HomeMy WebLinkAbout0213 RALYN ROAD - Health 213 Ralyn Road
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01/13/2000 14:39 15084283750 BAXTER,NVE&HOLMGREN PAGE 01
Baxter,Nye&Holmgrrn,Inc.
812 Main Street
Ostervdle,Massachusetts 02655
Land Surveyors&Civil Engineers
FAX 508-428-3750
Date: / zavo
TO: A5 FAX# 77S'r 3344-
RE: L
From: Stephen A Wilson, P.E.
_ Pages,Including This Cover Sheet
If you do not receive all of the pages included with this transtnitttal:or yif thet a is a problem,
please contact this office at 508.428-9131.
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01/13/2000 14:39 15084283750 BAXTER,NYE&HOLMGREN PAGE 02
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No.30218 uo
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F\��NAL
SUBJECT TO AMM-1,1L
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Applicati:on is hereby made for a Permit to Construct or Repair an Individual Sewage* Disposal
ti dress r Lot No.
Owner Address
nstaller Address
Typ?eof Building, Size Lot... ......Sq. feet
Z Other Distribution box (X) Dosing tank ( )
when 7
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T-7 T L- _ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
-r----' --- - Certificate- of Compliance has -Si
X .. .. -
-- '--
Application Approved By...
'Disapproved �� ---
Application bv the fo�oxmi�, reasons:---''_.n.................................................................................----------
------'-----------------'--------------------''-----------'--'---------'----'-----
Date
�
� Permit
' Date
' - ' �
- T.._
.y
03
�No.. ...?"�?...... FEs . ...
• THE COMMONWEALTH OF MASSACHUSETTS
i
BOARD OF HEALTH,.
....................OF...............-..........................................................................
Applira#ion for Dhipmiial rk� C��n rnr iun anti
Application is hereby made for a Per itt to Construct ( or Repair ( } an Individual Sewage Disposal
System at: C`C7"2`1 �.
�J /�Locatiot dress or Lot No.
..
Owner Address _,
W .-•.................................................. ._.
nstaller � Address
dType of Building Size Lot__... :Qo_____._Sggeet
U Dwelling—No. of Bedrooms............_3...........................Expansion Attic ( ) Garbage Grinder (,fo
a ,Other—Type of Buildli> g .............._..........., No. of persons...,........................ Showers ( ) — Cafeteria ( )
Other fixtures ___ ______.__
W Design Flow....................... gallons per person per day. Total daily flow...........33�....................
WSeptic Tank—Liquid capacity��?? ;_gallons Length_ __ Width._./ Diameter___ ._�...._ Depth_S.__.�...-.
x Disposal Trench—No_.............._____.Width_ Total Length.................... Total leaching area....................sq. ft.
;D ft.
Pit No-________I--___::__. Diameter____________________ De th below inlet__._.___._._.____ Total leaching area_._._.___ ...a .
� Seepagep g q
z
Other Distribution box (,Y) Dosing tank ( )
`" Percolation Test Results Performed by...... ___.1. _ !---?�?"'_T_____________________________ Date...jam_'_..... .��___..__.
Test Pit No. l.._�__ __minutes per inch Depth of Test Pit_.__._t�_.._____ Depth to ground water__N6 AJ
Test Pit No. 2.._.�L.:�-__minutes per inch Depth of Test Pit....../_7........ Depth to ground`water r��!���? 7✓l �i F-
.................... f-----•-----•-----------------------•----------------------•----•---••-•----------- ----•-------...._.....--•--------••--
O Description of Soil .j ..' 7^ LG ^^ ��:_5 SC3? t�» Q ��' 1-.................................
W //
UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
•-------•----------------------------------•---------------------------------------._._..._..----------------•----------------------------------------•----•--------------••••-•----•---•............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
. - '1T I.1'^ .
the provisions of f.: t E, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued by the board
,o�. health.
f Date
Application Approved BY---:.. h* ..........................
Date
Application Disapproved for the following reasons__________________ __________________________________•-------•-------•--•-_:---•••_-••---------•--._...._...__._
-------------=---------------•---•-•---------------•------------------------•---_-----------•--------------•-----•---••••--•-••-------•••••----••-•-------------------•------------•---------------•...
af, Date
Permit No...................... "--- Issued_................................
--••--•.._.....•--•- Date ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF..............................:......................................................
f s Tnrtlfiratr of Toutplianrr
SKIS 0 C/ERTIFY, That the Individual Sewage Disposal System constructed (,, } or Repaired ( )
byjw
_P--- ;u vrzr� .....................
t� �1'u�y Inst
at---------•---•-- •--•---•--------- ._-•--------------------------------•-•••--•-- ---•- -•-•----------------•----•-•-------•------------------•-----------------._...•-•-•-••-------
has been installed in accordance with the provisions of �T 5 of The State Sanitary Code as described in the
applicationfor Disposal,Works Construction Permit i o. --- "- - __----___-_. dated-- - -
TFIE ISSUANCE OF THIS CERTIFICATE SMALL OT BE CONST UED AS A GUARANTEE THAT TIME
SYSTEM UHIL ,FUNC IONA/F.
FAC RY.�?
�.
DATE... . `_... -----••------•-------__------ Inspector
7//
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH s`
q. .................. FEE
�.
,_ r tv1 nrk �nno#rndilan 11amit
Permission js•hereb ranted----- • •---------------------------------------=-------------------
to Construct.(. ,,),or Repair (. ) an Individual Sewage Disposali§ystem at No.................................................................-.....................................=---- --------•---._._._._.-•-•--•-------•-------.......-•------------••--._._._.....••--
Street
as shown on the application for Disposal Works Construction P, r- t No____ _____ ______ Dated_,Z...._..�_d......... �.
a o ea
DATE .� ';;= -/•mil;''-ox----------------------
FORM 1255 &ORBS as WARREN, INC., PUBLISHERS
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