HomeMy WebLinkAbout0071 REDWOOD LANE - Health (2) e P-Q-auxyo t
i
No.... —..
THE COMMONWEALTH OF MASSACHUSETTS
B—OARDff HEALTH
..... .. .. -..------.OF....... .............. ...
Apptiration for lip noal Worko Tomitrurtion Pumit
Application is hereby made for a Permit to Cofistruct ( ) or Repair ( ) an Individual Sewage Disposal
Syst at; �� _" �
�- ... r, -
.. ------ ..
a c on-Address Lot No.
Address
a _ :Installer Address �-'------------------- ------ ---------
�
U Type of Building Size Lot..... t -------Sq. feet
- Dwelling Z No. of Bedrooms------------?----------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Buildin
a g ---------------------------- No. of persons............................. Showers ( ) — Cafeteria-(--•-- -
Otherfixt es -e--------------------•-•------------------•------•----•-----•--------------------------------•----------------------
W Design Flow .._.___..._ .....___._ gallons per person per day. Total daily flow............� _...gallons.
WSeptic Tank Liquid capacity/.;'egallons Length................ Width------------.... Diameter................ Depth___-___-_____---
x Disposal Trench—No. .................... ��'idth.______� T en Total leaching area-------------------- ft.
Seepage Pit No.__l_______________ Diameter_.�� __ epth o In et___... .. Total leaching area__T __-_sq. ft.
Z Other Distribution box ( ) Dosing tank'( ) .
`-a Percolation Test Results Performed bY......................................................................... Date......................................
a
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------_-
w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
f4 ---------------------------------• ---•------------
O Description of Soil__-----------------------------------
V ---------------------------------------------------------------•---•-------------------....-•-•-------------•--------------------------------------------------------...------------•-•-•--•------------
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 C — The undersi ed further agrees not to place the system in
operation until a Certificate of Compliance has b sued by theb d lth. leo
Signed.
Date
Application Approved By--------••-• r- . . • --•--• . --••-
,. " D to
Application Disapproved for the following reasons--------------------------------------------------- -------------------------------------------------------------
.......................................---•-•--•••-----•-••••--•--••-------••--•--------••-•--------------••-••••---•-•-•------'•---•------••-•----•-•-------•••-•-•-----------••-••-------•---•--•--..
Date
PermitNo......................................................... Issued..................._.----------:........................
• Date
40 p
No....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........OF........
Appliratiun for Mipviial Works Tialuitrurtiou rumit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst at
ion- o.
Add / N Address o Lot
ear
O n Address
Installer Address
dType of Buildin �` Size Lot_....7..J�:_: _-Sq. feet
DwellingGam—NO. of Bedrooms_--________ -_-•-----------------Expansion Attic ( ) Garbage Grinder ( )
`PL4L4 Other—T e of Building -_..--- No. of persons............................ Showers — Cafeteria
Otherfixtures ----------•------------------------------------------------------------------------------- --,� - - `---
W Design Flow ____________ _ __ --------
-.gallons per person per day. Total daily flow........._.._ "..__-gallons:• ,
------
W ___
Septic Tank Liqui capacity gallons Length................ Width----_----_-_-- Diameter................ Depth................
x Disposal Trench—.,No..................... Width................_ To al ° engt ....... ______ . Total leaching area-.------------------sq. ft.
Seepage Pit No.--/................ Diameter./ /Wptli n --- -- Total leaching,area.� sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) s
aPercolation Test Results Performed bY------- -----------------------------------------•-----------------------• Date---------------------------------------
,.� Test Pit No. 1................minutes per inch Depth of Test.Pit...:--_---_---__-___ Depth to ground water..--------:-___-__----_.
�11 Test Pit No. 2................minutes per inch Depth of Test Pit---_____.___-_____- Depth to ground water....................
..--
P4 -=---------------------------------- - ------------
ODescription of Soil = ----------------------------------------------------------------------------------------
x
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 Co- e— The undersi tied further agrees not to place the system in
operation until a Certificate of Compliance has bee Issued by the bo d f ealth.
j .�
Signed- _u f - �
F _ ' ---------- ------....
Date
Application Approved BYm
Application Disapproved for the following reasons:.......................................... --------------------------------------------------------------
----•-------------------•------------------------•---------------------------•-------------------------•--•-------------------------------------------------------------------------.----------------
Date
PermitNo......................................................... Issued--------------.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f y
.............. OF........ ........i..............
(Intifuatr of Uffli'llutphatta
THIS I D C TIF , T he Individual Sewage Disposal System constructed ( •. or Repaired ( )
tiby.... . ... = ----- -•----------
.o Installer
r4alled
IC
has in accordance with the pro sions of Article ZATheate Sanitary Code a descri ed in the
application for Disposal Works Construction Permit No-------- _._ _ �________________ dated.._::.' :._:_:, �_._:.
- -
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. # k L� i
1
u er t
DATE................................................. -------- Inspector--------------------------- i -•----"x --- -------------_ t
.tea f '�:�;!'i"'� •~ f•�l F
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
O F40
,rF
r�"j ,r1� yp....... .... .. .. $� ......... ..................... FEE_
, w ......` ...
No.... }
IPermission",is Xh eby granfed--- •--------------- - ------------------ -----------..............
to Constr ( ) or Repair ), a , dividual'S w ge •sposal System
at No. -
Street
as shown on the application for Disposal Works Construction Permit o--------------------- ated_.�2� �-
Board Iealth
DATE--------------------------------------------------------------------------------
FORM 1255 HOBBS & WARREN. INC:, PUBLISHERS - - -