The URL can be used to link to this page

Home My WebLink About2414 MAIN ST./RTE 6A(BARN.) - Health C j Y i��ICNWEALTH OF MASSACHUSETTS BOARD F HEALTH a� ...............OF..... Apphrutian for 43wiloual Worho Matuitrurtiun Prrmit Application is hereby made for a Permit to Construct (`.P) or Repair ( ) an' Individual Sewage Disposal System at: I Ur 4- f 441 2J -- ------_ ------ -•-- Location-Address or Lot No. .$.... L_________ __________________________________________________________________________________________________ W O®Rk Address iVy r Address 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 ( ) aOther fixtures ---------------------------------------------------------------•••--------•--------------•----...-•------------••---•---------------•--•- WDesign Flow____________________________________________gallons per person per day. Total daily flow............................................gallons. W Septic 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. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water__-____________________- �14 Test Pit No. 2........_.......minutes per inch Depth of Test Pit.................... Depth to ground water...____________________- ODescription of Soil............................................................................................................................. ------------------------------------------- x U •--•--••-------•---.__..•---•--•--------•-----••--------••--••---•-------------------------------------------------------------------------------------------------------------------------------------- W _______________________________________________________________________________________________________________________ ______ A................. --------- _Z_ U Nature of Repairs or Alterations—Answer en appl• bl _ _ _ _____ _ _ -------: •-- ----- 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 of to place the system in operation until a Certificate of Compliance has n ' d Y the board o ealth. Signed-- ---------------- ..... ---- Date Application Approved B D e Application Disapproved for the following reasons---------------_----------- ----------- --------------------------------------------------------- -----------------------•--------•----••-------•-•---------------••-•------------•-----------------------=----------•----•--•--------•-------•-•------•---------•------------------------•------•-------- Date PermitNo......................................................... Issued........................................................ Date Nc � .. ......... E .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F .. . .. .............OF. Apphration for Disposal Works Tonotrurtion Prrntit Application is hereby made for a Permit to Construct t or Repair an Individual Sewage Disposal PP Y ( P ( ). g P System at ----- ocation-Ad ress — or Lot No. ......•.I ... • - - -•-•-•-- ----------- ner Address ._.._. , -•-- -- -- -y'' - = .............................. ..............•••••••---•---------•--._........_._._._____...._----•-............................. r Ir Address Q Type of Building Size Lot"...........................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers G.I YP g ----.....-•----------------- P ( ) — Cafeteria ( ) p' 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 ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------:_----- �14 Test Pit No. 2................minutes per inch Depth-of Test Pit.................... Depth to ground water--------____________---- P' .....................................................•-•....---.....---.._._........------------.•--.......................................................... 0 Description of Soil----"""""---""""-"""-"---"""----"""-----"-""-----"..................""--""•-------"•---------------•----------=-------------------------------------•------------------- x ---------------------------------------------------------------------------------------••-------------------------------- ------ ------------------------ -- ------ - ---"-------- U Nature of Repairs or Alterations—Answer when applicable._ ._ .. _. c ....... .---___- 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 d____. by Signedthe board of health. operation untilaCertificate o Compliance has bee sued-•� � y - -c--__ Vr„ , , .__, -- _,. ------------ Application Approved BY----- b ?? D- Application Disapproved for the following reasons:..".......................••-••-••••---••- -------.............................................................. ........•.......-"--""""-""----""-"-""--•---"----""-••-"---""----•--"--"-•-"--"""-------. -----------------•..__...------=--------------------------•--------•-•---------•--------------- Date PermitNo...................................................... - Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... .. ...................O F..... T.. .. �°' :................ wrrtif iratr of Tontplia.mr THIS IS TO C. TIFY at the Individual Sewa Disposal System constructedor Repaired ------ ----- --- .. ---....-""--"•.-••-•--•-----••-----•-•------ •=•----•---•- ✓ sta6;r at...... --- 1--.._...._ •- ------ --•----- .... has een i stal e in ac danc th the pro to s of`Article I of The tate Sanitary Code,as desc ibed in the application for Disposal Works Construction Permit No............: _. .......... dated_._.a ._ _, .— -_-- ----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS--A GUARAN EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............—5_.:1.=_._� --"----"-"............................. Inspector..... "'=v/L �'�� :s-yGr—................. G�7 v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ...... ..O F....... �. . .. No.-=-- -- �-- ------ • FEE . .. f• �i��ro��tl ork� Cho rtt`rti�an err it ermission,is hereby granted...... -.._ � ----- to Construct ) or R ai (� ank`ndividual ewage iI3'p a stem � . r �� atNo. F a. ................ -- ---------- -r , ' as shown on the application for Disposal Works Construction Pet it No.- -" ------ -__- Dated_____ f He �r... ar DATE..... FORM 125 OBBS & ARREN. INC.. PUBLISHERS