HomeMy WebLinkAbout0049 SNOW CREEK DRIVE - Health (2) �Iq s � cf e_ui-e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
... ---.....OF.........!V..
Z�plifiration for Disposal Works Towitrurtton Vrrmit
plication is hereby made for a Permit to Construct (i<or Repair ( ) an Individual Sewage Disposal
stem t:
_. . � ..... ------ ------------•---.-•--------_---
tion-Address or t No.
ii .. .... ---------- Add ...
�� ress i
Address ®® /
Q Type of Building Size Lot-- d �" .....Sq• feet
V Dwelling No. of Bedrooms:.........`...............................Expansion Attic ( ) Garbage Grinder ( )
-1 Other—T e of Building No. of persons._-________________--___- Showers — Cafeteria
a' Other fixtures _._
Q --
W Design Flow..........................t ___ ._ gallons per person per day. Total daily flow......... _ ........gallons.
y
W Septic Tank�Liquid capacit gallons Length---------------- Width.......... ..... Diameter-___---._.__..-. Depth----------------
Disposal Tom=No. .................... Width _................ Total Length.................... Total leaching aren._1 .sq. ft.
Seepage Pit No..-'.'__-------------- Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit-____.._•------_____ Depth to ground water-_�_______________._--.
t� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
P4
O Description of Soil--------- - - - -
U -------------------------- ------------ ------- ------ -- ..............................
W
x - � - � - - -- --------i..... . --------------------------------
Nature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------.
C� P
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 iss ed by t e oar f he
Si = = - ------
---------- -----------/t�e-------------
Application Approved BY !6'!_� ..�.7 7.....
-'
Application Disapproved or the following reasons_______________'/ _____._...._........__._...-_.._....__...__.._..._..________.______..__.._...__.........
PP PP f f 9
...............................................--------------------- --------------------------- -----------------------------------
�--77 Date
PermitNo..... ...( ......__,�?.............•• Issued----••-------------- ................................
Date
------------------------------------------
...........
No.. .- '............... FED .......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
................ ...............................
Appliration for 43tripmal-Marko Tonotrurtiou rprmit
Application is hereby made for a Permit to Construct Repair an Individual Sewage Disposal
System�t:
.............................
...!�kA- ------------
i_;,hocation-Address or of No,
V.
...........:...... ........................ ......................................................................
;
Address
...........; ..................................................................................................
I . ........ . Address
Type of Buildi Size Lot___ ......... -----Sq. feet
U
Dwelling_JVNo. of Bedrooms----------- 7......................Expansion Attic Garbage Grinder ( )
P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( )
Other fixtures ---
-- ------------------------------------------------------------------------------------------Design Flow.......................... gallons per person per day. Total daily flow____._ __ ..____._.-----_gallons.
P4 Septic Tank 4--Liquid capacity.-..'....�--gallons Length................ Width--------------.. Diameter_-----------._.. Depth................
Disposal T+erith—No................... Width:................... Total Length.................... Total leaching area._!�. ' sq. ft.
Seepage Pit No...................... Diameter..................... Depth,below inlet....-_._.__..._._... Total leaching area--------------------sq. ft.
I
z Other Distribution box ( ) . Dosing tank
aPercolation Test Results Performed by------- .................................................................. Date-----------------------------------------
Test Pit No..1................minutes per inch Depth of Test Pit-_.---_----_-_______ Depth to ground water.n---------------------
(14 Test Pit No. 2................minutes per inch Depth of Test Pit_._................. Depth to ground water--___-__-___________---.
...........................-------
........ ----------/j -----------------------
0 1" e
Description of Soil........... k_,/e...........................................................----------------------------------------:........................
U ............. -6
..........I --------------------------------------- ...................-A--------------------------------------------------------------------------
-�4 ------
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 theboartpf hedth-,
...........S' A ---------- --
17------- --------------------------------
Date
Application Approved BY---- mxw..4........................ ...... -------- ---- -----------------
W bate
Application Disapproved f or the-following reasons:... ...........
7-,:---------------------------------------------------------------------------------------
............................................................................... ..........................---------------------------------
- -- -----------...............
Date
Permit No--------- ....... Date THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
........i .zr1►.................OF......
........................
T I - �6CEVf� f Y.. That Individual Sewage Disposal System constructed or Repaired
by...... .......................... ......... ........................................
e, . --------17
at.... ------_:.�.az ......Ux' .... ....
------- ----------------------
has been installed in accordance with the provisions of Article XI of The State Sknitary Code as descpibed in the
application for Disposal Works Construction Permit No____ ..
o------ M_
..........1_0_ ........... dated ---7-/--4. ............
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 .
.�..........OF.... .. ---
............ ....
- - --------
N .. ...... ........ FEE�-----
-------------
Permission is hereby granted------- ......
.. .. .........................................................................................
to Construct el of 2epair an Individual SeNpge.Disp I Ystem
No-----at . ......... . ------------------------..............
-
Street
as shown on the application for Disposal Works Construction V 0mit N - ---
t1b, Dated---- ...........
-- -------
Dated-
----------------------Board of Health
DATE...........f oa.......................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS