HomeMy WebLinkAbout0128 BISHOPS TERRACE - Health (2) /
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No. 4350 1/3 FEED
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.......... ....No.--- .. ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0 H EA T!A
................
ApVfiralivu for 13isposal Works Tonstrurtion rrrutit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System
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.. ...... x aa .......
ation-Address '
4(i
OwnerAddress
.......... .............................................................
Installer Address
Type of Buildipg/- Size Lot.42" ..... Sq. feet
U *"*......
Dwelling lZNo. of Bedrooms..........:��........................Expansion At Wi Gar7 bage Grinder
aCafeOther—Type of Building ............................ No. of persons.............. ........ Showers
teria
Other fixtures
Design Flow.................. gallons per person per day. Total daily flow............... ��.gallons.
WSeptic Tank—Liquid capacity/i"_.gallons Length................ Width__._............ Diameter................ Depth................
Disposal Trench—N Width.......... . .. Total Length....._____ Total leaching area sq. ft.
Seepage Pit No....../11___.________1---D_i1a1_m__eter._/_Y_W------ eepth below Total leaching area....._ sq. f t.
Other Distribution box ( - ) Dosing tank ( ) _'
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit..._-._-_____-__---- Depth to ground water-_-._----.-___-_--.----.
�, Test Pit No. 2................minutes per inch De_ th of Test Pit......_............_ epth to ground water.._._.._.__.._.._._____.
P4 ----------;Al�.................... ..
0 . ..... --------------------- ................................................................
-------------
Description of �-, _Z-o ---------...................................................
U ............................................... ................................................................................................................................................ ........
---------------------------------------------------------------------------------------------------------------------------------------------------------------------...................................
U Nature of Repairs or Alterations—Answer when applicable...... ..................................... ...................................................
---------- ------ -
Agreement-:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
The undersigned agrees to install th a oredesc i ividual Sewage iisposal System in accordance with
the provisions of Article XI of the State nitary C e undersigned
agrees t to place the system in
operation until a Certificate of Complianc has b n y the bpard of
Sie .. ........ ............. A
'e 2 Z
Application Approved By. ............... ......
D/e
Application Disapproved for the following reasons:............................ ........................................... ....................................
........................................................................................................................................................................................................
7 Date
PermitNo........ ..15..................................... Issued........................................................
Date
—----------------
a E
No...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD
Application is hereby made for a .Permit to Construct' ( ) or Repair -.( ) an Individual Sewage Disposal
Sys ,�,t:; .
Ji
.. }�i•iU !_,.. cation Address
............•...................... ....... or Lot No ............_._
� - Address
.op......................................e........................................................ .........,.........,:..,.,..:,.,.......e........... ..... ....__
Installer Address
Type of Building Size Lot.._5� .. . feet
�-, Dwelling- l�o. of Bedrooms........... ,**Z........................Expansion At ' ( ) G?r•.age GI inder ( )
Other—T e of Building ___-_-_- No. of persons............. Showers —
a YP g ----------------- -------------- --- ( ) Cafeteria ( )
d Other fixtures ................................... -- ---------------------
__ _,gallons per person per day.
w Design Flow.................. Total daily flow..__._.._. ,* ""'i'____.___..gallons.
------------
Septic Tank—Liquid capaclty�&.._0 wgallons Length................ Width................. Diameter................ Depth................
x Disposal Trench-N _-_---_••---_,:__-- Width ... ��Total Length .r Total leaching area sq. ft.
Seepage Pit No___ _ _________ Diameter.-/�f : I�1'epth below inlet......&_......... Total leaching are<1te . .. q f±.
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__._:___-_,__..,__.._._.
1~ Test Pit No. 2................minutes per inch Depth of Test Pit....................Pepth to ground water........................
•-- ........................ - ..................... .................................................................
O Description of Soil-------- `C s . ' --------------------------------------------------------------
U ..............................................................:...........................................................................................................................................
,
w
U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------------------------------
........................................................
--------•..............................•-•-- ---------------------------------------------------------------- --••--••---••-•---
Agreement
The undersigned agrees to install the oredesc •b ividual Sewage Disposal 'System in accordance with
the provisions of Article XI of the State Snitary Co undersigned f the, agrees > t to place the system in
operation until a Certificate of Compliance has bee s y the board of. v6{ .
Application Approved BY______, ,�� +' `, Date
Application Disapproved for the following reasons---------------------- ------------------•--•--•--------------•-------•--•••-
------------------------•-----•-•----•-•---••----.._....-------------•--- -••----•------•--.....-•-•---•--.._...--------------•-•-•--•------------••--------•-••-•----•----•-••=-----•-••---........
Date `
PermitNo......................-..................................... - Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS.
BOARD QF HEALTH
\ ..............OF.. ..... ,; .....................-......
•ANY� ifir�a�P
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( )
�
eitl,,%he - ----- -- ... ...........................................
has been installed In accordance provisions of Article oLT t Sanitary Code descri d idle
�. r.,
application for.Disposal Works Construction Permit No---------------------------------________ dated.-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GS9 RB�RIT � THAT TI°IE
SYSTEM• /ILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector.....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
a BOARD OPP HEALTH
4 .
•% OF........ y.. J°
w
No.•. J ......... FEF.,��, :;;�""
....
Rapagal Markii Tonfitr.udion Vrruttt
Permission is ereby granted........................
to'.Constr�e' n or Repair ) an Individual Sewagp' sposal System -
at No :. •v s e °
�. ' "
• � . Street
as shown on'the application for.Disposal Worl:s Construction P.rnait �T �^ �,._. ..... .Dated... . _. ^....•
Board of I-Icalth
DATE..........................................................................
7,
FORM' 1255 HOBBS c'§ WARREN, INC.. PUBLISHERS � 7 4o �-