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Home My WebLink About0033 PALOMINO DRIVE - Health �1e /cot I No. 4210 1/3 ORA sindo sv 10°l0 U& 0 0 0 0 lqo LOCATION SEWAGE PERMIT NO. i Lor ion ALIm )lU0DRIV45C VILLAGE I N S T A LLER'S NAME i ADDRESS e UILDER OR OWNER C-Jo In Yu ( y YU� 2�.rz!��e " All, DATE PERMIT ISSUED � ... c2,2 DATE COMPLIANCE ISSUED ?7 a- 'vt- ; Fii$............................. No.. .....1 .. t t THE COMMONWEALTH OF MASSACHUSETTS BOARD 0? HEALTH .I.........O F......... ........144J!1:....... ............................ .. t. ... a_. Appliratiou for Disposal Works Toustrur#ion ,"rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: 40 L tion-Address s!5�.!- Own Add e / Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_________________________________ _Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria a Other fixtures ------------------------•----- w Design Flow..'-J*/&.............................. p per 'ay. Total daily flow-------- 4)..................gallons. WSeptic Tank—Liquid capacity/, gallons Length____ _. 'Width__V........ Diameter________________ Depths _____ x Disposal Trench—No. .....gE--�`'....:.. i :. :_ _ Tength_____'____......... Total leaching area___.._____ __ s . ft. __ . . . � Seepage Pit No.___._�_.._______. Diameter_._ Total leaching�_�...� Depth below inlet.__�rx__�___ g area �_._ . ft. Z Other Distribution box (Joo�r— Dosinank ( ) ~' Percolation Test Results Performed by.. ds.✓_�'..__.�� &........ C__.__. Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------•---------------------------------------•--•-----...---......_._.._.._................------......................................................... Description of Soil______________ ___ '� �c� -- - --- ---------- ------- --------------- 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 ilTi is p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasjb�e�iu by boa- Dealtigned .__ . Date Application Approved BY-••._--•• • •- ----- ?.!/1�i ' Date Application Disapproved for the following reasons------------------------------------------------------ t --------------•-----•-----•--------•--------•--------•-----------------...-----•-•---------•-•----•---•--'-•---•••---•--------•--`---------•---•---------•------••••-•--------•-•----•••••-•-•------•---- Date PermitNo......................................................... Issued.....`-0- ..................................... Date K 1 J No.......... .................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD 0, HEALTH r/ `.--........oF.........dJ_. :L. -----------------------------•---------------- Appliration for �-4pnii al Works Tomitrurtintt Vanfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: p ►. f/ ......... _` fF I L r LMocation-Address Owner Add Addfre s / ..Kra ......... 1 Installer Address dType of Building Size Lot................... Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures .. -•--• ---- .-- Design Flow...4i.44...............................gallons pe ee"rsoa pe day. Total daily flow--------.- __��__..0•....._............gallons. W WSeptic Tank—Liquid capacity/ gallons Length . .._.' Width_x y� .. Diameter................ Depth�Z......... x Disposal Trench—No �....:_:=_=W>dth��'°�__ Total Length Total leaching area..__ ....sq. ft. Seepage Pit No..__.__ _ Diameter._. _f!'.. ..... Depth below inlet.. -•C-�?..... Total leaching area-'' .,/..L ft. P --------- / Z Other Distribution box (&o)- Dosing tank ( ) Percolation Test Results Performed by..... f ! !._ ''•.....1 .......PAf!.!'....... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...................... LT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_________.____--....___ 1:4 •-•----•--••-•----•--•-•--•-•--•-••-•-•-•-•----•-----•----•-•....••-•-•-----•--------•....................................................................... 0 Description of Soil............ ............ =------------= ---------------------------•-:'f -----------------------------------------.......---- V 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 TITIE 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., 4'.. .... ...--== = . 1 , ' Signed__.... f Date Application Approved By.- �! �' � � /l� .... ----3•- ...` . ---7 ------ Date Application Disapproved for the following reasons-------------------------------------------------------------•---------------------------------------------••---- -----------------------------------------------------------------•---•---....---......-----•--------•----••--•-•----•---•-••--••--•-••••••-•-•-••--------•-------•-----•-•-----•...............-------- Date PermitNo......................................................... - Issued................ .................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... P__Z:. .?..I.........OF.......... ae- 1:�:�.;/�v.��!t�-�..:................ Trrtifiratr of ToutpliFattrr TH S IS T CERTIFY, That the Individual Sewage Disposal System constructed Repaired ( ) ri �........................- C ----••----•------- --------------------------------------------- ------------••-•-- ._ ! Inst• erf �i at.--- .. f G.S �! �L�!! _�7!Fc.cl �-- ................ has been installed in accordance with the provisions of TIT175 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......((�`......_. --------- _. 4.............. 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 ......... ....li..L/ �........OF..... 1........_ ............................................. No. ..� :-- FEE.--�-.. ........ L11 Z11.1 ' at Permission i hereby granted.--•-- �_iI _XCvidua'1"`S'(e .. _ ----•-.........•••...•-••••--••--•-•-•••........•_.... to Construct Yl or , {air ( ) rge Disposal/Sys at No.�../!. , .f..�R`�..:-- --�.... ........_1..�— ` Street as shown on the application for Disposal Works Construction Permit No.___..�__�,:.____ ated_._.1.-_�_y_:__j�............ / G�z I %. _ tom(ca-G- U � -•••---.••---•-••-•--Board of Health DATE................................................................................ FORM 1255 HOSES & WARREN. INC.. 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