HomeMy WebLinkAbout0041 HADRADA LANE - Health 41 Hadrada Lane
Centerville
A= 148-108
0mrforde NO. 1521/3 ORA
s
No9l. ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD gF HE
W.2 --........ OF...... .:....................icv!................
.......................
-Houk 4 A liration -for Dio oottl Works Tonstrurtiott - ]runt
Application is hereby made for a Permit to Construct ( or Repair ) an Individua Sewage Disposal
System at: 4�1"
. , .. t o.
Ad s 11 ��l
�P ca' Ndress Lo
...... ...................... .... ..... .... ........__..._......._......................
Owner Inst er Address
Q 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 ( )
Q, Other res ..
Q -------------------•-----------------------------------------------------------------------------------------------------
W Design Flow___________ ______________________ er person per day. Total daily flow............ __--__-_-.-.-------gallons.
WSeptic T: y- _ .l�`__Tank—Liquid cal .' .0ons Length---------------- Width. ............ Diameter--------_----- Depth.-.--------.---.
x Disposal Trench—No............ . .... �' Tot 1 en th---- ______ Total leaching area.._ -..sq. ft.
Seepage Pit No.2_.__ e� ----
._ _...... Total leaching area.___._._____..._sq. ft.
z Other Distribution box ( � Dosing tank ( ) 0/_�� _"-"-/' t5_ -7 /
aPercolation Test Results Performed by------------------------------------- ------------------------------------ Date.--------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..._-._--__--__.--.--.-.
41 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.-..---_------___..___
P4 .................... - Al
Description of il----�------- -'�~ j�----- j r/
W ^' �`�" '� - ---------------------------------------------------
--------------------- ---------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature 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 Co e— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b ' sued by the b rd of e lth.
Sign ,-- - -••- - -•-----------•---•------------------------ - - - ------- � - 76------
,I� Je��2� -- Date
Application Approved By_"-_.....-�-- --- -- ----- - ------- - ----��--�Q������---.---------- �-------------- - ---------------
Date
Application Disapproved for the following reasons:..____._._.
,....._-----•--•-•--•--------•---••-•--•--•-•----•--------------------------•••-•------••-•••------------•.......--•-•-------------•••-•----------•--•-----•--------------.......------.•-•--------.------
Date
Permit No......................................................... Issued.......y-2 F -7 L
i Date
No......... S Ficizz ..............
THE OO'1RDALTH OF QF MASSACHUSETTS
OF...... .. ............................. 0
Apphratiun -for Ripuiittl Workii Tomitrurtion Vrrniit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
-• r'
. Wress -- --•-------•- -------
�j�� o Lott
ca n: dres N No.
.... .....................' ......•�
4
Ow*1er ;
3/` /� Ad s
� Insta Address •�,/
Q Type of Building Size Lot......e!�-!I.. ---Sq. feet
Dwelling—No. of Bedrooms._2----------------------------------- Attic ( ) Garbage Grinder (Y-
PA Other—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ( )
Q' Other Tres ----- ----------------------
WDesign Flow_________ _______________________________ _ }�s,Ijer person per day. Total daily flow............ ___.._._._..._.....gallons.
Septic Tank—Liquid calm �__ loons v Length................ Width- -------------
Diameter................ Depth.----..---.----
xDisposal Trench—No. ...I.�......... .............._�Tot1Len th... . ... ..... Total leaching area-__ ...sq. ft.
Seepage Pit No.1-.:_��_" l�jr ✓ e _.. ..... Total leaching area..................sq. ft.
z Other Distribution box ( � Dosing tank ( ) / 01- �G _�`� S -17 L
a Percolation Test Results Performed by-------------------------------------------------------------------------- Date--
ate*-------------------------------------
a 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-----.-_-_--_.-_--_-.-_.
tx ---------------------- p....... -•••----- -•---------•--------------
O Description of oil--. Q �_` , u,r, `�•--- j............_� 1_� ._..I
x P - -
U ---•--•-------•-- ---
- ----- - -
- --
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 C e—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n ' sued by the b and of. Ith.
�Sign = f^� ---•---•------16X0L !...�� �aDateApplication Approved By- -� ----------- -
Date
Application Disapproved for the following reasons:............
................-----._._.._._............................. ------------------- ------------•-
.•---------------•---------------------------------------------..-----•-----•----------•-•---------------------------•--•--•------•--•------------------------•.----.----._.-•------.----•--------------
Date
PermitNo......................................................... Issued........................................................
Date
E COMMONWEALTH OF MASSACHUSETTS
BOARD/f HE LT
4Q
..........OF...//� ��!..... ....4.h................................
wrrtifirate of f omplitture
THIS IS TO CER" 1 Y,_That the I.ndividkml Se e Disposal System constructed ( or Repaired ( )
by............................ • ---- ---- ---- ---- ---------------------------------------- ........................ .................
's ler
has been installed in accordance with the provisions of ' r c XI of TheState Sanitary Code as described in the
application for Disposal Works Construction Permit No -___-._-__- --------------- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WI FUNCTION SATISFACTORY. �
DATE ' Inspector.---------•- -- --- .-�
THE COMMONWEALTH OF MASSACHUSETTS C� /
BOARD F HE
7 ,S .... ....f %v"L...........OF...- ------------------------------•-----------------........
No. ......••... ' FEE AC...•••......••...
inpaiittl ark-4 (n t r rtion Vamit
Permission is y granted------ --------- --------------•-- ••---_... -------------------•--- ... ........................
to Construct ( or ep �/ a ndivi 1 Se ge Di os
."T/ �j.
Street
r
as shown on the application for Disposal Works Constructio '°ermit�o---- ------------- Dated........__.�......... `'
/ ......_....
!} % Board of e_l ii
DATE------ i
---------------------- -----------------------------------------------•
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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LOCL,TION ' 95EW&CtE PERMIT V-JO-
WSTNL ER S I A � ADDRESS
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BUILDE/R '5 Q &MF, I�DDRE.SS
DATE PERNA T ISSUED 76- -
D ATE COKAPLI W-4CE ISSUED : - - -
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