The URL can be used to link to this page

Home My WebLink About0015 PILGRIM LANE - Health 5 Pz�.�RzM wN 3!0 - Ql� 0 e," .:.1 ass �- No.-- •-• ._�... 1 t Wl F ss.................. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..._.... ................OF....... - Appilration for 14spooal Works Tonstrnrtion jhrmit Application is hereby made fo a Per it Co uct ( ) or Repair ( ) an Individual Sewage Disposal System t: is tt,Olt ........ _ . .. . ...LEA • ......... ..... 1 �•- ..-. ocation ess or Lot N'/�/a .._ ._.� -•---•--•.................: ..........................................................................................•__•__.. Ow Address a �... .... -=- --• ..... ............................ --•---•-•--•-•---•------••----...-----•-•.._..•••••.............••-•--=--._........•-•••••-••••--- In taller Address Type of Buildin•g/ Size Lot............................Sq. feet ►-� Dwelling C—/No. of Bedrooms_____________ _—_______________...._Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No, of ersons____________________________ Showers a YP g ----•-•-------------•-•----- P ( ) — Cafeteria ( ) Otherfixtures ------------------------•--------------------._.._..--•-------------------•••-----•-••. .............................................................. 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 ............. Descr' t' n of Soil-•------------•----•--�•- .......-•-•�9L.,C, .......................................... ................................ -•---- U Nature ofNd r Alt ations Answer when appli ble_.__.._—____ __ _ _ __________'_________ ______ - - Agreement /""�The u agrees to install the aforedescribed Individual Sewage Disposal System in ac r ance wit - the provisions of TITIL4 5 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. Sig ---- --- -••----------------------••------•--------•--------•--••--•--••--- -------- ----•-••-•-•-•--_----- Date Application Approved BY l �O �._�!/ - 111 ..:_ -------------------- �� 7- �� --- Date Application-Disapproved for the following reasons:-------------------•---------------------------------•---------•-------------•-------------------------------- ......................................................-................................................................................................................................................. Date PermitNo......................................................... Issued-....................................................... Date A .4W „ s No....--- .....__Y._ FE$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OE H EA Tip T.jf ...............OF....... Q.I�i _... ............................... Appliratiun for Disposal Works Tonstrnrtion Permit Application is hereby made fob a Pe�r�'t Co�uct ( � ),or Repair ( ) an Individual Sewage Disposal System t: - �, ,61�� i�,`D f ........ _•................................ ... .-::....... ........ _ , ,t�' ocation A ess -.�or Lot N • NI ----- ------------------------------ X w Address at...f`'•.... !..................... ................................................. ............... Insta ler Address U Type of Buildi7g1' Size Lot.................... .....Sq. feet ' Dwelling-L No. of .Bedrooms..............`....................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building .............. No. of ersons__..................._._.___ Showers a YP g -------------- P ( ) — Cafeteria ( ) dOther•fixtures -•-----••-----------•---•-•---•--•--------•-------••---------•--•••--------------•---------•------••----------••-----------.....----------------••--- WDesign Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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. Test Pit No. :l................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-----_.............. Depth to ground water........................ a ...................... ---- - ----- D Descr t- n of Soil ........... , '". - - ---• . ...2 x t., - - WUF Nature of pairs r At ations Answe-4 .. wi%r when appli ble. --- __jzleli _ i/`_._......_1 ... ..____.. - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL.1� 5 of the State Sanitary Code— The undersigned further agrees notto place the system in operation until 'a Certificate of Compliance has.been issued by the board of health. Sig .d Da t -------------------------------- Application A roved B -- �---' PP Y----- y Date Application Disapproved for the following reasons:............................................................. ......•........................................................... ....---•------------------••------•-•---......--••-•-•••----.......------••--••--•---.._...... --........---•--•------------------•-•-----••---------------•----------------•------------•--•.......... Date PermitNo.................•-----••--•-.....--•---...-•-........... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........lI.jL46.1.........OF..............X..a.44.1.........................................._... TertifirFatr of TomptiFanrr - T IS T CERT Y, hat the Individual Sewage Disposal System constru ted ( ) or Repaired �[lf/��f/J 'a 7'�'__by - -- f Installer 2 l� . h . .. ---------- at. - ---- has been installed in accordance with the provisions of T ` of The State Sanitary Code as des cr' m the application for Disposal Works Construction Permit No _ - ______________ dated......7.:_--./ =_..;�"'�..------- 'S THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION'SATISFACTORY. DATE..................•--••-•--•----...............-•---------•----•-..._...._••--_. Inspector............................