Loading...
HomeMy WebLinkAbout0051 DEER HOLLOW ROAD - Health 0�JoS-� _ n � THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA TH 01 /-I�v..��..........OF........... . .... Appliration -for Uis viittl Workii Cnowitrurtion Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: l) n ® el6 K�9t � � ' o tion-Address � r I o No .,,,p ---.I�AX 4...... �s Owner Address Installer Address UType of Building Size Lot.... ."Z......Sq. feet .- Dwelling—No. of Bedrooms._--------------------------------------_Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---_____.-_-_______-_____.__ Showers Cafeteria PL'' Other fixtures .. _ W Design Flow.I-_____________________ _______ gallons per pet son per day. Total daily flow___._______.-------------- -------------- ....gallons. WSeptic Tunk—Liquid capacity/ _-_-____gallons Length___-___--___-- Width................ Diameter................ Depth---------------- Disposal Trench—Igo..................... «yid _.._ ___ ota Total leaching area--------------------sq. ft. Seepage Pit No_____________________ Diameter_._____.____._.___. epth below 'nlet_........_.... .��. Total leac tiltg :tre:l.___.---.-__.-___.sq. it. z Other Distribution box ( � Dosing tank latei/ Percolation Test Results Performed bY-------------_- -------•--- -•---- -••-••---------•-•••-•... -----------------`-ram---------------- -- Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-..___.----__-.--.-....- f� Test Pit No. 2-----_----------minutes per inch Depth of. Test Pit.................... Depth to round water:_.-----_-_-.__.----.-.. I---- - ---- ----- - . .d----- O Description of Soil------------------------ / �'...1---•- -- ' --- ------------ x ` .................... .. VW --------------- - -- --- °--------- �- /----- - �-y --•......................................... 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 Article YI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b sued by the and o health. Signe _ ^� -- / a Application Approved By....... _ ___ --__._._..._...� ,,((�� ate - ------------ ----tf - -----Date), ate----- ---------- Application Disapproved for the following reasons------------------------------------------------------------------ .......................................••---- ---------------------------------------------------------------------------------•--....-----------------••---••---•••-----••-••--•-••-•--•----•------......------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date No._-J 4...... Faa. ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH :.-------.OF...........A '.......... Appliratiun -fur Di_nvmal lVorks Tomitrurtiuu trrmit Application is hereby made for a Permit to Construct or Repair ( ) an'Individual Sewage Disposal System at t� ! QQ_._'_"_ty_. .(ow--- .......lt('S�'n1s.".�`s tion Address r Lo No. p Owner Address Installer ess of TypeDweBllindingNo. of Bedrooms._�__` .`______________________________Ex Expansion Attic SizderLot..Garbage" b.y �,_.�,;.Sq. feet U g— p ( ) g Grinder ( ) Other—Type of Building ............... a YP g ............. No. of persons.---------•-----------____-- Showers ( ) — Cafeteria------------------------------ Design d Other fixtures - W Flow. .... ____.__._. lions per person per day. Total daily flow_____ ''._.':._. tllons. ,�,.,fga P P P Y. y g R; Septic Tank—Liquid capacity/jl_----____gallons Length................ Width................ Diameter---.._.--------- Depth...-.-_-_..__. Disposal Trench—I5,o---------------•---•- Wide' ot� >�_____.__-•----.. Total leaching area.--.-.---_.-. -----Sq. ft Seepage Pit No......_,_L_---------- Diameter_/................. epth below 'nlet_._..._________ __. Total leac ding area......_.__------__sq. ft. z vOther Distribution box ( Dosing tank �. Percolation Test Results Performed bY----•---------------------- ate--•-_---------------------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------�............ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to round water........._.___ ----- ------------- -- -L---- D Description of r /}� .f Soil d."- t-±±rd r- x --: U Nature of Repairs or Alterations—Answer when ap icable________________________ _�_ ._.___.._. _ _. _____.____...__.._...__.__._.._..._.. -------------------------------------------- ---------------------------=--------------------------------------------------------------------------------------------------------------------------. 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 b sued by the board of health. Sign e t - ` ^--- � ate Application Approved By...... /" -•---•------ "' Date •-•------ ' �� �� ... Application Disapproved for the following reasons----------------------------•--......-----................._._.._... ............................................ ----•-------------------------------•------------------------------------------------•-•----------------------•-----------------•-••----•-----•----.....••----------•---•-••••----...................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH .............OF........ ...... .. ' %Untifiratf of Tompliaurf TFI IS T �ERTI ', That the I divy al Sewage Disposa yjstem ons ucted S or Repaired ( ) b _ � . • ,� Installe ,,[� r at---�- ... .. '1- i ..`•_.ik. .---- ..................................................... has been installed in accordance with the provisions of Article XI of The State Sanitary Code s d scribed in the application for Dis osal Works Construction Permit No........... ................... ................ dated..----1.1� ! `7-�..__----.---_•- THE=ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE© AS A GUARANTEE THAT THE SYSTEM WILY/U TI N SATFSFACTORY.DATE . • --•••-•--•-•-•-•---- Inspector------ _ .............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H '1.......OF.......... . ...................... . FEE ,.. No.. •--•-••.. ...-•-�- tt u �uu�tr�t mat �rrmi Permission is eby granted..... _ ? ____.___ - -------------------- --. - ---------------------- - to Con c ( ) or R a ) j� In 'v ual Sew ispos stem/ ' ' at No./! d�l►s�--... �' ..... ----------------- Street , as shown on the ,pp p Construction mit No------------_........ Dated...�� a lication for Disposal Works Constr �? , ' 7 " -•-••-... --L- a ;�.(. ... .. : ---------------------------- ✓ Boa d o ealth �' l DATE.--.. .• FORM 1255 HO BS & WARRE INC.. PUBLISHERS t r { U!• ,t �; i,. off, , - �� `'})`� ',4k 1( •:J�'°'�' ik 's v � ` .�. ., , ti' n • _ } • �� ,.. ,• �O� � � �� y., a 1. , f , r All .. ` � �' '��, f� � t� •V fir,. to , it ' • • f�. J? Z}' •P `7'�...!t '7 .Y _9 �Z ls. t:�!,.t �. (� (1 :,' , � .. v:. s 11 _1 , � �1 P C. } '-• � � NMtl'� } y � j}try s. - � - ( ,f• �. e �•� .O � ' f� �` 2k ��77T111 .•1 _ .. is -:t - �i - t,� �-�� ��. ,J.'�! � �.7;- e� 4z:. �..�'�_�--�—-s-�a- �• � -''--'_�.'�'�.t.;,� 3� •..,..—�s_+a,-v>>��_"-'-!h �; r t �l ��J � •i,e t)Ir,, t•= •h • - � ; 'ILA (f• 'j,.7 Lyy'1! -! �.� _���...�w _ _ yj S. j y f�• ,.3 ^3 T �'.., .� p _ !. ` p. ... s P r N i +F , vLk } , . �=r'``:. ---'-,z'�.:;,-._. �..,.,.� "�%�F y=:��,��,r,=,.d _,.,_.,,-"`.'1.Y'^h:•��(u S'r_ .sue-;c� 9:,,.y-r.-.�. � s _<_•-e` ..,1,a ,1 �.') � }t- Frn,F I Sq h { 4� v �1 � ,JG�I/`„�'` •'?Q ,'� �,.-C�„�, � ..Ej -,1.�''t t"p.r•`rr""..;,tg ��t o _ f,