Loading...
HomeMy WebLinkAbout0271 GREAT MARSH ROAD - Health (2) 1 (� - /d r7 i THE COMMONWEALTH OF MASSACHUSETTS BOARD F =HEA TH _. ..._.......OF..... ............. Appliration -for BiBpwial lVarkii C onfitrurtion Vrrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: .... — A I ._•..... _ - _ ._.... -_�� . --•- _ _ _._ ..._ Loca d 9 or of W Address .a -.......................... ---•------.......--------------•--------------•-•-••----••--------•---------••-------•--------•--- nstaller Address UT pe of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms------------------ -----------------Expansion Attic ( ) Garbage Grinder ( ) Q, Other—Type of Building ---------------------------- No. of persons---------------------....... Showers ( ) — Cafeteria ( ) a' Other fi_ tur --------------------- ............. ---------------------------- -------------- W Design Flow. ______,_.. � _______________gallons per person per day. Total daily flow........ -___ ------__�-_ _gallons. WSeptic Tatikt Liquid capacity__-__-gallons Length................ Width---------------- Diameter._.-.._--.-_--- Depth._-..-.----..... xr Disposal Trench—N _ __________ _________ Wi li-_--_--- _---. __ _. al tl,_._.____ ._______ Total leaching area--------------.-----sq. ft. Seepage Pit No________ _________ Diameter _:__ Total leachiD area------._____.._.sq. It. e t e o Other Distribution box Dosingtank 3d` a Percolation Test Results. Performed by Date s Test Pit No. 1____-_•_____ minutes per inch Depth of "Pest Pit____________________ Depth to ground water...----------.-._-.-.._. (� Test Pit No. 2-- ------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ ------------------------------------ --................ -------------------------------- O Description of Soil--------------------------------- `.. ` U ------------------------------------------------------------------------.......................................................0..... .................................................. W x ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------•--------.....__...------•-----. V Nature of Repairs or Alterations—Answer when applicable._---------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------I........_•. ........._.. ------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued byy the board of health. gned_. L.� DVte Application Approved B _ Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------------- .......... ---------•-••--•--------------------------------------------------------------------•---........................... _ Date Permit No----------:-------------------------------...... Issued.----- ­­ ---- J.........-......... S Date 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD F F-�EA - TH Appliration -for Di,q u�ptti Works Tomitrurtiott Vinnift Application is hereby made for a Permit to Construct ( or Repair ( ) an Injlividual Sewage Disposal System at: •. /r d + v y Loca or of /+ - ?----- -- --"------- Address -- ------------ r nstaller Address T pe of Buildin U g ��' ( • Size Lot...-•---"-••-•-----• .____Sq. feet a Dwelling No. of Bedrooms.___---.-_--�,�____-'--- -----------Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building _____________________:..... No. of persons _____._-_______-__-__--_ Showers ( ) — Cafeteria ( ) G4 ` O b ther fi_ tur ----------------------------------------•-------- -------•------- - ------ -------------------- W Design Flow; ____ _ _ _gallons per person per day. Total daily flow......... _ a gallons. WSeptic T-Lli�Liquid capacityf gallons Length________________ Width................ Diameter-------- ------ Depth.--------------- Disposal Trench. Ng____________ ______ Wlcc],ttl Total leaching area..-..---__._...____sq. ft. 't Seepage No.'..-.__tf__________. lAmeterr�J___ _._._ e' t Total leachiu area__ ._ sq. it. Z Other Distribution box ( ) ?`I Dosing tank (jJ� ..- .___.�► Percolation Test Results Performed by----.--- -- •....................................................... Date---------------------.----------------. a Test Pit No. 1----------------m anutes per inch De pth!of "hest Pit_._______.._...___.. Depth to ground water........................ f� Test Pit No. 2----------------min �tes per inch Depths of Test Pit.--_-_-_________._- Depth to ground water-_---.---_-_-.--_-__--- > ------------- ---- ............... --------•- _----.. D Description of Soil'-_:_=-- ---- .�" ------------------------------- - ----- ------r_ U Nature of Repair`-s or Alterations,—Answer when app icable.................................................... ...---------------------------- ----------------------------- - - -----------------------------•-------------------------------------- Agreement: The undersigned agre to 4nstall the aforedesc ibed Individual Sewage Disposal System in accordance with the provisions of Article X"I of the State Sanitary.Co — The undersigned further agrees not to place the system in operation until a"Certificate of Com'.pliance has been i ued by the board of health. ' gned --_• ........... ------ ----------- ------ ' Date Application Approved BY--------- D to .:-,Application Disapproved for the following reasons:._______-_________________________::__ _- ------------------------------------------------- Date PermitNo......................................................... Issued-------------------------------------------------------- Date +I l ' 1 THE COMMONWEALTH OF MASSACHUSETTS d— J i:. BOARD O EALTH O r r S .......OF..... .. ... f ►" ',+' * ................................... Tatifiratr of Tilutplitturr ,,. THI -IS T CERTIF hat dividual ge Disposal ste ructed ( ) or Repaired ( ) by == - -- - - vao, 't staller v�)M} application for Disposal Works Construction;peions of Article�Idof2The -State Sanitary Code a descr bed in the has been installed in accordance with the provisions No.__-___ . .___ �e ...........i pp P -----•-------• dated /�.1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE© AS A GUARANTEE THAT THE SYSTEM WILL .FUNCTION SATISFACTORY. DATE-.-.--•--•--•----------------------=-------------------••-•--•••---••••••-•---• Inspector..................---------------•-----"-•---------------------•--•-•••-••-••__••-- �t THE COMMONWEALTH OF-MASSACHUSETTS BOARD F HEALTH ..:.......... ::j. ..... OF.., ... - 1 ,. w -- ........... FEE -•-" -----•••• Bi-ripo 1 orkii, mi ULM JJymit r Permission 's reby granted__ Q- ': • ... _ J//// tp Constr ( . ) epa-- -----• . ( a idua.. ... .. .. ............l S ge D.. .. .......• p s System at N o.44/10-- U- - ---- - ---------- i ..... .. ........... Street-- as shown on the application for Disposal Works Construction r t No:. __ __ ated..._ � __. ........... bard o Health _ r DATE___ •• # FORM r1255 HOBBS & WARREN. INC.. PUBLISHERS ; 1 • r ' f t /Vey xv d, l' ti