HomeMy WebLinkAbout0006 STANLEY PLACE - Health _ (o S�{tt�t� PIACe� }��is
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LOCL,T.IOPl ' SEW&(:CE PERMIT VJO.
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iNSTALLER•5 1J&1 AFZ ADDRESS
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BUILDERS 1JL VAF— laDORE55
DATE PERMIT 15SUED
D ATE COkAPLI W-ACE ISSUED :
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THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEA H
...... 1............OF.......
i�................. .. ......... ......
Alip iratiuu -fur 33i>ipwiai Works Towitrurtion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (l/f an Individual Sewage Disposal
System at:
a -A ddres � Tor t o-�--- er
......................
--•--......--•----
�5_..._.__ •- O2 ..••--- - --••-----•-- ------..._!S_ ------- ............... ---------------------------
AddressI�staller S
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UType of Building Size Lot____________________________Sq. feet
Dwelling—No. of Bedrooms.-__ 3
------------------------------------- Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons-_._____-__-_-______________ Showers ( ) — Cafeteria ( )
QOther 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 ( )
Percolation Test Results Performed by.......................................................................... Date.........----------------------------.-.
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit..------------------ Depth to ground water-------.-___-____-_-_-
fX4 Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
------------- - •• ------- ----•--•------ -•--•--•-----------------•-•---------------•---•----------•--•-•-----•------_------
O Description of Soil_____-_--'�________________ i_-________-___
V •--•----------••----------------------•-------------•---•---------------------•---------------------•-----------------------•---------•--•-•-----------•-•--•-------------__---------------------------
------------------------•--•-•-----------------...-•-•-•----------•----•••-••---...-----•. ------------------------ -------
U Nature of Repairs or Alterations—Answer when applicable._-: ______-/_ d t�-1_.- _-----
----------------------------------------- ------------------------- ----------------------------------
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.
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Signed......- --•--•------------------�------�-- --•-•-------------•.--- ----....-..�3_�7�
Date
Application Approved By-------- ------------------------------
--'•---------•--- -- -------------•-----------•-------Date--------------
Application Disapproved for the following reasons___________________________________ - ��
................................•---__....----------------•------._...----.___...----._.-_-•---------•---__-----•------•--•--•---------------------•---------•-•-----------•-•--------•---------•-_-•••-
/ Date
PermitNo--------------------------------------------------------- �ssued.-------�.....� --------- - ------
- / 57Oe9 ���. � C�� �� s Date
Finic
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
----------OF.........V`,'.............................. - .............................
Appliration -for Bhipooal Worko Tontrurtion Vrrntit
Application is hereby made for a Permit to Construct ( ) or Repair (v)'an Individual Sewage Disposal
System at:
J/ Location-Address _ / or t o.
•------------------••--•-- -•------------- •----- �J== 1-------------- --••-••-••--1••---- --_____--•------
own
' dress
/11;
Installer Address
Q Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-.-----3
-----------------------------------Expansion Attic ( ) Garbage Grinder ( )
C`4 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. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date-------------------------------------_
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...---_---_----._----...
(1 Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water.......--_---.-------.
P4 ----__-----•----------- ----------
O Description of Soil--------. -.__._
x
------------- ----------- --------------------------------------------------------------------------- ------------- ------ - - - ---------- - -----------
------------ -- -------------
U Nature of Repairs or Alterations—Answer when applicable._.—_---��-- f ,lC�'�v lJ ...- --�------
-------------------------------------------------------------------------------------------------------------------------------------- -
Agreement:
The undersigned agrees to install the afcredescribed 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.
r i � ,
Signed.. __ e%i •---�--=�-----=, --_-------- -----
ApplicationApproved BY------------------------•---....-................................................................. --•----•----------Date----------•••-
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
-••••-•....................•-•-•-•-•------•-••----------------------------•-----•-------------------•-------•----...-----•------•••-- ---------- ---------------------------------------------------•-•-
Date
PermitNo......................................................... -Issued------...----------D .................................
Date
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALT
fio,1 ............OF.......... . .... .Cr ... .....'............
Trrtifirnte of f11ontphatirr
T IS TO C1F,Rj IF hat the Individual Sewage Disposal System constructed ( ) or Repaired
b -------------------------------- ........... -----•-•-- -----------------------------------------_-_-•----------------•-----------•---
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at-----`-..../.I__._Wit- .. /yaw .-._._.-.�� •..... --------------------------------•--•------------•--------
has been installed in accord nce with the provisions of : c�1 I of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----------------- _S............. dated----
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................................................................... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
7� BOARD OF HEALTH
-3 02-5-- .......OF-- ......... .: ................. °K1
No......................... FEE.••• -.........----.._.
�i��o� ork,� non�trttr ott�y � r�tit -
Permission is hereb l a d2 ---f- ------------------------------------------------------------
Y granted-----
to Construct ) or epair n ld* iadurl ' wa isp tem
Street
as shown on the applic ion for Disposal Works Constructio ermit ......... .......... Dated_7." 3 __7 ..:__..___..___.
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'7-a.S- 7�
Board� �f
DATE-------------------------------------------------------------------------------- \
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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