HomeMy WebLinkAbout0007 NATHANS WAY - Health r7,Nathan's'Way
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tP THE COMMONWEALTH OF MASSACHUSETTS
o-11t 1 BOARD F H
i ......OF .... ........
Appliratinn -for Di,iVuiittl Workii Tiatuitrurtion Prrutit
�► Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System
�......-----t............ �/
v /L_ocation-A s or Lot No.
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_____ ________________ __________________ __ ___ -_ -___.._.____.____ ...._.._.____._.__...._..._____
wn -.-.-Add -ss
�Wl -• --------•- •--•------ -----.. —
Installer Address
Ty of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms------ ----
----- -----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons./ Showers ( ) — Cafeteria ( )
Q' Other fixtures ...................................• . /
W Design Flow__:____?'_ O.........................gallons.per person per day. Total daily flow..........,- <_..a--------- -------gallons.
WSeptic Tank—Liquid capacity`gDOgallons Length................ Width................ Diameter................ Depth_.-----_
x (Disposal Trench—No______________________ W' -.-----..-.----_-_ 1 Len otal leaching area_...��z_�.- _.sq. ft.
Seepage Pit No..... ll a --------- n Total leaching.area- ---- -----------sq. ft.
z Other Distribution box ( Dosing tank ( ) �dd- e � - . �'-7 4
Percolation Test Results Performed by-------- ------- ......................................................... Date.......................................
,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water....-.-_---..-..--.-___.
�14 Test Pit No. 2----------------minutes per inch Depth of '.test Pit.................... Depth to ground water--.--.---__-------------
G �� �i 3 --- -------•-----•-----
Descriptign of Soil �' - i}-7 `` r .� -.me_ .�. s. - �
_.-,1�: 7�� .� ---C'try-=------f----------------------------------------------------
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 pl ce the stem in
operation until a Certificate of Compliance has been issued by the oard health.
ignec- •--• --.....--•••-----------------.........------ �� .
• Da
Application Approved By..------- ..•--- --------------- .. .. ..e...a. ` 7
I Date
Application Disapproved for the following reasons:-------•------•-•-••---•--------•------•-------•--------------•-•-•-•--••----------_---.-.. .--------------•----
--•-•---•--------•----•-•••------••---•...--•.---•-----------•••--•--------------
Date
PermitNo......................................................... Issued.........................................................
Date
Nod 2 7 F��....'�1 i.... .
t THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH'/'
AVV irtttirrn -fur 'MsV iial Works Tonstrurtiou Vanift
Application is hereby made for a Permit to Construct (i) or Repair ( ) an Individual Sewage Disposal
System,at:Cl
-------------------------------------------------------------=------------------------------•--••- -...-••--•••-------------------------•-----•••-•---••-----•-•••--•---•---.....--••--.......--••--
'. Location-Addresg � or,Lot No.
.c..... �-
-� Owni� Address •��--�-•�••__�� - -�-
a
--------- ---•••--.....---- ................................
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms______-________________ _____________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons ---------
Showers ( ) — Cafeteria ( )
Q' Other fixtures ----- ------------------------
W Design Flow.......`--_.---.-o--___--__--•-_____-_•-.gallons per person per day. Total daily flow.......... �/r ------------------gallons.
WSeptic Tank—Liquid capacity/9G_0gallons Length--_-__-_______ Width................ Diarreter---------------- Depth.__._____._--.
x Disposal Trench—No. ........... W W'dt14-------------- ,-Total Lengt otal leaching area---�r='--2_--.sq. ft.
Seepage Pit No..... D;ia�rne ..._..._--C)JePth'l�ei �Wsin''1 Total leaching area------- ----------sq. ft.
z Other Distribution box ( )r/ Dosing tank ( ) -�,�I- � + '`/^ .a J•-7 6
aPercolation Test Results Performed by------ -----------------••---•--•••-=--........---...••• -_. Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...----_-----------.._.
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.----_----._______-- Depth to ground water_-.--._--____---___-.._.
ti
!� . _ , l tq
V.:
D r ' 6, iescrton o o _ _O'_� Q f -----------------_-.
• �U4- 4Z � =•-------•-----------------------------------•-•-----------------
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 thejpjstem in
operation until a Certificate of Compliance has been issued by the board of,health.
.�.77_Signe `�s �'
-- - -----!------ Date
Application Approved BY "------- `:7A e -
.
Date
Application Disapproved for the following reasons:--•----•---•-•.............................•------------------•--...--•---•-•-••--•------......-•---•--•--------
................•-•••-----------•-----•--•---•-------•--------------•--•••--••-•-••---••.-••-••-•----•--•••--••••-••--•-•-------•••...-•••----•---------••-----•--- -•---------------_---_---
Date
PermitNo........................................................ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
f. BOARD OF HEALTH
...............
01rrtif iratr of TilutpIiatta
THIS IS,dTO CEJP"l F_Y at�the Individual Sewage Disposal System constructed ,('—) or Repaired ( )
bV
-----------------------------------------------------------------------------------------
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'��staller�
at.....�'` =------... .. ............. -----------`------ -.................................��------....---------....._--------------------.....------------------------------.
has been installed in accordance with the provisions of : i le XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.. .......e__-�_.J.Z.............. dated...-J__-__.Z ..........
.�..___..___.
THE ISSUANCE OF THIS CERTIFICATE SHALE. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE E: Inspector--••,. . --
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH, -
..............................OF 0 ....------.------ /} --�'
No.....-2- .7.... FEE/L"!__-------------
DinVoiial, drkq Tlami-rut- i it VrrMit
Permission,is hereby granted-----="'--- -`-=--`t ------ �u' �--.............................. -------------------------•---•
to Construct ,�/'� Repair ( aI.I. d"vidual Srawage Dispel aI S tem
atNo.•--•-•.. ....6`-... e--I':7-- (''`- ' - " ----------------- ------------------------------------------------•---
.t Street /
as shown on the application for Disposal Works Constructio rmit o_ ________ __ __ _ Dated_�.._'. ..........
G�..:_.__.__
r ----` --------- ------------------------------•--
DATE----------------------------------------------------------------------------------• Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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