HomeMy WebLinkAbout0439 NOTTINGHAM DRIVE - Health (2) M' ao��
No.-1-.';:;5'1------------ FE$.. ..... ......i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_. . — -------------- OF....... . ......... ........:
..........................................
Appliration for 19ispotia1 Workii Tatistrurtinn Vrrmff
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: is
.................. .... b ! 4.Z'04 .11E!4 ............ ............. ................
........................... Locatio •-Ad¢re6s.. ..1�::...�4... ........................ x Lo No.....,^ ..........................
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x .. ..
...................................... °�...... .............. ..:.. ......................... .. �. ..� ................
Installer Ad e s
Q Type of Building Siz ot___....._!.�d�Sq. feet
U � 1.............
Dwelling—No. of Bedrooms.�.../......... ............................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building !QJ_e�.-7 No. of persons.....__.._.0.............. Showers ( ) Cafeteria ( )
Other fixtures
W Design Flow............ .........................gallons per person per day. Total daily flow..........
WSeptic Tank—Liquid capacity/ gallons Length................ Width______-_-______- Diameter................ Depth............
x Disposal Trench—No..................... WilO�Depth
...... Total Length-------------------- Total leaching area..._3.0...._:.sq. ft.
Seepage Pit No..................... Diameter below inlet................... Total leaching area--- A "--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........................
f14 Test Pit No. 2.................minutes per inch Depth of Test Pit..................... Depth to ground water------_-__--___--____-_-
P; • •............ ......................................................................................................
Descriptionof Soil----------- ---------•-- ---•---�... .--•- •--•-•----•••-•--------•--•---------•------------ --•-•---•-•------•-----•---------•--••---•-•-•------•-•-_..
x
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 Article XI of the State Sanitary Co The undersi e further agrees not to place the system in
operation until a Certificate of Compliance has been ' ed by tllg)bo d o lth.
igne ------- - ...... ..�..... . .......... ...................... ... .............................
Application Approved By...... I/ --- ; / �
- ---•------•-------- ---
Application Disapproved for the following reasons---------------------------------------------------------------------------•----•--------•-•...................
N
....._-•..................•---•---•---•-----------............-----•••-•-•...........................
�' e't Date
,` �-
Permit No......................................................... Issued.-- ---��==------�..- ----..�V...........
Date
No. r Fx$.. �..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF. HEALTH
uo+-.............. OF.......���" f
Appliraiion for lgi.13posaf Workii Tonstrudion rrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at / F f// f f A
.. _ - .,�f .�°wr-ty-.,,s!e .C+.+s;:. �. �,�,,o;�t. ...........:. ..........: v-a!C=.•{ S..:........--•-•.....,
g Locatto Ad, reps d /��/gay �•---��r-or Lq�No !T 4
...........................l°!'�:: %w'"y-........ .C.3.?�.. .'+.....K:.....1.... ......................... "Ti�(,1.�;s�` $: a...?°'0.,✓. ..........................
`c1 owner —f
€ afIF
tvPt ...... t R e z i s i �I_Ee 1 yrZe
'>'_
% Installer Ad '
Type of Building i_ _ S1Ze-Ot...... _!��� -`_Sq. feet
yY
Dwelling—No. of-Bedrooms ............._, ............. _Expansion Attic (• -) Garbage Grinder ( )
04 —Type g No. of persons._ ...._�_______________ Showers ( ) —.Cafeteria ( )
Other—T e of Building X
Other fixtures ...•... �•.............. ... ---
...._
Design Flow__._.._ .. ....... .gallons per person per day. Total daily flow;_._._. �. ."'_'gallons.
WSeptic Tank—Liquid ca acitY -• x gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width................... Total Length.................... Total leaching area i tl......sq. ft.
.s Seepage Pit No_____________________ Diameter-""","-,;,,;,�Depth below inlet_.___._............. Total leaching area _-,` ?-. q. ft.
.¢. �'
z Other Distribution box ( ) Dgsing tank ( ) ?
Percolation Test Results Performed-by..........
"'"== Date
a
Test Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water--_-____----.-__---.---.
w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......................
............
Description of Soil............ = �: ' ._.._.... _....................
x ----------------------- ------- -------------------------------
U '----•-----------•---------------------------------•-----------------------•--•-•-----------------------------....--------------•-••--------------------------------------------------••=
W
----------------------------------------------------------------•-------- -•-------------------------•--------------.._........---------...---------------------------------•-•--•----•---........-•---
V 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 Article XI of the State Sanitary Cod The unde(do�l
further agrees not to place the system in
operation until a Certificate of Compliance has been e by thenbolth.
igne `'t''r -.... ...... .... ..
s
Application Approved BY------------ ---- - -- - ----4.:..... ..: . f. ...f/..--Za
Appl�ation Disapproved for the following reasons:--------------------------------------------------------------------------------•-------------•-•----.....1......,
a .......
• .,,....� f �.' Date,
Permit No......................................................... Issue...sue:._ .:. . ... ..........
Da
HE COMMONWEALTH OF MASSACHUSETTS
BOARDr,OF HEALTH
...:. .., .'1 . .............O F...... r. ����v"�* � � �'....................................
f9rdif irate of Tnutpliattrr
THIS IS TO-CERTIFY, ThaYiae 'vidual Sewage Disposal System constructed ) or Repaired ( )
bY..............................._ ..�"`y ' .�" ^,„ -- ..............................................................
JsrstaHei
at. �.. . ... .... L..�.3�........
✓'mo t , a .: ........................+.a
has been installed in accordance with the provisions of cle Xj of The State Sanitary Co Zaesrilied in the
application for Disposal Works Construction Permit No_____________ __----_•-___-_-_-____- dated__._ _./[ __. . ........_.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT EE CONSTRUED ASA G GREE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........-7 (' z •------------------------- Inspector-_._`,f" .. ..-...L L./ ....�. ..1.. ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OE HEALTH .
1p- f N.tr....... 0f........ .r�+lp�fTM
No......................... �;;, FEE. ......
Permission is hereby granted.........(_1. � .......... := /=to Construct ( ) or/Repair ( ) ait'Iridtz tdual Sewage Disposal S teen y y7� y!/
atNo................................... . .................................. �..n!"'-4^:.�.uf
} }; street �./
as shown on the application for Disposal Works Co:j�kructiZei.rmit N _._...*uard
Dated_.I � 77...................
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:€. f.H�._.. .....:....................
DATE....................................................................... ..=.
FORM 1255 HOBBS & WARREN.,INC.. PUBLISHERS W.
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