HomeMy WebLinkAbout0285 BISHOPS TERRACE - Health LOCATION SEWAGE PERMIT NO.
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VILLAGE �n
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INSaT L S S LER' NAME A. R.b lac ��
B U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...........✓40WIX)........OF.......
... f !C/ l 1.......................
,gyp.pIirFation for Disposal Works Tonstrnrtinn rnmit
Application is hereby made for a Permit to Construct ( ) or Repair (1,-J'an Individual Sewage Disposal
System at: _
... 1 �4 ........ 7... ..................................... . . ..........................................
Location-Address or Lot No.
O Her Address
a .w" .f_ � : .. ..... :.. --�-•--•--•........................................•--------•-•-•--•------------.....--------
Installer
Address
Type of Building/ Size Lot............................Sq. feet
�
�-, Dwelling�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—Type of Building .............. No. of ersons............................ Showers
YP g --------•----• ----•-•-•-------------P--- ( ) — Cafeteria ( )
Otherfixtures - -------------------------•------ --•--••-------..-..-------------.-..-.-.
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 ( )
a Percolation Test Results Performed by ---------- --------------•--------- •-•---------...----- Date
Test Pit No. 1................minutes per inch Depth of Test Pit..____._............ Depth to ground water........................
f1r4 Test Pit No. 2................minutes per inch De th f Test Pit.................... Depth to ground water........................
a -... ----- 40Z,41.............................-•-•-••-----•------......................................
O Description of Soil.......... .-....... -.
x
U -----•------••---••••-•......•------•-••••----•..............••-----------........------.......-•-------••--••---•--•••----••-•-•-•--•••--•-•---------•-•••-------••-------•.........---••-------•-----
�4 ---•--•••-••......................•----- -•-•--••••••-••-----•••----••-••-•-•--••-•---•----••••......---•-••••------------ ----
U Nature of Repairs or Alterations—Answer when applicable._--__. _...._._:. ..._..___...�C ._.aC .._..
.._•----•••--•••-•-••------•----••-••••------••--••-••-•••••••••--•-------.....•---•------••------------------•-----••-••••-•-----••-••---•••---•-•--••-••--••----•••----••••••----••••------..........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI.B 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 t boa d of 1 lth.
Signed .:= ----- . •--•---- --- .--- •.e... .... ......-
A Application Approved B .............. r Hate
PP PP Y ---•• --•...... ......... . . . .. ... ............•-•.-----• --•••----1--1-- -- ••!Vs
Date
Application Disapproved for the f wing reasons---------------••--------------......-------------------•----------------------------------.........---.....••...
-•----------------------•----•----------•--•--------------------.........-•------•------......------.....--•--•-•--•-•....••--•-•------••---••-----•------••-•------••••••--------•••---•-••------...... .
Date
PermitNo......................................................... Issued_.......................................................
Date
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f 5
Appliration for Dispoii al Workii Tnnstrurtinn Famit
Application is hereby made for a Permit to Construct ( ) or Repair (4-)' an Individual Sewage Disposal,
System at: w
-•----•--.....•--.........••-•----••••-•-_.. ......................................••.
�i Location-Address or Lot No.
....f............. ........:........... ..-•---•-•••••......--........._.... . .......................................... ....--•-••--•••-............-_._.._._.........
r' Owner Address
+•-----. _f..Y......!�.?:.rt Sr.`...r 1.'------------...
-
� Installer Address
VType of Building Size Lot............................Sq. feet
�., Dwelling'-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building ............... No. of persons........-................... Showers — Cafeteria
04 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....................
i a
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------.................
- ._.
f
O Description of Soil.___.... s �--'' -Z'�_-_-- ...t`_
U .------------------------------------------------------------------------------•....------------------•---------------------------•••.---
-- •-;•-----------------••-•--------•-------•--•--•-•••---••-••-•-•--••...........................................................................x a t
U Nature of Repairs or Alterations—Answer when applicable______. `...f: ' '......................'- �' ._._.
• •••-•••----•-••••-----•-••-•--••••-•-•----•..............•-.
Agreement:
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 r ..
. ..... ... ---__:-...=- .......
Date
Application Approved By--•-•--•---•-- ` �.�,-"Q
Jt! �..
Date
Application Disapproved for the f o ing reasons----------------------------------------------------------------------------•-----------------------------------
---------------------•---=----------------------------------...-•----------------.•.....----•-------......----------------------------------------------------------....................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
t OF.... f . r •..
... .................................................
Tr rfifiratr of Tnntlitanrr
1
'TH.IS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
Y _
r Installer }
r
at...... ...................... . -----• -.. • • •••..-- ` -----
has been installed in accordance with the provisions.of TI T IZ 5 of The State Sanitary C 6de as described in the
application for Disposal Works Construction Permit No......................................... dated_..,............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR D AS A GUARANTEE THAT THE
SYSTEM Vll� f NCTI SATISFACTORY.
...................................DATE............ Ins ector----�---./-�--• -------------'-----------..__._......_........:......_.
THE COMMONWEALTH OF MASSACHUSETTS
,•; ,- > BOARD OF,r HEALTH /
5 960..... .......OF....._ °.as:. ........ ,
...
No....... ............ FEE.r......................
Milan Vantit
Permission is hereby granted....LZ•. `. v •� ;" (*d 1�' ` L' "Y=°.....................
to Construct ) ,Rep Individual Se Is osal System
at No.--- . ......... ' !' .. ._.._._.,....?`�." "3 'fbr s
Street
as shown on the application for Disposal Works Construction Permit No____________ ___ _..
...................................... • .._ '--••_............. •----- ........
�' t^�S oa d of Health
DATE................ .--•--•-••••-......---.J -----------•- ----------------
FORM'125'5 HOBBS & WARREN. INC.,.PUBLISHERS