The URL can be used to link to this page

Home My WebLink About0035 BRITTANY DRIVE - Health��Gtn��nv2 - o a�-- o�► No.._Il a--.ta Fimim THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ........OF.....l�' f.. -....-.. Appliratiun for :43iiiVasal Works Tnnitrnrtion Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy em a ---------- .A-... .... ... �......0%. _ b ' _ ...... ------.. Loc on-Address — r Lot No. i rypeBuil, ........:.....•--...._..----- --- -- '•- -- --- - --- --�-•--�-=---�.... .---•--.14 Address P4 Installer Addressl< ii Size Lot1-`.-P.1.7....Sq. feet U Dwelling No. of Bedrooms._R.........�........................Expansion Attic ( ) Garbage Grinder ( ) `� Other—Type of Building ... No. of persons............................ Showers a g ---•---------•--•---•---= P ( ) — Cafeteria ( ) Other fixture -- w Design Flow...................... . .......... per person per day. Total daily flow..............�_�'"'�____-.-_-gallons. WSeptic Tank-L Liquid capacity. gallons Length...............: Width---------------- Diameter-.--__.__...____ Depth---------------- Disposal Trench—No..................... Width......... Total Length........... ,_.._._ Total leaching area....................sq. ft. x �� Seepage Pit No._:�_______________ Diameter_ M__..._.. Depth below inlet-------- _....... Total leaching are�J__.a--sq. ft. 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_-_________________----- G�, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._._.•.___-_::_.____---- ------••nn ---- ---•-- 0 Description of Soil--------------- Z __.: x U .--------------------------------------- -------------------------------- ..;........................................................................................................................... UNature of Repairs or Alterations—Answer when applicable--------------------------------------------____.____...__-----_-__-_-__-__.----_--- _-____----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individ wage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— he un rsig d further agrees not to place the system in operation until a Certificate of Compliance ha een i by the r of h lth. Si . ----- ..... ....... ... ..•---------•-...... ................................ • Date Application Approved B PP PP Y ••.-•-------- - -- --------- =-------------------- --jam-- Date Application Disapproved for the following reasons:---------•--•----•-------•--•••-•------•-------•-------•----------•••------------•----•--------------••--------- ----------•----••----••---••-•-•---•-•--------•-----••---••------••--•-•--•................•-----------------••-------•-------•--•-••--••----.....-•-------••----------• .....-�----------------- �• ----------- Date •---� ate----•- i Permit No.-----•--------••-------------------------------- ------ Issued.---- . . s 04) No... Fs$... .... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF 'HEALTH 7�-,Foovu-------_OF..... ApplirFa#ian for 13iiiVus al 19orkg Tang#rnr#iosn Prrutit Application is hereby made for a Permit.to Construct ( . ) or Repair ( ) an Individual' Sewage Disposal Sy tem f --- __. Lo ion_.Address r Lot No '.- ---- _ --• $"n' ----------------------------- Owner J � � y Address (sa III M Installer Address ype of Building Size Lot __ . :._�_ .___Sq. feet .-� Dwelling—No. of Bedrooms--_----------`" __.........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixture --------- --• ---------•-••--•-•------------•--------------- RW'I ------------------------------------ DesignSe Tank Liquid ca acit gallons per person per day. Total daily flow______________ . ..........gallons. ------ --• �f a P 9 P Y �_ -allons Length ............... Width-----------_-- Diameter---------------- Depth---------------- W Disposal Trench—No_____________________ Width_____.__�_ �___ Total Length____________------- Total leaching area--------------------sq. ft. x Seepage Pit No___ _______________ Diameter_/??1z.h-______. Depth below inlet....... Total leaching area__: sq. ft. 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------------------------ 44 Test Pit No. 2_______________minutes per inch Depth of Test Pit.................... Depth to ground water__________________-.__-- DDescription of Soil---------------`- �-----•-----•-----.---•--•---------.---------------•------•----- .............................................. ------- x ------------------------------•-.....----------------••----------------d�------•---------•----•-•----•------•----•---•------------------------•-------------•---•-------------------------------- W UNature of Repairs or Alterations—Answer when applicable._______________________________________________________________________________________________ -----------------------------•-•--------._.__---.•.----------•--...-•-•-•----•-------------------------------•---------------___--•----•-----------•---•-----------_____-•--------------•---.......... Agreement: The undersigned agrees to install the aforedescribed Indivi ewage Disposal System in accordance with the provisions of Article XI of the State Sanitar. Coe 'The u erred further agrees not to place the system in operation until a Certificate of Compliance been. s ed by th ar of lth. Sig P I- A Application Approved B - 7 71— _ ,* __ _- Hate PP PP Y a.z. -------------- Application ------- Disapproved for the following reasons--------------------------------................................................................................. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF :HEALTH .........OF.................. .........-.....--.-..-.... %un#tfir a#r of Tnnaph anrr.. THIS- IS TO CERTIFYn hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by V,�r - -- --------------- ........................... I stalled, has been Installed in accordance w the prowl Ions of Article XI of The.State Sanitary-CodeeTMas escrib in the application for Disposal Works Construction Permit No________________ .__9 dated.......__ __ THE ISSUANCE OF THIS: CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS a BOARD OF.' HEALTH l- A o F. � :, e ., -. No .. .. ............... FEE____ .......... Per at to Construc ion t orr Re aii nted a¢ o ` p ( , ) ividual S ge Disposal,Systg v ., w F No Street as shown on the application for Disposal Wor Construction 'Perin No Dated____ �� Board of Health DATE------ -- ----------------•---- ---------_---•---- FORM 1255 OBBS & WARREN. INC., PUBLISHERS u