HomeMy WebLinkAbout0007 JONATHAN'S WAY - Health iaa-�oS-14
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE L
---OF......./. ' .. ..... ..............................
� I
Appliration "fur Diipuiitt1 nrks Tvitiitrurtion Vrruift
Application is hereby'made for a Permit to Construct y or Repair ( ) an Individual Sewage Disposal
System a
° -
o inedress or Lot Ijjo.
-4.���V^� -.�. � ..... --------------------- !�fsrL�.�.
O er
W .................1:7--� ---------� ... ....... ........................... -_---------------- / --------------� �--------------------------------
Installer Address
Q Type of Building Size Lot_ha�.f..3..<;-------Sq. feet
V Dwelling—No. of Bedrooms-----------Q--__--•---------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ..................... . ..... . .
Q ------- ----------------------------------------
W Design Flow........S_0..........................gallons per person per day. Total daily flow..._....._.�..0--0_____--__-..--_---gallons.
R4 Septic Tank—Liquid capacity �g TIons Length_-__---_____-- Width................ Diameter__.......-._--_ Depth....___-_----.-.
1.
Disposal Trench—No. .................. Wi th-------------------- T I Length----------------- . Toleaching area..__...-____._____sq. ft.
�� /�" �a eachin irea-----
Seepage Pit No....af.�il� "/ t ..... .............. mle-.._-..-- - `�< - sq. it.
z Other Distribution box ( ) Dosing tank ( ) . /� �77
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------- -
Test Pit No. I----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water..----.------.."--..-.-.
Test Pit No. 2....._----------minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.-.-__._--_----.--_-.
............... ------p
Desc�ption of oil f�"!�" =--••----------- -----------
U _ --`-------------------------- ----------------------------------
W --------------- ------------------------•-------- --------- --------------------------------- --
----- -------------- - --------------------
VNature 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 by the boarl of health.
O9
Signed-i
= -"cp-. '�
o , D t
Application Approved By-------------4 -------------- ..... � - ------
Date
Application Disapproved for the following reasons------------------------------------- -----------------------------------------------------------------------
----•--•-•--•-•-••--••-••-------•------------------------------------------••---•-••---•----•------.........._...-----------•--------------------•-------------------------------------------------------
t.�q - Date
Permit No......................................................... Issued......&r_ _427 ..•• ......
Date
No.........................
Fsa..............................
'- THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... .-.OF. .. �rltrs.�G
Applirtatiurt -fur lhtipuiittl lVarku Tomitrurtion Prrui t
Application is hereby`made for a Permit to Construct (---j or Repair ( ) an Individual Sewage Disposal
System at -~
ti 'Location--Address or Lot No.
A)yes^� ................................../T
W ------1�--�.� Address
M�In•--•--•--In�'�_�� •-•---`-•-----'---------•- ---------••-----------=,f ..�,Q.. // '
Address
d Type of Building Size Lot_ .......Sq. feet
U Dwelling—No. of Bedrooms_-_______._r_�y___________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ----.__---__•___-._--_-__- No. of persons___________________________ Showers ( ) — Cafeteria ( )
a' Other fixtures .....e!..- :__--------------------------------
W Design Flow.__..___f._4I_________________________gallons per person per day. Total daily flow............. ._ ---
......................gallons.
R; Septic "Tank—Liquid capacity'4' llons Length---------------- Width...... ..._ ---- Diameter................ Depth-___---_-.----.
Disposal Trench—No. .......... ...... Width.................... Total Length-------------------:�Totalrleaching area--------------------sq. ft.
''`_'U Dtamete�''3 �^-__________ D`e th'below inlet "r%'`z-�Tofa1- acIin - -I....3 __S�_ sc ft.
Seepage Pit No �t:..___ P 1
r
Z Other Distribution box ( ) Dosing tank ( ) +�'
Percolation Test Results Performed by------------- ---------------------------------------------------- Date----_--.-------------------------------
,� Test Pit No. 1................nunutesper.ilach Depth of "rest Pit-------------------- Depth to ground water_.-----..-__.._-..__-.
f� Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
y ---- • •---•- ..
r tion of
UoiL._.. ' , f r r �* - --- -- ---'--- ---- -.---C'
I
Dese E
-irhd3 - -------------------------------------------------------•--••------••-------------------
W
U Nature of Repairs or.,,Alterations—Answer when applicable---
Agreement: s'
F}`
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 by the board of health.
Signed f
-------------
t� ----- f D to
Application Approved,-By •--
PP PP y------
Application Disapproved for the following reasons:......................... ..... ...... ....... ...................:.:.......... -...................
"s
•..................................................--------------------------------------..
Date
PermitNo.......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
.......... .....:OF.....r....... Jt .-.,'--''.... ..•..................................
%Lprrtif iratae of Tumphattrr
al a THIS IS TO CERTIFY; That the Individual Sewage Disposal System constructed:(- ) or Repaired ( )
, .
by =
a` } Installer
l-aP.fc►+."i_r i- lJ-ram----•-----C/./•'At^/f,sl....../�w`•�-----•------•--
has been,installed in accordance with the provisions of Ahxle XI of The State Sanitary Code as d scr#e m the
application for Disposal Works Construction Permit No .__.._ e.lr. ........... dated'.. . .±. ... ............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED.AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION°SATISFACTORY.
DATE....................................-------------------------------•---------- Inspector........--.....................---------------....................................
THE COMMONWEALTH OF MASSACHUSETTS x
BOARD OF HEALTH
!/
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OF ...............................✓.sue ................................................
No. FEE:==.....................
�i���r�tt1 urk,� �utt�tr�trfi�tt �rx�tit .
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Permission;y s,hereby grdpted---------- ---`=----------------._ ...............
to Construct ( f) or Repair ( ) an Individtal Sewage Disposal System
._
at No = _...... = = _ - / -----------` -- ------
_ .str,, t ? .
as shown on the application for Disposal Works Construction Perm-i No Of. �
.. ated.... ". ...:................
°
Board of Health
DATE... _�.z� x
r FORM 1255. HOBBS & WARREN. INC.. PUBLISHERS _
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