HomeMy WebLinkAbout0153 NOTTINGHAM DRIVE - Health D 1.4
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF 1HEALTH Mjq ITE- b4to
_... "WA/.... .............0F.2......:,�ft !� 1�, . / ..............................................
, pphratiott fnr Diti B Mirks Toustrurthitt jhrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: Z
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m........fir. �- -------------------------- o.1,......14�.------------=----........ ..?3------------..
Location•Address
Lot
.......,l� ... �7�... Ql.>� ........:...T�!� .. N
.� *
..................... 1 .,. o.............6 MTOL Kdy .
a Owner Addre
...... . G ............./.v..............--..
Install Address
UType of Building �j Size Lot...l� ..........Sq. feet
Dwelling—No. of Bedrooms.............�J........................Expansion Attic ( ) Garbage Grinder ( )
PP4 Other—Type of Building ZU0j9td No. of persons..............6........... Showers ( ) — Cafeteria ( )
P4 Other fixtures -•...................•-•-•----------••---•----•---------
W Design Flow.................1.50....................gallons per person per day. Total daily flow.............:3'-Q Q-..---.---.--.......gallons.
WSeptic Tank—Liquid capacity. -gallons Length---------- ---- Width...-------...... Diameter---.....-----.-- Depth---..--.....---.
x Disposal Trench—No..................... Width----•-... -..... Total Length.................... Total leaching area....................sq. ft.
�> Seepage Pit No--------------------- Diameter---------- arlrepth below inlet.................... Total leaching area--.3 o-....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by... .....................-----------•--- Date
a
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------------------.
44 Test Pit No. 2................minutes per inch Depth of Test Pit...........---.----- Depth to ground water.........----.-.........
W -----------•-••---•-• s
O Description of Soil........
Nd-.` --.5.2-!?A-✓_ .-.-.•---.-.---
V ......-..---•------•--•--•--••--•----------•---••-•••---•--•---•-------------------•----
W
---- --------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------
•------
V 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 Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has •een iss d by the board of health.
`,
� Di ` D tc
Application Approved By--•-y''' `°� .. �. { a ------- F 2 ..�
Date
Application Disapproved for the following reasons: ------------------=------•-•-•------------•-•-•--------•-•-•-•---...---.....•----•--•-........
-•-------------------------------•---------------------------------------•-------•---•-•-•-------•--------------------•--•--------------•---------------------------...-------•••-----------------.....
Date
PermitNo.-------•--•--•-------•----•---•-•---------------------- Issued........................................................
Date
4 c A�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
rr
a)
.
m f
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal '
System at:
� r
e. .:.t ._ t t r iJ
.... Location Address._. {. or Lot ... .... ..
P/
..... s .............................. ............... ..............................................
. ... ......Owner Addr .
41
..... d t. ........ .... .............................................. ........ _,,....,,_.__ ..r........r t�fr.. .......................................
.
Installer Address
d Type of Building _ Size Lot..::r:r..:..':l ..........Sq. feet
Dwelling—No. of Bedrooms....... ... ...........................Ex ansion Attic
W ... p ( ) Garbage Grinder ( )
aOther—Type of Building No. of persons.............f........... Showers ( ) — Cafeteria ( )
Other fixtures ---••---•---•-•-••.... K:
Design Flow.................. ..�-2.___._......_.__....gallons per person per day. Total daily flow.............._r' .....................
WSeptic Tank—Liquid capacity f_t.�,_P._gallons Length................ Width................ Diameter................. Depth................
x Disposal Trench—No..................... Width___„ ........ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter`.,_,_...:%_ �XDepth below inlet.................... Total leaching area..,�_`_.. ..:.:__.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date.......................................
W
Test Pit No. 1........._......minutes per inch Depth of Test Pit.................... Depth to ground water........................
(•q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..._....................
ODescription of ......:_-__:_---c'_x,..1 .__„.1.................•----•„_,_-•--------------•-----------•-••-•---------••------•--„_•-•-------••---•----------_--•--
V ......_•---••.....................................................................•---.,_.._......_.,_..._.._.,.-•--•-,......_,._.._..--•--------•---,_.____._.__._..._.._-----•--------•--...,•----••---
W
-•--•-•---•-•----------------•..-•-•---•----,-._.--•-••--••-...----.._.,_..,.....-•---.......•......._.....,_.•.....------••----....----•-•••-•--•----._....----......--•-----__,__•-------------,___,__
V 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 Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has een iss-ed by he board of health
r� Si ne ............ ............. ............... ....... ................................
Application Approved By..... ......................�_a' ..�j .
e. ---4''':... .�."..... .......................•-•--...-- ...............Date-----------•--
Application Disapproved for the following yea,sons:.,. --------•-
.............................•----•---•--•-----------••.__,..._.................__...._......•-----..._...
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
( ntif irat a of Tuntplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-......... j/ji __f.._._.__l Jr .........
.,. 4 — Inst-ller
- �.; '
at -- ---_... ...........................................................
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
4
application for Disposal Works Construction Permit No..............................�_ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE
SYSTEMS L FUNCTION SATISFACTORY.
DATE...-_ `id•-•-• ... '.. .. _°.............................. Inspector.... ? ._ - ._. �C.�. t' ...- •_-.........
YPt THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....". ...:... . .....` ...............................
r✓
No.4r..................... FEE... ..............
� 1���2 (� nsfr�trtinn prrnttt
Permission is hereby granted........................................... .........................
X......................................................................
to Construct ( ) or Repair ( ) all Individual. Sewage Disposal System
at No.......... .:. .............................. 1 e#.
. ...'� fts`. . 1 ,... .. ...................._.. . f .......rf i✓ .................. .
Street s r.
as shown on the application for Disposal Works Construction F'�Jiyiit No . �4y Dated._..�°r._:.. � �............
..._,. n Board of Health
DATE.....
FORM 1255 HOBBS WARREN, INC.. PUBLISHERS