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HomeMy WebLinkAbout0009 NATKA DRIVE - Health (2) q �1a�"�CE, C�r�'ve , �en� . Oi t - vO No... •��-� b"1 Iliq Fims..Ys.0............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ----------- ( ` ApplirFation for UigpnsFal Works TontitrnrnnYt Prrmit Application is hereby made for a Permit to Construct (✓1 or Repair ( ) an Individual Sewage Disposal System at,: lo ......1 a ,9. ..._ ......f•......e 1 Locati s or Lot No. 1..... ® _._. -.k. ......................... Owner-------�-'- Addr --........----------------.....-----•-•-- •..640 .---5T.- es .A.v............................ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedroomss...._......�.......... ..Expansion Attic (Y) Garbage Grinder ( ) . !NY _. p ........... Showers ( ) — Cafeteria ( ) p., Other—Type of Building� ��'�___.�� . No, of persons dOther fixtures ------..-T -.b--�' QjS0.n7 Design Flow...............S.s. ....................gallons per person per day. Total daily flow.... ..............gallons. WSeptic Tank—Liquid ca.pacity.).B9._0__gallons Lengthleo6r n__ Width..:. ....... Diameter................ Depth..Y..J!!. x Disposal Trench—No..................... Width ................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......... --.......... Diameter.__ _-___-__---- Depth below inlet--_A._ ......... Total leaching area..Z©o._._..sq. ft. z Other Distribution box (✓ ) Dosing tank ( ) `-' Percolation Test Results Performed by.........).9F4i.042......A C ............................. Date...719 fl ............ Test Pit No. A.W.1._minutes per inch Depth of Test Pit.__l L 1....... Depth to ground water..Now •- ! Vwf�rtd (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a y� P r Lo Descri tion of Soil 2 °lam 5 ui?..S®1.1............... e• ...................... .t 'v...�.... �-2.........L_,T.gs� U •--------•••---------------••---..............-•---.....---------..................------•--........._._..--•-----------------------•-----------•---•-•-•••--._...---------•----•----•-_.. 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 TITLE 5 of the State Sanitary Code—T e dersigned further.agrees not to place the system in operation until a Certificate of Compliance has been is e board of health. Signed........ ... ...--- ----- -----------------------------•---•-•-------------------. D to Application Approved By---------- ----------------•----- ..•.----------------------------- ............. ..---•� -• -�z---e� -- --------- ate Application Disapproved for th ollowing reasons:-------•--------------------------------------••------...--•------------------------....._...--•---------...._.. .............................................•---_...._..._...------...........---------••-•---•-.....••.•----------------------------------•--------------------------------•-•------------•---•-•---•- Date PermitNo......... . .........®.��8__.._.. Issued-........................................................ Date Of No------------------------- Fxs............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...................................O F.......................................--------------........._......---.................. Applirtttinn hur DiSposal Works Tonstrurtiun "anti# Application is hereby made for a Permit to Construct (✓I or Repair ( ) an Individual Sewage Disposal System at: ... ......�:d l..�y3-.. -- (J-o�,e,�-��..e1�� .....:........ ........,•1 ev. ......................................................... Location•Address or Lot No. -----••-------••-----•--------•-----•---- spa' o d k.. _T.....LA tA.J.19 Z16�....................... Owner Address a ( a _�►-.J. 1..� F.,.r iv 4z..: o�.k... % ! .1, ►. n1................--.......... • -•-•- Installer Address d Type of.Building Size Lot............................Sq. feet Dwelling—No, of Bedroom . _ Expansion Attic (� Garbage Grinder ( ) Other—Type of Building'-L�.ST:��4.(q.?Q2 No. of persons............ ........... Showers ( ) — Cafeteria ( ) a i d Other fixtures --------7ta 6---`-N---• 3.ka.!,c- --•-••�1 .1-.l........................................................................... W Design Flow................5_,.5........_-_--.a____gallons per person per day. Total daily flow.... ...............gallons. WSeptic Tank—Liquid capacity.1.00.gallons Length-L-_.!a"'.. Width..,............ Diameter................ Depth..4/..S.... x Disposal Trench' No. .................... Width........_......... Total Length-__......._....._. Total leaching area....................sq. ft. Seepage Pit No........�.__:__.... Diameter...c9.......:..... Depth below inlet....4............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...... l �W...... N -'............. �-`��Date_._Z.1.- -•------------------ as Test Pit No. 1�2;7_1.---minutes per inch .Depth of Test Pit---L_4:/........ Depth to ground water_:/1/alv4.. ^ vh+%mod Test Pit No. 2................minutes per inch Depth of Test Pit.................__. Depth to ground water.-----............... __. ............... ..... -------------- -•-- ---...... --....._ _ } p Description of Soil---- � I-0.1 I... _u�.:�.P..(.I. nl f`..... . N�...... ` � v ........................ •-•-••••.............................................................-...........................................-................. -------•------------------------------ W ...-•-•....•-------------•----------- •--•••••-----•-......................................................------......................................... ..................................... U 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 TITIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is e board of health. Signed..... f. •----•. -------•----------------------................... l/fly 1 Date Application Approved By--..••---- •--•-•---- ••-- -- --------• -•--• 4 Hates" Application Disapproved for th ollowing reasons:..........................................-..................................-........................... -------•----•--------------------------------------- •-----•---- ...................----•-•--=-----••-•-----•--•-------•--•••--•-•--•---- ....................-.............. Date Permit No.....�� :-:._�.��' ............ Issued-.'.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................O 0.........OF_......._T_ ..........:... �r rifirttr off�untlittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired byQn tL ................. ............................................................................................................................................ Cys alter..._ at Y has been installed in accordance with the provisions of TIT of The State Sanitary Code s des ribed in the application for Disposal Works Construction Permit N -- �---- dated_._..._�_� ..<2���--------------•-•- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT THE a SYSTEM WILL FUNCTION SATISFACTORY. DATE............... � �`� ............................ Inspector----•C- ........................... -------------- THE COMMONWEALTH OF MASSACHUSETTS BOAR - F Ht`EAALT,Hn - j........(....Q.u?`!`)................OF.......` c*7" - C`�ca No... ......� ''I b F4. es ......... Disposal Eorks Tons ution Prrutit o Permission is hereby granted----•------------+--------•---.....��-•-------- ••----••-------•------------------•-••--••----..............._.._. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No........................L.O .T..------.¢" .......D-0_1- ..(al:L---- T -.-. Street W �S--lt�Q�' .� as shown on the application for Disposal Works Construction Permit No. _............... Dated..... __•___ ................................ 's...< . ............................... DATE-------- ', Z1--------------------------------------- Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS �M ��s/Gx/ �.4•--T,�.. �^:/cc.4L tee. — �! ►� 7_ .: <. ;� S/ /G�-L= - nlQ W. ( D �o j,.0 TT'DYZ : I I. T� • r - 1` 1 l f r. r I _ - /�•fo JEST,�ICaLr_ _ I 1 :. r i i I _ ------�--.r Si 1350/L L I 4 y Q ._.. 614 O � 1 1 20 FillI t , n : I � I r I , I n Icy • i , y _ >k : I 1 LC .4F->L/C-4-A,1T A-/,4k/n//