HomeMy WebLinkAbout0101 SANDALWOOD DRIVE - Health 101 Sandalwood Drive,
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LO-C AT ION SEWAGE PERMIT NO.
VILLAGE
INSTA LLE 'S NAME & ADDRESS
f LAO')
BUILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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I RA Z- 47`6 60 '
-77
THE COMMONWEALTH OF'MASSACHUSETTS
BOARDY
F HEALTH
......_..--.OF...... L`P?.P�'. �. -/ .-..-..-..
ApV irtttiun -fur Biiipuiittt Work,5 Tomitrurttun Vrrmft
Application is hereby made for a Permit to Construct e.j or Repair ( ) an Individual Sewage Disposal
System ( --•---
T/I1,11—don-Address No.
own e �,/ / Address
a ................ �� �......- !��._....._.. /_1.4e`!cY_CLFC f�S.�l...................................
Installer Address V
UType of Building Size Lot.... __f-..-_.O---S-J_-__Sq. feet
�-, Dwelling—No. of Bedrooms_.._..__. .......................____.Expansion A is (/74 Garbage Grinder {7p)
p., Other—Type of Building p ( ) ( )............................ No, of ersons.__....._.... ......_....._ Showers — Cafeteria
W Other fir ores --------------- -------------
W Design Flow.................. ............:.........gallons per person per day. Total daily flow_____ -q..........................gallons.
WSeptic Tank—Liquid capacity _gallons Length---------------- Width---------------- Diameter----------...... Depth.-_.--------_--
x Disposal Trench—No..................... Widtl -------------------- Total Length------------_----- Total leaching area----..::_.._.:------sq. ft.
� 1Seepage Pit No.-___--_-QQ_ - Diameter..._�x -- Depth below inle�;• Total leachin .
--------- - P , trea---•--------------sq. fr'
Z Other Distribution box Dosing tank ( ) f7�
Percolation Test Results Performed by.--:-..../1� 7. .!2e".j�_____________________________________ Date---------------------------------
Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water------- ....
t14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............__.-----____
---------- ---...... ..
O Description of Soil..___ _.._ G" -._...__. `
----- -/-� -----=---
- --- ----------
U -----•----....... - -® ,.Z-__:? -----��r--- ----- - -;( t ------------.............................................
W
UNature 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 issued by the board of health.
igne/0% ......- --------- c� �C y
ez
Application Approved By----------- � ---.� ' Date
Application Disapproved for the following reasons:---------------------------------------------
-------------------------------------------- --------------
--•---...---"-•..._-•---•---•.................•-----._--•.-••--•----•------------------------••--•-------------•....•---------------•- -------------------------------------------------- ..............
Date
PermitNo......................................................... Issued.................. .....................................
Date
...........�/v..... Finc
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
W r7- .....OF...... F...5'.4 re. &................
'.4plirallon -for, Uhipviial Workii Towitrurtion Vanift
Application is hereby'made for a Permit to Construct or Repair aft,,,4ndividual Sewage Disposal
System,at:
7
Me,
... ................................... ......... .................................................................
LMI&on-Address No
...............*........
r.�L
............
..
j------------------------------- --------------
Own & Address;,,........... C
................ ..................... .. ................................... ..... ......... .....................................................
Installer Address
2
Type of Building Size Lot ,AP-Q�
U _-Sq. feet
Dwelling—No. of Bedrooms-----------3.............................Expansion A�tic (J10 Garbage Grinder (1)o) i,
Other—Type of Building ............................ No. of persons............. ------------- Showers Cafeteria
P4Other fi.-1jures ------------------------------------------------------ ------------------ ---------------------------------------- ------------------------
Design Flow..............S-0----------------------gallons per pet-son per day. Total daily flow........3C.0------------------------------------gallons.
04 Septic Tank—Liquid capacity/ -gallons Length................ Width-_____----.---.. Diameter_____-----._..__ Depth----------------
Disposal Trench—No_--------------- ---- -'Afidtll.................... Total Length------•----_------- Total leaching area_------------------sq. f t.
Seepage Pit No........./.......... Diameter.___ ... Depth below imlq*----;eA........ Iyal leachin area------------------sq. f t.
Z
Other Distribution box Dosing tank
Percolation Test Results Performed by-_ .... ................................... Date------------------------ +
Test Pit No. I----------------minutes per inch Depth of Test Pit__--_______________ Depth to ground water..'--- ---------
fX4 Test Pit No. 2................minutes per inch Depth of Test Pit,___________________ Depth to ground water__--_-____________----
-„--------- ...... -----------.............i 4- -----------------------------------------
0 ------- lk 14 -- ---V/ �l �Xpmro
Description ofSoil----- 17- -- -- ------ ------ ---------------------------
-
---
. ....... --------- ----_-
U ------------------ ...................................................... ......................
----------- ------------ ------------------------------------- ..................I---------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations=Answer wherf applicable---_------------ i--------------------11._._.�_.$
r�F-,�-------------------------------------------------
-------------------------------------------- .....i -----------—-----------------Agreement:
The undersigned agrees to install the aforedesc.ri6ed :Individual
Ind'ividtial'Se'wage Disposal System in`accordance with
the provisions of Article X! of.the'5tate*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.
& .. ...... .................
- ---------
Application Approved. BY--,... ..... --------------- --------7------- --- -----------
Date
7'
Application Disapproved'for the following reasons:--------------------------- ----------------------------------------------- --------------------------------
4.......................................................................................................................................................................... --------------------------
PermitNo.......................................................... Issued.........................................................
Date
TA-,E COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........14.60�.Iq................OF...... ........................................
Tatifiratr of Tompliana
THI-5,IS TO CERTIFY, Tbat the Individual Sewage Disposal System constructed (/11 or Repaired
61...........42
by---------40_v� ................................................. .................................................................................................
7staillier,
at------_------------- .......................0 lamp
....ne. ------------------------------------------------------------------------
has been installed in accordance with the provisions of Artj�I of Tpe State Sanitary Code as describcd in the
V A4 0 7- .2 7 - :17
application for Disposal Works-,C 6fistruction Permit No.
_C11------------------------------- dated...............................................
THE ISSUANCE OF TH I§-`CERT1 F1,CATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FU�CTION S'.'TISFACTORY.
DATE......... 1_'7-7------------ Inspector... ................I...9. .........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
, ?F
......... .......... OF...... es-te,
.................................................................
N ...... ......... FEE-------------
Permission is hereby ranted_____________ ......et)--------------- .......... ............................................................
to Construct I,( or Repai an Individ% Y
Se age Dispos Syst in.,6_j......... ................
at No..............
Street
e, 1 7- A 7- 7 7
as shown on the application for Disposal Works Construction Permi -----------r Dwd�.........................................
................. ---------------
DATE. j/PY/7_7----__---- Board Health
---7_77-71---J�--------
/ . .•
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FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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