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HomeMy WebLinkAbout0024 BRIDGET'S PATH - Health 11 6n'dy4:s No......7��..7� Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS II Z r BOAR® OF HEALTH �Y%q .............. ..N.. --- ..... _OF......�' IZ.tV- -�, f'13. ------------- Appliration for Bwvoiial Works Towitrurtinn ramit 1 �j� Application is hereby made for a Permit to Construct (V, or Repair ( } an Individual Sewage Disposal ' ' System at: / fit ..._.-C���T,�'1�G!� 4. ._ LI �j �S"ocatio A�dr s or Lot No . ........ ..................3 .S�cc�..... ................ ._YY!i -•- .. Owne a .t14 Lr7T5 '^�`�Lf-:r- 6 7 J/i r% .� H'1.OId - .....................•-_.. .-• ........................................................................... Installcr Address QType of Building Size Lot.._/6118........Sq. feet Dwelling—No. of Bedrom �U .............................Expansion Attic (tve) Garbage Grinder (NO) '4 Other—T e of Building ..M. A No. of persons............................ Showers — Cafeteria Otherfixtures .....................................-&e-l...- op-------------------------------- �•----------------•-------•----..... W Design Flow_________Z40.......:.................gallons per pper ay. Total daily flow__.................... ._.............. WSeptic Tank—Liquid capacity/O A Z.gallons Length&..6."_. Width.-Y.r/&"" Diameter________________ Depth..S_`8.'ry x Disposal Trench—No. .................... Width.................... Total Length................... Total leaching area....................sq. ft. Seepage Pit No.__../--e--------- Diameter....t9.......... Depth below inlet.....$......___._. Total leaching area..a__0Q...sq. ft. Z Other Distribution box (1-01 Dosing tank ( ) Percolation Test Results Performed by._R_00A.4:6.... &D..... l.t, Date....�ju_6s-----34.. "6 1 Test Pit No. 1...4 -_.minutes per inch Depth of Test Pit.....Z.? .'..... Depth to ground water.:.A tA AAA.._.. Test Pit No. 2_._.4:�:_�;—•___minutes per inch Depth of Test Pit..... Z'...... Depth to ground water.Av.o.At.�_-_____ --------------•---------------•-----------------------------------.-------------•-----------.......................................................... O Description of Soil__.___-2_IV ` ---60'A n3-___-..4.W.. .__----5-V!_!' S_Q_P. ---.r---a`Z_.Sl_`�:_._��l�C'_"___J�_ d?lUM ................ .Mal _ ..............S'alyc........ a,c.r)4T0-0nv-s--------d'W-------marzle--------------- .................................-...................................................................................................................... UNature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement The undersigned agrees to install the aforedescribed Individ ial"Sewage Disposal System in accordance with the provisions of iIT Z 5 of the State Sanitary Code The and igned further agrees not to place the system in operation until a Certificate of Compliance ha?b,,e iss ed by e o rd o ealth.Signed .... _...•...•.Application Approved BY ie l4 ••••-••-•-• {' . Application Disapproved forfollowing.reasons__.............._____________________________________________________ -------- Date.............. .._ ........••-••-•-- -•---••.......•••-••......••.......-•-.••••• ----_... -•••------•-----•••................. --------------•-••-- ----••-................................... Date Permit No......... J � ......., 6, ---•--------------- •----- Issued------+h '- �. Date � W _. . ._ No...._ 'r FEs.............................. THE COMMONWEALTH OF MASSACHUSET-TS BOARD OF HEALTH ......��_..t.7l+i.--...... ------.OF......8/9,RC:�..�.�r��� ... ..................... ApplirFation for Disposal Works Tonstrnrtinn Prrutit App'licatir Yis hereby made fora Permit to Construct (1/) or Repair ( ) an Individual Sewage Disposal System at: , f<. �: ... .......... s .f........ ............. ocatio Atld s f/ or Lot No rS 4.0 W ®_4' /ate +............. C ' .L.�vra t C M.AOV7�.4 ---•----•---•-- ----•-•............................... . ...•------•----..........-•---- Installer Address Type of Building Size Lot_./4k./f-' ........ feet ., Dwelling—No. of.-Bedrooms......... ........___ ............_Expansion Attic (rUs) ,`-,r Garbage Grinder (+VPt) a Other--Type of Building _t-1/A............:.. No. fof persons_ Showers ( )�j Cafeteria ( ) ---------- Otherfixtures ---------------------------------- . # ------....�:.....-----=•..... _.... ---------..................