HomeMy WebLinkAbout0151 BISHOPS TERRACE - Health S " I �� e
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No.-•-..�131....... Ficim 7..:.�.61........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TU. .. .. .... Or...... E.......................................
Appliralitin f yr 4%ip aal Warks Tvautrurtion Vnind
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
l ........... ...... .
............................... ..............•--.........................................................•-•-•....................
o i d ress or Lot 1\o.
............ ....�.:.............. .......................................... ........................................... ..............................................
. ..... . .........
C Owr�¢r ����� Address
•--•-•..........1 . ,l ..............L__�............... ..----•-............... ...................
Installer Address
Q Type of Building �� Size Lot............................Sq. feet
V
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
P`-4 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
P4 Other fixtures ------•-••••.............••••--• . 7
W Design Flow............:, d......... per person per day. Total daily flow........._.7-� ....................gallons.
WSeptic Tank—Liquid capacity/O gallons Length................ Width..............-- Diameter................ Depth................
x
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..Id/_V4-�Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a
Percolation Test Results Performed by......................................................................... Date.......................................
Test Pit No. 1...............minutes per inch Depth of Test Pit.--.._-------------- Depth to ground water------------------_
GLI Test Pit No. 2................m.inutes per inch Depth of Test Pit--------------..__-- Depth to ground water.....................--.
9 ••--•••-•--•-----------••------••-••---•••••-•-•...............•••....... -----••-••--..........--••........................................................
O Description of Soil-----------------------------
�5�9
v .............9!�EL------------------------------------------------------------
x -------------------------------------------------------------------------------......................------------------------------•----------------------------------------------; .................
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 been iss ed by the b r of heal h, j �. F
Signed.... .. . ------••--•-••----......._ �-`16-� '`
fit' .
o D e `
Application Approved BY ..................j j 11-- I1��1_�---
i Date
Application Disapproved for the following reasons--------------------•••--•••6.1................................................... ...••••-•.....,._..
:.... ...
Date
Permit No..._-/- .r...................................... Issued.. � /a-1 �..................
Date
No...... �`........ '414'.......................
FF.H
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
O=
. ......... ....... ........ td
................................................
Appliralian for Difipagal Workii Tonstrurthin Prrutit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
............ 7............................................................................. ................................................................................................
kocaj14
iop dftess
/ or Lot No.
............................................ .............................................
....................................................... ........................................
........
Address
Installer Address
U Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
Other—Type of Building --------7�.................. No. of persons............................ Showers Cafeteria
PH
Other fixtures ......................................................................................................................................................
Design Flow................s..._..................._.gallons per person per day. Total daily flow_.._._.....:.:'`Z-)Z .....................gallons.
WSeptic Tank—Liquid capacity_Z�"Ii-O.gallons Length................ Width-_--__--------_. Diameter............_... Depth___--__.--_---._
x Disposal Trench—No.................... Width.................._. Total Length_..._._..._......... Total leaching area....................sq. ft.
Seepage Pit No._ J"__'
Diameter-...._.._....._..._................... Depth below inlet.................... Total leaching area..................sq. ft.
---113 ------
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 Depth of Test Pit......__._..._...... Depth to ground water_--_--_-___.-_-._-_-----
-----------------------------------•----..........-•---••-----------------------------•--••---••----........ ................................................
0 Description of Soil...................................................................................... ..................................................................................
U ................................................................................................------------ .................................................... ....................................
------------------------------------------------------------------ ................................................................................................................................
U Nature 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. Code�The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been,iss ed by the board,of heal�h.
X e
_ . .....ASig -- ?' . "/: ... A;t ........ .....................
Date
ApplicationApproved By............. ........................................................ -.................... .............
Application.Disapproved for the following reasons.----------- ------------------ .................................................. .........................
........................................................................................................................................................................................................
Date
Permit No....
........................................... Issued..................... ..................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ell- .
OF.......................... ............ ... ......
.. . . ..........................................................................
'Wrtifiratr of Tamptiatta
THIS IS_TOCERTIFY, That the Individual Sewage Disposal System constructed O or Repaired
1, / P-1-7,41P
by..- li, A
.................................................................................................................................................................................
installer
at--------_--------_---- _,40---------94ii�t...............Z, .. ...........--------------------------------------------------------------
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...._...;, --------------
---- dated___---_-.-_----_-_--._---__._---_--__---.-----.
V-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..........................I........................................................ Inspector--...-- ............................................ .................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....... ...
................... OF......... /......................................
No.........pr 4......... FEE........................
Permission is hereby granted-----------
40
.............. .................. .........................................................................
to Construct O or Repair an Individual Sewage.Disposal System
at ...........
.No.....4`.'Z* ..............
...... ze-A..................................................................................
Street
as shown on the application for Disposal Works Con"';'timLion Permit Flo..
D . ...............................
.......................................................................................................
Buard ofjlcalth
DATE....................................................................... ........ .
FORM 1255 HOE38S & WARREN, INC., P(JISLASHERS