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Home My WebLink AboutApps-Permits-CompliancesNo.V..... ... Fmm..... C... �.. . THE COMMONWEALTH OF MASSACHUSETTS BOARQ JOF HEALTH Appliration for Disposal Works Tuttutrurttn rruti# Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal t at: �— -' _1 �.�d. r- 3/ 4 •��vs� c_ 4,ac'tj r/o� c �'fr ... _ . .............•----•--------..._...----•--•-----•--••--................ ------- --------- - --- • /�(�wne2` i /l.i �i / t �lr %la fLddre s /�v / / C o (l LJu ---•-----•-••-•--•---•----••-•--•--•-• -.... .................................-------------•-------------- Installer Address Type of Building Size Lot -----_-- - .Sq. feet Dwelling — No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other —Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( ) Other fixtu es .................................. Design Flow ................................. gallons per se �e�r� g. Total d)il,Yofipw.............j- ------------------ gallons., Septic Tank — Liquid' capacity_.._...._.gallons Length ................ Width.__ /._._... Diameter......._...._. Depth_._... ----- Width -----P ....._. Total Length - 5`.------ Total leaching area_�Q_. g ---s ft. Disposal Trench — No......_.�.____ g g q. Seepage Pit No ..................... Diameter .................... Depth below inlet.................... Total leaching area .................. sq. ft. Other Distribution box ( ✓f Dosing to ( ) Percolation Test Results Performed by ...... x-• ..........................• Date------f----f----------- -- <...._.q_ a .......!_.� �' o -� l/ Test Pit No. 1c-'_ .-.....minutes per inch Depth of Test Pit...7 Z ..__... Depth to ground water .... Test Pit No. 2................minutes per inch Depth of Test Pit .................... Depth to ground water ........................ Description of Soil � CA3 ..T&................................ r. ..r_5` - ".. •-•----------------------- Nattre ofepairs or Alterations —Answer when a livable..._ _ S� � ._ f#'__.._. ..................... Z. -..--.. 49Z... ............. 4 c� -------------------------------------------------------------------------- Agreement : The undersigned agrees to install the afore es ribed Individual S ag Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary de — The undersi rther agrees not to place the system in operation until a Certificate of Compliance has bee issued by Oe bo d of iealth. Sign-• • ••---- ....... - .................. - - ----- •--- -• ..l... ---------- - ApplicationApproved By ....... •• .............................................................. ........ ....-... -.. - ...... D to Application Disapproved for a llo g reaso s: -----------•---••-•-•-•......--•---•--------•--•--•-------••-----•-•-•-•------••-•--•-•-----•-•------....•...•- -------------------------•-----------•-••----------------------------•---.------------------------------------- ---............................................ Permit No. -• ------------------------------- Issued . y�11..-1 _ Z 1_.1....a� . $ 7�`�-•�--...... THE COMMONWEALTH OF MASSACHUSETTS .�-- BOAR�/D' OF HEALTH .low .............. .......... OF....GYA&# ................................................... Trriifiratp of Toutpliattrr HIS IS .ORTIF , That the Individual Sewage Disposal System constructed ( ) or Repaired O t�J --•-•---------------=--------•-------•------- --------•----------•-----------------------...-----•-----------------------•----------------...--------•--•------------ / at._�6.f�...!�'Oy_l�'f'.-1?%i/•_C�%'✓��f1��1_.............................................................................................. has been installed in accordance with the provisions of T of -The State Sanitar od as}}cjj' n the application for Disposal Works Construction Permit No. ................. dated.-_ __!0 f-1__ �..___----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A UU NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................ Inspector. o.�...... Fzs...../ �..r)._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH , l ..... -••--------OF .... .k.ZI�----- .....-•.........................•-- Appliration for Disposal Works Tonstrnr#iun ramit Application is hereby made for a Permit to Construct ( t,or Repair ( ) an Individual Sewage Disposal System at: C_ .� ------------------------------------•---------------�fL - .................---......----------- ---•............. rte.-,-o-----•-- d%ftr�2T �%I`ca cry2 ss T1— 3l C •¢ s'/�G %`JNA° / 012 cc TZ.�� - -- -• • ... -------------------------.....-•---•---•-•. . ......-- ----- 7_-..._._..-- a ®ems e�L. �O / ACG ......-•--•. -------------------'-------------.-------•- --•------•-••----- Installer Address S feet 4 Type of Building � Size Lot __.G___________________ _ q. Dwelling — No. of Bedrooms ------- ----------------------------------Expansion Attic ( ) Garbage Grinder (_44=> Other — Type of Building No. of persons ............................ Showers — Cafeteria Otherfixtures--------------------------------�,,.� ,e?,ts,.,�l-------------•---•-----------------------------------------•----- ------------------------ W Design Flow ............. t'r_ v ------ -----------gallons per on ped day. Total d�ily#ow_.____________-33-----------------gal�ons WSeptic Tank — Liquid' capacitye" gallons Length ----------6..... Widt . .----___.. Diameter ................ Deppt� .---� .. x Disposal Trench — No. -------I----------- Width ..... Z.O. ..._...... Total Length ...... _--_-�.... Total leaching area_;.;..............sq. ft. Seepage Pit No................eameter .................... Depth below inlet.................... Total leaching area --_-------------sq. ft. Z Other Distribution box ( Dosing tank �' p y �i �. c e �d.•�cS l7 /yam 7 Percolation Test Results, Performed by. .�___.___.__._........_......_?5.................. Date.. __._.______...._......_... _.__...._. aTest Pit No. I.�'._Il minutes per inch Depth of Test Pit .... 7Z- --- ..-- Depth to ground water ... ,tf..-....-....-..__. f= Test Pit No. 2................minutes per inch Dept of Test Pit .................... Depth to ground water .................... --------------- --- Description of Soil.d.............. ------------------------ Q=0AFM --- - •------------- ---- -- ------ --------------- . ------ --....... •--- -•--- ------------------ ------ Iure of Repairs Al r ions — Answer when applicable--- ---------- ---------- ----------------------------�•---••----------•-------- ` =1 ------------------------------------------------- --------------------- ..------------------------------- Agreement: The undersign agrees to install the aforedes ed Individual Se age Disposal System in accordance with the provisions of TLITAIE 5 of the State Sanitary Coe The undersig d Jurther agrees not to place the system in operation until a Certificate of Compliance has been i ed by thegboar ealth. Application Approved By --- Application Disapproved for the Permit No.. 7 2 = -----_----------------------- ?s`�7 •------------------------•---------------•--•-----•---------------• �/ l �,_ Date zIssu f -- -.. Z" .................. .� e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................OF..�J'.Ak.......................... Tntifiratr of f ompliaurr HIS IS XO A�ERTgY, That the Individual Sewage Disposal System constructed by_Ev_rtitS e.._.V.t..L,:"ltA...-�'-°------------------------------------------------------------------------------------------------• Installer ftU77y--------------------------------------------- has been installed in accordance with the provisions ofT 5 off The State Sanit application for Disposal Works Construction Permit No.�.............. dat THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector ) or Repaired (N ) as jr' >n the A ANTEE THAT THE