HomeMy WebLinkAbout0385 BISHOPS TERRACE - Health 23 +s �O� S r►-a-
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IN ST ALL.ER 5 W&ME ADDRE.'S
BOIL- E 5 Q &V.A
DLaTE PERMIT ISSUED
DATE COMPLI &MCE ISSUED:
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No.......... ..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD,, F F-�EAL
..... . .... ... .....:._.........OF....�1�................ ... .................... ---................---------
Appliratiun -fur Miipviitt1 Workii Tattotrurtiun PPrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at•
ocatio Address or Lot No.
✓ �. ✓._ ... . ........ .................................. ...............•-•----------------........--'•----......_.-'----•••••------------------...---••---
er Address
a c'-r.
Installer Address
QType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons----------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ----- ------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth----------------
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area........----------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by----------------------------------------------------------- --- Date..............----------------------.--.
,a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water-...__-.-_.__.____.__.-.
riq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.____-___--...____----
9 ------------- ------- ......-----------------------------------------------------------------•--.....................................................
ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
U -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W ------------------- ----------------- ------------------------------------------------------------------ - /
U Nat re of Repairs terations—Answer when applicable._.`''. _. .: .. .__-'.._..®D:D
----------------------------------------- --=� ....------------------------------------...------------...... ---------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article LI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issued by the board f h
-- s _ �---
Date
ApplicationApproved By......=............................................................................................ ---•-------.......--- . ----------------
Date
Application Disapproved for the following reasons----------------•----------------•---------------............-•--•-....-•--•-•-••------•---......._._...-•-------
-----------•-----•------------------------------------------------------------•-----•------------•---------------•-•--------------------•••-----•----------------------------•--•------------------•----
Date
PermitNo..... ...................................... Issued--- 7. _......................
Date
No........... Fa$.c °",. ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD YF HEAD
Appliratiun -fur 11.4puoat Works C onotrurtion Vautit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at• ^
r ^ : o Lt ......................
oocatin rds or No.
. 41. ------•-•- ... ........................................................
Address
Installer Address
UType of Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Other fixtures -----------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
P4 Septic Tank—Liquid capacity------------gallons Length---------------- Width------.......... Diameter................ Depth.--.---.--_--.
xDisposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft.
3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area-------.----------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by------- ---------------•--.....-------•---•------•----•-----•-••---..---• Date---------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water........................
(s, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_.---_._____--_----.---
t4 --------------------..........................................................................................................................................
ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------
U Nature of Repairs erations—Answer when applicable..... _-1 �.��_ _...� ®�D .
--
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 . n issued by the board o/he
Signed(. --����-��..4....: ....�. . ................................
Date
ApplicationApproved By--------------------------------------------------------------------------------------------------
Date
Application Disapproved for the following reasons:................................................................................................................ .
•.........--••--•--------••-----------------•----.. ............................................................................................. ------------•-------------------------•.---------------
Date
PermitNo------ ------------------------------------- Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... UG�..��. ..-.........OF...... ....�J.k7.f/'.STd1/'r C
...................................................................
�Prtifirate of fENoutphatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by.............Z�A.fl-.......... .---•---•---•--
/� Installer
at
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as descriJ�ked in the
application for Disposal Works Construction Permit No--------- ___________________ dated.-._.//-':;? ---
E THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. � aj' ,
DATEInspector-----T1-----------------j -------•-•-----•--•--••----------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'/3 ....................7/., -.......OF..._...... . ........................._.... Go
No......................... FEE.....
Bi-sputitt1 WorktiChou trttrtiu�t rrutit
Permission is hereby granted--------A-A_&- ------ 'r '-'----U-----—-----------------•--------------------------- t
to Construct O or Repair ( ) an Individual Sewage Disposal System
at No........!�./.j. �--------- ---------------- '-/ 1/,I,- 4i3 .:.
•- --------------------------------------------------------------•----
Street /
as shown on the application for Disposal Works Construction Permit No--- ....... Dated.....��'__ :-1 ................
DATE------- ��.i_..--•-----------------._._._...--------------
Board oHeat
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS