HomeMy WebLinkAbout0592 SANTUIT ROAD - Health l� 1'�.J�.�.'�C..Y
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LOCATION SEWAGE PERMIT No.
�I VILLAGE
INSTALLER'S NAME A ADDRESS _
V
B U DER ORqWN ER
DATE PERMIT ISSUED 2
DATE COMPLIANCE ISSUED
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No.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
........... g'4f/. .....--.--.OF...:.. .. iQ sS''% P- ------------------------------
Apptira#iun for Diupuuttl Workii Tunutrurttun Vautit
Application is hereby made for a Permit to Construct ( ) or Repair (/-1 an Individual Sewage Disposal
System at: _
• _.... !�Tr/t.T.... t►�✓...... .luf; ...............•--------•--•------••-•----••-•----•••--------•------------•---•-•...........---••-
L ca; -Add s or Lot No.
. > ......W-0-4.ff.......... ............ ••-•--••------•-•----..........................----•--
n / Owner •� —Address
Installer Address
U Type of Building Size Lot............................S q. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type e of Building No. of persons............................ Showers — Cafeteria
a yP g ••----•-••••-••••-••••. P ( ) ( )
a' Other fixtures ............................
W Design Flow......................•---------._._________gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length............... Width-------------------- Diameter---------------- Depth................
x 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 tank ( )
Percolation Test Results Performed by........................................................................... Date........................................
Test Pit No. 1........:.......minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0 Description of Soil....
U •--•-•---•--•-•-••••---•-•••••••--••••••-••••--•••--•••-•-••---•••-••••--•---••••••..._.....••-•--••-••••-•••••-••••••••---•--••••••••......-•---•......•-------
W ..................................-•-••---••-•••---•----•------•••••-•••••••--••-••-••••-••--•......---•......• -------------------------- ---------------
VNature of Repairs or Alterations—Answer when applicable.-.A:__e�_ r�� ...._.Jam _1 �4.......................
-------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------......---------.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iIHE 5 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�Veoad f health.� -. .... . -----••••• ... .
_. Date
Application Approved B ................••• 1� � --
Date
Application Disapproved f o e f o wing reasons:_-----------------------------------------------------------------------------------------------------••---.
....................................................... • ••-•--•••-•••••----••-••-•-•--...-•----•-•--..__........•-•...--••••-•••-•-•-••--••-•--•••••----•----•••-----••-----•••••-
Date
PermitNo......................................................... Issued.......................................................
Date
1
iJ 'V
No......................... ��.,. ,. Fxss - �._�� ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... ...........OF..... �Xl(U4 -S- �' . ..--------_------------------
Appliration for Disposal Works Tonstrurtion pamit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at _ _
Location•Address --•_.-------•---------••••----•-_--.•-_---or Lot No.
`......_....
Owner Se-
'.
•:. _{:P.l[�.v'1� 1�r! ... .... ....��l rrr::..... ......•--•---•---...-------••---......-----.Address---....__--__----------
---------_.....
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
p-' Other fixtures .........................................
d --------------------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............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 tank ( )
Percolation Test Results Performed by.......................................................................... Date......................... ••-----•--
aTest 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........................
a' -
O Description of Soil.__ .................. .
P/r.__..._._. .
-----------------
v
W ----------------------------------------------------------------=-------------------------------------•------ ------ ---- •----------- ------------- _--------- ----- ----- --------
VNature of Repairs or Alterations—Answer when applicable_f-:--_e _. ��-.--__ % r!j_.r '_______________________
----------------------------•----------------------------.-.-----•------------------.........---...-----.......---------------------------------•-•----------------------------------------•--•--•-•--_.
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLi, 5 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.
Si
g. _ �'
Date
Application Approved B
Date
Application Disapproved for the following reasons:-•-----------•-----------------•-------•---------••-----------....---------..--.---- --------------••---•••--
-----•-•------••----•-----------------------•---------------......_._....•---•-----------•----.._....-•-•----------------------------------------------------------------------------------•------------
Date
PermitNo......................................................... Issued-.............................. ....................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH . .
..: ell.............OF....+���` fir�� � �o� �'...........................
(I ifirttft-, of `Slantpfianre
THISJS TO CERTIF , That the Individual Sewage Disposal System constructed ( ) or Repaired ,.•''
by...t,1R_.®____ 11 ...... ...:,c- ----__-- -- ----••- ------------••- -•-------
Installer$+V
at........ iEX.......'. `� _lr �"•; ..... � � ...........................................
i has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No_________________________________________ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WIL FUNC ON SATISFACTORY.
DATE..,I 1 ..-• =- \................................................... Inspector........ .... --------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i?....................
.•--•-•• Disposal Forks Tian nrtinn lerntit.
�
Permission is hereby granted---3 ...- r'f�° r °.. .... .i9`d �`� ' .� .......i
n
to Construct ( ) orsRepair ( an Individual Sewage Disposal System
at No.---.. ........ ``' ' ' ,s't f t--• 5� i 9+ rt
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
.....................•--•------•-----------•--------------------------•-------...-------__-•---•---•--._
Board of Health
DATE--------------------------------------------------- `:.
FORM 1255 A. M. SULKIN, INC., BOSTON - •�
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