HomeMy WebLinkAbout0090 MURPHY ROAD - Health (2) qt) cnwphy fLaA
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No....... .. ( r Fix..... ............
Roj �) THE COMMONWEALTH OF MASSACHUSETTS
1;; t BOAR® F HEALTH
..............O F......... .... .......................
Appliration for Uiopoiial Vorkfi Tomitrurtiun Vrrmit
Application is hereby made for a Permit to Construct "( or Repair ( ) an Individual Sewage Disposal
System at:
L a on- dress o Lot No.
............................... ... .... •-- ----- -- ------- ----- ---•- ..................
wner -----•-Address
. ... ......... ------••-•-------------•-------------------
Installer Address
d Type of Building,/ Size Lot............................Sq. feet
V Dwelling No. of Bedrooms---------------- .....................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
04 Other fixtures -------
_
Design Flow......................... . ... •--•.__ allons per person per day. Total daily flow....___ .__._____._____________gallons.
WSeptic Tank Liquid capacity'Jallons Length................ Width------.--------- Diameter---------------- Depth-_-____---.----.
x Disposal Trench—No- _______________•___• Width------------ _ _ th__ __ .. Total leaching area___........__._._..-sq. ft.
Seepage Pit No._/__ :---_____•- Diameter.../ ep be m et.................... Total leaching area__ _ q. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date----------------------------------------
Test Pit No. 1................rninutes per inch Depth of Test Pit.................... Depth to ground water------------------......
rZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
= - --- .........
ODescription of Soil.----=---------------- a....I- -----------.----------------------------------------------------
x
U •-•----•----------------••------••---••-----...--•--•----------•--•--•-•-------•---••••••-•••••--•------••••••-------•-------•--•-••----•-----------------------•----------•----•-••-------------------
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----------------------•----------------_-----_----------------•---------------•---------------------------•--------------------------------------------•---------------------------------•------_-----
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 YI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance Zbnu y the boa o tSign - -----••Application Approved By------ -- •. -- ---•-- . •-- -• --
---
` 4ate
Application Disapproved for the following reasons:................................................................................................................
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
----- ---- .OF......�� '� =4,az;1'44------=
Appliration for Dispaatial Worko Taanotrurtion Prrmit
Application is hereby made for a Permit to Construct (41-(or Repair ( ) an Individual Sewage Disposal
System at.:
L a ion-Address r or LoY Igo.
w c a l. ... 4o ! ........
wne ' ---------------
Address
W
---------------------------------- ------------------------------•-------
Installer Address
Type of Building/ Size Lot............................Sq. feet
U Dwelling No. of Bedrooms..............._..________._.___._Expansion Attic ( ) Garbage Grinder ( )
`I
p-I Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ___________________•_••-.__-___._
Design Flow..........................`"' gallons per person per day. Total daily flow______
WSeptic Tank-�-Liquid capacity j .. allons Length................. Width---------.------ Diameter____-_ . _ _ Depth_--_--_---_-----
x Disposal Trench—No. .................... Width................. .T tal L gth_ �W ....... Total leaching area--__-----_------_--.sq. ft.
et_._._.._____._._._.. Total leaching area_. _ cc-sq. ft.Seepage Pit No./--------------- Diameter.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by--=---- -----------------•---•-••---••--•••--•-•-•-••-•-••-•--•-------_._. Date.------------ ........................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.-.-____----____-_-_----
G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..................
_.._._
------ ----
O Descri tion,of SoiL :........ �-------------
W
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 e k
- rf
Signed. °` f ---- --------- -•----------.--•--
ate
Application Approved By---------��- fig 'T-I_. - --------
at
Application Disapproved for the following reasons-----------------------------------------------------------------•---.-.----------------------------------------
------•-----•--••••--•-••---•------------•---•---•---------••----•....---••-•-•-••--
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF. HEALTH
..:..........OF.... .........................................
.. •.-�._
Tntif irate aaf Clutpliatirr
THI IS CERTIFY T a''the Indivi al.Sewage Disposal System constructed ( or Plepaired ( )
by......._. _.� _..�_ter..--- �""� - --•
nstaller /
Lot-
144
76
has been installed in accordance with the'proysons of"Artice The Sta . Sanly Code described in the
application for Disposal Works Construction Permit No.........1. :.. ................... dated..._.°. -----------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
n �, C
DATE-----•� -------•-•-•------------------=-- IsPector...=-•----•------------------ ------
7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
t........ FEE._
• , - �i,��raa�ttl., air � Cn�a���$• 'aatt rrnti�
Perm>i.Sion' . >$ereby granted---:_. _.. - -` --------------
:-
to C07irt!q ( or pair ( ) an b di i dual Se� e Disposal ystem
at Noy `� 4 a . ••---•••.
�y _. �
,_..__ .. ' .- Street f- - -- :..
as shown on the application for Disposal Works Construction P t`r`}it o._=�. ._✓_ at _----V2I�, ........
t" Ala -•----`°"//��� Board of Health-
DATE--------------- ------------�....................................... . .
FORM 1255 HOBBS & WARR.EN, INC.. PUBLISHERS • s