HomeMy WebLinkAbout0160 GLENEAGLE DRIVE - Health (2) S M E A,Ili
KEEPING VOU ARCANiun
No. 10334
2-153L.
MADE IN USA
GET ORGANIZED AT$MEAD.COM
a-d
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
Location dress
or Lot
ner Address
Address
U Garbage Grinder
04 Other fixtures
Design Flow .... ...�of , ----gallons per person per day. Total daily ----gallons.
P4 Septic Tank T
Z Other Distribution box ( ) Dosing tank ( )
04
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
The undersigned agrees to install the uforedeacribod Individual Sewage Disposal
the provisions _ Article -- _ —the State ._—._� �
operation until a Certificate of Compliance has issu b th oard It
ai
---------------------'---'---'--------------------------------------'-------'---'---
Date
| Permit No ---
| Issued_ .............o°te
^--'^—'---'--'—---------------'''''''------'-------''^'-'—''—'—''''- '---''—'''�
1
No. •--------- Fs>m ..... ................ 1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_..... ... ._ ..... .......OF...........................
Appliration for Uiipnoat Workii Tonstrnrtion rumit
Application is hereby made for a Permit to Construct ( ) or7Rair ( ) an Individual Sewage Disposal
System at: "
� � L ocatioi�d� ;�V^ � or Lot No.
...........r --............................. ................ ••....._................ ......-----•--••----.......
W C ,• s�': / Owner �'��L�--. Address
Installer Address
UType of Buildi> ^""" Size Lot............................Sq. feet
.- Dwelling--No. of Bedrooms....................................................................Expansion Attic ( ) Garbage Grinder ( )
p-, Other—Type of Building ___________ ................ No. of persons............................. Show. - afeteria ( )
Otherfixtt es ------- ----------------------•--•------•--------•-----.-------------------------------- . ---- --------•-------•--•---
W Design Flow.................. ... ............gallons per person per day. Total daily flow---------------------------------------------gallons.
WSeptic Tank- -Liquid capacity/(Q `t�llons Length---------------- Width---------------- Diame er__-_.._.__-.._. Depth-_.._-__-___----
x Disposal Trench—No. .................... Width........ nge
� Touching area..____..............sq. ft.
a
3 Seepage Pit No�.................. Diameter/.t.v.? epth be ow ' ....... ...__.._ otal leaching area________.____.•_-sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY..........................................................--•-•--•-•••----- Date------------------------------------....
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----___--__________- ---
(X, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-.__--_---__-_-_---__.
�,,� •. -
O Description of Soil_______________ .�S-7- ... - -
x ---------------------------- -----------------------------
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 the board of health.
Signed ---------------------------•----------------------------•-•-.---•-••------------• ...
: Date
Application APPlication Approved BY r
f ? r / Date
Application Disapproved for %e4 ollowin. ate. . I`
-- .
- ..............................-- -----•--•--- -- --•-•----------•Date----•-•-------
1P
PermitNo........................................................ Issued............................ ...........................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.: . �pr�ifis��.e �f ��rnt�r�tttnre
THIS I TO CERTIFY That the lndividuai age Disposal System constructed ( ) or Repaired ( )
b — 1-�
Y - V7----------- •. •. ---------- ---•••••••-•---•-----••--•---•-••••------•......---
t. + r nstaller
at ------------------ •----•----- --•-•--•-•---•---------------••-•--------------•--------••--••----------•
has been-installed in accordance with the provisions of Articl �I of The State 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.WILL FUNCTION SATISFACTORY.
DATE ................................................................... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r i
kso. s - FEE........................
No.
Permissionis'hereby..granted -= ---------------- -----•--------••--•---------•--•••••-••---•..-•-•--
_..._._
to Constru ( . )- or ,Repair ( )-.ap ,Individual:Sewag2_Dispo,4L- s m r ,
at No
--------•------------------------------------------------------------------,--------------------------------
Street f
as shown on the application for Disposal Works Construction Permit - !- ____. . ated______..=`f.__a. `_.__"___ -
----------------
Board of IKaTth
DATE zv � --- ---••-
FORM 125 HOBBS & WAR N, LISHERS