HomeMy WebLinkAbout0827 SANTUIT-NEWTOWN ROAD - Health o A'D _ ,
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No.......
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THE COMMONWEALTH OF MASSACHUSETTS _
3 Well
BOARD OF HEALTH 9t.o.� a
Flo mmsv .... O F... �., . ra. . ................................ .. .-
Appliration -for Uhipvii of Workii Tomilrurtion Vrrmi
Application is hereby made for a Permit to Construct (� or Repair ( } an Individual Sewage D a
Z� Syst at: M...
ation-Ad�drLgss •/�— �+ o/ or Lot No.
..... - - Ji ..15wr_ .- ---------� .�5r- !���-----..�?_�__S..s......................
Owner ••----.....--••--------•-•----•.............Address
a ------ ----- ---------------•-------...--•--•-------• ...........................................
Inst er Address
UType of Building Size Lot----------------------------Sq. feet
Dwelling ENO. of Bedrooms---__-_ .............................. p ( ) g ( )Ex ansion Attic Garba e Grinder
aOther—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ----- ------------------------ --
d -
-----------------------------------------
W Design Flow..........................F.0.........gallons per person per day. Total daily flow----39245-_----__-_--.-------gallons.
WSeptic Tank—Liquid capacity/400,6_gallons Length................ Width................ Diameter-----........... Depth_.-.------._----
x Disposal Trench—No. .................... Width-------------------- Total Length_-__--_-_=_----- Total leaching area......--------------sq. ft.
Seepage Pit No---------/____-___ Diameter.....A0..77.__ Depth below inlet...6._ 0..... Total leaching area—_-7D-0_--sq. ft.
z Other Distribution box ( ) Dosing t� )
Percolation Test Results Performed b
,a Test Pit No. 1------ ------minutes per inch Depth of "Pest Pit,9.:. O_ Depth to ground water---.!7_0..46!?1r
�Tq Test Pit No. 2.................minutes per inch Depth of Test Pit-----___.._•_______- Depth to ground water--------------------_
--------------•------...-1
..
0 Description of Soil_ -S AC - .. . .tl, v...�Q_l��®Q ._., �� ..,f?,9��0.----.�� - /YJ------------------------
xmay'/, so.. .... y�ace�� � � �� -------------------------------------------------------
---ram;!e/-------------..........................
V 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 XI of the State Sanitary Co —The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n. is d b the ard�f healt�
Sign ��ir
� 4 � "
Application Approved � --••-. ..........-•--•-•-- �
Date Application Disapproved for the following reasons:.................... ........................................................................................
............................................... •----•------------........._..---•--•------------_...---•..---------•••---•-------....•----••-------.----_...------------------•--•--•--------_.....-----
Date
Permit No......................................................... Issued..... 1 `-7
Date
OF
THE COMMONWEALTH OF MASSACHUSETTS a. y�
?r ia t^
ce"
BOARD OF HEALTH M'r.o.119a4 1944 CA`� p �
,/4.wC,t1 ._._._..........OF..., A.1eXA—;5.?.. ,5+416...----...-................
Appliratinn -for Biipoiittl Workii Towitrurtion Prrntit '
Application is hereby made for a Permit to Construct ()/) or Repair ( ) an Individual Sewage Disposal
Syst m at
` r t.... ca�io id or Lot.sr/_ s�
. .......................
C/r r Owner Addre
Inst er Address
Q Type of Building _� Size Lot............................Sq. feet
Dwelling 4 No. of Bedrooms-------_:''S...............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Ga Other fixtures -------------------------------- -
W Design Flow........................ .........gallons per person per day. Total daily flow...:4'!_� ----------------------gallons.
WSeptic Tank—Liquid capacityM44gallons Length---------------- Width............._.- Diameter.__-_-.-_-____- Depth----------------
x Disposal Trench—No_____________________ Width-------------------- Total Length----___-_R__._-..__- Total leaching area--_--______-_____.-sq. ft.
Seepage Pit No......... ......... Diameter..._.:! _P... Depth below inlet.. ... Total leaching area,3FO -----sq. ft.
z Other Distribution box ( ) Dosing tank
'-' Percolation Test Results Performed by
Test Pit No. 1-----�a------minutes per inch Depth of "Pest Pit_- '_- ?__-___ Depth to ground water--_fin_ � f r
44 Test Pit No. 2___-_-___-_____minutes per inch Depth of Test Pit____________________ Depth to ground water__-__-_____-_______----.
P4 ,�. --•---•.--•-••-•-------------------------•---------• ---•••-••-•••••.......----- ---------------------•--•-------------•----------------------.-•----
D De)s^'crr{iptiony}of Soi/lyCy �S y�sw ,i`may/c},� y"�rz/u/J/)���]i[3�/C>�}�O /� -ytJk°/.y� 4 //5!)•- l ars�a------------ ----- ---
U �1 sF} f �/N f yI`^" 4l 4✓ "' fed`-4}4. i' 3 J •--•------------ --
V 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 Co-de The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss-ed b the and heatt
Sin- '"``' --------- ........ . ................................
Application Approved BY------- ..l..-...... ------------------- -------�-----G--------- �---------------
-•--.-- Date
Application Disapproved for the following reasons:........... � ./ .....___...._____-_.____._............._..____-_______-_.__._._.._..........
..............•---••---••---••-••••-•-----•-••---•--•---••-••-•----------••-----•••••--------••••••------..-•------------•-••----•- •---------------------------•---•-------•- • --••----•---------•----
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................OF... � _ ,�. ............................
Trrtifiratr of Tomplianrr
THISIIS TQ CER" Y,% hat the Individual Sewage Disposal System constructed ( or Repaired. 06
( )
,f e ( Installer
at ° _ , e. .r �y!m+4}_s_""�____,�4/f GI! 7`x"e?Z. d, 7 r�.:.�
has been installed in accordance with the provisions of Alti'e- Izof Ae State Sanitary Code as described in the
application for Disposal Works Construction Permit No._.__ .____ ______- dated__.... .:..................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.....................J.'L '- ? ....................... Inspector----
THE COMMONWEALTH OF.MASSACHUSETTS
BOARD OF HEALTH
No.......--------•-at••.... FEE---- .............
RnVoiitt1 Norkii ( n trnrtinat rrmit
Permission Is hereby granted--- d=-_----__-----=--- 6..,rT�_ ------------•-------- - ------- e e---------- ••----
to Construct (ki or Repair ( � ) an Individual Sewage Disposal°System...,
at No.......... ...� `''�""s7J!. ...fa. ?atc� "----- -- - ----
Street
as shown on the application for Disposal Works Construction Permit No._._.! .... ___ ' ated______________/
-��-�
DATE--------------------------------------------------------------- •--•••.......... Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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