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HomeMy WebLinkAbout0044 SCREECHAM WAY - Health ol7 Wt — Cc L 0 C A T 44q S E W A aE PER RflT 14(p. Lid rc��v IN TALLER'S NAME AD DRI' SS o a.Y w► cm st .�._ i.cZA 2.1.E-lul D E R OR Q E p HATE PERMIT IS5UEC DATE C0MP3IA4CE ' SSUE0 � �S t.x AE - 2.9` 6" 3E- , 14G� 4-.151 r� VI\O/VA ... ... '.'.......„ r MASSA THEBOPI�DALT C FHB�1C TH TS .............OF........1.4✓`.a" .g..._..'.'....... .......................... ............. -� V Appliration -far Diipuiittl Workii (fut lrurtion Vieruiit Application is hereby`made for a Permit to Construct (�or Repairer( ) an Individual �Sewage 1 Disposal Syst//ems�at .. c/e yC 4 --- Loc on-Addre or Lot No. � �wn -------------04f ............ Ads-------•-_."`_ .........--••-•-- a � •�t•�i --....5. l--•----••-•--•-------------- -- ----���� ...���.®��� ... -----••--••-----•--•------ Installer Address , U [ Type of Building Size Lot....--I-/--L Sq. feet Dwelling—No. of Bedrooms--.___--l� ................................Expansion Attic ( ) Garbage Grinder (L_r� aOther—Type of Building --------................... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------------------------------ w Design Flow................................. .....gallons per person per day. Total daily flow............................................gallons. R; Septic Tank—Liquid capacity1� .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........................... ----------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water.____.__-_-__.._----_-- (4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water----.------...._____.._. P4 --------• ----------------- ----------------------.................................................. ............................................-------- O Description of Soil...... -- x ------------•-----------•----------------- ------------- --- w V Nature 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 \I of the State Sanitary Code—The undersigned further a ees not to place the system in operation until a Certificate of Compliance has been issued a bo of 1 te Application Approved By___________________ - -------------- Date Application Disapproved for the following reasons:---------------------------•-----•-----•-------•--------•------------------------------------------------------- ..................................•••--------•---------------•-•--------------.------•-------•------•--••--•-------------_---------•-------------------------•---------------•------------------•------- Date PermitNo......................................................... Issued........................................................ Date No.._cr--' .a FimiO�... ................ , THE COMMONWEALTH OF MASSACHUSETTS t� {, BOARD -jOF HEALTH. i, Applirtt#ion -for Bi,i000ttl Works Tono#rnr#ion Prrnti# Application is hereby made for a Permit to Construct (4,Kor Repair ( ) an Individual Sewage Disposal System at f _.... _ ................. ___. ......._.--- Loc ion-Address 1� 0 or Lot NO. -sc owne ® J� Address s I. ,. a ; a Installer Address , dType of Building ' Size Lot_..._/.� ....'`�......Sq. feet U Dwelling—No. of Bedrooms---------f------------------ --•_.---___-_Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Ga Other fixtures ------------------------------ W Design Flow________________________________ gallons per person per day. Total daily flow--------------------------------------------gallons. Septic Tank—Liquid capaci W ty ` ' _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 pet inch Depth of "lest Pit.................... Depth to ground water-..-_._-----.--._-.----. r3:4 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-------------------- 9 ----------------------------- -------------------------------------------------------------------------------------------------------------------=----------- ODescription of Soil------NO,._. `---- ............................................. ---------•-------------------------------------------- ---------•---•---•-------- x V --•--------•----•-•-------------•----------------•-----•----------------•--------•--------••-------_..---------".---•--•-•-------•-------------------------------------------------•-.----•--------- 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 y�the b9rd of I I i ................... --- ........................................... ..., -- . ate A lication A roved B - .�: ! ............. ., - --------- PP PPy----- ---- Date Application Disapproved for the following reasons:................................................................................................................ --••--•-•"......................••----------------------------------------------•-•----•-• ----•----•---•..--------------•-------------•---••-----•-•-----.--------_.-..-..............--••-•------..---- Date PermitNo......................................................... Issued........................................................ Date • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Err#ifiratr of 0.11.1lutph tnrr THIS 1 TO CERTIFY That the Individual Sewage Disposal System constru .dd (X) or Repaired ( ) by........... --- ---- h-•-- ------- fA& • -•- Inst ler at ---------------- ----------------------------------------------------------------------------------_------ has been installed in accordance with the provisi of Article X of he tate Sanitary Code as described in the application for Disposal Works Construction Permit No.__-.--- ............................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUE© AS A GUARANTEE THAT THE SYSTEM WILL FUN TI N SATISFACTORY. DATE----------------- �� f` ..................................... Inspector......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF..............................................--.................................... J3 o............... FEE.... ........... �i��o�ttl �rrk� �on�#r�tr#io$t �rroti# Permission is hereby granted...... ,- 4----- ----------------- ----------------------------=----------•------------------------•••-----.-•-'- to Construct } or, gepair (� ) an ndividu1all e rage Disposal System atNo.-------- `'.: ---�±_-•----..> ..............'. ..... -`-------------------------------------••-•------_-._------------------•-------•-- street as shown on the application for Disposal Works Construction Per it Noq� D,.,tecd___..9/:Y11P--'................. Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _d , : I . I ,_ - - - i 1 } I . y i .._--. 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