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HomeMy WebLinkAbout2208 MAIN ST./RTE 6A(BARN.) - Health ;ZOS 441, S�� V3) Z LOCATION SEWAGE PERMIT NO. V LLAGE i I N S T A LLER'S NA E A ADDRESS OR OWNER DATE PERMIT ISSUED �� � �L DATE COMPLIANCE ISSUED _ J� - : �uP " THE COMMONWEALTH OF MASSACHUSETTS Frag o BOARD OF HEALTH .................. ... ...................OF......................................... ..............-.............................. Appliration for Disposal Works Tonuitrnr#inn Prrmit 0 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sysa� ` ........................... A_ : /'—:z� ... .---. ............ . ..--•-or ............••---•--•---------------- W ocatio Address7 i ... .... ......t --•• -•••.....................•-•. .. -..... ....... Ad . ...... ...../t 0........ ,- ..............--- rde ...... ... ?� ................... Installer Address Q Q Q Type of Building Size Lot__ _.....................Sq. feet U Dwelling�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. 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. 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........................ Gd .......................................................................... O Description of Soil-•-G�=� d'--�'. .. . .......................................................•---------•---------------•---......_._.__...--------------............._.. W -------------- -------------------------------------------------------------------------------------- ---�4t UNature of Repairs or Alterations—A swe when applicable. _�© o .----- .. ----------------------��... --- ----- - --. ----------------.---•---------------------•-----------------------------------------------•-----_------.--------•---.-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 b the board f health. Signed_ ...._.. .. . .3 �J . •-•--•-••................... ...........-- f� Date ApplicationApproved By-•----- /- ----•.................•..........................................-----•------••. ............. Date Application Disapproved for the following reasons:.......-•---••-•---.....•-•-•-•.............•-_-------.....•-•--------------••-••-----•---••••....._.....•---•- ......................................................_..-----------•-----........--•-•-.............................._....--_------•...--•-----•------- �3--�- �-.-- Permit No.....L ' 1 . Date .......-• ..._._.. - Issued... --•- -_.o.............. - Date •. No.......................... Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...----.................... .. . .. ..OF.................................................-------------... Appliration for Uiovoottl Worko Tonotrnrtion erttt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: , 0_.�` .. ...............•-•-•....--•---•.---... ----.... �. r_.... -....... Locatio -Address + Lot ......�.._ .Y::`:�:!`.:.C:....:.Y.''t �_!' '�.`..S!'= _.________•'_'______-'_______"' '...... ,! •_'_"_ ............ ..r-..--"__'____w•-_-_-'................... or • ne -- -- - - - •Add ,/� Installer Address �/�y q ` Q Type of Building Size Lot__ ........................S feel U Dwelling,4 No. of Bedrooms.__.*3....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Cti Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .-----•----------- --------------------------------------------------------------- -----.-•-------_.-.----••-------•-••"--•-•-----•......•-- x Description of Soil < -G-1. "----"-"...................."""-------------•"•-----"-"••--- U •••-••••-•-•••-•'-•-----•-••-••-••'---"-"--•-•-........--•-•-•--"-"-------------------------"---•-•-"""--"-----..........-"-"-"------••---""•'--•-"....._...-"------------••--'"---.........--•---..--- W ----•-----------------------••-•-----------'--••••-•-----•--------------•-------•••-•-•-•---'--'......•. I "-• _- •--..... V V Nature of Repairs or Alterations—A swe when applicable -JLa G"�t:? rN ""---•--- ------------------ ----•-" .............. -- ------•---------..........--------------------------------------------------•.......................... ---------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAITL E 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 b the board f health. Signed.. _ ......_ '" Date Application Approved By........ ............�!--2-°•.: ..3 Date Application Disapproved for the following reasons:---••-'............."--"•"•------"""-----•--------••--••---•--"--•"----•---••-"'----------:.......---•--......-- a te Permit No. -?_...G�/..--•••-•....."--•-•--•-...... Issued..t .l. .... --"�•--................... Date 'THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w j/�/�/�J r✓9 tOF..................................................................................... (9rrtifiratr of Toktplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) �' j L e--e e-r ......•........_Installer ............ .. ' at...................................................................................................................................................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit-No.........f................................ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r 3 6 .................... .......................OF..................................................................................... No.... •' FEE........ .. �i��o�ttl ork� �on�tr�.rtion rrntit . �, Permissionis hereby granted.............................................................................................................................................. to Construct'( ) or Repair an Individual Sewage Disposal System ff i�v T _.........� L'S s' 'a�Al e'S YM6 e t�- at No.:--------� .e "5 .... - --.--•--•--------------=--------•-- •--•-". -•-----•-•--......--•----•--- Street A3' 171 2 as shown on the application for,Disposal Works Construction Permit No................ ... Dated..•.. _--_...... ........... ................ 3 0 , p Board of Healt� }{� DATE......... --"- -•""-•--J 3 V c FORM 1255 A. M. SULKIN, INC., BOSTON ' 1,