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HomeMy WebLinkAbout0039 OTIS ROAD - Health (3) 39 ®TTS p 3 `1 - oho e o No...._......VP........ THE COMMONWEALTH OF MASSACHUSETTS BOARD O H E A LJ7H4 Appliratiou -for Disposal Works Towitrurtiou Vrruiit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: T- s A?a- ....... - ---- 2atron-Address . . or Lot No. fr1------------'-----•--•.............................. ................••--------•--•--..._..........----....-•-•----•-•--------•---------------•----••-- owner ...............................•---•-.......Address --- c ----- - ------ 5 Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-_---A-----------_-----------------------Expansion Attic ( ) Garbage Grinder ( ) `l Other—Type of Building je l'r.__._ No. of persons--------_ _----------------- Showers I — Cafeteria QOther fixtures --•-----------------------------------------------------------------•---------- ------------------------------------------------------•---------•--- W Design Flow......' -"�'..................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv,/e?_,_-5ttgallons 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 ( ) Dosing tank ( ) -- '-, Percolation Test Results Performed bY---------- ............................................................... Date---------------------------------------- aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..._.--.___-_._.__._. - �14 Test Pit No. 2________________minutes per inch Depth of Test Pit__-_-____----_____- Depth to ground water........................ Ix --------------------------------------------------------•- --------------•--------- .. Descriptionof Soil--------- ----------- lzp/.................... ---------------------------------------•-•-----•--------------------------------- ---.-------- x W VNature of Repairs or Alterations—Answer when applicable----------->-.1'_,5 ----------------------------- ____----------- ------------------------- _ Ir ...6_°..._G•a�, ���r � - -------------------------------------------------------------------------------------------------------- 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. Igne - --••-• ----- �------------------------- •---------•----•------_--------- Date Application Approved BY--------- �-�-- ---- -- -- --------•- ----------- ... / _ 3 — 7.� Date Application Disapproved for the following reasons----------------------------------------------------------------•--.-•--.-•-------:---------•-----._._...--_---- .............•-----........__...._...--------------------••--------------•-•-••---•--•------------•---•-----------.........--•--...----•----•---••----------•---------•-•------------•------••-.--•-- Date ermit No-------------........................................... Issued........f/------- =-=-G----- ... Date _416 No..................... Fmic ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEM H / 4 !: ...... ....OF........... ...a. ~. .. �4� Appliration -for Uttipmal Workii Towitrurtion Prruid Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ,3 ...... --------- -�oca�tion-,----Address------------------------------------- ------------------------------------------or r*-Lot---No. ­...... • ........................................................... ..............:................................................................................... "Or ---- Address .ta.Ier Addres - ---------------------------- *-------- - -------------------------------- -- 's------------------------------------------- Installer Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms------Q----------------------------------Expansion Attic Garbage Grinder Other—Type of Building --- ..... No. 01 pet-solis--------. . ---- Showers Cafeteria Otherfixtures ----------------------------- ----------------------_---------------------------------------------------------------------------------------------- Design Flow........77"77-7_777...................gallons per person per day. Total daily flow.......................•...................gallons. 9 Septic Tank—Liquid capacitv./,2_�)_/2gallons 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 ( ) , Percolation Test Results Performed by-------------__--------------------------------------------------------- Date--------------------------------------.. a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ r3:1 Test Pit No. 2---------------minutesper inch Depth of Test Pit........-..-------.- Depth to ground water------------------------ Ix --------------I---1­1------------------­--------------­-............................................................................................... 0 Description of Soil--------- -----------6— /------------------------------------------------------------------------------------------------------------------------ �4 ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------I-------------------------------------- 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 been issued by the board of health. igne ---------------------------- ................................ Dale Application Approved BY-------- --- ---- -- . ........- ------------- -- ----- ---- ---- Date Application Disapproved for the following reasons:..... ...................... ..................................................I----------------------------------------------------------------------------------------------- Date PermitNo------................................................. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ✓FEZ ....OF.... .................... "Trdifiratr of Tompliaurr %Lk by THIS TO CEIMFY, That A, e Individual Sewage Disposal System constructed or Repaired zx�_ ------- ...... ---------------- ------ - - --- -­ ........................................................................................................................ at.- .... ........ ----—------ ---- -- ----------- ------------------------------------------------------------------------ - has been installed in accordance with the provisions 0 .,' r1fri XI of The State Sanitary Code as described in the 7 application for Disposal Works Construction Permit ----------- dated.----- _' ------ ---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A Gil RANTEE THAT THE SYSTEM WILL FUNCTION SATISJFACTORY. ...... ..... --- Inspector...._. ---------------------------------- DATE........... —------7. --------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD , F HEALTH OF. .. OF--- .4...................... .............. No. ................ 7"�'�....... FEE.....L�............. Di-spa,ial Workii CIT 1 marurpon Prrutit Permission is hereby granted-._."'...-.. .. -------------------------------------------------------------------- to Constr c or Repair a......Mn :iv.idual S age Pfsposal System -------------------- ---------------------------------------------------.........at No----�i as shown on the application for Disposal Works Construction er it Dated..../ .-.. G............ ---- -­ -- ... ........ .. _4.'�-- ------------------------------ 7 -- oard of Health ----------------------------------------------- FORM 1255 HOE313S & WARREN. INC.. PUBLISHERS