HomeMy WebLinkAbout0082 GLENEAGLE DRIVE - Health (2) 8d (�I e�-erz (�, priV�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............B NSTABLE--------------.........
...
Appliration -fear Biiipaoal Workii Cnonstrurfion Pprutit
Application is hereby made for a Permit to Construct ( -�' or Repair ( ) an Individual Sewage Disposal
System at,
_ZC
2 ,
..... ....... .-.-.-.. ..... . ---.-.-.-.-.-.-.-.-----.-.-------L---------------
.......� :.._�...._-_.--•-•-----_... 0S:e . --------- ..•1. 1-•-iS .----'---'•----•-•-•---------------------
Lo ation Address ✓� t t .... '
Ownrs� � Address
......................................................................... ....................•....------_---•---
Installer Address
Type of Building Size Lot...�ss..7 .z......Sq. feet
U Dwelling��No. of Bedrooms__ _________ __ ________________________Expansion Attic ( ) Garbage Grinder ( )
P4 Other—Type of Building _ 06---------------- No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtu s
------------------•-----••-•--------....---------------------------------------------
W Design Flow....................................� �s per person per day. Total daily flow-------------------- _ ..._. ......_-_..gallons.
9 Septic Tank J -Liquid capacity-_'. _----- llons Length---------------- Width.... Diameter................ Depth--------------..
x Disposal Trench— 0..................... Wi th-___.___.___._______ Le ...... -------
otal leaching area--------------------sq. ft.
Seepage Pit No.-----�----------- Diameter.1� -. ] p w�inIet_..---•----•••-•-•. Total�Chilig -------- sq. ft.
z Other Distribution box ( ) Dosing tank
aPercolation Test Results Performed by----------------------------------- ------.......... .................. Date____---..--___-------_-.-_-`-"
a Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water.--._--..--_--_--.------
(14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.--.--._-._-.---_-.--.
-
O Description of Soil-------------- - --._ ___ .
x - ----- - - -
U ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W
VNature 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 ben issued by the board of health.
igned . ... �' ` ?
Application Approved By......-- --. p
Date
7
ate
Application Disapproved for the following reasons: ---•-•-• •-----
..........--•--------•...-•-•---•'•-----_...'--------------•--'----------.•--•'•-'•'•-••-•----••••-•••••..........---•---•-------------------------------••-•••--.----------------•'-----•----------•--•'
Date
PermitNo......................................................... Issued...................... .................................
Date
J�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_. ..... r< :)-7. 0F...............BA�t 1ST:4BLE....A'._ ..i"7l-Af
Apphrativit -for Biiipoiial Workii Towitrurtion Permit
Application is hereby made for a Permit to Construct ('-) or Repair ( ) an Individual Sewage Disposal
System at: / r
---.....
-.................................................................. ----"••-•-'-------•--•---'•'........-•'•--.....................................................
i y - Location-Address �� or-Lot No.
--'---.........`....------'•.......-•-••"................•-•--..__............................ ............................_......................._..........................._.............---
Owner -� /� {_ Address
ai •-- -•----------•--•-••----•-••-•-•-------•---•--
Installer Address
d Type of Building Size Lot.. ------Sq. feet
Dwelling—A-'No. of Bedrooms----------------:3.........................Expansion Attic ( ) Garbage Grinder ( )
per-, Other—Type of Building �------__ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
PtOther 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 ( )
aPercolation Test Results Performed by.......................................................................... Date---------------------------------------
,� Test Pit No. 1................minutes per inch Depth of "lest Pit-------------------- Depth to ground water...-__-..----._---.-----
44 Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water.............•-_-___.__.
P+ ---- ----------------"---..................................................................................................................................11
..
0 Description of Soil C'r"�- -------------------------------------------------------------------------------------------------------------------------------------------------
x r
w
VNature 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 b n issued b the oard of health.
Signed..... ---------------•--•-•---
3� -9� ?s
-•-•-----•-- --------
Date
ApplicationApproved By................................................................................................. ........................----------------
Date
Application Disapproved for the following reasons:...............................................................................................................
•-----•-•------------------•-•---•-•------•--•---------------.----•--------------------•-•-------------------------•----------------•-•---------•--•-------------------------------------------••--.----
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... r" �1.......OF...........BA-RNS'T.ABLE
.................................. ...............
(�1r-dif iratr of Campliaurr
'TH�$ O CAf6kt
IFY That t'hetjndividug-Sewage Disposal System constructed ) or Repairedb
y... .... -
Instal er ni� r
v ---;i..........
......................................
has been installed in accordancejwith the provisions of Article profs-T-� State Sanitary U e des�19edCin the
application for Disposal Works Construction Permit No____________________"`.___ ________ dated---------- __ ._.•............
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL--nFU CTION,,SATISFACTORY. f ,�� ✓r n ;,✓'�
DATE-------•- ....................................... Inspector----------_-_'_-'a- ----.------------------ --`-'.----C1-- ---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTHd,
s;� ........... .. of.............J�AIt�1ST'ABLE-.......----------------........ `•�,
No..... ...... __, FEE.
Permission� eereby granted----..P ............................................................ rr
'...
to Constr..uet� �or e a r- ( )(An nd victual Sewage Dis,o,'sal Sy;�tem --�-�._
LC
at No.••"-=�•=(-•---•------- 1. Y�- --------------------------- ---- ------
�� Streets-o r-� ---- -
as shown on the application for Di p sal Works Construction Pe/r "i?Co......._ -Dat" �:U. __ _ - �...
•------------ -, m-= yl
/� !� ' Board of Health /
DATE------- --------r----� ----------------------------------------------
FORM r
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS