HomeMy WebLinkAbout0005 HADRADA LANE - Health 5 Hadrada Lane . ,
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No... ....�...
THE COMMONWEALTH OF MASSACHUSETTS
s- BOAR® OF HEALTH
/tee.
a� Appliratiott "for Big wittl Mare Tottstrurtiott Vrrmft
Application is hereby made for Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: Sr)- 1 ` ,4P1e,9i?1J 4-t-,YL
�l = ----- � -- --•----------------
_ ocat�on•Address or,Lot -o.
_F �=---v------•-------� �_._ .i ! �'°I--�--- �o
Owner Address f
��``��= S v.L./1 r Vic'`� r o.0 --- '......
Installer Address
Type of Building Size Lot_-/Z-.,..�0_1----Sq. feet
U Dwelling—No. of Bedrooms-------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
per., Other—Type of Building ---------------------------- No. of persons------------------------.--- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------- --
Desi n Flow-__-____---- _ �L-___-__-__ Mons per person per day. Total daily flow-__-___�_6_6_____-___-_
W g �--- --g� P P P Y• Y ---------- ---gallons.
WSeptic Tank—Liquid capacityL®1!d°_gallons Length------6------- Width... Diameter_------------- Depth---.-_-.--_--- �
x Disposal Tre ch—No. .................... NVi i ..__._._____ Le th..._..........__..-. Total leaching area.......-------------sq. ft.
Seepage Pito..rtl�- ...... Diameter__ pt e nlet Total leaching area-- sq. it.
O
z Other Distribution box ( ) Dosing tank ( ) '!� �s�%�. � �— ?,
Percolation Test Results Performed b
• Y•------ ---------------------------•-------------••-----•-------------•-- Date-------....---------•-----------•-----
W
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.--._--.___-..-._-.--.--
( Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..-- .-----------------
tt - -- ------ � f
5 ----------- --
D -----------escrptonoo -------�------ -- - --- -----------� ------------ --- ---•-l2•---•---------------
(� /�
U -------f---�.tt-�..�---,i --- ---. .�.... ............
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 Article YI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued bv the board of he/a�lth.
igne L%,. Wti(s /I 17
-- ------
- --------------------------
-Date
�j _Date
Application Approved BY---------- --•-. Lzej"L ---'------•--- •--- ---cr. �-4 . -Z-)
7, Date
Application Disapproved for the following reasons:.......................................................... ...................................................
----------------•--.-----•--.---....-----.....---.--.---••----------------•------------------•••••••--•.........----...---.....-_......_----•------.-----••-•---------------------_•---.....-------••-••.
DPermit No......................................................... Issued........
Date
-----------------------------------------
`4
No.........�...�� Fps.A)................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... ......OF........... . �'rL..................... .........:... -
Applira$inn fear Ditipma1 Works Towi#rnrtinn Prrntit
Application is hereby made for a Permit to Construct ( 41-or Repair ( } an Individual Sewage Disposal
System at
--
Lo ' n-Address or Iqt'IVo.
/Z------� ....�....----
- .... . . �------- ------ ----------------- -------------------- -- - - - --- ---- - -
�wner � � Address
............S &- .
Installer Address
d 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 ( )
dOther fixtures ----------
W Design Flow--------------------------------------------gallons per person per day. Total daily flow-__-______--________._____•--__.............gallons.
W Septic Tank—Liquid capacity___________-gall ns Length-------____--y--� Width................ Diameter----------.---
__ Depth- -----
-------
--
x Disposal Trench—No...__... � gh------ Total leaching area--------------------sq. fI.
Seepage Pit No_____________________ Diameter__-____ el el j._____________-_ Total leaching area---------------- ft.
Z Other Distribution box ( ) Dosing tank /' `• Gi .? �� ���
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-__--______--.____----
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__._...--___________-.
------- - ----------- - --�.--
O Description of Soil ------`��-'f_-f! �`' ' $- _ Cl, -
(� ---------- • r '------ !fir -� � � lJ= --
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 Article XI 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.
Signed..................................................................................... ----------------•-•-----•-------
Date
Application Approved By.-------------- ........
--------
Date 7------------ -------------------------------•••---
t`�/t'
Application Disapproved for the fol,owing re sons:..._.. .------•-------•----- -•--•--••--------••.........................••--
..........................................................................................................----------•-------------------•-----------•-----------------•--------------_.----.----•--------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARDG F HEALTH
1
r�fiiL
..... ...................O F.....................................................................................
Ter#if irate of TomVtianrr
T� 4 RdIY& I,asdividual Sewage Disposal System constructed ( ) or Repaired ( )
-----
ly
at............................................................................ - ----------- -- -----------------------•...
leas been installed in accordance with the pro isions of Article X of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No--------- -------_-__- _ ._�... dated-------------- .-..�.�_ ..71........
THE ISSUANCE OF THIS CERTIFICATE SHALL NO E CONSYRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
............. �t. F.......................... v v
No. G�''�' v' FEE � �
Bi.spoiial �rrk inn irn � $t rrnti#
Permission is hereby granted----------------- r - --- -*--- -----------------....-------------------------------•--...---..
to Construct ( ) or it ( ) an Indiv'Mtt ewa a Dos ys em a
atNo................ ........ ...-----.----- ..... ---
as shown on t app icat-�for Disposal Works Construction Permit No----------------- Date ----------- .--��-_............
t
......................;
ord f �
DATE................................................................................ a Healt
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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