HomeMy WebLinkAbout0154 BISHOPS TERRACE - Health (2) _ _
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ..Y`--........0F ..... ....t. Le�.................................
Appltratiun for Disposal Murky Tonstrurtiun 11rrutft
Application is hereby made for a Permit to Construct ( ) or Repair (� Individual Sewage Disposal
System at:
........... ------.......------......--•-•-----.. .............
Location.Ad ress or Lot No.
......... ___......._... .ix- .M................................ ...............,Vlf ....................................................._.....
Owner Address
a C.\?at. .. !4. 0..... t ![._........ ....... .................T..f.. .........................................................
Installer Address
Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms................. .....Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures ..................................
W Design Flow............. .........................gallons per person per day. Total daily flow.........�.3d.....................gallons.
WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3- Seepage Pit No......I-------------- Diameter.......W........ Depth below inlet---b............. Total leaching area..................sq. ft.
Z 9t4er Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
0-1 Test Pit No. 1................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........................
a .................•-------------...••--..............
.......•--•••----------....
....
.-------••-----------------------•--------------------------------
0 Description of Soil----...-•...............•---•--------.............................-----........-----------------••----...........-----..........-----------------------•--•--•-•-•......
W .....--- . --•-•••---••---------------•------•-----------••-••--••-•-••-••--•-•-•••---••--•--••-•-••-•••••...---•••---•-••--•-----•••-----•-•••••---------•--------••-••••••--••----
VNature of Repairs or Alterations—Answer when applicable............1A.wa........O.W .......(cz-$C(P...4P.1 Y'..W��.....
............ ......a-�....... r. ....... ass.-s -------------------------------------•-----------------...........------.....................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITi U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance hasj&cn issued by a board of healt
Signed........... ........ .. ....` =
a Date
Application Approved By....... ---...........
Date
Application Disapproved for the following reasons:..............................................................................................................
.............................-------•..............`-•---------•--•--•--•-•-------....-•--------.........._...........-----------•-•--••••--........--•------•-••-----......----- ....--•••-•---
PermitNo.... Date_g....._..r�.......�.-----_..... Issued---•----••--.....--•-•---••............................
Date
THE.COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... .....�:� ............OF...... ..................................
Appliration for Disposal Works Tonstrurtion thrmit
Application is hereby made for a Permit to Construct or Repair (`� Individual Sewage Disposal
System at:
%
......... .................... ...................................................
Location-Address or Lot No.
............................... ............................... .........................................................
Owner Address
e,k';N",)�i�?- �,,C; —_-�)
................................................................
.....................I................................. ........................ ...................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms....._S_
.......................................Ex ansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria
04 Other fixtures ......................................................................................................................................................
Design Flow..........: ....gallons per person per day. Total daily flow.........:Ii,. �-2.....................gallons.
Septic Tank—Liquid gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..__..;-------------- Diameter.......I&....... Depth below inlet.... ............. Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
1-4 Percolation Test Results Performed by.......................................................................... Date........................................
1.4
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 Nature of Repairs or Alterations Answer when applicable............P-.,_V,�D.........�L/V..............
........... ......
............ ......... ...I............................ ........................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has,be en issued by the board of heal
------------------------- ........
Signed..,.... ... . ....... .........
Date
Application Approved By.... ....... . . ..... . ........................................
Date
Application Disapproved for the following reasons:..............................................................................................................
......................................................................
Date...
PermitNo.._. ........ ............................ Issued.....................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
G, � ��c
..........................................OF....................................................................................
Tertifiratp of Toutpliatur
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by-------------------------- ...... .........................................................................................................
j
Installer ............. J v
at...............................11. .. ........Z��."�-.,Z!���,. ..... .... ..................................................
has been installed in accordance with the provisions of TI aro .. dated...... ...........to Sanitary Co e in the
O..0...... ....application for Disposal Works Construction Permit I ...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
0(7, ................. ...............0 F........... ....................................
No...&..lb........e FEE....
Disposal Works Tonstrudion rrrmit
Permission is hereby granted.. . ..................................................................
;------------------------- ---------------7-----------
to Construct or Repair e) an Individual Sewage Disposal System
aN o.............. ...............................................t ............................ .......... ..................... ...... ...... .........
Street
as shown on the applica 'on for Disposal Works Construction mit No.- ...... . Date ----- ... . ... .. .......
Cap
- ----- ---------- ------------------ ... .......... .......B r of HealDATE.............. .... . ............................................