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HomeMy WebLinkAbout0128 BISHOPS TERRACE - Health (2) / o� a- l-79 V9aw e H n's A 4 rO66 i 1 No. 4350 1/3 FEED -a a 10% + _, F U l 4e-1 ti .......... ....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 ..a,t.:.j..X/ .. ...... 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 �-