HomeMy WebLinkAbout0209 GLENEAGLE DRIVE - Health (2)r d0�f Gler�gle �Jr G�.t
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
ApplirFa#ion -lox BispoiiFal orkfi Cnomitrurtion Vamit
p0q Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
A -
tion-Add ess f r A or No.
..
wner Address
-•--•---------JY!" " .--—.... ��� •... --••-•-----------•----••-•--------•-----•-- ,
Install r Address
dType of Building Size Lot-r,_Ak/.._......Sq. feet
Dwelling—No. of Bedrooms.___-s3,................................Expansion Attic ( ) Garbage Grinder ( )
______________ Showers [9l. Cafeteria Other—Type of Building Air _ _ __ No o persons_______._____ (' ' • ( )
d
Other fixtures .� ,..__:<- _,____ _ ,�_
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacitvld_CG2__gallons Length---------------- Width..--_---..--..-- Diameter__.--.....-__-_ Depth................
xDisposal Trench—No_ ____________________ Width_------------------ Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No-------/.----------- Diameter.................... Depth belo 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 Test Pit.................... Depth to ground water_..-.---__--_----__.----
f14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_.-.-.-___----.___-----
•. I
O — y 9----•--• •---•- . ._y/ —^.
Description of S ' _ �. .. -- ----' • -••--•• -• = 2t� '
����
Vx = :c �- %�./.� ------------------------
---•--••--------------
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 been issued by the board of health.
Signed. ---•- --------------------------------
Date
Application Approved By.. ate
'� -----------
Application Disapproved for the following reasons:...........................____.. ________.__._______.____.........._....__.____._..._..._D ._............
-•..............•-----........_..---•-••--•--•---._...-------------------•-•---------•--•----------------I------•---------....----••...-•-•-•--•••-.......------•----------....._.....------------•..•---
_Date
PermitNo......................................................... Issued.. .......�� � S
Date
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
_... .... .OF....... ......................
t
.P.pliration for Uttiv sal Works Toustrurtion Vrrmft
Application is hereby made-for a Permit to Construct,( ' ") or.Repair ( ) an Individual Sewage Disposal
Sys)em-at
V, .o
tion-Ad ess or Lot No.
,,.,�/
-- i--
wner Ad rest - ._... �_-
a ............. ........ ...........--•---------..................
� Instal r "s Address -
UType of Building Size Lot_ ........Sq. feet
Dwelling—No. of Bedrooms...... -----------------------------'---Expansion.Attic,( ) Garbage Grinder ( )
pa.., Other—Type of Buildi>#�� Noofpersons_____________ __________ Showers (� ) — Cafeteria ( )
a
Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow_:-------------------------------------------gallons.
P: Septic Tank—Liquid capacity/�d_6...gallons Length________________ Width_..........`_.'Diameter_..._-.._..____ Deptli..._____._.-.-
W ;
x Disposal Trench—No. .................... Width--------------------- Total Length____-_---.--_____-_. Total leaching area-.------------.-----Sq. ft.
Seepage Pit No....... ------------ Diameter.................... Depth below inlet...... ..... Total leacliiii�area____--------------Sq. It.
z Other Distribution box ( ) Dosing tank ( ) O jidG ++ � :'"` ` 7i/.
Percolation Test Results Performed by.:.................................» Date--__._-----_-._.:-.-_---.-____.----_.--.
Test Pit No. 1-------------___minutes per inch Depth of Test Pit--------------------- Depth to ground water'.-_.--__----_.___...-
(14 Test Pit No. 2________________minutes per inch Depth of.:Test•Pit__..--_.__-______---- Depth to ground water--._----___-___.----.._
�., ------- -------
D 1_.T-- - -- --- ----- Y.,.... .1:4--------- ------6-------•--..._..
Description of Soil 40. f-� 9 1 :6s C ---- ---f 2-----------------------
W --------------------- ---- --------s� --------- -------- -� - -- --� ----- --
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:
igned...........-- -•-----•--•-----•--•-------•----------=-------•-.--•--- ----------------
.-.... ate
APPlication Approved By------- -- . --------
----
Date
Application Disapproved for tlae following reasons:- .:::..:....................•:.___ :_._..........__.____.,........__._.___.........____.....................
.----•--••-••••••----------------•----------•_----------•••----••----•-•=--------•-----••---•----••--..........----••--------=----••••--•-•-----------------•-•-----------•••-•-------•••-•-•--------••--
Date
PermitNo..............-•--------•.............................. Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ro_-��,411. ..........OF.............. .�..........
F (9rrtif irate of f.T-11m;Aiztttrr
THIS IS TO CERTI_ Y,, iat the Individual Sewage Disposal System constructed ( or Repaired ( )
by---•----
allg
at........ eZQ';_- - -• - h-slat ,�' ----------------•---•-•--•-------------------•-•------------•--------•-------•-------
has ben installed iri ordance with the rovisions of Article I of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No........... 10............... dated_...---_ '�,
THE ISSUANCE OF TEAS; CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. — .. ....4.......................... Inspector------- --
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
.......O F............ ... .. . �G 'T""
No.--•-- � FEE---- "" --
Uin:po'iial ork,i �II itru filattYrrmit r
Permission is hereby granted ..-•... - --••--•------•--...--••-------•--•-----------•----
to Constructer r Repair (. an ndividual Sew ge Dis al tem
atNo......Ucl 1.... � i�• w ............................ ... ................
- ` .treet -
as shown on the application for isposal Works Construction p'er No.._ D ......
,.
��
......................
Bo r o Heal
DATE.---•�>-_-�---•-�--------------------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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