HomeMy WebLinkAbout2444 MEETINGHOUSE WAY/RTE 149 - Health 2444 Meetinghouse Road
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LOCATION U- I-4 5EWW:f E PERMIT UO,
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WSTALLER 5 1l&NAE ADDRESS
BUILDER 5 l�J l�1ulE � ADDRESS
DL1TE PERNA T 15SUED
D b,TE CONMPLI A11,4CE ISSUED ;
LOCATION ' �$1 SEVV&C,E PERMIT UO.
I.WSTQLLER•5 UWE ADDRESS
BUILDER 5 Q [ MF- ADDRESS
DQTE PERMIT ISSUED
D ,.TE CONAPLI WA(� E ISSUED
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No...... .............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEA T
�'GL-...-0 F.......... ... ..... ... ......
Z�q� Appliratiun for IBWVoutti Works Tonfitrnrttun Vanift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
d � cat on A dre or Lot No.
(� r
Owner Address
11 II 6 ..
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling-No. of Bedrooms.-.-------�..............................Expansion Attic ( ) Garbage Grinder (AJ0
pa., Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ......................................................
W Design Flow.........��--------------------------gallons per person per day. Total daily flow..------------D�_C -C�------.........gallons.
WSeptic Tank�-Liquid capacity__P�HC D.gallons Length................ Width_.............. Diameter--------........ Depth.--------..-.--.
x Disposal Trench—No. .................... Width---------.---------- Total Length--.......---....---. Total leaching area--------------------sq. ft.
Seepage Pit No..----t............. Diameter....ld-M.64epth below inlet.................... Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( ) d 6` i-5-76 - '
aPercolation Test Results Performed by------- ----------------------•-----'•------'-------•••------------------ Date.-----------------------------------.-..
Test Pit No. 1----------------minutes per inch Depth of Test Pit.------------------- +Depth to ground water........--..............
!s, Test Pit No. 2................minutes per inch Depth of Test Pit-------------.-.---- Depth to ground water------...-.-------------
G - , - �
----------
Description of il---- �7'i'' ...- `3 d`z✓!k �"'"�`
x
-------------------- :�, .�.
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 * sue by e boar , f h.
Sig d------- ---
- --- ----- .---------------- ----------
Date
14 --•--- .....APPlication Approved By----- . ... 7 ....... �l�
Date
Application Disapproved for the following reasons------------------------------------------------------------------------------------------------•----------'''''-
---------------------------------------------------------------------------------•---•--------------•---•---------------------------------.....----------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS FRic
BOARD O HEA A4 ' IH
.....OF.......... . .. . .... ----.......------.
ApV irtttintt -fur 13hip ittl Eorhii Totuarurtion Vrrtltit
Application is hereby made for a Permit to Construct ( //1 or Repair ( ) an Individual Sewage Disposal
Syskern at• / d �y,
L 'o dress or Lot No.
------------ --- .•/•� wnee�' 44 / dr s
�,,,� --------- -`-�- .._------- --r------•-•••-•-------------•--•-------------- .............. --- ------...----- ------- ----------.-•-•_----------------------------
Installer Address
UType of Building Size Lot----------------------------Sq. feet
Dwelling 14*�No. of Bedrooms.-------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
QI Other fixtures -----------------------------------------------------
W Design Flow.. .................i-___.._........_gallons per person per day. Total daily flow---------�_r�_._.----___-..----.-..gallons.
WSeptic T..nk•�•Liquid capacity-/gallons Length________________ Width................ Diameter_---- .......... Depth-___---_-.-----
x Disposal Trench—No-____________________ Width-___....�.p___ Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No.......f........... Diameter_��_J�I�epth belgw inlet____________________ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed by------- --------------------------------------- ......................... Date--------------------------------------..
,a Test Pit No. 1----------------minutes per inch Depth of 'Pest Pit-------------------- Depth to ground water........................
�14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.--.-.-_---_---_-_-.
tx -------------------------- ------- --•-
O Description of oil --��------� C. _.. 4,. n - - ---
x 1 �'
w ......................... --- -------------------_------------ ---------------------------------------------------------------------------- -------------------------------
x -------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------
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 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 board of health.
Signd_..........--------•------------------•-----•--•--•----------••--•-•-•-•--••-......-- ............
Da.t.e•--•••......--
�j�� Date
Application Approved By------ � 's%j!,�'( �ti�r ----•----------•-------- -----��-
Date
Application Disapproved for the following reasons:...--•-•---•--------------------•---------------------------------------•-•---•------------•-------•-•-•-------
--...-------•----------••--•---••-••--•-----••---•--•---••--•----------•••----•---------•-•-••----•--.--_.. ...-•------•------
Date
PermitNo.......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/.�1„*'7.�.........OF............. .. . .4-14-r-171,117..............................................
(ITrrtifirttte of T o wlitturr
THIS TO CERTW, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by...."'. v e ...... { -------------------------- --:-.1,�2-�.......------
• � Installer
r ,�� --•--
has been installed in accordance with the provisions of A, crle��i o The Sta Sanitary Code as describ d in the
application for Disposal Works Construction Permit No._C'.� .. dated.... .
ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE :.. . --' --- Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
7 �
FEE_
�i����ttl, ttrk� � tt�trttrti�tt �rrutit
Permission is hereby granted-____
A_ �J
to Construct ( or Repair ( ) an Indihb_idual. Sewage Disposal System `
at No. 1 c.;Ie� � " L.............( .<_r n � = ............................
.� Street / 1 / 7
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as shown on the application for Disposal Works Construction Permit No........__/. .._/_�,,D t,�4------ -----------------------------------
rr — Board of Health
DATE------. f �. 6....................................•
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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