HomeMy WebLinkAbout0192 GLENEAGLE DRIVE - Health 1 )2 Glen Eagle Drive
Centerville
A= 192-149
5 M E A D'
No.2453LOR
UPC l2m
as mtoom • Yad.in USA
1lIWY1i1�R�W
Sf' �1111Yooi1Y a
aw�rw
THE COMMONWEALTH OF MASSACHUSETTS
BOARD RF HE T�H
Application is hereby made for a Permit to Constr Repair an Indjvidual S Disposal
System at:,7,
....7.4 Or
... .......... .. ... .. . ........... ...................... .........................
..Pd
;n.. ............
Location-O$ddre or
�4 Address
ype of Buildi Size Sq. feet
Design Flow ........ gallons per erson per day. Total daily flow...... ons.
Seepage Pit No-------!-_--------- j pPli ( ow in et.................—Total leaching area..................sq. f t.
Z Other Distribution box (�e Dosing tank ( )
Test Pit No. 22.............minutes per inch Depth of Test Pit.................... D�epthh/to round water........................
_______ ____
Agrorozcur:
The undersigned ugrcco to install t6o ufored:scribcd Individual Sewage Disposal System io accordance with -
the provisions of Article XI of the State Sanitary Codc--The undersigned further ugcecx not to place the system in
/ the board of health.
/ ^ ^ '
--------... ..............................
Application Approved Bv_ - ___ ---
�� ~.^~
� Application Disapproved for the following reasons:................................................................................................................
........................................................................................................................................................................
Dat
PeroitNo------------'-------------'-- Issued....��'��-�'�'��-��-��-'---_
/ o�o / '-
....^...~^..~..^''....'...^'...'......^..'..'..'..'......'. ----------- ------'--'���
jf
No... #.. ....
........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HE T- 19,2 -1-gY 7
------...OF....:ff...... ... .......... .................
... .... ......
Appfiration for Mopooal Marko Tonstrurtion 0;rlgilt
Application is hereby made for a Permit to Construct
r Repair ariIndividual S Disposal
Syst at,
...... ...... ......... .. .......... .............^.. ........ ........ ................. 2..... ......
LOCUti n ddre or Lot
F..
r ddress
.......... ............. - -----------------------------------------------------------------------------------I------------
Installer Address
Typeof Buildi Size zot:t�al.&, -0...Sq. feet
"F0000:
Dwelling No. of Bedrooms---- ... I
--------Expansion Attic M.. Garbage GHnider
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
A4
Other fixturese.................ji...........................................................................................1:..........4---------------------
Design Flow gallons per person per day. Total daily flow......
j \rj flow.._._._..___ ...........
Septic Tank Liquid capacity
ty W.gallons Length................ Width......_......._. Diameter-........*...... Depth..........._.__.
Disposal Trench—No.------------------ -W
-Widtli... qtal T, pj�th�-- Total leaching area....................sq. ft.
-et............... Total leaching area.................sq. f t.
meter. ...... ep i et...... ot
Seepage Pit No ia
z Other Distribution box- (le Dosing tank
Percolation Test Results Performed.by....-....................................................................... Date........*--------.........a .
Test Pit No. 1................minutes per inch Depth of Test Pit_._._....-._.._._.__ Depth to ground water.._.....__________......
04 .. I . .
GLl Test Pit No. 2.. ...."-------min'utes per inch Depth of.Test Pit.................... Depth to round water.........................
P4 ............. .......................... . .......
- ----------- -
0 Description of Soil.................*....... /4
cof . ........ ............... .....................................................
.............................................................. .. ............................................./...................................................................................
U -�i�
.......................... .........I....................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable......................................::........................................................
..............................e.........................................................................................................................................................................
Agreem
The undersigned agrees to install the,. y aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State SaNifilar 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.
e
-
Sign p�... . ... ................. ......................... - --- ---------
D-- 7
;e00
0�9
Application Approved By .
Date
Application Disapproved for the following reasons:..................................................................................................................
....................................................................................w...................................................................................................................
Permit No................................ Date
........................ Issued------/ Z ..... ..............
ate
THE COMMONWEALTH OF MASSACHUSETTS
/ */7
BOARD 9f HEALTH
........ ..............OF....::: A...........
(Irftifirate of Tomptiana
THIS IS TO CERTIFY hat the Individual Sewage Disposal System constructed ( or Repaired
by........ 94%." A----- ................ .... .................. --------------- ----------------------
talle I talle
Moot. ns X
#0.00 -4 at----- .. ..... . .... . ........ . .............................
has been installed in accordance with the n o Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..............��. ..3.............. dated-.--"--.
X----------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT 13E CONSTRUED AS A GUARANTEE THAT THE
SYSTEM "WILL FUNCT)ON SATISFACTORY.
DATE................. ..Lo. .. e7
............................. Inspector........ ..................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0 HEALTH,
.........OF.....
a-
No....... FEE..........................
umpos,A09 orks str um "ptrmit
Permissionjs,hereby granted.....—. ... ... ...i.......................................................................
to Consq)ot or Repair an I Se Dis al SUClb!9
. .. .... ..... .........at No.. At ........
as 0 ion Per Street �--�S.........
247 o........... D.24d.shown on the application for Disposal Works Construct 7 ..
...........
.or] 1�
0, Ntaord-.0 Hed h
. ...... ...
DATE...... ... ..... ..................................
7-----------
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS