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Home My WebLink About0086 SKATING RINK ROAD - Health (2) 8(o 5yali�n� Rin K Road 73 7 (� t�f 3 No..`j�s -1 ^ ' !3 FED: d. . . . ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® Of HEALTH 7 o'er+-- --- ------- ................. ... --------------------- _e- Appliratiun for Diap asal arko Tomitrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System A40-4:91: .......C . .tnsh.......... 'r Locatio ddress / _ Lot . . •-•---------• .e---- / l� ner Addx�ss W �•... ..... ....... -----------------------------------------------------•------•------•--------.............. r-a nstaller Address T e of Buildipx Size Lot----------------------------Sq. feet Dwelling No. of Bedrooms_________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . WDesign Flow....................... gallons per person per day. Total daily flow__.._...........?..__......._....._____-___gallons. WSeptic Tank I—Liquid capacity/gallons Length................ Width-------------- Diameter---------------- Depth---------------- y Disposal Trench—No..................... Width----......L�d__- To 1 ngth-___._____ ....____ Total leaching area__._. ......sq. ft. Seepage Pit No..(.................. Diameter-/. ..._... Depth elow inlet............. Total leaching are<t__ lj --5q. 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-__-____.__.____--____-. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___-_-_-_---_..___----_. O Description of Soil..._.___.__ I -Gam.-�--=`�-- --- - 1��!�Y�C..°-------------------------------------- ----------------------------------------- x W 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. Sign ---------------------•------------ ------------D--/te• ------------ �-- AP lication APProved BY z �- __ Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------------•--- ..---•---------------------------•--•---------------------------------------••----------------------...-----•---------•---••---------•------------------•---•--------------------------•------•••------- Date PermitNo......................................................... Issued.............------------------------------------------- 1�-- — — - - - --- - Date_- ------- No_51..41........ FEE:- .......... ........ .... ... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH -----._.....OF..... ..................... Appliration for,Disposal Works Toustrurtivit Prrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal SysVtem -. A Al� ...... . .-I f�� ...:....----------------- ....... ..... �.§ . Z ------------------- atio ddress E;-, o. —------------- ------------------ .............. --------------- .... ........ WIL0111 ner Address Installer Address T -e of Build Size Lot............................Sq. feet U Dwelling-No.No. of Bedrooms----------- ..........................Expansion Attic Garbage Grinder ( ) PL4 Other—Type of Building -----------------------_-- No. of persons............................ Showers Cafeteria ( ) PLIOther fixtures .................................................................................................. ...................... Design Flow........................j.. ....,-gallons per person per day. Total daily flow..............mo--------------------------gallons. W 6 o P4 Septic TankL-Liquid capacity/tr--gallons Length................ Width---------------- Diameter------- -------- Depth_--__-_-_--__._. Disposal Trench—No..................... Width.__________-._#--- T I ------- -------- Total leaching area sq. f t. a ---- ---------- Seepage Pit Nol................. Diameter.11V....... De�_thote�ownigntllelt inlet_..................... Total leaching area__ ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water---_------------------- 4i Test Pit No. 2................minutes per inch Depth of Test Pit-------------- Depth to ground water__-______________-___-_. 9 '1�1-----------I$........ 0 ---dailglm.ie....V------4- X Description of Soil........... .I.. -�-.� .. ------ U 7................................................................................................................................................................................................... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. Signc ---------------•-----•-----------------------•-••---•-••••-- ................................ /o- Lo 4 Date � ................40 Application Approved By--- &I .......... ----_-------- V Date Application,Disapproved.for the following reasons---------------------------------------17............................................................................ ...................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT -4— ................OF..... ............. ........ r:r tti f t' f Tomphiturr T; IS' TO lCeRTIFY hat the IrAi�_vpidaturalSew'age Disposal System constructed (-//) or Repaired ..e ... -Aae.�_ -----_------------- ------------ ------------------------------------------------------------------- by....... At.a.1.1er ........... at... ---------- •... •... --- ------------------------------------------------------------- has been installed in accordance-with_tbZovisions of Article X QLT�e)S/te Sanitary Cod as described in the application for Disposal Works Construction Permit No..............J_�---117............ dated---- ........... ..... All THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... fll THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H HEAL rl _I ......... ..............OF......... ...........41............ --_-------_-_------------- -_--_--------- No................... FEE. Ukat rurt Permission nted....... . ...... -------- ........................................................... Is gi�a �4kl B& 74 to Co ct Repair dividual/Vvtge Disp stem gel? . .... ..... ------------- viv ----------------------- ----- -------- ---------- ----/ ........ Street as shown on the application for Disp6sal Works Construction '.- t N .. ated---It -----j------7_�7 0 . ........................ 11, -e-------6_411�--- ------------- ..... .............................. Board of Health DATE-------------------------------------------------------------------------------- FORM 1255 M0813S & WARREN. INC., PUBLISHERS