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Home My WebLink About0600 OLD JAIL LANE - Health Goo d.d Tcul La4 e,. � alb/03/ Mv MAD &Pff#m 0HDM*WfamaUIjW �i11�fl0�d S71L N®ffl iBi! r '��JAtFS� Vsn ul open . woo•psows VEM Odn VOI£SVZ*ON v_ o-0 � LOCATION SEW(�- E PERMIT; NO. VILLAGE y I N S T A LLER'S NAME S ADDRESS BAR OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED -� �, -7 I ^0 ......................... No—A..........I...... THE COMMONWEALTH-OF MASSACHUSETTS BOARD OF HEALTH • ....................OF........................................................................................ Applirathin for Uhipaiial Workti Tomitrurtioll "truth Application is hereby made for'a Permit to Construct (,U-1-lor Repair an Individual Sewage Disposal System at: &J, 9e.-f1l71-: 12.el..S..JQZ7C.......Zdi ........ ................................................. L g'.. Add or Lo No. Owner ' Address ............................................. .. I. . .... . . .......................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......13.................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons....._.Y------------------ Showers Cafeteria ( ) Other fixtures --------------------------------- ..... ---------------7-------------------------------------*--------------------------------------- Design Flow..........1.0.............................gallons per per."n per day. Total daily flow........ ._.:_.._.._...........gallons.. 9 Septic Tank—Liquid capacity.V)00---gallons .- Length..li-E-T... Width...'11"T. Diameter________________ Depth.....�ET. Disposal Trench—No. .................... Width.....___.._.......... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No.......I............ Diameter...JI-A ...... Depth beloy mleV.Ps.0_4.... To Ipc ing area..,3 5 8 ...............sq. f t. Z Other Distribution box vj Dosm tank 14U 1-� ....................... Date...I ................................. Percolation Test Results Performed ly, 4 's Pi Test Pit No. 1---4?:�..minutesperinch Depth of Test Pit.................... Depth to ground water.._....:.._._._......_.. Test Pit No. 2................minutes per inch Depth of Test Pit__._._.............. Depth to g4roun water........................ ...........................................................I--- ------J-----------------e--r .... ............... . r o Description of So'l. _5. ... ...... 11, A. Jj...... .................t1--.0m..................... .. .... ......... . . ........ . .......................................................... ............... .................. ........ ........................ ................................................................ ........................................................................................................................................ Nature of Repairs or Alterations—Answer when applicable.......................:....................................................................... .........A.............................................................T................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT Ti M 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 by the board of health. Slone ...... ' �d..... ............. .. ............................................ ......... ate Application Approved By...... ;a�... f ;VZ Dat Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued__.- --- ...................... Date 3 Nil THE COMMONWEALTH OF MASSACHUSETTS BOARD Off' HEALTH e ..........................................OF.................................:....................................................... App irFatiou for Bi-gVilg al Workitungtrurtion Famit Application is hereby made for a Permit to Construct. . or Repair an Individual Sewage Disposal System at ..... .�� ... : a �----aftLL L ...... -...... r.. ......................................................... Location-Address �--- or Lot No. ... .�..�. ..�.��....I �..roc, ------------------------------------ .....p.h..w_nf. tea�' ......................................... � \ Owner Q a Addres j :._....... '� K ..............••••••... .....P 1 ,��1 Q ?e ---- ry1� . -... --- Installer 4, Address Q Type of Building nS Size Lot............................Sq. feet U Dwelling—No. of Bedrooms__....................................Expansion Attic ( ) Garbage Grinder ( ).Y — p-1 Other—Type of Building ............................ No. of persons........._................. Showers ( ) Cafeteria ( ) :, Q' Other fixtures ---------------------------- - --------------------------------------•••----"-"----------------•----------------.......... W Design Flow.......1.1"Q-------_-- --w....-----..gallons per person•per day. Total daily flow--------- 3-�-b----------------•-----gallons. WSeptic Tank—Liquid capacity-1DOU gallons Length.-.RE T-_- Width.__.__Lit-T Diameter________________ Depth.;_Y�-T- x Disposal Trench No.I.................... Width.................... Total Length........I............ Total leaching area....................sq. ft. n, Seepage Pit No 1_____________ Diameter.._. _�__-___- Depth bolo mle ifA:C�. .... To 1 lead n area 5�.._...sq. ft Other Distribution box (c-) Dosing tank ( Gr7, D " z 7 � . Percolation Test Result „ Performed by......-1�O.it��14 .�OP-.!7PC.n ". ------ Date_.:- - -------------- , ., Test Pit No. 1.._ _._:minuts per inch Depth of Test Pit.................... Depth to ground water........................ i ; (s, Test.Pit`No. 2...............nunutes per inch_ Depth of Test Pit..............._.... Depth to ground water........................ x »y............................. .,..,,..a. t. y.-" ...............om ........ .....p Descnpt n of Y -" U . ° 'd. ...............•---••---------------..__......._........-- ......-- --•--.._..------.. W --------------------- - --- ----- ----- •----------------- ---------------------------------------------------------------.--...................................... x =---------------------------------- -- --- --------------•_-......---' U Nature of Repairs or Alterations—Answer when applicable______-_"--____-- .............................. i. ................................. ........ ...... ..........................._.........._--_____.._......_......_.... --._._......... Agreement: The undersigned:agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE p 5 of the State Sa>itary Code— The undersigned further agrees not toaplace the system in operation until a Certificate of ,Compliance has been issued-by the board of health. ; r Signed Date eAPPlication Approved BY D1//�l` ��t�• ,''..,.. Application Disapproved for the following reasons:............................ ••-•_•.................•....._ ...........................................J..................................................._.....................................................:................................................... Date PermitNo........................................................ Issued--- `.................... ............. Date THE COMMONWEALTH OF MASSACHUSETTS f BOARD F HEALTH ....... oF.. ....................:..... (Ir ifira#r of TilutpliFattrr, tTO CE FY That the individual Sewage Disposal System constructed ( or Repaired ( ) nstall. �.�yJtJ'�, .y/f has been installed in accordance with the provisions of T j The State Sanitary Cod .,as describ d in the application for Disposal Wdrks Construction.Permit No.._...._.. �r. .! ._,...... dated �,�L!_�" ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT,BE CO STRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ((nn DATE....... ..... Ins .ector 6Iti THE COMMONWEALTH OF MASSACHUSETTS f BOARD, F yHEAL H ' �} 1 ,..........OF.-.:.:.._ :.................. *+G 4 , FEE.. .:............... No...............•--- t ao a1rkg vnotrftrtWn Pirrmit Permission is hereby granted ........_•--- 1"=---•............................. ............................... to Constr t ) or RepairbIVIZZ ual S , e Dispgsal System at No.-Aof_ --- �.. 4�- Street as shown on the application for Disposal ��Z.orks Construction P it No Dated-__ '' ., ........................ y4. ........ VrY/'°... ._ ". .............. Board o Health FORM 1255 HOBBS & WARREN.-NI NC., PUBLISHERS -. y -x+NAEW^RDYwfi#SFT+3�Yy'iM'WtfF'MYli49r`iFM1Rl3.s YS'J•f iX� p .9'.,:' 'Y"'w.rvr+.iT;.r'.`t.5t ••.' •-:. •r: '....; .. .•ad.Yakn..s,::r�r.+� -"'..�::+.waK>aWrx J,>.bASeiYW.'ivit%3nM+�'+4R4kS�RF�.JFS+L'�Ak. . . r43'Ati4�YR/MP'..+.krJ-+lF!k:NBfiin;:Sw:r:Yx'YIiMWM,k�'M14KrLrtA•La«*:ir>}n.Rc.j..., �'L.>.A,1\'..Yf•1t4dia�U`8'Oa';#YtiYiJkGdipP'a�.�iP�Je�k7`�"F:c:,>'::A1&sS:S +�.'SM�i'dkia'�[it'YR+M1r*YY{'f'f6.M'.4Fie'.�:ac.af•+rz l;N,x le k•h.,:::#r.,�,•.w.r.•. -.: -.. ., •tn.,a".:.. ..'. �rx._ _.=Y •,:'.. .., . ". 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