HomeMy WebLinkAbout0046 BERNARD CIRCLE - Health (3) 46 Bernard Circle
A- 148-028
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No... Y^ 7S Fes$.. l...
THE COMMONWEALTH OF MASSAC-!iUSETTS
BOARD OF HEALTH
Olt .
ad
0 / .................... ................OF.............
ApplirFation for Dist'as al Morkii Tomitrnrtiun frrutit
Application is hereby made.for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................__......_..................... •---•-------------- ..... -•-• . •-••----._._...-------•----•. . ... •••---------.................---••-
�_ Lo*onddes or LotNo.,A . ... . ..-- :�--- - - ...................
Address
............ Address
Type of Building Size Lot.., __7 ......Sq. feet
�. Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures ------------------------=----------------------------
W Design Flow.................//,0-__•---•--_-----gallons per person per day. Total daily flow-_______-__---._ ...____._._..._._.___gallons.
WSeptic Tank—Liquid capacity./P"—gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3. Seepage Pit No... ameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosin tank,�(�,)..
'~ Percolation Test Results Performed b .. ..... ...... .. Date___._..._.
a Y G. = .
Test Pit No. 1________________minutes per inch Depth of Test t._____.........__... Depth to ground water-------__-____-_-__-_-.-
fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W -------------------------------------••--------------------------..................
ODescription of Soil........... .........................................................•------------------------------------------.....................................................
1
V ....................•--•••-••••-••.........................••--------•-------......--------....--••--....--------••••---•---•••----------•---......--••---•-•-•-•••---••----------------•-•-----•-------
W
U 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 L I'i!L- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been 'ssued by the and of health.
ed.-- :
. ---- --
Application Appro y..--.--- --- --------••------•----••--------•----------•-------•------------------------- at ��//�
a
Date
Application Disapproved f the o lowing reasons:-----------•-----•--------------------------------- ............................................................
....-•--•...................................•---•-••--------•-------------•---------.....--•---------------------.. -----------------•----•----•------------•---------------------••---------------
Date
PermitNo......................................................... Issued_.......................................................
Date
No........................ FEs..........................
rf THE COMMONWEALTWOF MASSACHUSETTS
1.
BOARD OF HEALTH
...................................--••--..OF...............
,Xv.pfiration for Disposal Works Tontrurtion rumit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
............ -.................................. ....e..............•--------•-•---------•• � Lot------.................--------------------------------------------------.--.--------
Location_Addrss
e_ fi) V ^v+ .? c/. /:Jl�i -- ......••-------
or N�P� d'
-,� _
.................•. .... ...... ; .
/ Ow`ner :...._. Address..............................................
a
Installer Address
d Type of Building . Size Lot,Z_ _!� 1'?.`!........ feet
Dwelling—`-No. of Bedrooms.._.: .................................Expansion Attic (.J'J) Garbage Grinder ( )
aOther—Type of Building ___________________________ No. of persons._..........._........_.____ Showers ( ) — Cafeteria ( )
d Other fixtures
Design Flow.................,!1 '?.......__.....__gallons per person per day. Total daily flow.__.........._..� .......................gallons.
Septic Tank—Liquid capacity_.tn= ..gallons Length................ Width................ Diameter_............. Depth....._..........
Disposal Trench—No. .................... Width.................... Total Length.................... Total,leaching area...................sq. ft.
Seepage Pit No..,�!- •a,!f5 ^'D.iameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (;�' ) Dosing tank ( )
'-' Percolation Test Results Performed by__'''�-✓V'r.'�.�' /-: - �' `�/ '
a ----•------_... Date ------...�-------�-•--•-
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.--_---_________..__-
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fYi
Description of Soil..................................................................................................................................................
. ...................... i
W -----•-----•-------------------•'•-------•'----------•-----------------'----------•--------....--•-•'•------•-----------'----•----------------------•----------------------•--•-----•---•'-•------•-----
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 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.
�,.
Signed ..
Application A roved..B - / -- r ! ,�//I F
Date
Application Disapproved f orr'the following reasons:................................................................................................................
Date
PermitNo......................................................... Issued-......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
{
�rr#ifictt#r of Tompliaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
I'J7 V",4-�+,,•.off..'.r,1 ..�tf
bY .............................. . .. ..--- ------ --------•--------.......------------'-----------------------...---•-••.....----•-••...---
/ Installer
at. �7 ,..rr: �,.. ,, 4 B.,0 i. e t .. _.-.1-, _ _._ r .' ,
has been installed in accordance with the provisions of TITLE 5 of The-State Sanitary Code.�s described in the
application for Disposal Works Construction Permit No K'/__`_. >............... dated_..-------------................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
�p ,
DATE.............................. -. ! ......----•----------...--•-•- Inspector..... _:.._....._----•----------'•----------•-------•----•-----•----.......------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No......................... FEE........................
Disposal Works Tonstrrit-tion rrntit
Permissionis hereby granted.............................................................................................................................................
to Construct ( ) or%Repair ( ) an Individual Sewage Disposal System
at No.
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
.......................................------------------------------•--------•------•---''---•----_..._
DATE 1
e� Board of Health
��7.
FORM 1255 A. M. SULKIN, INC., BOSTON
• � k
<�I►JC�LC— FAMILY - ;3 BGOROOM
IJO GAIZESAGE �jt21ND6R. C/� -
DNIL' P%-OW ^ 110 X Pp
f 5EPTIG TA►JK = 33oxR5o% ' A9/r" 6.P. 9s.s-'`'�_ _ P7 S-
�.
U 51✓- I o 0 o GAL. -
i
Ot5Po5AL P1T v6E
tvo0 (SAL. ' I
S�DcvJAu_ AQGA = 15o5,F /�'� y S L •r''_,9J8
I, 150 S.F: )c 2.5 = 3?5 G.P C ,
BOTTOM AREA= 0 5•F. po,c Err?
�I 50 S.F X 1. 0 rj C> T S T r
rr s+ n
I' 'TOTAL- DESIGN = 42- G.P D. JG Q 9 8 N Q M
:I Tc>T AL. DA t L.Y FLOW 'S
PE2Co _ATIOu RATE= 1''IN ZMIN o�L�55
.. � z5� .9• G Fivo, � J�
P�ZH OF
DAVID. y
Z C. = m
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II CERTIFY THAT -TµF- ��vR Nam . SNoWN
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li AuD SATE .GK 2.6QuIR.rcM6NT� oFTµ� �� �,� Z�Z /5:.
A TpWN OF ��►�(S'fQ�jl-�ANO IS t�vT—
t-QEAT WtTNItJ TN' Flood P v.IN
!I DATE ll g "• - �a� BAXTE2e. tiYE ING• �� ':
jI REG I SZ 6Q6•�'v�N�5��.v�Y�eS
Tu►5 Pl&ti ► 5 N� Bnsc n a N dSTE2VILlE
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IN5T9_UMENT 5U9-V1=`( 'fNE D►=F,SE�S Suo�
NOT C�E. •�vSED �'o OETE.RI'11NE t_.oT I-1►-![_�j APP�,.ICA►�T