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Home My WebLink About0011 CHOLE COURT - Health (2) a7:4g / oz� F�s...�.®..�....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " - .....oF.......... ./... - . AVAirFa#ion -for Biiipv�al Workii Tiatu#rurtioaa Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: k- Lo"ati A or Lot No. '� -----� .c_✓- !/-�/..�/Ors! -•------- .y-------------------- ---J----��------------------------------ Owner / Address Installer Address of Building Size Lo _. 1'` a F_ U ;�ypeg -- -- q. feet U Dwelling—No-of Bedrooms----------------/...... .__._-.-__.-___Expansion Attic (.yam) Garbage Grinder ( ) Other—Type of Building� No. of persons_.___.,-........... Showers Cafeteria ( ) Other fixtures ---------------- ---------/-_---- W Design Flow______________.�A.....................gallons per person per day. Total daily flow----------,/tea_...............-----gallons. P4 Septic Tank—Liquid capacity/&6!__gallons Length---------------- Width_---------- Diameter---------------- Delith.___._.__._.... W - xDisposal 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 ( ) '- ��'s'' `''Y �-------------- Percolation Test Results Performed by.__ . .____ r` _ /�__ _ _ _____________ Date_ __ Test Pit No. 1________________minutes per inch Depth of Test Prf................... Depth to ground water-----------..__.__--.... �14 Test Pit No. 2................minutes per inc Depth of Test it... . ... Dr pt to roun�a e'er____...__._ ___.__. P4 Description of Soil �� - f� -- ------- t � '.a�' V ------------------------- i ./ `" �.. •-- 5 ----------------- 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 \I of the State Sanitary Code— undersigned furth agrees not to place the system in operation until a Certificate of Compliance has been i e y the b e Signd----- - .-- •. •-----••--• .......... .............................. •Application Approved By---- - ,; _. ...ie4,nf�`- - ------------------- Date X a Date Application Disapproved for the following reasons----------------•--------•-•-----••---•--•-------_--------------------------------------------•------------------ ................••-•-----•----------....--••-•---•---•-------------------•-••-•----•----••---•••-••---•--...•••..__....•-•....__......--•---------------.._......-----------•---------...----._......... 7 D tt PermitNo......................................................... Issued.----- ...............(--------- Date ��—_—_---'------------------------------------- --- --- --- -------- - - - -- -- --------- ---------- r. No._! --••-- Fimic .f ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH r�s -------------OF.-. �... ----- ,ppliratiun -fur Ui,ipuiitt1 urku Tonfitrurtiun Vrruift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Y S Std - �--7 - ioess r Lot N ✓ ------ G/� �sf�� !-- =C --------------- owner Address - -------------------------------------------------------- d� p Installer Address / ype of Building Size Lot--- ........... q. feet U Dwelling—No. of Bedrooms--------------/-------------------------Expansion Attic (ve-) Garbage Grinder ( ) PL4 Other—Type of Building -rye r_,�No. of persons_._._-�_______________ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------------------ W Design Flow_____________-_U______.._____._____.gallons per person per day. Total daily flow...............Q P.._.._.__._..._.-_....gallons. WSeptic Tank—Liquid capacitv/eeir,-.Igallons Length................ Width---------------- Diameter................ Depth.-.._____-_..-.- x Disposal Trench—No-____________________ Width-------------------- Total Length.-------------------- Total leaching area....................sq. ft. 3 Seepage Pit No..... --------`--,,Diameter__-dx_9._..._ Depth below inlet____________________ Total leaching area..................Sq. It. z Other Distribution box ( Dosing tank ( ) ._... •---•- Date........................................ .. a Percolation Test Results Performed by.____-. .-__ Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ (s, Test Pit No. 2................minutes per inc Depth of Test Pit.__r_ ___ Dipth to ground wafer..............--___--- i D ------------_---------Description of Soil .......'�...=----t-- ................. 0 W ................ ----------------------------------------------------------------------------------------------------------------------- ---------------------•`........................................ UNature of Repairs or Alterations'--.;Answer when applicable-------------------......................... ........:____'-____--____-_- _:_._.-_-..._... ------------------------------------------------••------------ '------------------------------- ------------ = ` Agreement: ' The undersigned agrees to install tithe aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The dersigned further agrees not to place the system in operation until a Certificate of Compliance has,been issue board of he Ith. Application Approved BY -=--- - / e.. ~' � Date Application Disapproved for the following reasons________________________________________________________________________________ ______________________________ •---------------------------------------------------------------------------.......................................................... ----------------------------------------------------------------- Date Permit No. -............................ Issued - Date THE COMMONWEALTH OF MASSACHUSETTS a BOARD OF HEA TTH�H jl Q'Irrfif irntr of Tliutptitturr TyjSfIS T?ETIF , That the Individual Sewage Disposal System constructed (441 or Repaired by ) L ---- �j e I alter n at-- -- - -----•-� •'-l-:-`--'=-��-�-�'�--y"1d�E#-p -�--4�:�- ----- --'---- -�3��f� - ------------------- has been installed in accordance with the provisions of Article XL of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------- _ 9 _ dated-.,0_.. L................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED ASI GUARANTEE TfiAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--!.... 1. ------------•--- Inspector - ----------------•-------------THE COMMONWEILTH OF MASSACHUSETTS. - + BOARD OF HEALTH F 06 ...................................... v^t! No.. j7 FEEA...................... %spolia ur 5 n n;itr rtiun rrnti# Permission,i�,hereby granted_-__. - .4 ____ _______ __ _.,._ _!/ '...........................••-•-•--•--•-•._ ....................... to Cons�ct i ) nor pair ( an Indi u ewage Dispo 1 System : . __.•_at No - =' Lam-- .............•----•••------••••-•- ... r '� Street . / as shown on the application for Disposal Works Construction P t N _ _____ ___ _______ Dated.IJ_....�-0 7�f Pet oard of Health DATE=--,�-�_::----��--------------��-----;------=--------------------------• FORM 1255 HOBBS & WARREN. INC.. 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