---• / g oa 2 . C� w Design Flow........._ __________________________gallons per s i perlay. Total daily flow.......... .................gallons. Septic Tank—Liquid*capacityl P©gallons Lengthy_"g_`"... Width V " Diameter................ Depth_. ''! .r! x ^ Disposal Trench—No..................... Width.............:....... Total Length............_._...._ Total leaching area___-._.._..._.......sq. ft. Seepage Pit No.... -- Diameter....e _ ______. Depfli'below nlet_._�..t_--___... Total leaching area__�V_q...sq. ft. Z Other Distribution box (e'f) Dosin tank ( ) Percolation Test Results Performed by. !@E. ....At...<�/��!=���__._A'AA Date...A.r/.�14 -:_-__ �._��%�� 04 Test Pit No. ._..minutes per inch Depth, of Test Pit.....eA`..._.. Depth to ground water.A)A?.!�+o--_-- Gi, Test Pit No. 2...4•..;Z-.._minutes per inch Depth of Test Pit..... ....... Depth to ground water_Aj/ja_^,-:_.,S....... --------•--------------•--•-------------------------------------•-•-•-------------•----•-----•----......................................................... O Description of Soil---- .-s i"�ft ,G° �R l------.4.&.1'` ........ --fee.---f _.5/..`0... �1��1.`r Ltd. �'�✓4j _.5Z1 .1A,4—--------------: ' r �1 s r . --------.ins------? a "�?' w5 ' ! S -= --- ----------- ---- -- - --------- -- .----_--------------------------------------------------------- ._... :.._._. V Nature of Repairs or Alterations!—Answer when applicable------------------------------------------------------------------------ _______________________ t Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T?T 1E 5 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. Signed....................• -- Application Approved BY......... ;. ,. Date r Application Disapproved for the following reasons:.................................................................... ----------------7---•-----•••---------•-------••--•--.....,.......-•---------•----••---•---------•--------•--------•/ '1 -------f�--:............................ q q Date PermitNo. ---....-----••---------------•--•._..._--•-• Issued::.,.l._.. ---------------=---------•---•-•----- Date SHE COMMONWEALTH OF MASSACHUSETTS x` BOARD OF HEALTH. ` . ,.... .`. .........OF...... ry ......:. a nr ] , THIS 0 CERTIF Th h :vidual Sewage Disposal Sys6i constructed ( ) br Repaired ( ) by .�: stalle7,Y,--'---- ---- . ---------•--------- has been i talled in accordance with t e provisions of TITLE, 5 of Th/StatAanitary Code as de- ribed in the application for Disposal Work§hConstruction Permit No.; •:�_________________________ dated-------------------------___................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / 7 rC� . . � DATE... `.L...1�..:`.............................. Inspector_..... --------------------- THE COMMONWEALTH OF MASSACHUSETTS y BOARD—O-F ALTH 7 :.............................OF..................... ..................................................... No........:................ FEE........................ Maps kil ns ion Uprrutit Permissio ereby granted-..-.-. 1. --... ......... .. ••------• .............................. .: to Constru ) or Re. ( ) a .,n In idual pos yst at No.. . .../ G... ..: -- -- ......... �t � -� Street - � � as shown on the application for Disposal Works Construction ._gmit 7_ . ..__..._. Dated.../_ --4K _ ---------- Board of th DATE { .-• ---------------- FORM 1255 HOSES & WARREN. INC., P LISH."s !+f � w i All OLE AL)&(1ST 3i, %9?6 1 - ' RtS RE PDX ` PR�L 1`!ltJr~�l?T LEASH Al - �1115PCCTOR LE / �¢, f 10 n/ /+ I'D ELEV. 1q.o SEPf<Ga�,. t LOT ! t TANre L0T 0- 9.4 LORM AN.p, SULiSO{L SAND i=01UN D TEST M . H0LES NO WATER EN( JUNTEREb } 4 + PROF, t LJata TO i.JATER S AVA � �.ABL NAIL. IN 71?u ;LINE ` E A SS,b/V SLZV. n- � r FA7 H 5 u/� 011VG S ETc3AC C,q `E '' Glzo DO SED n- 4 I ' _ [3E D2oo,vl5 I f SE P T/c y5 TAM CONS T2 UC T/OBI SHALL COn/F02M TO MASS . UES/v/l/ �_�LV ' GALS DAy i ENV/,eOn//yC-nl7,_4L COOS T/TLL 7/t, - �EV'1SED -7-/=77 ` (3ARN� TA }�( � LC 4G,�✓ 2,4TE A/E.�1LTN IJL 4 T/O/VS �Ey7C.//2C-L TOY OF �- U E,�iCN .�,�.'�•-� oC.G;7 _� > MAnINOLE Co/E/2 TO Tj /M/-,LQ✓/OCIS COt/E� ! TO �2E ✓eA./7- F/L722A7_/A sTo/vE % �r 13Ox A,)/n//n.JUi►/ f� M w1 _y 3..M.y 4„ D/q #VATF•z D/,q. i i %4'• ' Ft7 C T /O"M/N "2" M/N 11 �'-------- D/r i. r/,?"Y 1 ool /'ircf/ �,.f _ 2 D;.t. 1 DOO rt/A 5 E v /y. -- - j , - - /vvF�Zrr0AJE a r�ac / Tv ` 4/2ou/✓ci 13. 1 ! 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