HomeMy WebLinkAbout0016 GENERAL PATTON DRIVE - Health LA
LOCATIOt l 5E\Na(C E PERMIT UO.
IMSTQLLER'S U&tAE ADDRESS
BUILDER 5 Q &ME �. ADDRESS
DNTE PERNA VT 155UED
DATE COMPLI &MCE ISSUED ;
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
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Appliratzon -for IN-.lanai Workii Cnowitrurtill unift
Application is hereby made fo a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
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Installer e
Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' 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. It.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by -------------------------------------------------------------- Date---------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water_------------.-------.
G14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water---_---__--__-____----
9 ----------------------------------------------------........................................................................................................
0 Description of Soil..........................................................................................------------------------------------------------.----------------------------
x
U --••--------------------------------------------------•-----------•----------•--•••--•--•-----•-•----------------------•---••--- -------••--•••-•------------------------------•--•--.....--------- --
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U Nature of Repairs or Alterations— nswer when ap licable...�( (__���C___ ! S/ -SYSJ`ey'1
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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 b sued by tt e bo // 7
hrl
Date
Application Approved BY �G �1 = -
Date
Application Disapproved for the following reasons-------------------------------------------------------------------------- ----------------------------------•--
---•••-••••-•-----•---------•-------•--------------------•----------•--•----•----•-...•----•-••-•-•-••--.•-•-•••-••------•---------.._..--------•--•-----•-------------------••-•-------•---•--•-----•--
Date
Permit No......................................................... Issued....11 "`-/ __ -
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Date --_ ......
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliratiun -for Uitipuiitti Works Tomitrurtion Prrutit
Application is hereby made fo a Permit to Construct ( ) or Repair ( an Individuual Sewage Disposal
Sys �6 �/"1 ..
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Installer Address
Q Type of Building Size Lot.......::...................Sq. feet
V Dwelling—No. of Bedrooms--------------------- _-.-_._-_-_Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ---------------------------- No. of persons-----------._,, ( ) ( )______________ Showers — Cafeteria
QI 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. it.
X Other Distribution box ( ) Dosing tank ( )
1.4 Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------
Test Pit No. 1................niinutes per inch Depth of Test Pit.................... Depth to ground water...___-__-___----.------
f� Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth'to ground water---_-___-__--_-----__---
R', -------------------- -------•--•••-•--•-•-•---•--•-------•------------••-•••--•-•-•••-----......_._.......-••••----••------••-•----•-----•--------•.....----
ODescription of Soil----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------
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U Nature of Rep irs or Alterati ns— nswer when applicable._. _ 4�P.__e �sl`� •SYSi`P�-- --��r
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l_ S •. !C Z QD �' f ' , '',5 1 +!!(' Gif'Lc�---------------
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 his b j sued by
" thebo
S • -•--. ....-•-�-t�
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l ..... / .
Date
Application Approved B
PP PP y--- �. �1� �``dbiL' ��'` �•
Date
Application Disapproved for the following reasons:....................--------------- ----- ---------------- s
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---•-------•--•--•---------••---•------------•----------------•-•---•----•-----------•----•-------------------••-•---.-------------•-•-------------------•-----------•----------------a•-•------•--•---
,:, t o —ei � to `
Permit No.---•---- --•--•------•---•-••-•----•------------•--.... Issued--- `/ ° 70,
......
( Date
THE COMMONWEALTH OF MASSACHUSETTS`'
BOARD F HEALTH
f ...............OF.......
....�% ? .
ITrrtifiratr of Tontliftaurr
TO CERT Y, That tffyndividual Sewage Disposal System constructed ( ) or Repaired (40
rInstaller
at--`..... lG - ft------- --- . ... -- .... ------ --rh
---- -- �--------------- .
has been installe in accordance with the provisions of Article I of State Sanitary Code as described in the
applicationfor Disposal Works Construction Permit No......._. LI-- -•.----_--- dated_._ I/ --------------•-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUrC�TION SATI FACTORY.
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DATE------ IC=.._...--•-•-------•------••-•� ------•-•--••••---._....--•--• Inspector-- ..................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
[fy ........ ... ' . ...........OF.............. . ... .. ......--- ....
No. •--7 FEE.. --•
Di-spo 1 urks � stru-tion Vamit
Permission is hereby rante __-___. .___ __..._, ��st4,eXm
Yg pto Constru ) r Repai ' ( ! an Ir , id I ew e Dispo. S
at No.... . -�s ��t _ f�_ _.
i
Stre f /
as shown on the appticati for Disposal'Works Construction Per `tt o.._ . Dated__"" ��-___1_._.. ,1-.....
Board of H t r
DATE..........------------------------------------------------ ---
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FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS '
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