.~_- ` -~~.~'----- � ` THE coMwomvvExLr* OF wAssuc*ussrTs K��8�K� ��" ^�~ Q.1� HEALTH ---cxF---'J�� -~ - - --� --- ~r �� - �� ~~1� ��- �� ~°�� 8� �� - ~v-�--~-`~--- --- --~-v---'- ~ ~~'^-°°�~ =~°----°°°�°°~= m~ ~--~° Application is hereby ma for a nit to Construct or Repair an Individual Sewage Disposal Syst � --- Owne dress ��-`�- -- ^ --- ---' '�,�'--~~'~-----~-'--- .��------ ......................... ----'---' --- 14 T�� nfBo� � �� ' S6e Lot.. . few � I)vveIliogXo. of Bedrooms............................................Expansion Attic ( ) ��rM�pe Grinder ( ) Other—Typeof Building ............................ No. of persons............................ S6ovvccs ( ) -- Cafeteria ( ) 114 Other fixtures .............................................................................-..- � D ' F6n� �� cr ��ruooycrdu�. Total daily 8on,---�=�.'��.��-----' � 5�pt�o l� � o!d.cnpucd},c*c*��pUouo 1.eogtb-'------ YVidtb-----.. Diunncter'---.-- Depth................ Disposal Trench N ........ Width tull.eogt6 Total leaching area sq. {t. 3ccyaKe Pit No _-- Diaozc�r.//2 Depth below inlet....~`. Total leaching area. ft. � Other Distribution �� ( ) Dosing tank ( ) ' ~~ Percolation Test Results PcrfocoedhT------_'_-----------.-_----'--'.. Date........................................ ' Test Pit No. l................nliootes per inch Depth of Test Pit.-.-.----' Depth to ground water---------------- ------- Iea Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.---.--'- �� ----' ---.__--_'---_—.-____-'_------_-_----___---__ D�aor�� c� Soil ---_---_--'-----',-------'------'-_-'---' � U _-_--__- --------''-__'------- ' � �4 .--.-._---------_---.-_-------_-_-__-....---._-----_----_--_----._.------__-- U Nature of Repairs orAltecacinm--Auswcrnhco applicable..------------------------- -------.-----'-_--'.--_-'---.----_----_---.----.--__--.--__-_--_--------''---_--- ' g,-_-_-. The undersigned agrees to install dheuforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of theStateSanitary [ode—The undersigned further agrees not to place the system in operation until u Certificate of Compliance huob -'' Date Date Date Permit No .... Issued_ __--'-_.---_--__''_--__ Dat ___ ____� _____ - - _ No.... w_ __` .._. F$$...., .....` ' ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALTH r. .q........... OF......... Ew. .....:................. ApAiratian for 13i> volial 10orkil Tonstrurtion Prrinit Application is hereby maA for a Prmit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System '^ 6 a r kR" art rj /1�{t1 fJ/' s/ 1 1 Loca n Addr 's a-.., ....................... .......0 �7t ./ - ..-...............,.............._. Owner �' 1 Address r- Vr > �' Address as , sta er , ., UType of Building -- Size Lot........ C%-J-�---- . feet Dwelling X. of Bedrooms............................................"� Expansion Attic ( ) Garb g Grinder ( ) Other—Type 'of Building _.. ...... No. of persons............................ Showers — Cafeteria a' Other fixtures ...................... . .. W Design Flow........................... ..._..gallons per person per day. Total daily flow....._... ..4`� _....___-__gallons. Septic Tank Liquid.capacit lions Length................ Width................ Diameter................ Depth................ x Disposal Trench—N ..................... Width.............p,,eTotal Length............._. Total leaching area... .............sq. ft. Seepage Pit No____________________ Diameter_f; ; :d..._ depth below inlet......... ..... Total leaching area= �_.s'_ sq. ft. Z Other Distribution ox ( ) Dosing tank ( ) Percolation Test Results Performed by................................_.___.......................__,-_..__..... Date.................................... Test Pit No. 1................minutes per inch Depth of :Test Pit_....___________.__- Depth to ground water........................ 41 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ WI - •••-•-••-•-- .. O Description of soil..............:. c� .••--•-•-------•-•••.....•••-------•-----•-•-•-•-------------•----•-----•--•-----•-•-. W VNature 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 been iissjaed by the board,Qf health. Signed r > ` :�: �.�.. .................. r ✓J � Date Application Approved By...... ./, .._r+.,ty.«� " � .� _ .., ----- Date -•---•------•------------•--------•---•-•............................ ...._._ Application Disapproved for -the following reasons:............:....... ___._. ....---••-----------•-•-------------•----•------------- -•-•--•------••---........-•-------•------•-------_._....---•---•----•----•----------...--••------•-----••-------••••-••--•-.............•-•••- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L. b c ...........OF........ . .;s .................... Offtifiratr of TOmptiam THIS IS TO ER That he IAdividu) Sewage Disposal Syytein constructed ( r Repaired ( ) at - --•- > F --- -- ------------•---------•- - has �een�installed in accordance with the provisions of Article XI of The State Sanitary Code as de)cribed in the application for Disposal Works Construction Permit No--------------- ------------- dated--- - __:_ _ _.. .: ..�:_...__._... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A CaU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,� �� j a �.p^... ,. .......O F �, - -'•.,.s _.._"' .:.sus ................... , No,., ��. :I-,•.d. { FEE. ' ................... - � 1 ,� are To a iou, r�ud f. Permission is.hereby granted----- _ a;,.x:: _ f? � , �Cea 4 = ti st to Construe (F r Repair du I >�*du tl Sewag�e)Disposal S stem � ) 7 y � at No '- �� ' 7..: s ...�..*.?`"'lerf;{a.. �°4;. ;I. !�� / �:.Rt ' dam' ��.....:.......... r ..... ' Sheet ' j as shown on the application for Disposal Works Construction Per it No�^- ..... Dated k'. — j C Board of Health -----------------------------------•-_- FORM 1255 HOBBS & WARREN, INC., PU^LISHERS 3 3 73