HomeMy WebLinkAbout0109 NOBADEER ROAD - Health �51 -2,� -�'�
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
G ?T�cv .. oF...........
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AVVIlration for Btipnaa1 Workii Tonstrnrtion Vanfit
Application is hereby made for a Permit to Construct (-I or Repair ) an Individual Sewage Disposal
System at:
.............. -.1 . "--.../.
C ....... ....... �4.:..------•---•.............
L
ddress
------------�---------- . > . .....7s .. ..... ....��r�n�r � ....f> ,V/. ......
Own Address
a ................ iG 7�.• Gong .1:._.. .: . �1 e..f...... .:....----•---...................--•--....
� ( Installer �� Address
Type of Building Size Lot... ...Sq. feet
-� Dwelling—No. of Bedrooms..........................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ______________ _____________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .----•------------------------••---•---------......---••••••--•--•-•-•----•••••-••••-----•-•...••••---•--.....---....--•--•-•--•-............----•---
W Design Flow....................✓,°.................gallons per person pert d y. Total daily flow.................3.3 ................gallons.
WSeptic Tank—Liquid capacity,l®�Ogallons Length__ffT... Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No........:......... Diameter...../11_=_fir.. Depth below inlet...... Total leaching area 3%, o;?2.sq. ft.
Z Other Distribution box Dosing tank ( ) ,S/9�1�t3 S,o�B3
Percolation Test Results Performed b . :�'Y Y__ .1 fA . 41,.G.: Date.......................................
Test Pit No. ___minutes per inch Depth of Test Pit....../?......... Depth to ground water._/�4.!:%.._..
(.X Test Pit No. 2............_....minutes per inch Depth of Test Pit.................... Depth to ground water........................
R+ ..............................................---•-••-......
O Description of Soil...............�-.x4.....T, e/d5�,1- 3
V ,�.'. . ......K � ..... ......................................................................................
0 Nature of Repairs or Alterations—Answer when applicable.______.........................................................................................
.••• •••• • -•---------------••-------........--•---------...-----------------------•------------...............•--
Agreement:
The undersigned agrees to install the aforedescribed Indiv' ial Sewage Disposal System in accordance with
the provisions of iITI TIE 5 of the State Sanitary Code— The u d si ed further agrees not to place th system in
operation until a Certificate of Compliance has be 'Is d t oa health.
e
ed-•-. •• . ...... •. . ......... /// l�. �.
Application Approved By .-•-••••--••.........••--•---•-•-----••......•--•--.......--•-•----
-•--•--•---•••------Dat......-•.....•.
Application Disapprov oeasons:....---•----------------------------------------------------•-----------.......................................
---------------------------------•-------....._....---------••------------...-----------•--•-------•-------••••-•---••-••-•-•••-••--------•••--•---------•-•••--•-------•••......---•••......-•-•--.....
Date
PermitNo......................................................... Issued----------------------------•-•-••-••---------••-••----
Date
No.........................
Fes$.... .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................OF.............::.. ./
, ppliratinn for Uhipaii al Workg Tonstrnrtion thrntit
Application is hereby made for a Permit to Construct (4^ or R pair );an Individual Sewage Disposal
System at:'
................_........ -..... .........................•- ............ ..........:,.:.'._ -- ----_. ....------....---....---•-
f Locatioiv-Address _ or Lot NJ
w _
��7 v /v !S AGdLdr�elsr. ..........................
.........
j -•.s
O Address
....................
Installer
UType of Building Size Lot..Vic?_ 3 y_....S . feet
Dwelling—No. of Bedrooms............_5�............... .__..Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building .............. No. of persons............................ Showers —
a YP g ------------------•-------------•---••-----P ( ) Cafeteria ( )
Q Other fixtures .....-----•------. .....-•----------------•------------•------------------•---•-•---�------------.............._..
r--�
W Design Flow.................. ........................gallons per person per d y. Total daily flow... _ .................gallons.
WSeptic Tank—Liquid capacity Z '_�Ugallons Length...'...... Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Midth.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......................
Diameter....1 _:. :... Depth below inlet.....` ':'_ Total leaching area_..!...��....sq. ft.
Z Other Distribution box ( Dosing tank (
Percolation Test Results Performed by........::......................... .. .........� ___ /^-
� ------.__.. Date.............................
Pit No. 1..:�..?:___.minutes per inch Depth of Test Pit-----jZ......... Depth to ground water_ /'./--�',=.._..-
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_.................
O Description of Soil...............�J -n,/ ca x t_ f
....... ----------------------- -------- --------
w
---------------•--...--------•-.-----------------------------------------------------------------------------------......._._..------------------------------------------------------.._._............
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 TTTLi;
p 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.
`,. Signed--------------------•--
Date
Application.Approved By.................................................................................................. .........................................
Date
Application Disapproved for the following reasons-------------------------------•-----•--•------------ ----------------------------------------------------------
--•----•------------------------------------•------•----------•--•----------------------•-.....-----------------------------------•-----------------------------••--------------------------•--------•--
Date
PermitNo......................................................... Issued-.................. ................................
Dattee
THE COMMONWEALTH OF MASSAdRUSETTS
BOARD OF HEALTH ''°4•:
...........` ��.�.t .......OF.......... .. �1-1 y............................
C�ra�ifirtt�r of (�unt��i�tnrr ��
THI TAD CERT FY That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by--------- 4r.�'-- ................. --- --------------•--------------------------.....------.....--------------...._...----...----...---------------------
ller..M.
at .....�--- ��@" ' 4r........................ '� ��' ----------------------------------------------------------------------
has been installed in accordance with the provisions of TItT�LE 5 of The State Sanitary Code s scribed in the
application for Disposal Works Construction Permit No.___A + ----------- dated...... - ...................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE
SYSTEM WIIyrC F�j CTION SATISFACTORY.
DATE---._// ��.111�...._......-•...................................................... Inspector..... .-- ...................------------......------......------.........------..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
a( .............. OF.......... :_..._ ._..... ....
7 .r
FEE.. .. ::...
g
Disposal a kp. Ton;s•tr inn anti
Permission is hereby granted.................. ==� ---,� stem
- . ---------------------- --------.....------------...............------.
ua to Constr .) Repair ( ) an Indi ual Sewage D al,
1 ...................
Street
/ e
as shown o/the pplica ion for Disposal Works Construction Permit 3A__ . - Dated---_--__---.f F.�:_..$�_-_____
....................... ..................DATE../ --L---/---------------- d of He
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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