HomeMy WebLinkAbout0114 J.B. DRIVE - Health Marst L � S
LOCQTI-ON - SEW-QC;E--PERMtT 1�10.
D-A-T-E COM-P l:I�At�I-CE I SS-I�-ER--�0'�-76'
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THE COMMONWEALTH OF MASSACHUSETTS
EOARD F HEA TH
_..... .. . sL ........OF........ ... .. - ---------------- ..
Applira#ijan -for Uiipuiitt1 Works Cnowitrurtion Vrruift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:.
cacao -Address or Lot No.
Owner Address
Installer Address
d Type of Building Size Lot.... All... et-
U Dwelling—No. of Bedrooms_____________ ___________________________Expansion Attic ( ) Garbage Grinder ( )
ajQ0=—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
QOther fixtures .........LL)AS_/t49A-.__0JtYG/x----------------------------------- ------------•---------------------------------------------
W Desi n Flow.............�6....................... allons er erson er da Total dail flow __________-..._-----gallons.
g - g� P P P Y• Y - --- g�
P4 Septic Tank-Liquid capacity%v&_gallons Length---------------- Width................ Diameter-----.---------- Depth..---.._-_---
xDisposal Trench—No._____�_ ,____---_- Width-_---------------- Total Length.................... Total leaching area---------.----------sq. ft.
Seepage Pit No/_J.4!4-C.-.. iameter____________________ Depth below inlet-------------------- Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation 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 ground water...-.---.-___.-_--.---.
--- -------------- --------------- ........................................... ............................................................................
Description of Soil--------------------- � 4 _k_t
x i
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 hoard of h t
4 Signe _.... ----... --- ............... t�
D e
Application Approved B 1�/.. .. f - ��" -
PP PP Y
ate
Application Disapproved for the following reasons----------------------------- -----------------------------------------------------------------------------------
••---------------------------------'--------------------------------------------------••-----------•-•--••----------------------•-•---•---•-------•-----------•-----------------•----••------•-•••-----
Date
Permit No. Issued ...........7"- 1...............
Date
,3
No.. -1 ` ----•--- FIc$....f.lt�...............
y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F h-EEA TH '
Appliratiun -fur' Bi_qpasat Workii Tonstrurtiun Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
at=o -Address or Lot No.
t_ -o-8.90-1.....1�.`.... 01.__. ........._ ..
W Owner Address
p 4
..............................................1n--,------------------------------------------ --•--------•----------------•--------- ...----------------------------------
Address ----- -- .........._...
Installer /
U Type of Building �} Size Lot....l� ll
�-. Dwelling—No. of Bedrooms-------------12-----.___..-__-___________Expansion Attic ( ) Garbage Grinder ( )
p, rQ102—Type of Building __-_____.-_,+___•_.=....... No. of persons____________________________ Showers,( ) — Cafeteria ( )
a' Other fixtures ---------
W Desi n Flow-.•_____-__.4*0...................... Mons per person per day. Total daily,flow---------------ZI ::................gallons.
WSeptic Tank—�Liquid capacity/Ql*__gallons Length................ Width..........,::.:..Diameter-----........... Depth._.-_____'_---
x Disposal Trench—No. .... . ........ Width :'_.Total Length________ Total leaching area_.___._...-_. . --_sq. ft.
Seepage Pit Nol.`1.;�?�R_�� Iameter........... .... Depth belowinlet....... _ ... Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank
aPercolation Test Results Performed bY-------. ....................•--------------------------------------•••••. Date-------------------------=-------------
,� Test Pit No. 1................minutes per inch Depth,of Test Pit_.______._______.._. Depth to ground water........................
rXq Test Pit No. 2----------------minutes per inch Depth of Test Pit....' 'Depth to ground water.........................
a -••--------•------------------ - ------------------------------------------------------... ------------------------------------ .
a
Description of Soil------------------- + !- it•---• - �'�"
V �,V_&.
7�t -�- --------
------------------------------------------------------------------------=------------------------------=----------------:--------------------------------...---........................................
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 Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been
r
iss ed b�yth o h t
oard
Sign( _----- ------
Applicatioh Approved B ` e
. ... ..... '' .. .- .. ate
Application Disapproved for the following reasons:.....::.......................................... `
-y ----------------
.........
l x' Date
OPL
f Permit No......................................................... Issued----/......•.....
.............................
Date +i
THE COMMONWEALTH OF MASSACHUSETTS
• BOARD OrFALTH
0.1ertifirnte of Tontptiatirr ',��
TS C IFWat Individual Sewage Disposal System constructed (f� ) or Repairedby.--• . ... . • . •---
/ Installer
s* ............a t
has been installed in accordance with the provisions of Article The State. Sanitary Code.as de rib�ed in.the
application for Disposal Works Construction Permit No.___._-A.... of,,)............... dated.._,�.`A� .. .._.._...._...
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM W LL; FUNCTION SATISFACTORY.
DATE------. Q==" '�"'' ----.....Z ............................. Inspector------(/ ---- ---- . ---- ........................................
THE COMMONWEALTH OF MASSACHUSETTS l ..
BOARD OF HEA T r
/ . ..:.....OF
_ .No. L-. . =...... FEE..IAO..
Cunli Or goat rrmit
Permission .'s ereby granted k#.
•• ---- ---- -----------------•-- .---
to Con str r an ivid Sewa I osal S ste t
( ) r y -- ---- ----- --------------•••-
at No� _
Street
as shown on the application for Dispo �
Works Construction P it No.`_ -___ _ Dated- ........................
Board,of Health
DATE... ........................................ ,
FORM 125 HOBBS & WARREN. INC.. PUBLISHERS - ..
Q" �e4cH Q�.� �1000 �.a /