HomeMy WebLinkAbout0023 POINT HILL ROAD - Health �e
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THECOMMONWEALTH F`M�ASSASETTS
BOARD I-1
lY I E H
t- OF...... . `--.........
.
Appliratiun for 43ispuml Workii Cnuntrnrtiun Prrutit
Application is hereby made for a Perm' o Co struct ( �r Repair ( ) an Individual Sewage Disposal
Syst .
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�� or t No—
... — V`G
�.- . -- --------- ------- ,
ow Address
� I taller Address - `t
d Type of Build' Size,Lo .�_.. _.. ._.._Sq. feet
U Dwelling—No. of Bedrooms...........�v:........................Expansion Attic ( ) Uarbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures _____
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W Desi Flow...................... allons per person per day. Total dailyflow................__ ` gallons.
WSeptic Tank Liquid capacity..-___gallons Length................ Width-----------.---- Diameter................ Depth_--_-----_---.
x Disposal Trench—No. .................... Wicl h; _..Q . Total n t __ •---_----__-. Total leaching area-_----_--•__---_-_sq. ft.
Seepage Pit No------2�__-- Diameter_�..Q_..__�..0....`fjept b own ...... o14, hing area__.�.�__�_sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by--------------------------- ---- - ---- ----------- -- --- te--------------------------------------..
,aa Test Pit No. I................minutes per inch Depth of Test Pit,. _ -..::.....__. D th to ground water-.......................
�T4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_--.___________._ ...
---------- -- 1� •. --
O Description of Soil /: 7 4.j-".---- ----- -5.. �'tt�
U -------------------------------••-•-----•-•-•-•-••--•---•-••-•------•---------------......------•-----.....--•••--••--------•--------------------------------------------------------------------------
W
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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 Code— The undersigned further a rees not to place the system in
operation until a Certificate of Compliance has been ' d b t f healt
Signed. •. .... L `�/ ------
Doe
Application Approved BY? / - 7--_
Date
Application Disapproved for the following reasons----------------------------•---•--•-•• ----•---------------------•-•-••---------
..-----•---•-----------------------------------------------••--•---------....------------------•..........----•-••---•-•--•-•--------•---•--•-----------------•-•--•-------------------•-•-•---------•---
Date
PermitNo......................................................... Issued........................................................
Date
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH....__OF......Ab
y
,! VVp ra iou for Uigpoiial lgorkii Tonstrurtiou Prrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
.&6 ,,�'sl
f�........ .. ....-- 'Ir'° ,. r--•- ¢-pjJ.---ri ,!"�& .__ 7�"!7 i=^--?. �i�- --�
V ac-;;:�A Leo ti n' Add,es' a _ It
A o.�
Own Address
W
Installer Address -�
d Type of Building .� Size Lot92��._. ` -.___Sq. feet
U Dwellin No. of Bedrooms-__--____-_ _Ex Expansion Attic C�arba e Grinder
g— P� ( ) g ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ----------------------- -
Design Flow................................G1....... allons per person per day. Total daily flow.................... gallons.
WSeptic Tank—/Liquid capacity_/ allons Length---------------- Width---------------- Diameter................ Depth..___----_-_.__.
x Disposal Trench—No.................... Width.:.�.,._�_ .__.__ Tot al J;e�ngtY} Total leaching area... ---------sq. ft.
Seepage Pit No.....`. --- ___ Diameter�?` _:fl.._t�__ ep bo '°l°n ____ _ ____,. otal leaching area__�r_d_ : sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) j I,
~' Percolation Test Results Performed by-------- -....._..__.. Date___________________________________
Test Pit No. 1-------_--------minutes per inch Depth of Test 1t--.............__.. D th to ground water.._.___________.__..___.
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------- ---
11
......................./a..............................
.....-•--- •-- r-
Description of Soil--- -) k
--- ------------ ------ ------ f
x
tJ
-----------------------------------------------------------------------------------------------•---------------------.--------------------------------------------------------------------------------
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 ail of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i sued by th®. eag�,f health/'`
Signed _ -44(1-ij. �` .I `' � Yr � ----- -----
�€ D to
A lication Approved B
PP PP Y fs�� t Da
Application Disapproved for the following reasons-------------------------_-_-- -------------------------------------------------------------
•--------------------------------------------------------------------------------------------------------.-------------------------------------------------------------------------------------------•-•-
Date
PermitNo......................................................... Issued..........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r _
............OF....
(9rdif iratr of Tomlilittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
byf ------------------------
sta er .
a . .....,
has been installed In accordance with the provisions of Article XI
P he State Sanitary Code as described in
application for Disposal Works Construction Permit No.____..__--_ _______________„__-___ dated......../----tR ........73.........
THE ISSUANCE.OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................................................................... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH n`
p
Nd. FEE----•--- ••---.._..
4 •1.
• �i�����t1 �r�,� Cn�ia��r�tr�i�Yt rr�i�
Permissionis hereby granted----------------------------------------------------------------------------------------------------------------------------------------------
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No........— j `'== < °�" `4° � -----
l�
w Street
'
'Disp osal Works Construction PmT �as shown on the appliat for J �-f��- Dated___ i -3..............
oar of-Health
DA �
l --FORM 1255 HOBBS & WARREN.-INC,. PUBLISHERS