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH SGO ...........OF.......... .. I------------------- ............... No......................... FEE....1! iupu 1 rk nuIriun fermi# Permission is hereby granted..... (y�.J��q//� to Cons turt ( ) o Repair an In ' idual ew age D' p'osal st at No.. !!z `r-4, Street as shown on the application for Disposal Works Construction PermNo. ,r Dated .............................. 7- f} �Q Board of Ilea 4.--- DATE I�=....... (! FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - - 01 No.----��--'--13-------• Fps.......J..�................... THE COMMONWEALTH OF MASSACHUSETTS BOARD �OF HEA TLJ l �f �. OF .......J.�1LL� LPL .....................--- Appliration -rear UiBvosal Works Towitrurtion Prrutil Application is hereby made for a Permit to Construct ( ) or Repair ( V51 an Individual Sewage Disposal System at S ... . ....... .--- V .------- ------------ ------- �!- ---4 Location Address or Lot No. Owner �� Address ..... .._. .. ..yf- � ........................................................... ............ . ..... ......... .......................................................... Installer Address Q Type of Building Size Lot____________________________Sq. feet U Dwelling�o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) per, Other—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. it. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date----------.-.-----.-----------------.-.. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit_-______.__________ Depth to ground water._-_._________--_----- fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......______-_______---- -------------- ------------ -- ------ •----•---------------------------------------.................................................... ODescription of Soil------ ------------ ----•-----------•-------•--------------------•-•---------------..-------------------------------------- W --- 4 ------------- -s------------------------------------------------------------------------------ -------------- ------------------------------------------------------------------------------------------------ -•--- ------- U Na e of R airs or Aiterat'•ns—Answer when applicabl _.____ ."�_.--- . -- -------_; .j� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I 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 bo � y oof health. Date Application Approved By-----j ......... .. " Z'--- .�..7s------- Date Application Disapproved for the following reasons:--••--••-•-------------•-----.....--'•-----•------•-------------------•-------------------....------------------ .....--•-------------------------------------------------------------------------------------------------------------------------------•......-••-------------------------------•---------------.----- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for u Permit to Construct ( ) or Repair ( L,�~ao Individual Sewage DisposalSystem aV.1 � Installer Address Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) -- Cafeteria ( ) Otherfixtures ------------------------------------------------------------------------------------------------------------------._-_'-.- Deaigo ..gallons per person per day. Total daily 8ow-............................ ....... ....gallons. Septic Tank—Liquid capacity---.�dlous Length.--_-- VVicbb-----. Diameter DcyJ`--.--- Disposal Trench--0v--.-__--' Width-------------------- Total Length-------------------- Total leaching area--_---sq. ft. � Sccyugc P6 No..................... -' Depth below inlet.................... Total leaching areo-------sq. b. � Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.......................................................................... Datc.--_-.--_------- � Test Pit No. l----------------minutes per inch Depth of Test Pit.................... Depth to ground water ----------------- �rq Test Pit No per inch Depth of Test Pit-------------------- Depth to g,vuo6 water.............. _'- 01 , - r -------- -------- Agreement: - The undersigned ugrocx to install the uforc6eacribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code The undersigned f rth to place the system in operation until a Certificate of Compliance has Zbee issued It bb ,Aoard off heal.th. ----v---' --��'-6� /\ �-'--- on�at��o Approved �y-.. 1_�.��.�/i .--.--------' ___��, 7a�.__ Date Application Disapproved for the following reasons:--------------------------------------------------------------------------------.............................. ........................................................................................................................................................................................................ . Date Permit Issued..-__-_-_.-_---_-_---- --' THE COMMONWEALTH opmAsemz*ussrra --~` BOARD OF HEALTH . ��---��F-1� ----------� ^ � THIS IS T CEA19 hat the Avidual Se e Disposal /stem constructed or Repaired has been installed in ac-ordance with the provisions of -1 ficq X! Tfhee State Sanitary Code as described in the ' THE ISSUANCE OF THi! CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATKSFACTORY. DATE........................................................................ lospectoc--_-.-'--_---.--'--------------------. THE COMMONWEALTH ormAssxcnuSsrrs (ZEj BOARD OF HEALTH � »~ / -'�� ---OF--. -----' Nu..--_'-----.. Fuo-°=/.............. Bi.rwviiat Nor #a ru.�rflftvn. rrmit Permission is hereby granted--------- . ........Ma to Construct .�7rRA a Irldi:v*' e,kDisp S ystem at No.....1.5...... . ...... ...... ... 1/0-sx,06? ------- et >Sto _� — as shown on the application for Disposal Works Construction ^ . 411 �/ - -- o�� e"��'7110, .......--- � ------T--`-------------'------_-' ronM /sss xooasaWARREN. INC.. puaLIs*cno � --