HomeMy WebLinkAbout0052 BRIDLE PATH - Health �� ��,�2 ���s�rs ��` 1fs
LOCATION SEWAGE PERMIT NO.
VILLAGE -'
INSTALLER'S NAME & ADDRESS', I
ourr co
B UIIDE R OR OWNER
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DATE PERMIT ISSUED 7L
DAT E COMPLIANCE ISSUED
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LO•CAT�10 SEWAGE PERM
l S NO..
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VILLAGE
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INSTALL R'S NAME & ADDRESS
ahem ourc co
B U I,L D E R OR OWNER
DATE PERMIT ISSUED m � -
DATE COMPLIANCE ISSUED
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No.... .....: -• .............................
THE COMMONWEALTH OF MASSACHUSETTS
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BOAR® OF HEALTH
1'kw�►...................._0F...-&A.V..s ao 61.�-.....-----------------------.........................
Appliration for M-4posa1 Workii Tomtrurtinn Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
lu,4rt,rr0rvX kult i 1 (mr b
..................•-•--------- ......... .....
--- -----------.- .......... - -.....
Location- ddress �/ or Lot No: S'.......' �-•.-.-.•-.
.....�l.On/.._.`......w�!!!.0�........................................... .... Z7 Kl✓J/A/..._.Sr 0, t iviv I
W t?oaC4r OuvL Owner Address
�s. NA NQvlwlcr�
Installer Address
Type of Building Z ✓ Size Lot'L_S.,....................Sq. feet
Dwelling—Y No. of Bedrooms............................... . r,,,Expansion Attic ( ) Garbage Grinder (/elf}
P-4 Other—Type of Building _.whoa_-.S!" �N of persons._.._L................... Showers ( ) — Cafeteria ( )
a' Other fixtures -------------------------------- -
W Design Flow......&I .........................gallons per person per day. Total daily flow__� ...........................--gallons.
WSeptic Tank—Liquid capacity.......d..gallons Length. a'!..._.. Width---------------- Diameter---------------- Depth_....Q._...--
x Disposal Trench—No. .................... Width..- _.............. Total Length ... Total leaching area....-_.........sq. ft.
Seepage Pit No._1_P�_D-------- Diameter.._.___.__.. Depth below inlet.......fJ.--..-..,9 Tot 1 leaching area...24.4.......sq. ft.
Other y z Distribution box ( ✓j Dosing tank ( ) 'L` 7k• !4" C
CLc?✓e
Percolation Test Results Performed by----------------------------------------------i6--6-----E--------------------- Date.
' 9
a Test Pit No. 1....b-`�-__minutes per inch Depth of Test Pit----I---_-.--__ Depth to ground water_____.MoN-C---
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O •----•......-----••. •••-••-----:w,..-�-�,oNp-----------•-•--.....----•-n.----•- ---------------••-- J-
Description of Soil , -------------------- "' �"......'!•..-���v,r�- -fir
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 iITL is 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be�n . ued b=he ard of health.
�.n
..... /.... --•--.....•-------------------------------------------•----•--------- ................................
/�� ate
Application Approved By..... ..... -�.7 .....
/1 t/ Da7�
Application Disapproved for the following reasons:.....................Q _.. _ _�__._. _C.S l .N._1.....v_ .L _.---- �'..
................................................•----------------•----------------------------------•-•---------------•-••-•-•-------------•------•-•----•....•-••---•------•-----------•---••----------
•- Date
Permit No.......................................................- Issued _ -- -
•-----
Date
N dod 4V
THE COMMONWEALTH OF MASSACHUSETTS
BOARD .OF HEALTH
---�.. .. .............0F.... sr��ir.�.
Appliraation for Disposal Vork,5 Tomitrurtion Vamit
Application is hereby made for.a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
..xoN ir WYt ''~ + .. ......................••••--
....... ------- ....
Location Address or Lot No.
...............................................
.....................
Owner Address
_
H f r li ri J.....
Installer Address '0
dType of Building Size Lot' t. �.............Sq. feet
U Dwelling f�No. of Bedrooms.....�"".................... . A'y,.Expansion Attic ( +✓) Garbage Grinder (/{�
P4 Other—Type of Building _.�tt?�!?!_n 'h40 fw of persons.._.�`.................... Showers ( ) — Cafeteria ( )
d ----a Other fixtures ................................................
-------------------------------------------------**
Design Flow.,.. !"...........................gallons per person per day. Total daily flow___ ._. . __••-----_-_-_gallons.
WSeptic Tank—Liquid capacit/R!:_._...gallons Length*P.__._ ..... Width---------------- Diameter---------------- Depth_04±.......
xDisposal Trench—No. ..................... Width...:................ Total Length.................... Total leaching area.._"'-_--------sq. ft.
Seepage Pit NoJAa_.!? ....... Diameter b ...... Depth below inlet.................... Total leaching area...16.4.......sq, ft.
Other Distribution box Dosing tank ( )
a Percolation,Test Results Performed by.....................................................441C..................... Date/ ----_----------------.
Test Pit No. 1... ±~ ___.minutes per inch Depth of Test Pit................. Depth to ground water------40!!?'_X'_
(i Test Pit No. 2:`:.............minutes per inch Depth, of Test Pit____•-•.--________ Depth to ground water........................
O Description of Soil...... AV�4 -: .. `!VN 0 _ ^ !._. ,�,/ '' �"'.f
x
() ---•----, a--- ��E,al. ..' J+ ... ..+�... ... - - -------- ------ � .............................................
� 1 "c ,
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 TIT1:2 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i ued by. he board of health.
�,w> Signed-•_.: --- ----------------------------------------------•- .........•---------...-•-__....
:: t - Date
Application Approved By......_tr.............
• Date
Application Disapproved for he following reasons-............
••------------------------••-------•--•--•--•----------------------•--•-......---._..........•--•------•-•-----•-----•••------•------------------------- ---•--•----•-----•-----•-•---•-- ------------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... f .. :.............OF.... .. .................................................
��`�rr#if irtt#r � $at�rli�aa�rr
THIS IS TO CERTY, That the Individual Sewage Disposal System constructed (.4.), or Repaired(•_.)
by........ c •----------------= •----- . ----•---•--•--•------------....----.._......_..----..:..-----•-•--------------.......-•-------..........-----.......---....---------.......
�y4 Installer
at... t -"'
� �
has bee AtalI d i acc c 'wilf4 th visi ns of j of The�Sfate ��nita'ly i a d c in the
P
application for Disposal Works Construction Permit No .___.__ .__ _-.- dated__.....___...._........_......................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT C®NSTRUED AS A GUARY&EE"OAT THE
SYSTEM WILL UNCTION SATISFACTORY.
DATE............ ...�_ ........ ............. Inspector. - -"
-.
THE COMMONWEALTH OF-MASSACHUSETTS
BOARD OF HEALTH
:..... .: . O F.....--•-•.... .............................................................
No. !••
�& "`s'r 1...... �.� FEE..._.'. 04...
Disposal Worbi onstrudwit rrnait
Permission is hereby granted----An
........ ------•-••---------•----......•.......................................••-•-•----••-•-••...
to Construct ( �or Repair ( iii ua ge osal System
atNo... N j� ` ¢ ...............................
as shown on the application for I p4sal Works Construction Permit N .................... Date ..........................._..............
g ." Ile
,e_-- ��� oard o ealt
-- - ............. ........ _
DATE `-_. Cl -• ----------
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS