HomeMy WebLinkAbout0220 ANNABLE POINT ROAD - Health a��o
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No..L.... ... Fimim. ................
THE COMMONWEALTH OF MASSACHUSETTS
.........OF..V,/�
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-i� Applir tion for Dhipmal Worko .Tonstrudiou Prrmit
A p i -ion is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal
y at. T k G1.
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oc ion• s or Lot No.
. ... =... =---------•--......---•-----•------•-----•........................................
ddd O vn- Address
g� Insta er Address
Q Type of Buildi Size Lot. .Sq. feet
Dwelling' No. of Bedrooms.................. ----------------- Garbage Attic ( ) Garbage Grinder ( ) t
'4 Other—Type of Building No. of persons............................ Showers
Pa, g ---•----------------•------- P ( ) -- Cafeteria ( )
Other fixtures ------
W Design Flow................;®�;_.:..: 4allons per person per day. Total daily flow............._ (/ .gallons.
WSeptic Tank Liquid capacity/2,_ ._ allons Length---------------- Width................ Diameter. -Depth. :..:..
x Disposal-Trench—No............ Width..._......__.._____. Total Length......_............. Total leaching areaj(J. _. ...-sq. ft.
Seepage Pit No....;�—.._.._. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other DistributioiFr—O( - ) Dosing tank ( )
aPercolation Test Results Performed by. Date
a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground w .
._. :__..
�TA Test Pit No. 2................mirutes per inch Depth of Test Pit.................... Depth to ground water._--.__-_..__.__--_-___.
. .......................... .............................................................................................
O Description of Soil....................... 1�.--- . .__ —.
-•-----••------------------•-----------•--------•--•-•---•--•---•---•-----.................
U ---------------------•---•-••--•----------------------------•----------•------------........-------•---------•-----------•---•-------------•----•---•-------------------•------.............------------
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 Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by th board of health.
igned -
f - ate
Application Approved BY----•---- - - ----------------•--•-- �{t• 7/7... �: `--/---------------
A ate
Application Disapproved for the following reasons:.. . --------------•-•-•----•------•-------•----•------•---•--•--••----
.....................................•----•----•-------------•-------------------•--•--•---------------------•-------------•••--•---•-------•-•-------•------••............---------- -•-------•-
Date
PermitNo......................................................... Issued........................................................
Date
... ., .pn-.. s-..-..., .. . .a. �•.......... . ..... . . . ..... .. ...-,...........................................................�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
...............OF....... l a.............................................
rdifirat of Toutpli tta a �
T IS S T4 TIFY, T the Individual Sewage Disposal System constructed (4) or Repaired ( )
by=--.. .. ........... .ry/.. -• •-----. . --- -•-•-•---- ....._
at
R t.
Ins r ;
,�` --�;_ _
has been installed in accordance with the provisions of Article XI The Stake Sanitary C e s descr'bed in the
application for Disposal Works Construction Permit No________________ _ __-�� - �-
--�._. dated------- -- ----�f--�' ----�.�.------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................•.......---......................_............-- --------- Inspector....................................................................................
r _A. _--=. ------
No.a ....'" _,..�:r? F��. '`•..................
THE COMMONWaEALTH OF MASSACHUSETTS
�.. BOAR® O HEA 1"H
�_ ..
Applirativit for Dispaiial Workti Tonotrurtiott Prrutit
Application is hereby made for a Permit to Construct ( 4110r Repair ( ) an Individual Sewage Disposal
st at: i f
..y /Z"-'l............. ..... ............................
s
Location A dAess or Lot No.
:• trL��. -------------------------------
-
Add-r'ess
Instal er Address
U Type of Building Size Lot _ "' q. feet
Dwelling No. of Bedrooms..... ...........................
Attic ( ) Garbage Grinder ( )
aOther—Type of Building ........................... No. of persons-........................... Showers ( ) — Cafeteria ( )
04 Other fixtures ---------------- -----------------------------------------------------------------------------------------------•-• '`
W Design Flow_i________________`-'"" /� ....... allons per person per day. Total daily flow..............�`y! ...._gallons.
Ix Septic Tank.Liquid capacity�d_.,f: allons Length---------------- Width................ Diameter... ...__--Depth.....Z_.......
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 ( )
aPercolation Test Results Performed by.......................................................................... Date..................... J , .
a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.... d '
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--•--•-_________--__-__.
--------------- ......
--- --------------------
--------------
---------------------------------------------------------
O Description of Soil.................... -i-f-.- "•- , -
x
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 '-r"'''-=��� " -•----�W..........
- --'....'...... ...�..5---
Date
Application Approved By-....: .. - ... ....s+f � V
✓ �s.. y Date `
Application Disapproved for the following reasons:........................................... •••----•••••-••-••••-•••--•---....•-•••.............•---•-••.......
............................................................................................0.....••r-}-
, Date
PermitNo......................................................... Issued........................................................
<Y
# Date
}Y
THE COMMONWEALTH OF MASSACHUSETTS
I
BOARD OF HEALTH
o�
.............. OF '1-1 - .-+?..............................................
rriiz �r of TwOtttptittttrr
THIS "S rTD.&TIFY, T.K t" the Individual Sewage Disposal System constructed ( or RepairedI �.0 --- --- --'-.r. .. e
•-»•• �1 ���Install r l� yM
at .. �'d E°± .L_4e �s '3r�r®R� 4 ' ��• 1_ - j'€;°'K r t. ' 'r
has been installed in accordance with the provisions of Article XI of The Sta e Sanitary Code s described in the
application for Disposal Works Construction Permit No................ -.. _.„ ._. dated....... .�� .' _., ._.._..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................................•---•--........._............--•._......•... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 09 HEALTH
OF
NO.. ... --••- a - FEE.....r .........
W5111115a1 ' rP : tt trail,hut rrtYtii
Permission s re eby granted "` r ...... ......
/� � ... a ............�...... :... ............:..
to Construct or Repair ( ) an Individual.Sewa g�Dispo l System
�-............................................ ...0
street f1 w
as shown on the application for Disposal Works Construction Permit`s o....................:. Dated. .. ��-.,. ......../ .. .
f Board—of eaith
DATE...............•.....................................-...........................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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