HomeMy WebLinkAbout0273 NOTTINGHAM DRIVE - Health (2) a�� �va+�nyhum �. ,c� .
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No..... s.:.. � Fps.., '.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CIG ..............0F......�! t. !,!?r ........ ........... ..:....
ni 160
Allp iration for Uhivvii al Works Tomitrurtiun 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair (f ),Oan Individual Sewage Disposal
System at:
....r=4.6_-y. .I/. 1.&.P. -•-------------------------------------------
,��/t//� ss+��+••�� ��.� Locatiiln,,A(dDdrreesstz,,�.Atz
_ ----•----•--.-..or Lot No.
all-5 .lP,R--mil- .�+-/'#S':!_----- 4--- . ................... ......-----••---•----------------•••••........._.
W 1�j� wnje Address ....
a Installer Address
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 ( )
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........................................
1.4
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes pel inch ep of Test Pit.................... Depth to ground water........................
CDescription of Soil--------- .. .. ------------------------------------------------•--•--------------------------....--•-.-----
x
V --------------------------------------------------------•---------------------------------.....----...._..--------------------------------------------------------...-----•....------......------.......
W ............................................................................................................... ..°_. .... d ..........................a.................
U Nature of Repairs or Alterati ns—Answ when ap licable_.....1... ._ . .. � � . .... .. .... ...........
9 !/
Agreement:
Q/
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of TITL U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b90 issued bVebdo ealth.
Sign .. . ---•- -- . ..-•-• .. -• . .. ......... . ......... .............
Date
Application Approved By.......................................... •. ----- ........... . ...
Date
Application Disapproved for the following reason - ------------------------------••----------------------------------------------------------------...-•-----•---
....................................•----•--------•--------------•--------------......-----•------------•..............-•----------------•-•-•---...------------------------------------.._...........---
Date
PermitNo......................................................... Issued........................................................
Date
No......................... Fss... ' ?.".......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
----....OF...... 4�' " �!_......---
Appliration for Disposal Works Tonstrnrtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at: _
....: .:.�I��. : ...� ..... F _ . :. .. ............................ ........................................................••.....
Locate Address or Lot No.
...... _. -•......: ...............•---•--....... ..---..................._.....................
.► t ner �4 "'' Address
Installer Address
d Type of Building Size Lot............................Sq. feet
V Dwelling .No. of Bedrooms..................: ............_......Expansion Attic ( ) Garbage. Grinder ( )
Other—Type T e of Building ............. No. of ersons._.._......_._......_....... Showers
_ GL YP g •-•--.._..---•- P ( ) — Cafeteria ( )
aIOther 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........................................
-
Test Pit No. 1................minutes per inch Depth of Test Pit...._............... Depth to ground water........................
Test Pit No. 2................minutes per inch Depx h of Test Pit.............:...... Depth to ground water...................
D Description of Soil.........°' - � . Ar °
U --------------
---------------- -----•-•--.---------- - ------•--------•-------- - ......
.............•- ---------•---•••--. ---...---••------------------ ------•••........••. . ' ----•--------
UNature of Repairs or Alterati —Answex;�when ap icable.. .-�` .. °° .. �'� .. :::. ...........
-I.........................................................................................................
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—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bpo issued by t(e bo d of ealth.
/�
Signed ...•....... - ---------
... � .....
Date
ApplicationApproved BY...........................�----••......-•••---•••••-••-•-......••-••••••-•-••••----•-•.-••---• ........------------------...........---
Date
Application Disapproved for the following reasons:---•..............:...••--••---..........----•----.....--•--•------------------......_....._.._..__........._
--•...•....................................................•-•••-••••-•••--•---.............-•••-•-•----•.................-••---....-------------•-------...------•--...---•-••-•-------•-•••-••._.....-
Date
PermitNo...................................................----. Issued.......................................................
Date
,t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT r
rf...OF.....
(ffrrtif iratr of (aoMptittnrr
THI$,,,1<S,T C IFY Trat the Ind vadt�ai Sewage is gsal System constructed ( or Repaired
by--........ F. ............... _r .. '"� '�......../Ing % a . !.-•- . ........................................ __...
��.- ---- 'J/.... ,..°.%.-✓f__ auer d j ...at.......... J ' r
..............................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......` -*_"_ ( _____._..... dated................................................
4 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE
. SYSTEM WILL FUNCTION SATISFACTORY.
DATE.. ....... '. .......................... Inspector-------•--- - .... .... ......
l�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH)
' . OF...... . �<: `.`:ram ...` '... ............. �+ ,.
No.. �..�. .. FEE..1.2..........
Disposal., wrks f(ffonsfr °tiott Permit
Permission is hereby granted... ...................................................... . .......... ............-......
,.
to Construct ( Rep Wr n Indrolr]ual Sewage Di,
i-PA
Sy, '
Stat �-
� Street �y
m as shown on the application for Disposal Works Construction Permit No....9�•+"..`+'fib Dated __________10:._:1..`..���.......
...........................-
`Boar4. H ealth f
DATE................ ..................... ------•-
FORM 1255 A. M. SULKIN. INC.. BOSTON' -