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Home My WebLink About0054 PINEWOOD AVENUE - Health (2) F-5q PineWa��P �Cev�uQ. � }�,nni 5 No.-. .................... .. ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH OF.... .. Appliration for 473ttiposal Workii ( onstrurtion Prrutit Application is hereby made for a Permit to Cmistruct ( ) or Repair ( ) an Individual Sewage Disposal Syst .. . at . ........ . ...alvv. ... .. . ..... Loc ion ress 9 t No. ...ek.........- ... ,! ..ti.. .:. . ti er Addles X1 ..... .... .. ...... ......... ........... ................. .. .. ......................................... Installer Address Type of Building Size Lot._-!.�_-7__•_ q.�L S feet aDwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.' Other fixtures __.._ d ---•..................•-••------- ..................... W Design Flow...................... .. ................. allons per,person per day. Total, daily flow............ ........gallons. P4 Septic Tank—Liquid capacity/At- allons Length................ Width—------------- Diameter................. Depth................ xDisposal Trench—No..................... NVidth..........�_ otal Length.................... Total leaching area---- q ft. Seepage Pit No________ __________ Diameter ._.._ llepth below inlet...... ,. Total leaching area._ .......sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) '-, Percolation Test Results Performed by.......................................................................... Date........................................ minutes per inch .Depth of Test Pit____________________ Depth to ground water___......._......._____.Test Pit No. 1__._..'�-�_ tz� Test Pit No:2................minutes per inch Depth of Test Pit..................... Depth to ground water......................... ..... ............. ------ - ' O 'Description of Soil......... - - -• ... --- x - U. ------------------------------------------------------------------------------------------------ ----------------------------------- .......................................................... ---------------------------------------------------------- V Nature ofRepairs 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 issue by the board of ealth. Signe -- ...--•---. -•••-----•-------•.. ...... ................................ Application Approved B l Date' PP PP y---••-•. -- ------ .----------••--- { 7�� ate Application Disapproved for the following redsons---------------------------------------------------------------------------------------------------------------- ------------------------•--------------------------------------...--------•---------.......-------------•------......--••••-•-•-•••------•-•-------•----•. ............................................. Date _ PermitNo......................................................... Issued.......................................................... Date No.- N:r"` THE COMMONWEALTH OF MASSACHUSETTS B0ARD ,�F -HEALTH Applirativa for iRispusal. Works Tnttstrurtion Vamit Application is hereby made for,.a Permit to Construct ( )_or Repair ( ) an Individual Sewage Disposal Syst at,.� ,i ♦ �� a d r - .:. ( � ....: ..: .. .. ..... y� ( Loc on re s f g}�+ t o a` R..r / ` R4'� .:'....-- .. '-•- -1 R.,tp``Rv W b Address�0 41 :' .. ..,! .e. ............. 7. Ai"# ?.i �"n`.'ly ....................................._... Ins a lei Address V Type of Building Siz e Lot feet %,j,1...7.Sq.Dwelling No. of Bedrooms...._.. ........................Expansion Attic ( } age Grinder ( ) , `4 Other—Type of Buildin No. of persons....YP g P ••..._...... Showers ( ) — Cafeteria ( ) dOther fixtures ..._ ............................. .............••-• ---•••••..... ......•• ...... ...................••-- Desi n Flow..,' .._ .. lions er erson er da Total darl flow...._..._ ..gallons. W g ga P P P Y Y WSeptic Tank—Liquid capacityallons. Length............... Width---------------- Diameter:___.___ Depth ------- Disposal ` Trench—No otal Length _. Total leaching area sq. ft. x - -._.. Width—.-.....,. Seepage Pit No.. _.,_ Diameter. e th below inlet Total leachin area"_ ft. Z Other Distribution box;;,( .. } Dosing tank Percolation Test Results Performed by---------_:......................................... .. ....:... Date.... ..._... .........._.__-- aa -minutes per inch Depth of Test Pit............... Depth to ground water_Test Pit No. 1_----�" .-_-- •-•-.......... Test Pit No. 2.....:.: ......minutes per, :inch- Depth of. Test .Pit,........_............ Depth to ground water___:..................... ........... .. F-..................................................................................... Description of Soil........ k-.;. .... U .......................•-......-•----••....-•--••---....._........................••• -:__._......_......_•••-•_.............._-•---- ---•--------.................-•••-•-•-• ------ ----••---------------------- -------------••••--•-•••......--,..__ .....--------------...........------.....•.. -------•-••---------•••-•-••---•---•-•••••...... ••.........•-••.........._. 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 X'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.of,,4ealth.', A r " J l f M Signed__r ;_1zatt l .,�, 1• ,; �^ � Ky� ._.. ;ateA hcation A roved BPP PP Y - . • to Application Disapproved for the follvz�ing reasons:.. ... ...... .. .................................................................................. ............................•••••-•-•-•••--•••--..._.•-•••••.........._•-•-•••...............•-••••--•--• •-•----••--••__....--------------------•--•--•----•-••---••---••--•......•••-•_.._.......... Date Permit No............. Issued................ .... ._.. Date ..... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD IF:� HEALTH OF ........ Tertifirateof Toutplianre it HI IS,TO CER Y,. Th tl ividual Sewage Dispos y�stem constructed" ( or Repaired (' ) ........... + at... ,�s 1 ,rf' ,r has been installed in actor ante with the provisions of Article XI o ''f ye ,tate S�nitar ode as described •n the application for Disposal .Works Construction Permit No..__,. ............... . dated. _-, �_ .:�_., , 7..- .- THE' ISSUANCE OF. THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM,WILL FUNCTION SATISFACTORY. 'DATE............ �- .._y ,. 1 ...................... Inspector .... . ........ •....... ................•.......... . THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEAL H ..... OF "�~ No FEEAV wo li t ur 'ousts ' n ernti , Permission is hereby, granted * ;�� ....... ... to Construct Vol Repair,( ) n Indix r al e duwage rspo em st as shown on the application for Disposal ��orhs Coifs*ruction P` r" No.: � e7._.�� ._.!� •��_.. . oa d o } Calf DATE..................................................... : , '�" FORM 1255 HOBBS &'-WARREN,`INIC.. 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