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HomeMy WebLinkAbout0089 MIDWAY DRIVE - Health (3) r a ° o ° 1112 MAIN ST., unit 10+11, OSTERVH LE ` WRICO INC. i A o � a UPC 12143 HASTINGS,m" t lj�cPYt No.._G(•-.1.__®....... 73 ®I j/ Fizic..'2..r: . THE COMMONWEALTH OF MASSACHUSETTS BOARD O,4F HEAL H OF.... ........ . .... ....... ............ ................... ApVtiration -for ]iiiVuiittl Works Tonstr"an j Prniit Application is hereby made for a Permit to Construct or Repair L Individual Sewage Dis osal PP Y ( ) P ( ) b P System at: =------- -- --------- y f'--------- e r1 -- ----© - ---- io -A ess or t No. p O er Address a ---- --- •- ..... •-•- -- -- --- - ----- --- ---••--•-••--••--•-••--•-•• ----...---......----- -- --••-•--•--•-•----------------•-...-•--•--- ns er Address Q Type of Buildirt Size Lot____________________________Sq. feet U Dwelling—No. of Bedrooms________________ ----_-Expansion Attic ( ) Garbage Grinder ( ) ~ Other—Type T e of Building ---------------------------- No. of ersons.---------_----____-.___-.._ p., yp g p Showers ( ) — Cafeteria ( ) p' Other fiat s ----I----------- W Design Flow.. ................:1 ___v __ _ __ Ions per person per day. Total daily flow-____-___ -------gallons. W Septic Tank Liquid capacity_-.--_ allons Length________________ Width...__....._.._.. Diameter--.------------- Depth--- .......... _ x Disposal Trench—No Width Width Total Length.................... Total leaching area.--._____-_.._____-_sq. ft. 3 Seepage Pit No.......... Diameter__:,_, __ aBepih 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-----------------....... 44 Test Pit No. 2................minutes per inch Depth Test Pit-------- ._._.._... Depth to ground water._.-.------_____---..___ Description of Soil C �. � ....... -- ---------------- x --•----.-- -----------------.........-....................-------------- ---------- -- x ------------------------- ------------------------------------------------------------------------------------- ------ -----------`------------- ' U 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 b issued t oard heal h. l- Signed. -• •-- .._._.. •• -••---f �J�� ------ ---y-------- Date Application Approved By. _______ __ __ _ ______ �/f_ ,r Application Disapproved for the following reasons:..................................._____........................................................................ .._.._...-•-------------------------•-----------------------•----------•-•-•----•--••-••-•-----•---•-•--- Date Permit No........................................................ Issued.---�.. to �_-----•--•--- Fps.. ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OW, HEAL H ''h--------OF..... '....... a......- Appliration "fear DiBpmal Norkii C omitrran � rrniit Application is hereby made.for a Permit to Construct ( ) or Repair ( dividual Sewage Disposal System at: y • ......... io •A ess or Uot No. W q� er. .. ... Address ns er Address UType of Build' Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------------- r-__-Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building _--____________________ No. of persons-.--_-_--_-._.---_----__-.-_ Showers ( ) — Cafeteria ( ) Q' Other fixtures __A---.-----_ -- ------ -------- W Design Flow_.....:..........'_` ...� Ions per person per day. Total daily flow-__.-_-__ gallons._...:._.... - ..Mons. WSeptic Tank—Liquid capacitu -.-_-_- allons Length---------------- Width................ Diameter-----....-...... Depth....-.__--.._. Disposal sposal Trench—No j______________;_ __. Width _.__:. ._. _ Total Length-------------------- Total leaching area-----.--------------sq. ft. Seepage Pit No---------------------- ._.Diameter_ d ._ epth 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-..-----------..-..--_ rZ, Test Pit No. 2................minutes per inch Depth Test Pit....... ......___. Depth to ground water....---_--.------_---. a' ---•-•--•------------------------------ D Description of Soil '" '.., •---- ------------------=------------- ---------------------------------------- x U --------- -•--------------- -------------------------------------•-- - -- -- x --•-------- -- ----------------------- ------------ - --- ------------------------------ -- .-f U 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 \I of the State Sanitary Code,— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued y t '.oard heal h. Signed._ ---- -�� ------ ------"---- - �� -- A lication Approved B a to PP PP Y = Application Disapproved for the following reasons:................................... ............................................---------------------------- ------. ---••-------------•..............--------- Date PermitNo.......................................................... Issued.............................=..........- ............. Date x THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH C.rrtifirate of T-0-Whaurr `t THI TO C RTIF hat the I ividual Se e Disposal System constructed ( ) or Repair4 by Inst er +► ` e, at---- 1 C. i has been installed in accorda e with the provisions of Article T State Sanitary Code escribed �t application for Disposal Works Construction Permit No. - PP p ---------- Q- dated THE ISSUANCE OF THIS CERTIFICATE SHALLAOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY � P tDATE--- i ;_ nspeco � v r THE COMMONWEALTH-OIF-e4ASSACHI 4EETTS ' BOARD ;t EALTH O F............ .. FEE Rispa,ial orkii 11n urtion PamV h. . Permission'is hereby grante ----- ------•-- to Coristr ( r Rep t an I dividual wage > posal S at No:"" ........... ----- -----. e eet J • '� as shown on the application for isposal Works Construction 'er ift No._. . ._ ::; __ ated----l_.'."� ... - .... ... . / Boar of Health DATE_,_( � .............................. FORM 1255 HOBBS & ARREN. INC.. PUBLISHERS .. -T r. i 11 .� � � . r- J � ` for b - Ell i 1, ,. i it � '� • � • �' ` � � � � f � � � � s � r � �' z t , 4f"' Ile- }06 ® i M rl�H �- ��