HomeMy WebLinkAbout0079 REDWOOD LANE - Health v
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UPC 17734
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No.--]--7j-------•--• Fizz.... i................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® PF HEALTH
J I OF....
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Applira iun for Dispnsal Works Tomitrnrtion rrmil
Application is hereby made for a Permit to Construct (Kor Repair ( ) an Individual Sewage Disposal
Sys a
A ovation-Ad ress No.
�. .................................... ............. _
wn Address
W -
a
Installer Address
UType of Building / Size Lot----------------------------Sq. feet
Dwelling—KITo. of Bedrooms............................................�'� Expansion Attic ( ) Garbage Grinder ( )
Other-T e of Building .. No. of persons............................ Showers — Cafeteria
Q' Other fixtures ______________
,�I ---------------------- --------------------------------------------------------------- ----------- l
......I..?--L.� Ions per person per day. Total daily flow___________________________________
W Design Flow,,: p p p y, y � .____._._gallons.
WSeptic Tank-Liquid capacity-/-4� allons Length________________ Width----------.----- Diameter....------------ Depth----------------
x Disposal Trench—No..................... Wi th____. _.__._�.�1 Len ------------- Total leaching area....................sq. ft.
Seepage Pit No------- ______ Diameter . ............... e th below inlet.................... Total leaching area------------------sq. ft.
Z Other Distribution bdx ( ) Dosing tank ( )
Percolation Test Results Performed bY------- --•--------------------•....-•-•-----••-•....-------------------_. Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water__.___--__--_-_--_-_-.-.
fq Test Pit No. 2----------_.....minutes per inch Depth of Test,Pit.................... Depth to ground water........................
a ----------------------------------------------- -----------••-----------------------•--------------••---------------•-----------•------------•-------------
ODescription of Soil--------------------------------- -............... :--------•--------•---.....------------------------------------- ---_-----------------------------------------
U -- ---------------.---------------------------------------------------------------------------------------------------
W
V 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 issued by the board of health.
Signed- -----•-----•----------------
Date
Application Approved BY f ..sue-------- 1.... -
ate
Application Disapproved for the following reasons------------------------------------- -.......................................................
----------------------------------------------------------------------------••-----------•---------------------------------------•-•----••-------•-•---•---------------------•-------------------------
/'6?'e "' Date
Permit No. Issued...: [2
�
No... ......... Fps.... :.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. d° * .. OF.... ..
Appliration for Uhipvii tl 10orki.i Toutitrurtiou Vrrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
SysLem at
iW_� -a o 1
----•-
ocation-Address No.
- �- 1 s»3 -------------
ill Own Address
Installer Address
Type of Buildi Size Lot............................Sq. feet
Dwelling J o. of Bedrooms.............. '."':......_____.._.Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( )
a' Other fixtures --------------------------------
------------
W Design Flow.- ^.:. �____.. _ llons per person per day. Total daily flow----_---___ --____-----.-----_.--.....gallons.
W Septic Tank Liquid capacity__/ ions Length---------------- Width................ Diameter---------- -----
Depth__-._.-_____----
x Disposal Trench—No..._.__.. ..... Wid h__._. ____________ Total leaching area.__---_--__--______.sq. ft.
Seepage Pit No..•-•__•-- ---__-- Diameter. __ p g q.
._. lie e0Leng14r'
below.inlet..............:..... Total leaching area-.--.._-_.-------s ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date--------------=------------------------
W
Test Pit No. 1................minutes per inch Depth of Test Pit-__--______-______ Depth to ground water_-_-_-___-_-__-__-_-----
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-____.-____.._-----
-------•--•------•- ......
DDescription of Soil---------------------------------- �_---.......---.....------•-----------------------------------------------------........----------------------------•---
U ------------------•------•---•-•-•----•------•- •--•• •--------------------------------------------------------------------------------------------------------
W
VNature 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 `YI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed ........................................................... - -ate
- ---
DA lication A roved B -
Application Disapproved for the following reasons:--- ................................. •••-••--•-•••---•••-•-•••-••------------•..................•-•-••---
-•-•-••••--••-•-••---•--••----------•-----------.•--------••••......--•--•...••-•----.._.....••••--•-•••...
-----------------------
Date
PermitNo......................................................... Issued..............................................._........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
. .:.... ...............o F.... .. . .:. °'.
A, ,f tf rat r tip Tome atirr
THI" S CER IFYx at dividual Sewage Disposal System constructed ( ) or Repaired ( )
• -.{ .............. ..../ .....................................................................................................
staller
has been installed in accordance:with the provisions of Article ' f he •State Sandary Code s described ii the
application for Disposal Works Construction Permit No.................. .. ....__.... dated_._. __ _` .._..___.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS &GUARANTEE THAT THE
SYSTEM WILD�IJN TION SATISFACTORY. i
DATE .? Inspector I ...--------
THE'-COMMONWEALTH OF MASSACHUSETTS
°BOARD OJIF HEALTH
f
No.,_ ..
FEE---------.........................
Ifit Permit
Permission's reby granted
to Construc e( or Repair,( ) n Indi 1dual,,.Sew e'Disposal Syste
at No... 4- `#- ----- '� _ ._--?..:� - -- . . ---........
• � Street ,
as shown on the application f Disposal Works Construction Permit �� ed._ ---------------
7 ...
//---
, ------------
Board of Health
DATE ==---
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS