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Home My WebLink About0030 ENTERPRISE ROAD - Health (2) 30 - '199 3- oa 1 -co I I 1 I I 1 r, I No. 4210 1/3 YEL ESSELTE 10% No.....7___L-.-__--- 6 Fes$. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appli•ration for Bi-vusal Works (fulaundinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) n Individual Sewage Disposal System t��. L n-Add- 'ss or Lot No. • .� µ. .�.. ... ....................... ........... .. .. ... _•.........................................--_... __..._._.—: Owner .Address � ... ... ._nstaller . .. .................... ............................................. .Address........................................... U Type of Building Size Lot.............................Sq. feet Dwelling—No. of Bedrooms............................ ..............Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Buildin o. of persons............................ Showers ( ) — Cafeteria ( ) Q' 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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--_______--.____._-____- GL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... D th to ground water........................ a .. .. -- - O Description of Soil........... x 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 theV f h h. FSign .. -•---_--•................ Da Application Approved B 1-1110, __ - �_ . PP PP Y = 7 •---•••.... Application Disapproved for the following reasons:._... ------------------------- --- ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued..............................•........................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------------ ... ...®F...... o .. .......................... Apvtiration for lkiyviial Ware C onfitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (.;: ) an Individual Sewage Disposal System at ............ =. . . 9 --� �%' ................................................. L n-Add ss _ �$r Lot No. ... r: ... ;...,. ,: _ »>._. :....... �� •� .................................................- ' Owner Address �] •' a? __.. . ,-y,.. :. .............. ......................................-.... ..._....._.................--- .. . nstaller - Address d Type of Building Size Lot..........................Sq. feet U Dwelling No. of Bedrooms.................. ..___Expansion Attic ( ) Garbage Grinder ( ) a aOther—Type of Building !/1�a .at To. of persons____________________________ ShowersCafeteria ( ) Other fixtures :_...-------•------------ ----------------------•- W Design Blow...............................:............gallons per person per day. Total daily flow............................................gallons. 04 W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench=No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No............... Diameter____________________ Depth below inlet.................... Total leaching area....:..............sq: ft.' 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---.__--_-___-_._-----_ r-T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... D th to ground water......................... ODescription of Soil---------- ". - -s�:. �`°r °r� ---- - -- ............................................................. U •-----------•----•------•-------------------••-•-•-••-•------••-•-•...•---------•----------------- ------------.._...._-•_-- -------------•--- ---•--. ----------------•---------------------- ----:_ .._ .._ .. U Nature of Repairs or Alterations—Answer when applicable..,, .K►-_.. •---.-.•..............•__ :-.-----------_-----. ; ---_--------_:_..__: ..__. .. 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 Poardpf h h. 00, Signed.._... . .::..,. ... ,,P • < V Dat Application Approved B PP y---- ; ----- r _ ------- Dt Application Disapproved for,the following reasons----------------------------------------------------------------------------------------------•----•---._...._.._ ..............------- -----------------------------------• .................................... Date PermitNo.......................................................... ' .:`, Issued.................................................__..... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Og HEALTH �` .......... OF......: ...: .� ...::fl M.Wrtifirate lif (911tttphattrr T IS S TO CERT (I at th ndividual Sewage Disposal System constructed or Repaired O by------- A. ..Y,f == - ---------------- ------------ -•--••. •--------------•--..__.....---•----..........-- gycp Iusza! r -r" ---°---- r has been installed in acc dance with the provisions of r`rtic XI o The State Sanitary.C d as desc`ibed in the r application for Disposal Works Construction Permit No.... ............... - - -- -------. dated �"""�'•---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A G ANTEE_THAT THE SYSTEM CT SATISFACTORY. t DATE..... !° . ° ..................................... Inspector. '" ... " THE COMMONWEALTH OF MASSACHUSETTS f BOARD F HEALT J A J NO..... .-P-•----._._ BEE '.'G_L. J� H jPermission a, -hereby granted....:. ,► _ . ...:... ........................................ to Constru _ F an Indi�idwag *sb&a Systemat No.,_.. ) { � . treet as sho,vii on the.application for Disposal Works Construction e ilt N ..:�� _ Dated.:_ . -. .__. .............. Board of FIc nth DATE--------- --------h --•-----•......................................... FORM 1255 HOS Sll& w- RREN, INC., PU3LtSHERS