HomeMy WebLinkAbout0302 BEARSE'S WAY - Health - ----- -�, o i
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THE COMMONWEALTH OF MASSACHUSETTS
OAR® OF-HEALTH
OF............ .... ----- ---. t ��..
..........................
Appliration for Dispnfia1 Works Tonstrurtivit 1hrutit
Application is hereby made for a Permit to Construct ( L or Repair ( ) an Individual Sewage Disposal
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.. tom � / J=� . --. ` DJ '
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... _ , �........L^ t n. ✓... .... ........... -
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a Owner Address
........ _Q=� ......s-.� ................ ............•........................... ...........................................
Installer Address
Q Type of Buildlu Size Lot............................Sq. feet
U Dwelling t-No. of Bedrooms------.-----2...........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ........................ ---
W Design Flow...._,....._._....- . .._.... allo s per person per day. Total daily flow............... ...............gallons.
_�a31 ns Length................ Width_.._.___... Diameter................ Depth.__.._..__......
W Septic Tank-Liquid capacity./e .g g •••--
x Disposal Trench— o..................... Width..�...,.r r:.--- . to Len .�......... $tal leaching area....................sq. ft.
3 Seepage Pit No.... ----.------ Diaineter .Lf_!✓.._` p el t.................. Total 1 Ching rea..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) �j- � ���
`� Percolation Test Results Performed by.......................................................................... Date..........• ..........----------.....
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth o Test Pit.................... Depth to ground water........................
Description of Soil..—. = c—
x
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 Article XI of the State Sanitary Cod The undersign!,d further agrees not to place the system in
operation until a Certificate of Compliance has bee iss d b the of /�
Sig d r... ------..... '
! D e p--
Application Approved By--..: ... ...... ............. . �(;� �----•------...
Date
Application Disapproved for the following reasons----------------------=-------- --------........................................................................
.......................•-•-••----••--•-•--..........---------------------•---•----......--•-•-----------------------------------------•---•--------• ....
•...........
.----------------
•---------.....
Date
Permit No......................................................... Issued...... -----
.d. .....; ...............
Dat
-oil
rRAIG MEDEIROS
Trucking --bulliloKlng
142 0
..gpnisT" 77Jr-0>828 /
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ao® '7��,ea se— -.a- /o --o_ -ap �
5
N0...,,-2...� FE$... ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O� EALTH
... .......OF............ ------...........
Ar
Aliptiration for Diopoitt1 Works Tanotrurtion Prrmit
Application is hereby made for Permit to Construct ( �r Repair ) an Individual -Sewage Disposal
Syst at:
.. f-. .- �----- .!2-f
n ----14 ----------- - "' . --J•---
L .. ......" tS. ............ Ni..... of W.....
j
'., Owner Address
Wi.!... � . ..... ............................ ..................................................................................................
FMB Installer Address
UF'•I '' .__.....Sq. feet
Type of Buildi Size Lot____________________
Dwelling . No. of Bedrooms..................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures .. ..........:......
-----------------------------••..•--••-----••----••----••------•-•--•--•---•---•-••--
W Design Flow.................. . all s per person per day. Total daily flow.....__.....__+r ,.....................gallons.
P4 Septic Tank Liquid capacity g ns Length---------------- Width---_----------- giameter................ Depth................
W Disposal Trench— o. ..........:......... Width....... �Te . tableaching area....................sq. ft.
Seepage Pit No._:�__.__.._... Diameter _�J__v_.." t................ .. Total 1 ching rea..................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 Depth o Test Pit.................... Depth to ground water........................
P'
----------------- ------------•----------------------------------------------------------------
D Description of Soil-'.....-------•----...---•----•--.....-- '�. "'" � '`,."...-
x
0
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 Article XI of the State Sanitary Cod The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee is b th f
Si :'� t......---•--••-------•-•.......................... ./ -----D, ......------.
Application Approved By..... '-• ... ............. -�, .k/1, 3...
Date
Application Disapproved for the following reasons:-----------•-••-•-•-----•--• . ----
Date
PermitNo........................................................ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
t .
BOARD 6....4,t
O HEALTH........ .....�I?:r/Ll,........OF........... .....G...........................
Tntifiratr of Tomptittnrr
_TIIIS IS T( E -�FY, That the Individual/,Sewage Disposal System constructed <or Repaired ( )
Y ... ..
_ / Installer
has been installed in accordance with the provisi of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No............. c�....)......... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
'SYSTEM WILL FUNCTION, SATISFACTORY.
DATE................................................='---.............-••''•......... Inspector......-----••••......_...........--• ----......................._.......-----.....
• '^•RAJ
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
`4. ......
. !!r OF..... `
No... 2...... ........ FEE.......
Bill mit o C1on15 rtio rrmit
Permission is hereby ranted.=:-. ,- Gt�!c lI�_...: .... ...........................................
to Cons u (�or Repa� ( ) an ndividual Sewajre posal System d
atNolAy. �•_."�...-.., � !. �• X. 1 ................ ..............................................................
T Street
as shown on the application for Disposal Works Co struction , mif N __ __ ____________ Dated. - --- ..`. - �..-_-....
��� L� N- •l.L.c •.............•--•-"......._
/ f Board of Health f
DATE---f�--•-1 •....................................•--- /
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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