Loading...
HomeMy WebLinkAbout0324 PATRIOT WAY - Health lq3 llqr i I -144 Nd(fe�)-.ILA 3 I Fps. ) THE COMMONWEALTH OF MASSACHUSETTS BOARD Off` I-I ALTH —\ OF...., .. . .. ............. - Aliptirttiion for Bispniia1 Worko Totw4rnrtion Prrutit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: ......... -. .................. ......-V 4:...••-•-................. . cation-Ad ress r L Y � 19Lot_N ... . .. .............. . O.� . ........-- a am ' Owner Address v-------- .A........ :.... ........ Ins ller Address d Type of Building Size Lot. K,/-._Y'52o-.....Sq. feet V Dwelling—No. of Bedrooms.--_ ' _________________Expansion Attic (�✓� Garbage Grinder WZ1 a p-, Other—Type of Building ....77:�_.................... No. of persons___�____. Showers 4td04-- Cafeteria ( ) a' Other fixtures ..............•-•-------•------- . •• . W Design Flow.Ylal...P........................gallons per person per day, Total daily flow----- a...� ......gallons. WSeptic Tank—Liquid capacity/i gallons Length ....... Diameter________________ Depth.1_YJo1.. x Disposal Trench—No........ Width. Total Length.....,�."._..._.o. Total leaching area--- p:,t......sq. ft. Seepage Pit No-----------e........ Diameter_............ Depth below in et ....... Total leaching area. ...sq. ft. Z Other Distribution box (/ ) Dosing tank '~ Percolation Test Results Performed by---ht/12 A'Y6................................. Date_.: -.._.._........_._____. �a Test Pit No. 1 `_'.-R....minutes per inch Depth of Test Pit...4.........._. Depth to ground water.& .A�!'9?L`�� Gz, Test Pit No. 2..............._minutes per inch Depth of Test Pit--------------------- Depth to ground water----------------_----- ------------------------------------------------------------------ -••......---------------- .. 0 Description of Soil... ® ©� __.. �� =.11— ------------------------- ----------- �rv� V ••••---•--•--•-•-••••--•--•-----------------••------------••---••••---••------•----•...........---------------•--•-----------•-----------------••-•••---••••-------••-••-•.........---•••------------••. 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 iITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. SiL d.. C .............................. Date Application Approved'BY �... --- .._. 111 --------------------------------- .....' r�'` 7-P Date Application Disapproved for the following reasons---------------------------------------------•----------•--------------------------------------------..._.._..._ •-------------------•---......------------------------------------------.....-•--•--•---•---------.....--•------------•--•-•----••••--------•-••••-................................................... '. Date Permit No--------------------------------------------------------- Issued._.7_: `--------- ......`�" ........ Date ,r. �1UGL.•E �L\Iv�1l..� - 3 8miz�o�K _ .. - T�dlf`� ;=LAW s do -c 3+ 3sb 6.p.17. ,es-ri c TA"V- = 33o.e ISO % • 4�S 6•.R D. 1' \ F ' ' USte- I,00C:�, 6A L . + i ��ISPoSAI PIT use I000 60� . , ' Z L'WPJA/A,L1L AIZEA -. ISD S 1=. _. . _ 1 �8 \ L. G10 FI t ISF7 142 VIV ' '8aT1"n�i/l A,f�1�• � 5i=. G '� + i I �(•--- p��Y � •,i° -� ' �' . I. So fis'. it ► .o ti ' 6o C->.P D. • I•. �. I6 .R D. A L. T�ES 1.l G•Cn" • s i ,t T �5 ; , ) � s � co LC �,•� ToT.&L .0ow o-r F'L ow * 33D 6�PD. . I `I ; 164 v�aG>,t.e�t•%oL!` ¢e. -c'e : ► l.N .2titiu on l.�X• + ; set $ , ,' 1 ;; ,, , • 3. i � .I ' �. .-: 7-7 f , �.. I i• I - i + 1`` + ! '1 ` `" �` , t 'r� e r _ I S IJ, ? Q �. i ► j OF q ��l -; ;�, Q� ,WILLIAM yG ^�r- 4p eC. N Y p No. 19334 Q Q �• 51 I i_ �� i } I , 1 i �^ 2r100 `�D $11 ��' csslQNl11 F:��T sT 1 mm Tor, frwps%Ido:o: # y �-loc 1 e ►. vBw�L / 'sox cK, ScnC q tlis (DOO �1 IWVy{ �{, P. s ,T E I WASMED • T '• ' I l • N d Plzo�-1�� 'taGATtd� � J. /2 a.i'o ..'Sc l�.L�-. t. A.(o w,�T 5c•AL� (Z►Z3,T]; ETL ? t C.6lZ'Cir-,{ TWAT, TNa V of uD/&i1GU -5"cw►J t t `..l PLL1.�1 1Z�F'EQE►.1GE' ?' �. ti-t F:iZ!`01-1 Gc vI PL_�(S W l Try T t-l� S Y o E_Ll►-lam:. t` :f r , A•uv SET%BACV, :VE4ulQeMaWTS OP TNT -TOW►J of 8/S 2�5'i'A r`�� DATE 1 1 f BI&-AT ciz. ? REGISt'c-_tZ>rD t-AIJd.' SUevGLYo¢S F THIS 01-AW I'S 'W'OT P,ASE'C� ��.I . A�.1 � aSTE2VIL.�.G o MASS+ � IWSt'QcJMEiJT v�`{ TI�c cat=.�S�Y'S Sa�r✓wl_D: 'AP pl_i GA.l.1T I s a�;.'ar �G USd`..1-G-DL�.•C2MIaIt` 1_O'`i. . d_eM�;.�,�. n -.._..,.� -7110i? jr .� , - -' -- - __ _._ _ ..- .__ ,__ .».__'i -..ram.•—�..•,