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HomeMy WebLinkAbout0044 SYLVAN DRIVE - Health (2)��t1t ��g9 -o9v THE COMMONWEALTH OF MASSACHUSETTS _V BOARD OF HEALTH ai ppliratinn -for Uiipuiitt1 Works Tatuitrnrtion Vrrm ft pplication is hereby made for a Permit to Construct (411"'or Repair ( ) an Individual Sewage Disposal Syst d ... . __ ______ _ �-- ess or La o.vf�,kAv �.... ... � ner A dr - Installer Address U Type of Building, _ Size Lot----------------------------Sq. feet Dwelling No. of Bedrooms--------- ------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q, Other fixtures . _ W Design Flow ................... llons per person per day. 'Total daily flow................ d �_..:gallons. WSeptic Tank Liquid c pacity. ---_g llons Length-------------_- Width....... Diameter---------------- Deptli.._-_-_-.-.--. x Disposal Trencli--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 ( 4) Dosing tank ( ) aPercolation Test Results Performed bY-------- ------------•---•••--•-•----------------•--•-•---•......._...... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................:.... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------.------------ -----0 -- ----------- Description of Soil-----------_---- � �S f W ---------------------- 3 ���/ble -l✓SN`6 -• -- ---'-o°`-?y. ..,..... U Nature of Repairs or Alteratiorfs—Answer when appli ------------------------------------- ----------------------------..__.---_. ------- '— -----•-••-•--------•---•---------•--•--------------------------•--------------••--•---•--•-••----•--------------•--••------------••---•----•--------------•---- .--.--•-•----------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a rd, with the provisions of Article XI of the State Sal ry Code— The un er 4gned further rees not to lac tl,e s tem in operation until a Certificate of Compliance ha een issued by the oarW of he %h. ° gned. T /..�.....�............ ......._ /� � Date et�; _ _• _Application Approved BY--------- `�-��-�` --------- ------- --- -- = - - ----�--``----D-te --� - ' Application Disapproved for the following reasons:........................ -------------------------------------------------•---------------- i -----------------------------------------•--------------------------------- .------------------ Y Date Permit No......................................................... Issued---:.._ ... Date --� r, No...... .1../v...................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ApV irtttion -for Bi,iVuiittt Workii To' ngtrurtion Prrmit 4k Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal r System.-at: r /� .................. Las ..... ._ 1.- -+--r-,_ - -- - -------------- ---�7 ....------------------------..•.....---- (� L cakion- , dress or Lot}�o. --------------------------------- wner Address' �., ----------------------------- --•--••-•...•••-------....-------••....._....--••-••--••---••--.---•-----•••--•••-..........--.--- Installer Address Q Type of Buildiin Size Lot----------------------------Sq. feet U Dwelling No. of Bedrooms--------------- ...--------.Expansion Attic ( ) Garbage Grinder ( ) a.,., Other.—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------------------- W Design Flow------------------------.;.__.-�-----_ Mons per person per day. Total daily flow............. .� ---.:gallons. W x Septic Tank l- Li did capacit l 0---- flons Length................ Width---------------- Diameter_----_ -_.-.-- Depth.---- ._-.-_. Disposal Trench—No`-------- ------ Width.................... Total Length-------------------- Total leaching area..�/._r_�_�sq. f t. Seepage Pit No..................... Diameter.................... Depth below inlet--.................. Total leaching area------------------sq. 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_------------------_- 44 Test Pit No. 2................minutes per inch Depth of Test Pit---_----.-_.._---_-- Depth to ground water-..--------------------- ---------- - -- - ` ------------------ `----------- --- -------------------- '� U Description of Soil--------- ------------•-'r: =/-.... . ,�7�-!�"....Z 1r•-�" it - ' �t--- ----- x rx '� w ---- �� ------ - ---=--------------- U Nature of Repairs or Alterations—Answer when appli ble._..-------------------------------------1.•....-......._.._--.--__-..._---._.------__..__ ------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. Signed. -- == �a ......_....-•-•--•------------------------••-------- ---- •--•Date ----._ Application Approved B -__/�rI Date Application Disapproved for the following reasons:----••----------- ------•--•---- --------- --------------•----•-•-•••. `--•--- ••--....---•-•----' ....................... -------=-------------------••---------•----.......-••-------•-......-•---•-- Date f.` Permit No......................................................... Issued........................................................ ' Date THE COMMONWEALTH OF MASSACHUSETTS k BOARD OF HEALTH .t��!i/L't.....OF......... .. . Trrt' iratle of Gl am;i iatirr THIS T E TIFY, That the c vidual Sewage Disposal System constructed ( ) or Repaired1. ( ) by . ------••--= ----- •...\_ ----------------`--------------------------------•---------------- ..................--......... / ) tirhstaller / at----- E''� .-::..--L`xsG.'`.�, -,'�"�t"• it/ `---------- has been installed in accordance with the provisions of Article XI The State Sanitary Code as described in the application for Disposal Works Construction Permit No._.--.._....�:-.-___--fir°........... dated_ _ ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCTION SATISFACTORY. DATE................ --° .. ... - Inspector---' !''.. —' _Ct • . THE COMMONWEALTH OF MASSACHUSETTS �,,----- BOARD OF HEALTH .....�0....�`" ...........o f........- �. '.................................. No.•-,5... ••-•-- FEE. - ................ �i��>Q� � Cnn� �trti>Qit �rrmit Permission is hereby granted.--• -- - - - - -•---- ------ ^.. .- - ._.,. to Construct(�cr Repaiv,( ) an,.-Individual Sew e-Disp©sal Systemat No_ treett-- "-i-. _-_�....-.._ .- as shown on the application for Disposal Works.Construction emit No. __---..E`Dated-. ` d��� / •---........ Ile Board of Health DATE................................................-...-........................... FORM 1255 HOBBS & WARREN. INC... PUBLISHERS _ ,` m .. . �' .~.,:, - Q . „ , _ , - -- - _ s. t t -. .± . s ... ,+ s .,L-.. 'r ,pl''i:.rt. ',. 3~ ,;.. ; - _ s .4. r nk-.-.i..F' Fa;Tr`:a '�`„f' k }'�rJ • r �,. W 1 �.y�. : ,o. x + ,t Y 1 . -. c .. - - c a aa, . .r a•. a _ :r - " i`.e 7 _ S- - .;ro`r '' ( I '+5. �r � i.. � ;~• •t�i,R',1.,,,,, .f,_,1--1}`r " t",G��' . N_".s.x'',S 1% j. °a i r,<• ' + I , •'•t.•f ' , r ,a. F 4 r.,,-RK ,.Rt.. ^• tr•� -.R-'�. r. • ., w, . -! 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