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Home My WebLink About0354 NOTTINGHAM DRIVE - Health 3 54 Nottingham Drive Centerville A= 171 —087 I I SIIII J aECYCtFpUPC 12543 IIII � No. 53LOR �'Pon.cpNS°�� HASTINGS. MN 1 No... ...... _3. ,C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT�i ........... . ..... ........0F.. ....................... Appliration for Uhipjaiial Works Tutudrurtion Famit Application is hereby made for a Permit to Construct or Repair k*r an Individual Sewage Disposal System at: 4 ..... ------- . ................................................................ 0 ddress or Lot No. her & ess G'4"W'Z............................ Installer Address T/e of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder �1 P4 Other—Type of Building ............................ No. of persons............__._.._.._..._._ Showers, Cafeteria 04 Other fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow...............................;...........gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width........___..... Diameter____.._......... Depth................ Disposal Trench—No..................... Width.....__............. Total Length.._.............._.. Total leaching area....................sq. f t. Seepage Pit No_____________________ Diameter___.........___..___ Depth below inlet_...___............. Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................................................... .................... Date........................................ Test Pit No. I................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-.__-____-_-_-_--------- a' 0 Description of Soil....., .................................. _44f4lol----------------------------------------------------------------------------------------------------------**-------------------------- U ........................................................................................................................................................................................................ ... 0i......... .rs --------------------------------------------------------------- .......... ... ------- --------------- ......... ----------- U Nature ';'C' Alterations—Answer when applicable...... ... ...... ................ ................................................................................................ ................................................................................. ............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliant ,has ben issued bo 11 d of heal Sign ,(/% ....1,4e....... ign ApplicationApproved By-.. ....... ....................................................................... ........ Date Application Disapprove o following reasons:....................................................................... ....................................... W;r 4e ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued_....................................................... Date .`r / Jo' No. .... _ ...............!............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H17 EALTH 1...........OF_.. ' `.i/f 1,1,I ........................................... Appliration for Disposal Works Tonstrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ,!,,ran Individual Sewage Disposal System at: ,r f/ F,= r f Location-Address or Lot No. j Owner Address // • W / �� l'J iiJ �''/-:r`.�✓J�-/fa/!. =� ._ •�'� ..//,'t,`_. ,« f�� v /-,!� % .� ` i,.,..,r: /�j c 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 ( ) a Other fixtures --------•-••-••-•-•------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................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..........:......... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.. ......................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------ •...... ---..... ----------------------------------------------- •--- ---------------------------------- ---------------•------- DDescription of Soil---- .r.:.'.f"---------------------------------•-•----•----•-••-------•...-•-•••......••-•-----........................................................ x / UW ••-•-------------•--------------------------------••----------------------------•-••......-•-----•----------•-----------•----------•----------•••-----------••.f '-- Nature of Repairs or Alterations—Answer when applicable................�`J..... .............� `..................................................... 1 !- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianc has been issued by the board of health. ��_ { : Sign r , .... /� ✓`fr ;�° .ft s �' n� r' ---------------- ApplicationApproved BY... .•••• -- ".x --- -----•.....----•...............•-----•-•------------.................. ..-- ........ Date Application Disapprov 'f o the following reasons--------------------------------------------------------•----••---------------------._...--•-••......----------•- --------------•---•---•-•...•-•---•---•-------•------•--•-•••••-••--------------•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / .ram. �pz�gfirtt#le ,af (t�nm �inr� MiIS IS TO CERTIFY, That,/the Individual Sewage Disposal System constructed ( ) or Repaired (�)- bY .-... ........................... r '.' _=_ ��'-` '..................................... -----------................---------•---- -- Installer f ------------ -,has been installed in accordance with the provisions of T . State Sanitary Co as d cribed in the l application for Disposal Works Construction Permit No... ...5,5AThe ........ .................. dated. - - - �__........._...... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE®, S A GUARANTEE THAT THE SYSTEM WI F NCTION SATISFACTORY. DATE...l ........... Inspector... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � f 1 ............. t NO........................ FEE....:..:......---...... Disposal Works (11tnnstrnrtion rrmit Permission is hereby granted ' . ......`...............,..----------------..... .` ............................................. to Construct ( ) or Repair (6,1,an Individual Sewage Disposal System t j at No j _,_1 /:! r �.._.,.................................... . .... . t . 1 .� ...✓s .. ... Street as shown on the application for Disposal Works Construction Permit No.............. Dated.��.�.................................... .................................. .............................................................. Board of Health DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. 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