HomeMy WebLinkAbout0194 SANDALWOOD DRIVE - Health •194 Saii l.ewoodl DrMa,
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LO,C T ON-A SEWAGE PERMIT NO.:
VILLAGE
INSTA LLER S NAME & ADDRESS
B UI'LDE R OR OWNER
DATE PERMIT ISSUED 3®`
DATE COMPLIANCE ISSUED 61.. 1p �
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kN"
No `g J� f Fzs.
J THE COMMONWEALTH OF MASSACHUSETTS
BARD F
..... -------
.OF........ HE LT
Applira#inaa -for Bhipvii ai Works uaaiarurtioaa Prruld
Application is hereby made for a Permit to Construct ( or Repair ( }• an Individual Sewage Disposal
System at:
Z�.f ® 't Q p -----, ;, ------- --w. ..-•-----•--•--------------- -----•--- --••----
. •-CQ LocCa�to n•A►d d.re1-s � 1[�!.C.e t ... � �-•a`.or Lot N
... . .............. r
�— /�!''Addressj
a ................. �.1�7 / ` •.�/° {rJl r a l K-l.N`�='Y ---------------•-----------•--•-•---
Installer Address
d Type of Building Size Lot----------------------------Sq. fe t
U Dwelling— No. of Bedrooms.3- ------------------ --------------- Expansion,,Attic f/16 Garbage Grinder *q
U
per, Other—Type of Building ____________________________ No. of persons...... 7------------------ Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------- -------- ---
w Desg gallons per person per day. Total daily flow______________ _�?_0_____...__.._.gallons.
i n Flow...._.. __-,0___________________
r4 Septic T-ank—Liquid capacitv/'000.gallons Length---------------- Width------._........ Diameter_-.-...._-.-___- Depth.-.------.......
Disposal Trench—No------------- ------- Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No----- _ Diameter. _._ . Depth below inlet_ ______ ________ Total leaching area.----..__-_.-__-_sq. ft.
z Other Distribution box Dosing tplk G� '1 , —77
Percolation Test Results Performed by-----/- --✓', °- .._ . - r------------- Date-------------------------
Test Pit. No. 1________________minutes per inch Depth f Test Pit_------------------ Depth to ground water......W. ..-�.....
f3, Test Pit No. 2................minutes per inch Depth'of Test Pit-------------------- Depth to ground water------------------------
a' - -----��
/ Jj
O Description of Soil U----= �; ..... v
x
U 2-�- �r -- - --- _ s --- --------- - --------------
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.
Signed � �r_LP .. `- ✓----- �rr1----
Date
Application Approved By------- � � = /, �`'
/ ------------------------- ----------------------------------------
/ Date
Application Disapproved for the following reasons:----•----------•------ ----•----------------------------•----------------------------------------•---------
..-._.....--•-----------•---------------------------------------•---------------------•---•-------------•----------------------------------------------------------------------------------------------
` Date
Permit No......................................................... Issued.--/ �� �?/. ••Z_-7----•-••------
Date
9v
No..-••---------•---•-- Ficiz.........j7..............
THE COMMONWEALTH OF:MASSACHUSETTS
�t
BOARD O HE
a w
....... ...a'�- .-------.O F.......... . ..:Q!,:.. ... ...............
Applirataon -for liopoiitti Works Tonotrnrtiou Vamit
Application is hereby'made for a Permit to Construct ( r Repair ( ) an Individual sewage Disposal'
System at
LocaUopnf,Address ,,�/lam �`'or Lot No. j`/'` /J �/ p J/�"J
"7' �_i,•Z^f'"YYd_. 1 �'��'' '_A� A..... --•--_-- _.......3 J- ... ..�> k �-_le/_..tfi✓'f-1�(i
Installer Address
Q Type of Building Size Lot--- -------------------- ---Sq. fee
;t Dwelling—No. of Bedrooms.:...--.___.._._.. _"....Expansion ttic,( Garbage Grinder
aOther—Type of Building -._:._..-.-.-..-. ------- No. of persons_. ".- .... :.:...... Showers ( ) — Cafeteria ( )
d Other fixtttres -
------------------•----------------------------------------------•-------------------._..... ------- -------------
W Design Flow----------T a.......................gallons per person per day. Total daily flow.--."---........ ---------....gallons.
W Septic Tank—Liquid cai�acity ? allons Length-----------_--- Width............._.. Diameter-----=--------- Depth................
x Disposal Trench—No. ........... .. .. Width-------------------- Total Length-------------------- Total°leaching area........." -----.---sq. ft.
>> Seepage Pit No------- -- ------- Diameter 4----. Depth below inlet,--- .__. Total le hi g 1. "
z Other Distribution box ( b?f Dosing to ( (.1� 4
�/�rea-----------------sr ft.
~" Percolation Test Results Performed by.:_... ... .................... Date---..-------.."...------" . _-.
. . f • �`
Test Pit No. 1.."----..--.---Ninutes per inch Depth lest Pit-------------------- Depth to ground water____----- ......._..-
fJ, Test Pit No. 2................minutes per inch Depth of fest'Pj,---_--:-.------------ Depth to ground wate ------------------------
P; k. ,
Description of Soil „ .. �f .......
(xj It ... . -------------------------------------------- .• - ----- - ------•-•-
W rZ '
x •---•------ -- --------- ------- - --•-------------------------•- -----------•-•--------------- -------------- ----
-------- -- -----------
U Nature of Repairs or Alterations—Answer when applicable -._ ,K --- ""------._
' :.
Agreement ¢ '
The undersigned'agiees�;to ,install r'the. aforedescribed..Ind_ ividual Sewage'Disposal,System*in accordance with
the provisions of Article \I of the State Sanitary Code— The itndersigned.further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health t r ,
ign
V r
Application Approved 13y= r:. =------ . .........
Date
� wApplication Disapproved for the following reasons-.......................... -------- - ..------ ------- ------ •-------------.•---------- -=
-----------------------------------------
Date
Permit No. ==------.......... Issued
n - Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF...... / ..:: .....................
uplertifiratr of 101.1"Jamphanrr
THIS IS TOCERTIFY, That th Indivtdu -pisposal System constructed ( or Repaired ( )
by --- c ' -"'
at...la�ii.!___� W- "----_- "��1:��/�•��.� ��nstaller /
(/�'
has been installed in accordance with the provisions of Art le o The State Sanitary Cody as d cribed in the
application for Disposal Works Construction Permit No...... ........:. A{ n " ��""? y
dated -- ,_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
-- - - - - - - --
SYSTEM WILL FUNCTION SATISFACTORY.
Inspector �� �r ��l_.�'�✓L.--<<- __ ____
-- - - ----- �-'`=��----=--------- •-"�-------_�
nl
THE COMMONWEALTH OF MASSACHUSETTS
X BOARq OF HEALTH
77 ( ' . ..OF *..... ` c
No. .�. ..:{... .............. FEE-.....Ap -•-.
Permiss,>on is h reby granted --- `"to Construct or Rr.pair ( ) an Individual Sewage Disposal Sy -emi r
• . - � Street -
as shown on the application-for Disposal Works Construction Per o.."_ Dated""__-�- �77
Ve .-
-- --------
DATE Boa"?I of Health c
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
i
(�� � � P R T NO.
.
10�CA/ T10N� SEWAGE E MI
VILLAGE
INSTALLER'S NAME & ADDRESS
BUYLDER OR OWNER
DATE PERMIT ISSUEDz2 ®` ,
ISSUED
T
DA E COMPLIANCE
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