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Home My WebLink About0223 NOTTINGHAM DRIVE - Health (2) - V79 - 639 No. ............. Fx$..... ............... THECOMMONWEALTH OF MASSACHUSETTS BOARD —- ------------ OF.......&t.''s!�� .. .....-.. 172 1 Appliration for Uifipoiial Works Toast ion Vautit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at: 1 / ��a r+� / Nitf3 '4�1�:.. ................. .. ......fir. ':............ .... ............► ............---.....� ..f t � ocatt. --Address or,jot 0. .................... r...... ..... �................... .......... .. .. . ......JAB:1... ................ ...................... ...._ Installer Address ......................................... W UType of Buil ng Size Lot.._ 3;1, Q.........Sq. feet Dwelling—No. of Bedrooms.............3.........................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building _jri.iKi7# _ 1 !brs. No. of persons............9............. Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. WDesign Flow......................CPU.............._gallons per person per day. Total daily flow..........110Z.........................gallons. 04 Septic Tank—Liquid capacity/ ....gallons Length................ Width-----------_.... Diameter................ Depth................ �31W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.X� _ Depth below inlet.................... Total leaching area.�0.�-.......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___________-_______.__. 444 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... Caa.O Description of Soil------------ --•-- ! -------•---------------------------------•------------------------ -----------.--------------..------ x U -----------------------------------------------------------------------------------------------•-------------------...-------•--------------------.... ................................................. W V 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 been i d by the oar of ealth. Signed- . .----•-• . •.... ...... •.-•---- --•• ........................ ........ to Application Approved By--••_.... ....... --- . --- ----- � � Date Application Disap roved for the followin reas ns .......... � .................. �E ' ....................... -------- - . ---...------------------------------------ ---------------------- -------•••---•-------........................... Date PermitNo......................................................... Issued........................................................ Date No. .. Ficim............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF,1�'.HEALTH 17-2 — 7 .........7 ...........OF....... ................... ------- Apphration fvr RiiVosal Worku Tonotrurtion Vamit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at ifE .........a�24................................ .................. .. .................dy ....... ... ........ ... .... Location-Address or Trot to. .................... .................... .................... .............................................. . 'Address ewn�,T ........................................ ....................... ........ ...................Installer Size UTyl 2gi ize Lot.... ...........Sq. feet Dwelling—No. of Bedrooms............. .........................Expansion Attic Garbage Grinder 04 Other—Type of Building _f4wz_0.:�i No. of persons____________________________ Showers Cafeteria P4 <(1 Other fixtures ...................................................................................................................................................... Design Flow...................... ..............gallons per person per day. Total daily flow...........".71k7w........................gallons. r P4 Septic Tank—Liquid capacity/,M)...gallons Length................ Width-_........__.___ Diameter._........._._.. Depth......._....._.. Disposal Trench—No..................... Width.................... Total Length..._.._._..._....... Total leaching area....._..............sq. f t. Seepage Pit No..................... Diameters e--"f '7 - 3; Depth below inlet_.__.._.____.__.___ Total leaching ..sq. ft. z Other Distribution box Dosing tank Percolation Test Results Performed by............................... .................. Date........................................ ...*....................,4 Test Pit No. 1................minutes per inch Depth of Test Pit.___._____..._..._.. Depth to ground water_---------------------- Test Pit No. 2................minutes per inch Depth of Test Pit_.........._...._... Depth to ground water------------------------ .-------------- y..........�f................................................................................................................... 0 Description of Soil.............. ............................................................... .................................................... U ........................1................................................................................................................................................................................ ------------------ .................................................................................................................................................................................. 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 iance has been rd by the?,oar rof/Alealth. pj fJ izaed, zk, .......... ........................ ........ S, DAte ApplicationApproved By...................1._U----------------------- ----- ------ —- ----------------------- ----- Date Application Disa o�ved for�th�,,�Lo�lwi �easons:----- .. ............ .. . ........ ...................... — ----- -ZIC2----------------------- ........................... .. .... ......... ................................. .......................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS 4- 17 -2 BOARD OF HEALTH .................................... ..................OF.......ruizk�_ (9rdifiratr of Tautplitturr THIS PV0 CERTIFY That the Individual Sewage Disposal System constructed or Repaired . ... ...... ........ ......__................................................................................................... Instat.!q at_...._ ........... . ......... ................................................................................ has been installed in accordance with the prUisions of Article X f The State Sanitary de n the O�e application for Disposal Works Construction Permit No--------------------n�_7_7--- dated------------------- ............... ,TIME.ISSUANCE OF THIS CERTIPICATE SHALL NOT BE CONST UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI9N SATIVACTORY. DATE................. Inspector............................. ...........7=�............................ .............7..... -----/ ........... THE COMMONWEALTH OF MASSACHUSETTS /4 *7 BOARD OF HEALTH ..............OF..... NO......................... ....... ......... FEE.... ............ Permission is hereby granted........... .......................................................................... to Construct or Repair an [Wdivid.ual Sewage Disposal Syitem atNo........................... ......... ........................................ . .......... ....... ...t....... S as shown on the application for Disposal /7.-T. 1 . 1 0....... d.... ..... Works tonstruction ................ .......... .............. ----- - -- ---- --------- ...............Board of Health DATE.................................... ............................................ FORM 1255 HOBBS & WARREN, 1,NC.. PUBLISHERS 1 3 /lam 4� s� 1 :i► O� a /_cYSTqu_eh JAllBE5-I�OI,I,AWAY --— _CONTRACT-OR ------- ---- 1082 Old Stage Road --Center�• le'Maes-0283$