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HomeMy WebLinkAbout0012 KALMIA WAY - Health (2) 1 � - lf oo � No......................±: Fss............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..... Applirttttan -for Dispoml 10orkii Tonstrurtion Prrutit Applicati n is hereby made for a Permit to Construct (�r Repair ( ) an Individual Se wag isposal System at: N: %4j A ...... C .., Af - --.• . ••-•------•---------- ----• ----- ....... Locatio •Address or Lot No. Owner Address { a .....00.0 -!1---------------------------------------------- ---•-- ........ ............................ Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........../-------------------------------Expansion Attic ( ) Garbage Grinder (M(j Other—Type e of Buildin �'_.�•1 /p-, yp g�_.-!�_..__..V_&___ No. of persons._.....,1................... Showers ( / ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------------------- -------- ----------------------------------- w Design Flow.......50.............................gallons per person per day.. Total daily flow---1O.O-.-_----_---_-----------gallons. WSeptic 'Tank I Liquid capacity/dWAgallons Length---------------- Width................ Diameter----............ Depth---------------- x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area..._-.--_--_..._----sq. ft. Seepage Pit No------.I----------- Diameter_/d'71V___-___ Depth belo�}�° inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) O,7— ,P-ClA,�- y/, i 9- 7-7 Percolation Test Results Performed by................. ................................... .................... Date--------------------------------------.. Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ f� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ ------------------------------- --- - - ---------------------- Description of Soil--- --------- ----� c r� rr� !`? --�••��`� � -4 - - a r w U Nature of Repairs or Alterations—Answer when applicable........................................_..._._..._.__.__.__.-___..-_........---__.--.......-.-. ----- Agreement:'? The undersigned agrees to install the ore cribed Individual Sewage. 'sposal System in accordance with the provisions of Article XI of the State Sa nary C — The finders' ne u the agrees no to place the ystem ' operation until a Certificate of Compliance h s be is ued by the 'r o h igne -•-•-----------•-• --g.. ---• ---•-•-• � / Da ^7 Application Approved By.. ----- �- ----- --.----- �..-a Date Application Disapproved for the following reasons----------------•---•---••--------------•--------------•-----------------•------------------•--•---............ •.........--•---------••--••--••-•......-•-------------•--••-•-•--------•-••••-•--••--•---•-•--•••-•••-•....._..---•-•........_.......-•-----------•--------•--•--•--•-------•--------------...-••------ Date Permit No.....................................------------------- Issued... .__�_`� _� 7 Date J , •- Fic$...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF............ .........- «. ,��s��irtt�i�at -��nx-�i��u�tt� lyrk� Cnl�tt�#rttrtimyt �frr�tit {.` Application is hereby made for a.°Permit to Construct , 0"o'r Repair an Individual Sewage Dis osal PP Y (�1 P O b P System at W ^• �o i Addres _......._.. ! .. or Lot No caner Address.... - Installer Address U Type of Building _ Size Lot---- --------- Sq. feet t Dowelling—No. of Bedroo s-.__ f _________ ____ Expansion Attic ( ) - Garbage Grinder aOther—Type of Building :..-_ A06-- No. Of persons _.__/___ ______,;,: Showers.'( 1 = Cafeteria ( ) Otherfixtures ------ ----• -------------------------------------=- ...................................................... W Design Flow._ d t ___--gallons per person per day- Total d ally flow Zd d gallons. � Disposal Trench ic all Liquid cap acrtvdi} g��ilns--_• Length Total Length Width --------- Total leachin" area--=I�eptli -----sq.• ft. Seepage Pit No-------, {_:.DkLmeter Depth" belo ::`inlet. _____ .Total�,leaclii g area sq. it. z Other Distribution box ( ) Dosing tank ( . )„eA►, �r A aPercolation Test Results Performed by.............. Date............: Test Pit No. 1................minutes per inch Depth of "Pest.Pit.................... Depth'to ground water ____---___-___-__ GXq Test Pit No. 2................minutes per inch Depth',ofa Test.Pit __.__; Depth,tb,ground water-------------------------- ----------- - - O Description of Soil ' ' * ' ' t"" '% J ryY u.. --. -, W ------------ - -- -------------- - ---------------------------------- ----- --------- - VNature of Repairs or Alterations—Answer when applicable ---_ "_' _-__ . u <: w ; Agreement: The undersigned agrees" to install the ore` cribed Individual Sewage sposal ,Sy st&m to iaccordlnce with the provisions of Article XI of the State Sa` tart'C — The finder n u Elie agrees n. to place the, ystem operation until a, Certificate of Compliance;h be is ued bye, r o h j ign -- - - - - - -- 1 Day Application Approved By------------ -- / ___ ,, +"' ram.. 77 at Application Disapproved for the following reasons: ______________ ____'........................_ .-___- .. ... _____= r •------------------------------------------------- --------------------------•---------------------- ------- ----•--- ----- - - -""'--------------------------------------------------- Date PermitNo................--------- ........................ Issued.------ : �f--------------------- Date THE COMMONWEALyTH OF MASSACHUSETTS BOARD F HEALTH .. OF..... i Qlrr#if hair Of TpMplittatrr T IS, 0 lIFY ' it the Individual Sewage Disposal System constructed (" ) or Repaired ( ): bY------- �E �» : ------------ Install y at _. _.X! . Ydn._..._. - _ J f! ...Joy* ry.D has been installed in accordance:with the provisions of Ar e' XI of The State Sanitary Code as described in the 9 application for Disposal Works Construction Permit No.- t�� �. -- ---------------- dated---• `�-�_-_`�_`•�._. THE ISSUANCE AF THIS.;CERTIF;CATE SHALL. NOT BE CONSTRUED AS-A GUARANTEE THAT THE SYSTEM W!L FU CTIOLV SATISFACTORY, .......r-7---------------•--- ---------•-•. Inspector-., l✓ - - ----- THE COMMON WEALTH?OF-MxASSACHUSETTS - BOA'RD O HEALTH !1 . .. ..OF.... ...........................................-.. •-.. ....... .:... . No.----- / FEE. /��� - • �i>����ttl err k� la�,��r ��r�il�$t �rruti� Permission i . hereby granted_••---- °� ` '.._.... --•----------------- to Construc : ( ) Ur Repair an I ividual ,age Disposal .ystem /f ` at No.- J� -•-- '!!�" •.A--*..-----( J:- =4 - -------------------------------------------- Streetf��� as shown on the application for Disposal,Works Construction, Per • N ----- _ _____ / p�/'7 7 ated- /�------- - --------- 1 Board of Health y DATE_ r.:.__P . FORM 1255 HOBBS L.-w."ARREN. INC.. PUBLISHERS r' wpm ZO FIT MIN. M g4T m(N. 4d-pi!C. PIPE, SCLEANV SAND F a CONCRETE T � -_ o 7;o COVERS �N 't z_ PER- FT _ . �. CO�ICREE - OVER � C dFR ` 4 , LIQUID LEVEL ;...,.r CASE'- o 2 YER PIPE OF .6 3f6" ^W i o @ / g -SEPTIC' AN d FT o >�Box I u '�' '`s ,_' � �:,. .:. •. ram" � c _�. ♦ ♦ z�, � _ ••<. � .._, WE 77 _ .. _ •'e - . — i,tit/ � �. ' WF ryp,1 �B jt{ Y 94:6Y.STE LWT . S; PAE PIT 9 :z FT 3 3�C,A�C �. // ':O R 4 TIM =� - - li .. _F 0 3 _ L��tEN . a ,. - - .4Gt coC S0Li9t. 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