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Home My WebLink About0038 WESTBURY WAY - Health THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..............TOW.n-- ....oF...... �17v7ZZ,�,��..........................:........... Appftratioa for Di,ipn:aal lUorks Tnnitrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair (1-1 an Individual Sewage Disposal System 1..l.1�1177:r.. . 4,49Y .... ....-=-•-------------------- -----•---•••..........-•-•--------._..........----•---------------•--...........................-- Loc i n e or Lot No. . --:----------•.................................................. O ner ddress ....... ............ .Y �/ . ........-----------------.............--------- Installer Address dType of Building Size Lot_...........................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures ------------- -----=---•--•-•-•• . - 1W4 S p personer per day. Septic Tank—Liquid capacity Length daily flo w Diameter:............... Depth.._gallons: 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. 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...._................... P4 ..... (f............ .......................... Descriptionof Soil------------- . .....g <...-------•----.---------------------------------•--------------------._- ............... x W ------•--•-•--------------------------•--•--•-----•-----------------------------------•••----•-----•-------•---•-•--------------------------•--•------•--••- VNature of Repairs or Alterations—Answer when applicable...1.-=1V52--.':YGZk fuy........................................... •------------------•--------------••---------------------••-----------------------.................•...................................................................................-............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTTLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of health. s Si ned. �' ems_-� -�..'..... Application Approved By........... ' ..... ............................... Application Disapproved for the following reasons------------------------------------------------------------------------------------------------•......---------- ....................•----•------....-----••-•----------------•-----------•----...........--••----------•----•-•-••-••-••-•-•••---••-------•-•----••------------••-•••--•-•---••-•-----------•-•......... Date PermitNo......................................................... Issued..------......-----.................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w� 1f .%af.........OF..... :...................................... Allp irFation for DwpaiiFal parks C onti trnrtion rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at 1 ` a .......... %kr ti..e,t r 4Z..," JA--- t ---------• ............... - ............... F " / Locgon Address 3 F- or Lot No. ...................................... .............. .'C'P .................................................... ` O Address Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures -----------------------------------•---....................---•--.......--•--------------------------••------•--••-----....._......------------------. W Design Flow............................................gallons per person per day. Total daily flow................._..._.._...._._............gallons. P4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth_............_.. 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........................ w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil........ a, .: W --•-••----•-------------------------------------•---•--•-•---•--------•-----------•----•----•-•---•-- •. -- . -- --......-----------•-----------•------. UNature of Repairs or Alterations—Answer when applicable __ f ----------------------------'---••--•--......---'---------•--........-•---------•----...................._.......-----------------------•-------•-••-----•-------------.------•--•-.................---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I.JTE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beery issued by the board of health 3 Si red '' �'' ,k .F" ' ° � ��` '1 ....__ % f �"! .. ��,� �?._ ✓�r D to Application Approved BY !-' /lt ... �r Date Application Disapproved for the following reasons______________________________________________ ---...---•--•.............................•... ......-'-•-- ................•------------•----•---------------------------------------'------•----................................................................................................................. Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. .k...=:. :. . ........OF..... ........ . ...�. '. .................._.............. Trrtifiratr of Trrntplianrr THIS-.IS TO CERTIFY, That the Ind:vidual..-.Sm, e Disposal System constructed ( ) or Repaired ( �) by................ ... r ' ...� ... -""�L'��V. ` I�r¢.............................................................. ....... ... ._.._ `6� � jr 3,r+"3 �d J.,j J f"p„ At"' �t i staller 1 1 c at r�Jrc ...__t �._.....E....t........._... . .. �f has been installed in accordance with the`provisions of `l I T L , 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... `. .' ........... dated-------------------------........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFA qTO Y. ff DATE................................................... ..... Inspector......................"�� ................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH �......OF.... �._ :�e�� rd✓�t NO...+ �..% _.. .. FEE Disposal nr�,q Tnntrnrtion . rrntit- Permission is hereby granted_.__s _i_.___. _ r..../.,_...... to Constr et ( ) or Repair ( , ) an Injd'ividual Sewagg Disposal System at No.. l_ •l r�/° �?tom Or t. _..- �'.`}�* `J'S`� �J Street as shown on the application for Disposal Works Construction P Now...::............... Date y__...._._..-_--_.------------------. Boar f ealth DATE.............................................................. ...----••--•----- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �L�O CAT 10 SE N WAGE PERMIT NO. . VULA6E INSTA LLER'S NAME & ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSYED DATE COMPLIANCE ISSUED __ � .. 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