HomeMy WebLinkAbout0158 HIGHLAND DRIVE - Health (2) /S� fh�P/�,cGt�i. � .
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
1 ............OF...........4..ae/_ .......... ...
Apliliratinn -for Biipngttl Marks Tonfitrnrtinn Prrniit
Application is hereby made for a Permit to Construct ( ) or Repair (1/) an Individual Sewage Disposal
System at:
........ ..t Ad t or Lot No.
a ......... �` ! ,=fir'L"_)�.._.. .-. -a....... Address .... ....
nstaller r Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building .---_-.. _-------------- No. of persons_----_--..-.-----.-.------- Showers ( ) — Cafeteria ( )
QOther 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 ( )
aPercolation Test Results Performed by.......................................................................... Date.....-------------------------------....
a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth.to ground water.........----------.---.
fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........------I-------.
Ix ------------------ ------------------------•-•--•••------------•-•--••---------.......................................................................
O Description of Soil-..
U ----------- = ----_------_---- --------------------------------------------------------------------------------------------------------------------------------------------------------
VW ------------------------------ ------ ------- ----------_---
Nature of Repairs or Alterations.—Answer when applicable....... ..1Lt- .... - ..... _ ..._...--.. ...- .
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
��
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b is ed by the board oi health.
Signed •�r�.'�!... ...... .-+'� / �(
/ Date}
Application Approved By...--- -. -- _ y
Application Disapproved for the following reasons:........-•-•---.-.-.-. /
Date
---------------------------------=----------•-------------------------...•-••--........----.........-•••---.........-----......................------------.....---------------....•--------------•--•-
Date
PermitNo......................................................... Issued................... ..---...........-•--••-•........
Daatete
No.........`J�'.�.... Flms..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEAL
rnW ............oF .......... �.
Appliratiun -fur Bi-gVooal Workii Cnunitrurtiutt Vanift
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at /
......................................✓� 1`) F 1 P=..Y,..�i'.+c7 f .J,l._,"�'+s'�'S� i"/? 'tC�./..........`�•`/] ... ......_. .._.._._. .............................. ...... _.
tion sa "or Lot No.
} Addres _
f fer Address
............... �!rt 'r! • _ ,r- ='-�=`�---------------------- -•- '----
.
Installer Address
Q Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
QI Other fixtures
W Design Flow............................................gallons per person son 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------------------scl. it.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by------- ---------------•---•-••-•-•-•••••---......------------------ •... Date---------------------------- --------....
a. Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground wafer..-.---:-.---.-----._-_.
fz Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--.-.-__---------.._.
---------------------- ---------------------------------•-----------•--.............-•••••......•••..........................................................
G
x Description of Soil___;? !?+!^ ._.__..._._
v -----
W
U Nature of Repairs or Alterations—Answer when applicable......1)_—-If? ?... -------------------------
------------------...................... •-•-------.--•--------•---••---------------------•----•---------•------•--••-------•-------•---------------•-------•---------------------------------......---
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 b-e is ed by the board of 4alth.
Signed ---------r .-----`- -•-----•• ----•-•-•----•--•---••-- -(�.. --/-- •---
G t Date
Application Approved.BY---------- : �-------------------- ----- -------
Date
lJ
Application Disapproved for the following reasons:..... .......................•---•------------...........--•--.......-•----.....--•---....----•••.
.................................................................................................................................................. ------------------------------------------------------
Date
PermitNo......................................................... Issued...................... ---------------------•---••-••--•
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......... r./..1�.......OF............. .� ..
�p ttfiratr Of Tomphaurr
THIIS IS DV CIF, IIFY, That the I dividual ew Disposal System constructed ( ) or Repaired
!� p _
by •.... ....-=rKed
`/ "f - .
a e
at. ------- -- -•G�----- - ---U - •-• ---- -_ .----•-- ............. ..,rid-�►� .!l.:..--.-f-�-. -.
has been insin accordance with the provisions of c. XI of The'StatVariitary Code as described in the
application for Disposal Works Construction Permit No _7.....1��.r .............
.. dated--- '-s lJ 7 -6................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............. --------- p- Inspector. ='
THE COMMONWEALTH OF MASSACHUSETTS
7 6 BOARD OF HEALTH
No. r j t..........OF......�(�.. ...... - ....... :.................
FEE..... ---•.............
Nispulitt lurk Tu 5 rtiutt rrr it D .
Permission is hereby granted------ 1 �� - ... �:#%% si2 c " ' d .....
to Const ) or 1R'eppair a I ividual age Disp sal Syste /
at No..
r
Street L,
as shown on the application for Disposal Works Con ruction P No____ ______ ___ ed....
.. .. -----------------
^-V [/ ..................................... Board of Hea th ..
DATE.-----�__�-----------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS