HomeMy WebLinkAbout0101 NORTH PRECINCT ROAD - Health (2) 1 �1 NoN-h nc+
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No.----•................... +r t Fad.; ,i.....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................._0F.....,
C.
Su Di
Appliration for a c®I r � C r r inU10
ernti
"Tl A lication is hereby made for a Permit to Construct DC or Repair an Individual Sewage Disposal
PP.: Y ( ) P (' ) g P
System at:
--------------------- -____--_-------------- l=_' ...................................---•--.
oration•Address or I.ot
a� __.
Owner - ----•Address-•
r `........---•-•................•---•-••------ -•••-••........... ......_...____.._.........-•-•-•--•--•••.
Installer Address
d Type of Building Size Lot.2_'!�,__0,90.__—Sq. feet
Dwelling—No. of Bedrooms.................. _._.....__.._.......Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons...-•____________-_•.__-___- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------- -------•.._....... .-- . -------------- -----------------------
DesignW Flow.................. r....._.......__.gallons per person per day. Total daily flow...........;. ....................gallons.
WSeptic Tank—Liquid capacity.AWAR.gallons Length-----9'_.__. Width...... Diameter________________ Depth_...__._.....-
Disposal Trench—No. .................... Width.................... Total Length................. Total leaching area....................sq. ft.
> Seepage Pit No--------l........... Diameter......40___..... Depth below inlet......4..._..... Total leaching area... ft.
Z Other Distribution box (p<) Dosing tank ( )
'~ Percolation Test Results Performed by C' ,--- h!L� Tl!v�-�............................. Date.r
Test Pit No: 1----------------minutes per inch Depth of Test Pit-----J __ ..... Depth to ground water.... ........
f=, Test Pit No. 2................minutes per inch Depth of Test Pit-----r2___----- Depth to ground water---- 7____--____--.
Gd •--••--••-•••---•-----------••-•-•••----•----•---------•---•.................................•--...-..............................
O Description of Soil./------- g 4y.!e c -----C
V >'-u�k�.. }n�Z?t--- .4-.1 _`vl`_- ...--- __._0_ - P�.-•----.._..
W �f�M8".=- -" 'v�s�al i "' -----A''-Ep----'c c_c�c,a-_<s�l---- - ^�" � .``�' Vic, b ../..&1E
•.
VNature of Repairs or Alterations swer when applicable.....-................... .....................................................s`g....�
jrGU== � - , �- ,�P. M_
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of:T T LE!,
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bDeAl issued the board of health. � J
Sign _.._ 4'r•••pv�p---- - Date----
A -
Date
Pplication Approved BY••--•• t,. = 1 - �j�'- T/6.___
- C�2� ate
Application Disapproved for the following reasons:........................................ --------------------------------------•--------------------•----------
....•••••••----•---•---...--•--•----------------•-••----....••••--•-••-••-----•••-•---....._.....__....•--••••••••-••••.....-----...------••----...----------------------------------------------------
Date
PermitNo......................................................... Issued.......................................................
Date
r
No. ...... M... . ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.._./ 14/1U . ..... ........OF...... ........ ....._.. ..... -.-
Appliration for Bhipmal Works Tontitrurtion ramit
Application is hereby made for a Permit to Construct (X) or Repair ( )' ar`Individual Sewage Disposal
System at:
---.... - --- .....
Location-Address or.
........................
............................ Ownez Address
............•-----•--•---••----- .
Installer Address
Type of Building Size Lot_Zl..pO_lJ__.t q. feet
U Dwelling—No. of Bedrooms...................3........_............Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures
W Design Flow................. gallons per person p,�er day. Total daily flow_---------------___....3_..-�._ _........._.._...............gallons.
WSeptic Tank='Liquid capacity./aOa..gallons Length..... ........ Width...... _ Diameter................ Depth....4:_......
x Disposal Trench—No..................... Width.................... Total Length..................... Total leaching area....................sq. ft.
_
Seepage Pit No......./---_______- Diameter...../.0._....... Depth below inlet......'¢.......... Total leaching area..Zv�...sq. ft.
z Other Distribution box (X ) F< Dosing tank ( )
Percolation Test Results Performed by...... T/ G............................ Date_6z __Z� /7.16.....
a T Z -
Test Pit \o. 1____-- ._- _minutes per inch Depth of Test Pit..../.._.��____. Depth to ground water----/-/___............
T "
(s, Test Pit ti o. 2................nainutes per-inch .Depth of Test Pit..... Depth to ground water__-
...____...--`---------------------•-----•---_--•--------•----••_•-------------------------.............-------......---------------
.-----•-•-.-.....-------------
4 r'. — a n
O D(eJsLcr>ptio/n�of Sopik l Qy�,, wo_Y.A.....Lc?.Ft/_'C'7.).._.TB.,-`-- ���1 ue3, o/ .2, `fR�. �1:?�1
UISr� L�E1! S � T3. .._�-d-..------ 1_,I... /Il1C.._.W C. .[.�r._S7!_!N..K.t...__ __...V_fA..-.L.l_i�INVV ............
L!lf1M_8"=_rr :'SvSol`. Al,
Q.._Yc=c.c.o�/
U Nature of Repairs or Altera ions saver when applicable _..._ ___________________________________________ __._. .._..._..........
4" ft
-•.
Agreement
The undersigned agrees to install' the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of f'1T T-' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complfance has been issued by the board of health.
Sig
Date
Application Approved. By..__. .__._
F Date
Application Disapproved for the following reasons:................................................................................................................
------------------------•---7......--
Date
Permit;No. ="•'-------•--------------- IssuecL.......................................................
Date
? , THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....... 1J` mot!. .'�.........0F.............. ,e0........... ......................
�rr�ifirtt�r laf f�n�t�rlt�a�rr
THIS %1 T E 1FY, That the Individual Sewage Disposal System constructed (� Repaired
' ( )
by ..�t '.., , .� - .. ..-.---- ------
a er
�3 �
at.=►. -. `!!l. t.._'.:. `� 7 F i"7�f �'�. �r+a�'K =--- = ------•-----------------
has been installed in accordance with the provisions of TT" Z 5 of The State Sanitary Code `s describe in`the
application for Disposal Works Construction Permit No."'!��__.-___-:�'�............ dated_ t4'e�. x.-____-j�,F�_._.
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIOP SATISFACTORY.
DATI'................. Inspector.....--- ---•-�'� �l
---------•-----•------.-•---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
4 i
• � I
. ........OF........... ................................................ +-7 47 �......,�,,.
N .:.:.................... FEE.
Permission is here' granted---------`--- -------- ----------- --•-----------------------••--•-- ........ --------•-•-•--•-----...:...........
to Constr t (I or epair ) an I 'iv r al Sew>ag ispos Sy _
treet K
oP
as shown on the application for Disposal Works Construction Permit No ._..__.._.._/._.D ed.___r _____-:__...'t`.r j{� /
,.* Board of Health r,
DATE..:``_' ..rj
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS "
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2- f't:a�. fNT- PTIC TANK SEWAGE SYSTEM DESIGl
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