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HomeMy WebLinkAbout0031 WOODLAND ROAD - Health (2) UDO C 0 Fim$.. .. .................. THE C H OF MASSAdHUSETTS BOARD 0 FIEAL.TI-j �u _:...71f --.........OF......... .......... Appliration for Bispoiial Igor 'n tr tion anti# Application is hereby made for a Permit to Construct Vorepair ( ) an Individuab Sewage Disposal ysr r -----•... ............... ....................... peat' ddress Lott u ....... `... .__. Owner Address Installer Address d Type of Buildipy"' Size Lot............................Sq. feet U Dwelling 'No. of Bedrooms......... ............ ...._Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ...... No. of persons............................ Showers -- Cafeteria p-' Other fixt es -------------•------ - W Design Flow.............: .______ allons per person per day. Total daily flow....---............__._....._'_gallons. Septic Tank Liquid capacilr�..... allons Length................ Width....._._.._..___ Diameter---------------- Depth................ W Disposal Trench—No..................... Wid h....___ _cl Tot. - ------ Total leaching area....................sq. ft. x Seepage Pit No...... ........ Diameter . __. epth nlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed b .......................... .... Date................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..... q........... Test Pit No. 2................minutes per inch De0q of Test Pit.................... Depth to ground water........................ -------------•---•--------•--•-- - ----------------------•- ---------------------------- --------------------------------------------------------- O Description of Soil...................:............... ... ,�+ _ U ......................................................................................................................................................................................................... W --------------•--------.........._..._................................................................................................................................................................. UNature 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 issuegpby the board of healt igned:: ._.. 7 .. ...... .... .....- ...... ............................... /at., Application Approved BY------- ..... ....... . .•-- -- ..... � Gl... Application Disapproved for the following reasons--------------------------------------- ...................... ........................................ ....-•-----•----••................•-•-------•---.........-•-•--......---•--........---•--.......------------------•--•--------------•--------. •-••-•-----•------......----•----........-•--------- ate Permit No..........................................._.. ------• Issued......... •--- ,�- ---Date�---•• - -'•-----...---• f� � Iy"w✓i`.f No... .... .......... . FIzIm.. c................... THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH ,gyp iration for Mopasal Worko T onstrurtion ramit Application is hereby made for a Permit to Construct ( �`®r Repair ( ) an Individua Sewage Disposal System at: 4 .. ......_ _f / r ,1 _ ! ...... ...... Locatio ddress �j ��, # / � ,o'r LoJto .p.r........I- .................. .--.a........ 4:.s...................... .........._...?sf':'.-2 -'i.. .- Owner Address W Installer Address Q Type of Buildin Size Lot.................... .....Sq. feet Dwelling No. of Bedrooms.................:..:...........................Expansion Attic ( ) Garbage Grinder1.4 ( ) pLI Other—Type of Building ...______________--_______ No. of persons............................ Showers ( ) — Cafeteria ( ) P-I Other fixtures ----•----•---•-•--•----•----•----- --------------...-•---------------------------------------•--:- ----•---•---- Design Flow...............+ .... gallons per person per day. Total daily flow....- ..............................gallons. W •` WSeptic Tank Liquid capacity gallons Length--------------- ^Width................ Diameter .__._.__..... Depth................ x Disposal Trench—Nq!.................... Width............!"__. Total-- ngthn.................. Total leaching area....................sq. ft. Seepage Pit No......F_____________ Diameters !'. �✓ _`{`Depth Alo nle.....�._.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date----•--•------------ ... a aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water._.....�:........... G%, Test Pit No. 2................minutes per inch Deppka of Test Pit.................... Depth to ground water........................ PJ ....................................... •_'•mot--_ Descriptionof Soil. ..... ..... "' ��"' .•= - « -------------------------------------------------- ---------------------- x W UNature 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., n Signed �:�,�r 4'. p Dat Application Approved BY -'rw' "'�e .... :.. ISace Application Disapproved for the following reasons:.....................................-•---- ---------•-- ----•---------------------------------- ......................•--.........-•••-•-•••------•-•--•-•-•-•-•---••-----•--•-•......-•••-•------•••--••I-•-•-•-•---•-•---••---•-•-•-••--•-••--••-••••-•-•--•-••----•-••---••--•--------•-••---•--•••... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF�EALTH 'Wrdif iratr of Tomptianre l THI I TO RTIFY hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ... ...... r Installer �l has been installed in accordance with the provisions of Article XI of The State Sanitary Code}as described in the application for Disposal Works Construction Permit No.............. .....0.:. -___-__ dated____ '.Z_W.A�................ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH HE A. L'TH ........... O F..... N ` v ..-.:: ._.._.. G� "ICJ FEE- _............... Diapooal Word T truriion rani# Permission is ;hereby granted.......r_!FF--------- ------- --- ---.-----------.-.------.----------.-..-..---•--------:---•---•-•------- to Construct ( or Repair,(/" ) an Indivi Aual Sewage Disposal System f 7 at No.. Ar �. /IJ . i Xt . l� .LCrtr `jrc.Lwa; r � • _s4i.�d ,..,. •---...... .. ......• J Street s� ✓✓� f y as shown on the application for Disposal Works Construct i�Perrm t No f'.1..__ Dated_._. ._._.,*---...:-'.......... 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