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Home My WebLink About0255 INDEPENDENCE DRIVE - Health (2) ��s�-� �__- -- �t� � ��s- �� / �. , . Ficz 3' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .._,:;J.tJll ........:......oF......, 4Z ....................... Appliration for Dispas al 18arks T anntrixrtiun lirranit Application is hereby made for a Permit to Construct ( ) or.Repair (X) an Individual Sewage Disposal System at: u;pGP ��'LCCg = H`Allll �LtS. �� ._.............___...._................................._....-....... ......_....------ ................-....__..................... ......_..._.............._......_.__ `i Location-Address or Lot No ._ if --CO.-�?.. :t�_... ..lo ss...... 2.. 1�5.4312�1 ,14 r�.: :�'--••------------------- .... 0_01 ner - Address a......�!..:..S JJ4!---............................. ... ......................................................... Installer Address Type of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms...............................:............Expansion Attic ( } Garbage Grinder ( ) '4 Other—T e of Building . No. of persons............................ Showers — Cafeteria 04 Other fixtures d ............... WW Design Flow.............................:.............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity......._....gallons Length...............:Width................ Diameter................ Depth................. x Seepage� Pit No...................... Diameter....(..�.t.�...- --•--. Total Length.................... Total leaching area..................sq. ft. 3 Trench—No............ i Width:..-••-•- Depth below inlet....4P............ Total leaching area 3 A...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) "l Percolation Test Results Performed by..............................................•-------------.............. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.._.--......._...... Depth to ground water........................ f= Test Pit No. 2................minutes per inch. Depth of Test Pit......:............. Depth to ground water........................ ................................... ...... •--- ....................._............... ------- --............ ..................._.... ODescription of Soil.............................................................:......•---------•-•-••-.........-•••••-...........•-•-••-•-•••-•-•---•--•••••...................._.--•-•- W - .............. .......•--•--.------ -------------------------------------------•--......................--•--........------•--------...-----•--•---•-----------.....------•-----------•-•--.............------......._..............--•- U N 3e of Repairs or Alterations—Answer when applicable.AQO..Tp•• c �Q�-rr.�� .1.- 1 G KI6 H'lo '1"WASC U,&L0e. --... .......!T_ �T......... ......---•-----•-•---•.......................... .....................................•---...........----.........................-------•............... Agreement: The undersigned agrees to install the afore scribed Individu Sewage Disposal System in accordance with' the provisions of TITLF, 5 of the State Sanitary ode—The unde further agrees not to place the system in operation until a Certificate of Compliance has issued y the r ofhitaLth. /0/ �8s ::. ... ........................ ..._.... a Application Approved By........ ... . ............. .......................................................... --10 ..... - ate Application Disapproved th oll ' g reasons:..........................................................................................................--- ...----•--•--•------••----•--•------- •..............•••---.................-•-_......._....... ._........... --...-----•-•---.....-•----•....._........._.....I...•.. -D�--•-.......-- PermitNo.... . ...................._......._................ Issued—,--*...... ................_.._......_ 0 t O 0 THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF HEALTH . ...............OF.... .......�....................... r_ {_ .... Appliration for Disposal Works Tonstrnrtion f rrmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ri %' - n ......• tion_Address »»» _ of Lot-No. • » 1_I12S!•. at» ttiL1C :_C�P[12A.tlal.s• ��$✓L • QSlSJ2EiC ... VJi4. .....».............».................. Wt?rj ]LT Q 0 ZT1 Ili C �(. I-(G4CW t 1 C t{ Address r.a ....._ _» ... ..Installer ............. ............».... .. .... .t" •Address- ..... .................»....».... T of, U ype Buildin g Size Lot..:....:....................Sq. feet ., Dwelling—No. of Bedrooms......................... .Expansion Attic ( ), Garbagt`GGrinder ( ) aOther Type of Building No. of persons...........:.::.:.c..... Showers (7) ( ) � — .:._....-•------•---••-•-•-- _ .�.,.. _ J , , =,Cafeteria �•� Other fixtures ;' Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------•----•gallons Len ----•------..... Width................,Diameter..................... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........!............ Diameter.... Z_:5_... Depth below inlet....�a............ Total leaching areal :A...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ..4 Percolation Test Results Performed by.....................••-•-•---.................................._.... :.. Date........................................ ,aa Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch. Depth of Test Pit.................... Depth to ground water........................ a ..... .................................•-•••-•...... ---_--*-------•--...».__...... -........ _.............•.............. .. O Description of Soil..........................................................................._---•------------------•--._.............---.........................----....._••--- W .....------------------------------ ........------- •_•............................ • ---•--- ...........................- ._.................... ..............................................•-•_-•...•-•••-•-•-•--•-------......•----.k �---.............••--•--••----•-•-...........-•--....................................................... U Nature of Repairs or Alterations—Answer when applicable �`.'� ...r�..:5t,1 SM� ��Y5 ...........................�JITnk 3 ter- S1vA-EC L4laZa2r .. ...... ..............................-•----_.....�scribed ........ Agreement: The.undersi ed ees to install the afored Individuall Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary ode he undersl ed further agrees not to place the system in operation until a Certificate of Compliance has i issued by the board of health. APPlication Approved By.:... ... a - - ...fc' z �r?...... ._ ... G .........1................ ......_.._......•••--••••-•--•--- .....• ---Date... .. Application Disapproved th ollouriag reasons:.............................................................. .. .......-•-•........ .........................»..................»............--_-_............---•---•----..._........... ..---------.....-•--•-...........D�..---._-•__ Permit No..................»..»»»».. ... Issued.»...»....._..... ------...._...».».»....... THE COMMONWEALTH OF MASSACHUSETTS otj BOARD OF HEALTH ..........................................` OF.....................a. :�........................................... Tertif irstr of Tomplianrr THIS.IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired Q<) by...»..... 6 ...... ...:...Q V _...C.40»....1 w�c...........---........_..._...•--.........................-•-•--••-•-•-..................»..»..»» Installer at..........................tt ....Co-:..a p 6A-1A� CDP Itk i t 0� Cc (Tb'� . ............•--- .... .._........ ......................... has been installed in accordance with the provisions of TI of The State Sanitary Code �e i m the ------------ 'ri a application for Disposal Works Construction Permit No... .� ..................... dated-_.ld_..............._.__._.._........... . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W I N ION SATISFACTORY. DATE.-AL 7...........................................». l Inspector.... .,•-•--......»:.................----•---.............................•-- THE COMMONWEALTH OF MASSACHUSETTS BOARDS OF HEALTH o.. i ( .................................................OF..... N ..r4.......... Fzz........................ Disposal Works Tottshwtion f rrmit Permission is hereby granted.....2�0-__�9 O to Construct ( ) or Repair an Individual Sewage Disposal System at No.._.Pk' er"9 .MacC-...W A-Y..__._......5 Gi-sm:'t -A —c7P......1 A-0,1K...: (-,pt-v n-r-;o�s C_1~-w uv Street __ . ; ...................................... as shown on the application for Disposal Works Construction Permit No.......... 2'.. Dated.......................................... vo" -... - ..... ... ----_.... ........_ Board of Health DATE................................................................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS —_ b