HomeMy WebLinkAbout0029 HADRADA LANE - Health (2) a� FI�cPr�,�FA Ca, .� �e�$ .
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THE COMMONWEALTH OF MASSACHUSETTS r�
BOARD,�k
" a /L
:.... '"�....... ......OF...........................-..-----.... -- ......-....--.-.-..-...:...
Appliratioaa -for UWVviiFal Works Toaastrurtioaa Prrutit
Application is hereby made for a Permit to Construct ( or Repair ) an Individual Sewage Disposal
System at• . * 1
-Locatio---Add��j l.� Lot No. ..................................
------ ( - -----••-•--•.... --•-" --•- ----- -f�
ow el
re
Installer Address
Type of Building Z— Size Lot......!�1'. _Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------------------------------------------------------------------------------------------------------------------------
Design Flow_____' `____._ ._____._gallons per person per day. Total daily flow..._._.._._ e�V___________________gallons.
W ----------- --- g� P P P Y• Y --- --- g�
W Septic Tank—Liquid capaciXgallons Length---------------- Width--------------- Diameter__-------------- Depth..........
-
x Disposal Trench—No_____________________ �Wid _ ___._....._._._ tal th_ _. .. Total leaching area.....� _.sq. ft.
Seepage Pit No_____________ ___ _ ft/1--
c �`-_______ -- Total leaching area-----------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( i' ) --"8h. /�— ,7-
~ Percolation
n t Re minutes by sults Performd inch---Depth-ti= --
----------------•-•----••-•----- --------•-••-••-•---• Date_--- ---•---------------- ------------
perTes
of Test Pit____________________ Depth to ground water---_-______-_____--_-
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......___-___-____----
P4 _._.._...__ ----------- ...................•• w---- l.... ff
Descr of Soil-------- •- ----• --•---
1 W114
- �;
x --------- - ------------------------------------------------------------------------------------ Y
j
-----------------------------------------------------------------------------------------------------
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 bee issued by the board health.
Signe
CG -------------
Application Approved B
Date
Application Disapproved for the following reasons:---_------ --------•-••--•------------------•.--------•-•--•-----------•-•-_______________...---_-•---
---•--••---•..._..••----•--•-•-••-••-••-------------•-------------•--------•---••--••----••-•---------•-•-•--..__._.-----•-•--•---------------•---•---------•-------------••-------------•-------------
Date
PermitNo. ------------------• Issued........................................................
Date
�-------------- •------------------------ - - - -
No.........3 ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD PF HE • L,7fH N
OF.......�•-.%w��..C1` �
Appliration -for Diipoial Works Tonitrurtion Permit
Application is hereby made for a Permit to Construct ( t)-6i Repair ( } an Individual Sewage Disposal
System at 1U-��
Locations Addres;�� or Lo No.
Ow er � dr s '�
a :.-p
----•--------•----•--- .� ./-_4/\ -- -- -• -- ---------•-_---._.......--------`-
le ---•---•------------------------._-•------
IFIF
Insta r Address `� ���
S feet
U Type of Building Z�- Size Lot____________ ____________ _ q.
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ---..___.--____--------------------------------
W Design Flow.......:1 --•__-15 ......gallons per person per day. Total daily flow------------acam ------------------gallons.
WSeptic Tank—Liquid capacity,/,,*.. .r__'allons Length................ Width................ Diameter_-.-....._..____ Depth_..-.-__.,__.
x Disposal Trench—No-___________________ Widt _ _.--_____--'�Ktal�en th..t,--� -------- Total leaching area..... r-� ...sq. ft.
Seepage Pit No.__ _!_
�r , C`c�ia eteEe-= C�7 D.e e'l o in9et--p j L .. Total leaching area__._..._.._______sq. it.
Z Other Distribution box ( ) Dosing tank �/✓• �� 71"'
Percolation Test Results Performed by.......................................................................... Date----.-----------------------•--•-------
,� Test Pit No. 1................minutes per inch- Depth of "Pest Pit.................... Depth to ground water...._-_-_.__-.---_..___.
f� Test Pit No. 2................minutes per inch Depth of Test Pit.--_-_- .._--___ Depth to ground
/ ' - _ water r--.--._.-__---.-.-_-___.
----------- ---------------•----•. ------- ---------
, � d ,2 -
Description of Soil '# - 6
-- - ----
(,----- . •.-- -- ••---- ...
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 o health. `
Signe _ •-------
/) ,
Application Approved BY------- 1:��-tit.. ( d
Date
Application Disapproved for the following reasons:................................................................... . ••--•-..._.__........._.......
....................................................... --•-----•---•--......----•------------------•--•-•-----------................._•-•-------•-•----•........------------------....................
Date
PermitNo......................................................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD,-OF HEAL
.................................... .O F....................................................................................
Qwrtif irate of f IlImpli�anrr. a �c�
THIS IS TO GEIi IIF , Tha��the �flividual Sewag •spo yst construe e �)o Repaired (� )
bY....................... �"�' " '•rang - �._ = =,
/ " Install _ /'9 T' h! l i
7cU� %C
> 4
t.l
at ............
has been installed in accordance with the provisions of trticl$_XI ofTie State Sanitary Code as described in the
application for Disposal Works''Construction Permit No1`,.__.-_--________________________________ dated..._��_'__�.I..... ...I .......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL F CTIO . S TISFACTOR1f.
DATE------- / G Inspector -
/X -- -----------I----------
r� THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF rtLTHOF ' ,
ti
No......................... FEE-- •---------•---•---
i o ttl orkii (nomdrurtion r
Permission is hereby granted______________ _________ __ ..._ ..............
to Construct or Repair,(. �) an1 Individual Sewage Disposal Syste
at No. ...A' �-�' '." .! .-cam`' ,-,. -rf•L'/<:R,..f�:.,w
. -=-----••-••-•-••-•----•-----•----•••----•---•-•-•--•---••-••--•--••......
Street
as shown on the application for Disposal Works Construction e mit r .,V _ ated___1U................................
. J
----yl -.- LL............ -- ------- ..............
+� Board of Health
DATE..-- ±'„ -----------------
FORM 1255 HOBBS & WARRENN..INC.. PUBLISHERS
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