HomeMy WebLinkAbout1431 IYANNOUGH ROAD BLDG A UNIT 1D - Health 143I i ���� � U�,,,�s
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No................_....... FBB-90 __...._
THE COMMONWEALTH OF MASSACHUSETTS r-)
BOARD OF H&NQ-I
t,�►p,.
TOWN OF YET a
Appliratiun for 11ispusttl iforks Tonstrurtturt rtrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( el"an Individual Sewage. Disposal
System at:
...... ........
.... �// . G l........... •�--...... --••---.........-----.(..................................•-------....................................
S�/\- Ad ress/-i `� f Y fN- , •---or Lot No....................................».
V t CA_) ( l
W , / ��n � Address
�., G.....12_......•-•-••-•••-•-•-•••.................•-•-•......_......_ ........ --...................................................-----•--......---....-•----
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
U
`k Other—Type T e of Building No. of persons.......................... Showers
Gr YP g --•-•-•------•-•-----------• P •- ( ) — Cafeteria. ( )
dOther 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.
3 Seepage Pit No...--f............... Diameter/4Z!�J_;�:.. Depth below inlet..f q........... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
1.4 Percolation 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........................
A+' •--•------•-•••-•-•--••---•-•••••....-•....................••--................•-••••--•--••.................................................................
ODescription of Soil.............•----------•-----............--•---.........--•------•--•-----........-----------------•--------........................-----...-•--......._..._......_...
W
U ----•-•...................... ......
.... ........................ ............
.....................
........
W ------------- -------- -------------------------------------------------------------------•-•-•--..............
U Nature of Re o Iterations—Answer w n a�plicable.. o2ekJ.D.._. GN!'e ...,�_� ...........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITL 1S 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issue the and of health.
Siened. ............
f ...
Days
Application Approved B k�....... ..--•••---•--•.........................•-•-_. ......� l
Date
Application Disapproved for the following reasons:............................................................................................................_.
•-----•--------------•-•-----.............p..�....----------..........----••---•--------....------------.----...--•............--•-•-•-•-•........•---•-••••-•-•---•--...•-•-•••--•••--......_..........
Ll
Permit No..........� ............... . ......................y� Issued--......... -......Date......
Date
...+i ....�...-..''Y'-.,n���N•-r7(7„*•{�.�' ? ` �,. -�'.y„`'.Y�.'�^.•-.`::.:.d�`i(7'G`H+..slYy4f'^Y»i1i1 �iHfr'4lr'dd'wee.'Y�"S"^,`p-l►�+,►Y''�.tiT;•�a,rryYc'V"Sy7. �s��,1l�'w.,�lw".�.�"i'r.
No._. Fss_.......�J.._....._....—
{ THE COMMONWEALTH OF MASSACHUSETTS i
Nam.
BOARD OF�H�E ; tH
{, TOWN OF H "�
-,� lutttiun for in nn�tl Works innstrurtion rrutit
Application is hereby made for a Permit to Construct ( ) or 'Repair ( "'an Individual Sewage. Disposal
System at:
.. .' 3 �/�_ � A.!`? G v c 3 Z .)Location ................... ...........................
Id........ j f L_... •Address............. S Lot No
.......... ......... ....---•......N-.•.. •.. :.--•--•--•--..........................
..........
` Address
/.1....... .......... _ 1.. Y.........
a .._......._. .......................................................... ....... �...._...._ ..... ._............._.............._...._....................._. P
Installer Address
Type of Building Size Lot............................Sq. feet
,..� Dwelling—No. of Bedrooms............................................Expansion,Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of persons.......:.................: Showers
Pa yP g P -• ( ) — Cafeteria ( )
04 Other fixtures .-•--•-••---•---•--------•-----•...............d ---•-•..--...-•-•-•••-•••.......... ................. .........
.----------
Design Flow............................................gallons per person per day. Total daily flow._......................._.._..............•gallons.
Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth.................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No.....L.............. Diameter/j2ek�J.;� .. Depth below inlet../. ........... Total leaching area..................sq. ft.
ZOther Distribution box ( ) b- Dosing tank
Percolation Test Results Performed b Date..... .:...'
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Lsa Test Pit No. 2................minutes per inch Depth of Test Pit.....................sOepth to ground water........................
a ............................... ....... ...._...........---- ---------- -- ...
ODescription of Soil..............•-•--•---.................-•--•--•---•-------•--•-----•-••---....-•-•-•------•--•-••-•-------------•--•---....--•-•-••----....................-----..-..••
V ........ - .._.....................•--- ............ .........-•-------•-•--------.----------......----------•-•.............--- ---••---------•------•-----.......... '
�..... _ -------------- - f GlMc /�.t {f
10
Nature of Re or terations Answer w n a llcable..... ..............1.:...........�7 ........�7_:_.�...... .............
U ••-•..........•-•-._f._!�..... ,' [. _1 f ...rl/ .1...�." !..P................./ ..............................................................
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 undersigned further agrees not to place the system ifi
operation until a Certificate of Compliance has been issued the o rd of health.
Si ned. .w �`......---•--•.......................
/Application A roved B / Da
:....../
Date -
Application Disapproved for the following reasons: :.................•-•--:....-----.....--•--•-----•----•-.......................=----.........
1 Yr
..`..............................................................................:....................................................................................................:..._...._..........
Date
` Permit No.-•-•--9....... ..y.....3................ Issued.£................................ ..............
?. ate '
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH/
TOWN of 'Y WH
(Intif rate of T—outp iunrr
,THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (✓)
by....................................W. .....Z72 .......C.-4..................................................................................................................
Insta,er
at -��Z ..._...? A.�.�-. .C.f- -- .... h�. .lt� �...............•------•----------------------------------------
has been installed in accordance with the provisions of TITLgE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No............... ...3............. dated._...��!�`�.�................_...,..
..................
THE ISSUANCE OF THIS CERTIFICATE. SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. '
�q
DATE............... Inspector..-----(j ............... -..............................--•--•-•---•--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�iOR/Vf�h lE
TOWN of _�IU��H QQ /
No....l.:v.......!:-Z FEE........................
• �iu�nntt nrkn n tr�trtiun �prutit' .
Permission is hereby granted... ..-----.Gu.._..:..... ................:�..................................................................
to Construct ( ) or Repair (/ an Individual Sevda a Dis io System/
at No.......... �.y.}.1............./-. UIU._�/v...�7. , .l. tf?.!v.I�:t:S..........................................
Street `9 y 12 3 / 9y
as shown on the application for Disposal Works Construction Permit No..._:.-_..... Dated...... . ...................
...........}-..................- `��' /s ::. -
q Board of Health
DATE............Y... ........................................................