HomeMy WebLinkAbout0008 HIGHLAND DRIVE - Health (2) W�flj-fld Dr.,
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THECOMMONWEALTH OF MASSACHUSETTS
BOARD
--• ------ ---------OF...... .... .. .... ... .. . .. • -- . ---...... ..........._._.......
Appliration for i pout Marks Tonstrudion Urrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Dispos
Sy � •... pa,1 0... ... .. .. ` '= --- ..... ..............................
L tion-Addres t No.
....... ..... ... ... ......... _. ..... ...�...a.wr..................
.t. .-
wner Address
I al er Address
Type of Buildin Size Lot...........................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Pk Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other 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 ( )
Percolation Test Results Performed by---------------------------------------------------
....................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�TA Test Pit No. 2................minutes per inch Depth of Test Pit........... _... Depth to ground water........................
----------------------------------------•---_-. . - •- --------------•- --•-•-•-----------------------------------------------------------------
0 Description of Soil....................... --------••--
x
W -----------------------............................................................................................... ---- --- ....�-----------------
UNature of Repairs or Alterations nswer 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 Co e— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ssued by e ar health.
Signed` '. `.. .... ,f1'
D to
Application Approved By........ ;fiL.!1�.,
- ------
DAte
Application Disapproved for the following reasons----------------------••---....... .--------------•--•---------.....-•-----z----------•------�-e---..�--..
...•..........................T......--•-•...---•-------•-•--•----------•---•----•-•-••----------------•.......................-------•-•••-••---••----•...-•-----•-----------------•---••....-----.....
•• Date
Ig Permit o......................................................... Issued..,!- -••••.• -
......
Date
---_- ---- -- — --------------------------------- ------------------------------'
No........L...a...... FEE.- ...... ....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F HEA► H .
-
-
..... OF..... ..... .. .
App irFa#inn for llispmai Worko Tonotrurtion ermti#
Application is hereby made for a Permit to Construct ( . ) or. Repair ( an Individual Sewage Dispos
... •• dd ......... --._ ..............................
�I L tion•Are Lot Nod
....... _._. .. ... ...... __ _ ..._ _�............................
ner Address
I al er Address
UType of Build. Size Lot............................Sq. feet
�-, Dwelling—No. of, Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons,............................ Showers ( ) — Cafeteria ( )
P- Other fixtures ................................................•......................................
WDesign Flow_____________________________:___________._._gallons per person per day. Total daily flow_________________________________________.__gallons.
WSeptic Tank—Liquid:capacrty _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 ( ) - I • .
Percolation Test Results Performed by........................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit..................__ Depth to ground water........................
rml Test Pit No. 2................minutes per inch Depth of Test Pit...........
____ Depth to ground water........................
P-I' •----_-• --------------- ....•• -•-------.........................................................
Description of Soil____________________
c� -•••------------•••----..._...-••-••--•••-•••--•••••••••-•----•••-•--•-•-••-••-•••••..._.......•••••••-•-••-•••-•--------------••-
W --------------------------------------- -- --- . - ---- . ._......._........_._
___
V Nature of Repairs or Alterations nswer 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 Sanit.* ' 'o e— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ssued by e r health.
Signed '> ��s--- •--•--. :.
Application Approved By - ' "
V
Application Disapproved for the f ollozvmg reasons: ......................................................D•......•••-•--•--
................•--•••-••••••••••--••••••••••••••-•••-•••••.._-•--••••-•••••.._...••-•--•.
Date
PermitNo......................................................... Issued----- 7
'--- •---------------
Date ^THE COMMONWEALTH OF MASSACHUSETTS
,. BOARD F HEALTH
t.. .'..:OF.... ,, ;�js, ,o .. ._...._...... . ..... .._...
TrdifirFate jad Tlimphattrp
T IS I 0 . RTL.FY,,That th Ind>vi 1 S ge Dis osa y ', onstructed ) or Repaired
by # ,, it = ..................
ns aller -
(^�f
has been
11applic application forDispo al accordance
Con.Construction Permit No rticl7 -of The State Sanitary dated_---Code a� described mthe
THE ISSUANCE OF THIV CERTIFICATE SHALL NOT BE,CONSTRUED AS A GUARANTEE THA TIE
SYSTEM ,WILL FUNCTI N SATISFACTORY.
..... Inspector '.. r ,, .--- �.:....
DATE...'.:)_• ;` ..... .
f
THE 00JMMONW'iALTH OF MASSACHUSETTS a{
BOARD HEAL-H
r
No...... ...._ . ...,. F.. .• -----••-••._.........••.... FEE.-2...............
• � �t���t�Fa� �� - • �T�tr�t���t �nti�
Permission is hereby granted....:n..• .......... .................................................
to Constru ( ) or epa'. ( an, ividua "Ijispo 1 S st q
at NO..
��e s:3k !fly. L�f� ."' .......
'.
Street /
as shown on the application for Disposal Works Construction' PgzV No._._._ ted_-,.X
7.•• - • v - B and of. Health - ?..............
f,. DATE......... .•'.... .,
-...;
FORM 1255 HOBBS &-WARREN, INC., PUBLISHERS .4