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HomeMy WebLinkAbout0444 NOTTINGHAM DRIVE - Health (2) C I I No................-....... .�. ................ THE COMMONWEALTH-,OF•MASSACHUSETTS BOAR® OF HEALTH T ^�...............oF.. f� /�L-E Appliration fur Di-span l Work.5 Tonstrudijan rantit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal ,t OCMA/07rh-fGh'7� at: ................. 2�vE CC;.(1�T�r/i............................................................... GAT•a3 Location-Address or Lo N ........ o ._ .�tr -y ------------------- -------- ------ ------ .. .----------- .......-----......--- w r A res ...............e .... ------- -------------------•--- -... Installer Address pq d Type of Building Size Lot./ oo_�.___...Sq. feet Dwelling Y No. of Bedrooms___--__---_-Dwelling Y Attic ( ) Garbage Grinder NO) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------------------------------------------•--------------•--•--------. Design Flow................�.........._......_._gallons per person r day. Total daily flow--__--___✓... ....®......_---.-.-.----- . .. _ _ aw Ions. WSePtic Tank—Liquid caPac y_ e.gallons Length Width.4�� . Diameter_ _�_,_ llePf1,.5 _&,.i.. x Disposal Trench—No..................... Width.................... Total Length-------_............ Total leaching area....................sq. ft. Seepage Pit No.........I.......... Diameter-------A...... Depth below inlet.._.. .......... Total leaching area..2�_..sq. ft. Z Other Distribution box (✓) Dosing tank ( ) U p � . Percolation Test Results Performed b G' �'` �_.. ��/ w _- 6................................ ® Y _.. = -- Date---- �aj Test Pit No. 1--- _7-...minutes per inch Depth of Test Pit______J R------- Depth to ground water. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water4Nv! /ZED f� _...... Description of Soil----D '`'l------c...&3cS8�C�--------------------------------- -��., -------------------------------------------- x ;/Z`-1 Z 1 1 uM...Cr1 s `sA b i/114 -------------- w VNature of Repairs or Alterations—Answer when applicable._-------------------------------__---_------------____-___--_-.._-----------_--_-_-_-_-----__. -----------------------------------------------•----------•---------------------------•--------------------•-------------------------------------------------------.------------------•--------------- Agreement: The undersigned agrees to install the aforedescri d Indiv' ual ewage Disposal System in accord nce with T ^ the provisions of . �� . 5 of the State Sanitary . od The dersi ned further agrees not to place t _S in operation until a Certificate of Compliance has en ' ed by e bo d o health. / �q Sig .. .------ .....:.... C� - .. •. ---- _.. Da Application Approved BY---- .Z.r' ......G[lll� -� �_� - Date Application Disapproved for the following reasons---------------'--- ----•.......--•---------------------•------•-------•---------•-------------------•--•----- Date Permit No......................................................... Issued....LIS...... ---.................-..... Date N� .............................. THE COMMONWEALTH, OF MASSACHUSETTS BOARD OF HEALTH O.W. ................OF........ AVVIiration for Bi-qpnaal Works Tnnitrnrtinn Prrmit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: ........ Location Address or Lot N ------------- w r / A re(-- a � A-----. ....................... ............ 4 ----•' ......--...............................-- � Installer � Address � �� Type of Building ff,: _ Size Lot---------------------------Sq. feet DwellingjK No..of Bedrooms............ ...........................Expansion Attic ( ) Garbage Grinder f(U) Other—Type of Building ............................ No. of persons:-------_-_--____-__-_:-____ Showers ( ) — Cafeteria ( ) dOther fixtures .........................-•-•----------•-•-•-•-----•---------------•-•-----------------------------•---------- ------------------ W Design Flow.............., .._.,__ ••__gallons per person per ,day. Total daily flow........- gallons. W �: Septic Tank—Liquid capacityl.10�.�_.__gallons Length--E.&...... Width.:�'._1�._._ Diameter_ _._. Depth.,' ._ .�... x Disposal Trench—No--•---_-•. --_-- Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No._.;`'_`_ -------- Diameter._._:. ....... Depth below i let..... . ......... Total leaching area_ .... ft. Z Other Distribution box (�) 2 Dosing tank ( ) V /,� Percolation Test Results Performed by �d-.�_-_..._ _.. ......" ....... Date.. _ Test Pit No. 1.. ,minutes per inch Depth of Test Pit------ ........ Depth to ground water 6V d�/c:--_---. Gi, Test Pit No. 2............:--_minutes per inch Depth of Test Pit::......:........... Depth to ground watea!�M04�.)✓N2Z.'e6z> 0 - --- r---- -•-- --- D ' Description of Soi -------- Z:..._1� .► .. - ! __ x -----------••-•--•-.----- v ------------ •------ •--- '--- .. W UNature'of Repairs or Alterations—Answer when applicable-----------------------------------------------•-.,_-___-__-_-____________-_-_-------•-•-----_-. ..------•-•-•-----•--•------•--•------ .............................................. Agreement: r The undersigned agrees to install the aforedescri d Indiv' ual ewage Disposal System in accordance with the provisions of Ti9 5 of the State Sanitary: od ,T The Iders' ned further agrees not to place t syste in operation until a Certificate of Compliance has en ' sued by e,bo d of health. Sig --•- -�---- ----t-l- ----- J Da-e Application Approved BY �,� C i .• 4-1- --------•-•------------- ".Zff--•- ..J-)....... Date Application Disapproved for the.following reasons: -- -• --------------------------------------------------•-•----••--------•---•------•-........ .....................................................==..................................................'................................................._---- ---- ------•-..--;..- --•--••------- Date PermitNo.............................................. Issued ..................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF HEALTH ........................... / :.ma ........................... Cww�rrtifiratr of Tautpliatta THIS IS TO ERTIFY, That t Ind:,dual Sewage Disposal System constr cted ( or Repaired ( ) b ...................... A. _.... nstal ler has been installed in accordance with the provisio is of T i. r. 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ..1-�.� "................... dated-4�/l c 'd .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - DATE....../.-`._.2 .......... Inspector ��`--- �G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.----•-------------•---- Dispns WorkB 1tr ion rrmit Permission is her granted......---clrt/i -•-----•--� ------------a-�77— Streetto Construct'( or R pair ( ) an In idual �''.wage Dispo System at No.-•----•..... �---.S•6---.�L11�- �--f�d 1 -c.._... ............ as shown on the application for Disposal Works Construction P Dated..-.,v/---- 7._' d:_ Y _ S ..._...- .•-- -------•- Board of He�I�. ✓/ DATE------�-------•-------------•--------------------------•--•----------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS . . , < . ' ,. . . . - \ „ - ' .. t . > ' IC 1. ? cue t, } �' L? a� r # i "' -* ' "�: e.r,,.- c / tea/ �, Tom}" ti L. o. 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