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HomeMy WebLinkAbout0113 WHITMAR ROAD - Health � �3 �1��Iwu.r f2mc� _ _ � -- J - � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....../0w1,1.............OF..... Appliratiuu for KILUP00al lI vrits Tuuotrurtitutt Vernfit Application is hereby made for a Permit to Construct ( Y�or Repair ( ) an Individual Sewage Disposal System at: I W owner �..«.......»...».». dares.-..«...«.... Ll a ..............«..»..« ... ...».. ... . .. . . ... . ...........«�.....» ........ »........«...»�:3 .«.�G /;/c/ ........... r" � 4 .u;r -Installer Address --��• -«-""----"'• Type of Building .. Size Lot.. .-.Sq. feet Dwelling—No. of Bedrooms............«1..,1.........................Expansion Attic ( ) Garbage Grinder (1,<_ p4 Other—Type of Building ...... No. of persons.............. .... Showers ( ) — Cafeteria ( ) POther fixture ...........«.............................................................«.......:....................... Design Flow................... gallons per person r da�. Total flail .-�-- -- Septic �i Y flow.. ...............�f. -�. ............ga�lons. p Tank—Liquid*capacity. gallons Lengthe.Z) . Width. ... Diameter................ 11e tl>4�-...7...` Disposal Trench—No ................... Width ....... Total Length................-• P 3 Seepage Pit No......../.. lliam • g ;;- Total leaching area .. t, eter..,��Q... Depth below inle .... Total leaching are ' ... ..... ... ......... Z Other Distribution box ( ) Dosing t ( n ~' Percolation Test Results Performed by...' ,. a ..�...! .........0....... Date.....LZ-I..g...f � ...... ►a Test Pit No. 1...............mtnutes per inch Depth of Test Ptt...t!���a.-._..... Depth to ground water.............- ►-. ...... G4 Test Pit No. 2....:...........minutes per inch Depth of Test Pit.................... Depth to.ground water........................ 01 O escri lion of Soil...•�_..�j. ��....�.�: �!�� t :.'. ��.� .��«... ... ..... D�s�.�..�.� ..F.�s..U ! 1. .....«: ?,:.:: %r.. :............ w ..............«....»........................... ..................«............................................ ..._.........................................._......... x ...........................:...................•---•--••••••••••...............:....................:.•- ................................ ............ V r Nature of Repairs or Alterations-=Answer when applicable............................. Agreement:................................. greement...•.......L ....•.......................................................................................................................................................... The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE : 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. Signed. - ................................................ ....... 3...8..?... Application Approv ..(ed By.._. , .--,,.« ........... .........................» ....._.............nets...... Application Disapproved for the following reasons:....... . ...................................................... ............. .Date..»..«»..« Permit No... 7:.. .... nz� »8 o Issued_......-...:.��.�7«e..............««..»»....«» Date i THE;COMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEALTH _.......�.v!� '............OF......�:;.6TGi�r.... / ...... Appilratiuu fnr 39iu ilul Works Tuttutrurtivtt Verutit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal f Syst at r.»zi &h/fir, , ,lro `Mott e°'�« ....»«... .«.......»»«»«»«......»..........or lot Na....»» ..._............».1.. a ..................» ......«...«. ... ....«.... .«......»»..... a •Address `,. .��nyE' .f '. .............«...».».................aa►. . .......................»..... Type of Buil is ng r ....... Dwelling .. Size Lot�.,�....mil._._.-.Sq. feet :11 —No. of Bedrooms........... .....Ex Expansion Attic p.,1 Other—Type Type of Building ...........................•No..of P ( ) Garbage Grinder ( ) a persons............................ Showers ( ) — Cafeteria ( ) �i Other fixtgs ................................................................. DesignFlow. ................................. ,............................... c=' Desi •........................... .. .gallons per person r day. Tota i ,low.............«� .............. Ions. W Septic Tank—Liquid•capacityX::'.........gallons Len tl/��.... Wid ht•?_„ „- Diameter................ % Disposal Tr g t Diam Depth .. Trench—No....................: t ........ Total Length.... 3 See a .....„ "' ,-• Total leaching Seepage Pit No. lliameter.��..`.,....... e .....J. h area................�� eft. ••-•- - Depth below inl ...... Total leaching areas Z Other Distribution box ) Dosingt�iik a Percolation Test Rests Performed by..... r:.X. .. ...... ..� .................... Date. _ �t_ Test Pit No. 1. .....minutes per inch Depth of Test Pit.`t:..�-'�.......... ll"''" epth to ground water............ Test Pit No. 2...»:..........minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4i Dfj 1 G .,.... x'� .. .. ,�..... .......} . ,j/ `f l Of SOtI..�., i........................................»...........................1/�.1...f ....J '.......... ��..: ..... CWU�>!1.1�J............. W .....................................••L! ...-...---._.--.-.-:--. ......._...................»....................................... ............................................................. ....... ..... .................................................................................................. .............. Nature � ••••• U e of Repairs or Alterations—'Answer when applicable. Agreement:........................... greement:.....»...:.... .........................................:..«......................................................«....................................................... The undersigned agrees to install' the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the St�te 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. Siguedf..:... ................ .. „ .... .............................•--.... 2 ) Application Approved By..... 1A.1 '. :��....- :�:`:^:: :. . VV.. ..........................a ».... C0Y Application Disapproved for the f olloviing,reasons:...... .................................... ........... . Date ..... . »..«................................. QQ...a...........».«... .......«..».......«»................................... ........... .......................-nzi�....»...«» Permit No...«1�.Z..«: .j«� . ........ Issued.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........2 .......OF.... n � ....................... Tertifirate of (ffuutpliuttrf THIS IS TO CERTIFY, That the Individual.Sewage Disppsal;,Sgstem constructed ( or Repaired ( ) by................r.......... ..... 'i ..........anata0er.............«. .................«.»..........................................« at.............�.., -l•... ..�...»..�N...�... .�;.�:!..':r.. ........ . .......................---......---................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary �cxle•,asescribed in the application for Disposal Works Construction Permit No.....�2...........35 C?.._._.......... dated...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION ATISFACTORY. DATE........».......... ..�.» :' /? .».....«......... Inspector........... .......».....»......»»...:....... i THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF .HEALTH ..:.......... ��� y. O F •rn No....2'.�35c) ...... -----�;�..............._.................... Fitz....... j 13i"Ift"WHAirful Towitruutiutt Vgrut't- !. , Permission is hereby granted............fCZ ` to Construct or Repair ._...�J•-. ............................................................... .»«».. ( p r ( ) an Individual Scvaag Disposal SYs............... at NO...i........L.—_?.'.:..« ... .n.- ...... as shown on street D �'• ;•_7 o .. ... the application for Disposal Works Construction Permit No..... � « -... ed.......................................... ''.. DATE....:.r�f"..`07.:...75 7 »................................... !'Board of Hea th............................... FORM 1295 HOBBs A WARREN. INC.. PUBLI8HERs LOC TIOPI 5EW&4E PERMIT 1JO- zc VILLAGE Z�Z �l IWASTaLLER S MWE E ADDRESS ri J . C ry) BUILDER 5-/tJ A1.AE �QDORE S DQTE PERMVT 155UED '�1�l1 l�7 — -- D ATE COMPLI b6MCE ISSUED : A e 131 lo') 0. oz L)!� 6 N2� 6 g � ter - - �sG j --4 O uTLEr ,\ INLET KNOCKOU76' 6 x 4 DIA. i r / •1•-Ib'' I �vI� Li 1 �.• '• � \` . 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