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Home My WebLink About0080 AIRPORT ROAD - Health (2) �� Pa r�- �� s i �� _ Ilk ASSESSORS MAP NO: PARCEL NO: YHB THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Q.ccv. ..............OF........� ..ems _.6.1-�................... Appliration for Ui iposal Works Tomitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal stem at 1 n 4 an................ —�.......... `. ..`....... ................. .....••••-••............•......_........... ............. ._.....••••---•--•••. Location-Addsecc._ or Lo 0 `-�o � ' s . ...........17 Q---�Y.....(........ d.......�..............--- -uy��•-- ............. ..... ............................................. •... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' 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. 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------•----....---•------------------------.....-•-••-......---......................................................... 0 Description of Soil....................................................................................................................................................................... x V --- ••-•---------------- ----...... ------------------ ---------------- •---------------------------------- ------------------------------------------------------------------------------ --------•----------- W ---•---••-•----------------------------•-•----•-------••••---------•------------------------•--•--••--•--------------•--------------•--------•-•-•--•-----•-----•-----••-•••-•......-•--•-------•---•••. UNature of Repairs or Alterations—Answz when applicable ...... ... C ! ut Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT . . p of the State Sanitary Code— The undersigned further agr s of to place the system in operation until a Certificate of Compliance has bee -wi,,ri the board Signed ` L ----------•------- ------------- ..................... S Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons----------------•--......----•--•----------------...----.....--•-----------------•----------•--•---••--------.... .....................................•-•--•--......----•-----------------....................•-------•----••--•••-•••-••-••----••--------•-•---•---------------....................................... QQ Date PermitNo......... --•----------------------- Issued-....................................................... Date a �y No— THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ^.............................. ............... .:. ................._. r Appliratilau for Disposal Works Tottuuurtiott Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ° �................,� .. ... -- ---------------------------------------- -------•---------•--•-------------------•- Location-Address- __- or Lot,No.— �J ...................... --.- Owner Address t _ IZI :....... ................... ....:_..........._.. -••-------....---•-- ----•-•.....--------------.........---•------..............._.._..........----_•-_._. ...._ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons................_----------- Showers ( ) — Cafeteria ( ) Pa Other fixtures .................................................. 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit________._________._ Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------- -........... •---•------------------------------------------------- --------------------------------- •----•-----•-.-------•-- 0 Description of Soil---------------------•------------•-----------•-----••------------•----••-••-•-----------------------------------------------------.....-------••--•--••--------_--•_.. x rJ -------- -------------------------------- -•------------------------------------- •••-...... ----------- •••-----------------------------------------•------- ._._................ _---------------- --__---- W ----------- ------------------------------------------------------------------•-------•-•--------------•-•---------•-----------•-------•------•••-•----•------••-------•------•-----------------•..... UNature of Repairs or Alterations—Answer when applicable..._.. ... -_� -:.__.._..``'...._...._r.......4__c—.._...................................... c- r4,./ C. ..,__ . .. ............................... \ ____��__�-r I� t._'"/ ............. ................ ._________________ __.�..................................................... ^, Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provision of T I•T p 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 e .,board of.health. f Signed.........4::1 .--- r � ! �7 ..— Date ApplicationApproved By........................................._........................................................ ........................................ Date Application Disapproved for the following reasons----------------------------•----•----------------_...---------------------------•--.---------••----------••---- ----•..............•-----._...--------------•-•---•-•---•• - ----•-•---•----...----------••-----------•-----------•-•-----------••--------------••-----------•-----••-------------•-----•-•---•--•-------- qq Date PermitNo..•-•--•.?,?.. .. -------------------------- Issued....................................................... Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD (nOF HEALTH ......... 0?'f^"-............OF.......,.!.'...'. r.. fir@# ....................................... (Irrtifirab of f ompliattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired k�<) by------------------A......b-.....l 0-----Lr...-d-------------.----.---_-----------------------------------------------------------_---_------------------------__---.-.----------------- QQ p Installer at-11.0- -1=. 1......... ._. �� _.. has been installed in accordance with provisions of TITLE; j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... IE�.:___&'_____________ dated-.-............................................. 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 ...........0. ram..............OF..--...'�} -Y. ------....-...-.._-......._...-..__. No... .._�..... FEE. ............. Disposal Works Tuustrttdion rrutit Permissionis hereby granted........A...... -•-•----•----------------•---._...-----------•......--------.........---•-•--•---•--- to Construct ) or Repair k) an Ind•vidual Sewage Disposal System atNo...------•-•-• 42...... _ c x .... _--.--•------------------------•-------------------------•-------•-----------------------••---•------•------------•----•-- Street as shown on the application for Disposal Works Construction Permit NokM_GG__ Dated.......................................... .................. r ',,,"----------�--•-•-•----•---•-•--- Board of Health DATE ----•------ - FORM 1255 HOBBS & WARREN. INC., PUBLISHERS