HomeMy WebLinkAbout0163 CAMMETT WAY - Health M cvzSfrn,S hfr Li�
SEW W::�E PERMIT _UO.
---_IWSTALL R'5 ►J E ADDRESS __.
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_ -BUILDER 5 1J &MF- . _ADDRESS.
_ DC.TE PER"I'T ISSUED
D ATE COMP-LM 4CE ISSUED; - =L
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No._....�..I of. Fsal....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OE HE&L.TH,
3 . .........OF..........
l ,0 pfiration -fur Uiiipuiitti ,irks Totm rltrfinn Vrrmtit
46,plicat, s�h eb made for a Permit t Construct (X) or Repair ( ) an Individual Sewage Disposal
S em at:
1--------------------
� . %ocation-A ress
. .. ----------------------------- - ��.1 .I ' Pe :� /) �
/ Owner A
Installer Address
d Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms..........:Q----------------------------Expansion Attic (JUJO Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons-...___----____________----- Showers ( ) — Cafeteria ( )
0.' Other fist res ......................................................
W Design -Flow............ .. .••----__.__.____.._..gallons per person per day. Total daily flow.......... ........gallons.
WSeptic Tank Liquid capacity .< ___ lions Length................ Width................ Diameter---------------- Depth__------_--.
x Disposal Trench— o. .................... Widt _.__...__._ XQe
L h________. ,::__.__ otal leaching area--------------------sq. ft.
Seepage Pit No.___ ___________ Diamete _ Total leachin area-.--_ --__.-sq. ft.
i �
z Other Distribution box ( ) Dosing tank ( ) 40 . " j—
aPercolation Test Results Performed by--------- -------------------------------------------------------------- Date------------------------------------.-..
Test Pit No. 1----------------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..----
�+ ` ..............•--•
O Des r' ion of Soil ® .6e�_.. .- --. !( ! .: 1
x
m V ----------- ---------------
_ - � ----� - -.� --
- • - ---- ----------------------------------------------------
U ature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------..
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
. The undersigned agrees to install the aforedescribed Individual Sewa isposal System in accordance with
the provisions of Article XI of the State Sani - y ode T n s' ned ther agrees not to place the system. in
operation until a Certificate of Compliance as bee u t o_and o alth. -
Sig e
--------------------------------
ate
Application Approved By---------. �- - ... -------- `#� •�' Date
Application Disapproved for the following reasons----------------------------------- =-.........................................................................
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
� j`� /
Permit No. Issued. ---- ----------------=--------------------
Date
--_'----------------------------------------------------------------------------------------------------------------------------
No.................... --- FE.H ................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEM H
}
[4110'" '.........OF..........
d.�1 i .- --- - --------------------
Appliratiun -fur Miivoiitt1 Works Tomitrurtinn Prrutit
Application is hereby made for a Permit to onstruct (Aor Repair ( ) an Individual Sewage Disposal
Syy§tqm
Ecatio / dress r� No
/. ........................................... f .....................
��
/ C1
Owner d ess
ar Installer Address
�`'' S feet
Type of Building 'f' Size Lot__________________________ _ q.
-, Dwelling—No. of Bedrooms--------------�------------------------Expansion Attic (�(J Garbage Grinder ( )
Q, N Otlier T ............................ No. of persons---------------------------- Showers ( — Cafeteria ( )
Q Other firtu es ________________
---•-------------------------------------- -----------••---•----------------•--•-----
W esign Flow ........ Mons per person per day. Total daily flow...._...._.: ._...__...gallons.
W eptic Tank Liquid capacity_ __�allons Length................ Width-----------;g�r.'Diameter__-------_--_ Depth---------------
-
I,
x Disposal Trench= 0. .................... Wi tl .-. 40t,61Le
z ._... otal leaching area..._._.._......._._.sq. ft.
Seepage Pit No.._. L...._..___. Diameter/i ._ Total leaching—area area..................sq. it.
z Other Distribution box ( ) Dosing tank ( ) , '�. .» / � V^`-7,0
Percolation Test Results Performed bY.......................................................................... Date---------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.---_-_-._.--.---_--...-
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to rot)pd water-
.. �'--------------
i i
x . „�.....
O _._
x Descron of Soil d' 1= Ga^�► �.' ------
- .
�, . , ', �. -�. -------------------------------
- -
V Nature of Repairs or Alterations—Answer when applicable.-.......:..................................................................... ...............
----"•-----------•----••------------------------------------------------------------••••-----••-••-----•-••---'..--• ------•----.---_-•--.------...---•---"-----------•---------------------------•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewa , isposal System in accordance with
the provisions of Article \I of the State Sani " ode T and s ed rther agrees not to place the system in
operation until a Certificate of-,Compliance as bee e oard of alth.
ige . ... . .. ............................................ ................................
Date
Application Approved BY --- -- ---- ..... • - ---- � �•�* - ' " �«..
Date
Application Disapproved for the following'-reasons-................................... "----------•----------•-•-•-•-.............-•----------••-----•-----••--•.
--•-••--------------------•------•-.------•--•------.----••••-•----------•--•-•••-•--...._•--•.•••------•----•-•....-_....---------•-..••_.._........---•-•---------------------...........--------•-•-
Date
PermitNo................................. ..................... ................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH.
"`I►.� 0 .....................................
(90tfrr of f�lantplinnrr
THIS"S C „ gI ' hat the Individual Sewage Disposal System constructed ( or Repaired ( )
Installer
at ~ IC
y= './ ----- - --- -- ' P = °°�
has been uistalled m accordance with the provisions of A 'I f The State Sanitar Code as described in the
application for Disposal Works Construction Permit No._ -_.___ _. + .._......__. dated.......
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE O-P�;STR'UED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
.' 2� l ,�
DATE------�............ ••-- L� Inspector-1..... �---- r 1 ----------------------------------------
THE
COMMONWEALTH OF MASSACHUSETTS
t7 BOARD O HEALTH
_. ..........O F...-......
FEE....
Y.
�rrntit-
Permission ' ereby granted---- - f ----- .............................................................
to Constru ( or e air ) an Individua ge Disposal S ..........A ...................
_A.
reet
as shown on the application for Disposal Works Construction Pe mit No----_--------------- Dated------------------------------------------
G� / = -------- - -- ----� _.tom Board of Health
DATE.........k..............
././. s
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I r _
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