HomeMy WebLinkAbout0109 RASPBERRY LANE - Health �02-
LOCATION SEWAGE PERMIT NO.
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VILLAGE
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INSTALLER'S NAME ADDRESS
B U I L D E R OR OWNER
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DATE . PERMIT ISSUED -�
DAT E COMPLIANCE ISSUED _ �
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THE COMMONWEALTH OF MASSACHUSETTS ,
BOARD OF HEALTH
ell?" '!�4�............OF....A1� sst- r ----.-
Appliratiun for Diipusal Warks Tonstrur#iun ami#
Application is hereby made for a Permit to Construct ( ) or Repair ( Lan Individual Sewage Disposal
System at �1
... ..��.... . �.l�e.. . -----....W. ...................................... ...------.................................
or Iot
.ocati Address ................................................. No.
._�• wsner a Address.......----•-•--------------•-•----'- .........--------._..._...----•--'--..._.... ............--••-----•'-...................
Installer Address
dType of Building� Size Lot............................Sq. feet
U Dwelling`�lo. of Bedrooms.....................•.:......•.........._..Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
a Other fixtures ------------------•-•••_•---__. ..
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit...............:�... Depth to ground water........................
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�i '--•---•••---...................
0 Description of Soil................ ........--•......................•...--------------------------------------........------•-----.................-----'..--•••
x
W ----•••--•-•---------....•---•-•••••••••--•---••-• ............................................................-•••••-•••-•• ------•-• .._......
--------- - --- -WU Nature of Repairs or Alterations—Answer when applicable- �-/P -............. ...:.....................................
...•------------------------------'----...-----------•--...-----•------......-----................---------•-----------------------------------------------...............-...........................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLIE 5 of the State Sanitary Code—.The undersig ed further agrees not to place the system in
operation until a Certificate of Compliance has been 'ssued by the oaWof
Signed.. ..
Date
• -`
Application Approved By..-----�-----�=- --•------•---=- �........ ................................ ............... - ._...
Date
Application Disapproved for the following reasons:..............................................................................................................
-
.......................................... •--•-•---•-------•--•---------------•--.._.. Date
PermitNo... - ------.....---"-•"----------•. Issued-------'---------•- ...............................
Date
------ _ _ - -- -- �� -
1 S
y ��J
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........OF.......... ,9�% �/If/ ,� ._....._..
Appliratiun for Dispnoal Works Tonotrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at
j' LLocatio -Address or Lot No. .............................
..... ..... .......................... ...... ......................_........................._...
fi� a caner Address
a '.........f ' ! � ....
. ...... ...........................
......................---............................-•---•-----....------........................
._._..._.ter-•
Installer Address
Type of Building Size Lot................ ....Sq. feet
U Dwelling o. of Bedrooms............................................Ex anion Attic a g— p ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .-•---------------------------------------------------•------....--------•---•---•-•---- .............................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length.-_---.-------- Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) , Dosing tank ( )
Percolation Test Results Performed by ---------•--......---•-- .......--•-•-•• Date....._.. ......
Test Pit No. I................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........................
a -----------------•••. ••----•---•----•-----............._......•----.....•--•------.......•--•--•----.....-•-----•....-----•--.........._.
DDescription of Soil..--------•.--•-=.... ...�. .. .................•..............................................................................................................
-------------- ----------- --------------------------------------------------•--..._......-- ----------------- -•----------------•------ -..;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 TITLE 5 of the State Sanitary Code The undersig Led further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the%oard �
c
R` 01
✓ d
Signed.. ... ........ ..... � ..r� /"`�
Date
Application Approved B _......... �)
Date
Application Disapproved for the following reasons:----------••-----•-------•-•---••-----------•-----------------------------------------------------•---....---
........---•--------•........................•-••--•-•-•----------..........•..........-----•-•-•-----•-'-•----•----------...---------------•----•---........------------.....-•--.......-•-•----.....Date
Permit No............................
.. -.___ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT,
.............. i.ice. .OF. - z ........................
fIrrtif iratr of Toutphattrr
IBIS RTIFYTtthe Individual Sew�age Disposal Syst m. -constructed ( ) or Repaired ( ,r.
by...T -----...-- »J`r . ............. :-.- •................_..........•---.......... .......
-.
Installer. _ t'
at.._..._•'.�..�...... .... ` • s:--ef! r '`�' - -....
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.......e�_(:;....... ...:........ dated..... ._.q.lp. .................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM W LL FUNCTION SATISFACTORY.
DATE........ .._.... ...-• -........... Inspector..........1..... .................... .....-•----•...---.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. ,1.�.vl�^'......O F............�t o ` . ?% a :
No.`.bC�....�.. Fag.. .'-'�.....�....:
�tou� k rrrut
, Vim
` onotr tt
Permission is hereby granted...._4 .... ---•-• ..---•.........................................................-----
R air an Individual Sewa a stem isposal S
to Construct ( ) or • ( g y
Street
as shown on the application for Disposal Works Construction Permit NoK��2:.2----- Dated.I.......2.-.r ?
....................
.................
—•!.:=- / .........................
• Board of Health
DATE............
FORM 1255 A. M. SULKIN, INC., BOSTON