HomeMy WebLinkAbout0880 ATTUCKS LANE - Health (2) •,a y�iJ�,1
No..__ ` 12 �� F��. ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
AB...6t.-U/.. ..--......OF................. .5 L�... r .........
�IVI _
�ppliratiuu -fur 43itipuuttl Works Tonstrurtiuu rrutit
Application is hereby made for a Permit to Construct (�r Repair ( ) an Individual Sewage Disposal
&_
Location-Addres or Lot No.
----------- -- --------------• ---- .I------
Ow Address
�� Lam. --••••-----•-•-------------•---•-•-•........--
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwellin —No. of Bedrooms _------- -.-___-__Expansion Attic ( ) Garbage Grinder ( )
aOther ype of Building o. of persons---------------------------- Showers ( ) afeter' ( )
a' Other fixtu es _--- ---_------------------ ----
W Design Flow.7•.__-•-__-_-_-_ :_.aP.. .._ _.__ gallons per person per day. Total daily flow-------- -------------�ry ._D.,--gallons.
WSeptic Tank T Liquid capacity gallons Length---------------- Width................ Diameter---------------- Depth---..----_.-----
x Disposal Trench—No--------------------• Width-------------------- Total Length.................... Total leaching area,Y ....sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area-----.------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed b .... Date..................
-- ---- ----- ---
,4 Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.. __-_.__
f; Test Pit No. 2--------x.......minutes per inch Depth of Test Pit.................... Depth to g nd water-..--._____--__.-___-._.
_ - ---------
.--
0 Description of Soil----------- '} -- ---- - - ------------ --- ---
x ----- ----
-- ------- --------- - -------- ----------------
UNature 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 en issu y t boar of heeh.
Sigd . •-------- ------•••-- ---• ---• ----`----. ---•------ -- ---- . --------------- .
ate
Application Approved BY----- ---- ------ �" -�.�
E` Date
Application Disapproved for the following reasons--------------------- ----------------------------------------------------------------------------
..--•••-•-----•------••---•••-•------------------•--------•----•------------••---•---•-------•---•-----••..-•-----------------------------•-•-----•---------•---------------------....._....------•••--•.
Date
PermitNo......................................................... Issued....................... ................................
Date
No... : ... FR$.�:;... .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Q,�4 �H
............./.. �.� ._-.OF.................................._---------------------fir
Appliration -for Biipu,ial Workii Totutrnrtion Vantit
Application is hereby made for a Permit to Construct ()or Repair ( ) an Individual Sewage Disposal
System rat: l
------
Location-Address f or Lot No.
�..'E•"' ................................... .............................................
�I (� Owner Address
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling— ___ _____________Expansion Attic ( ) Garbage Grinder ( )
No. of Bedrooms�._.__..._-_�_ __.__._ _
, ................. ----------------------------------------------------•---•---•-----------•=-•-.-•-.-
-V e of Bu>ldin l t�Yt E =_ No. of persons---------------------------- Showers afeteria ( )
d Other Other fixturesg??� � p // ( )%' .-•--•--•---
Design Flow... j........................... allons per person per day. Total daily flow------- � ._7,...gallons.
Wt
R� Septic Tank—Liquid capacity .._gallons Length................ Width_......-------- Diameter---------------- Depth----------------
Disposal Trench—No-_-____-._-__---__- Width.................... Total Length-------------------- Total leaching area4f` -----sq. ft.
Seepage Pit No_____________________ Diameter-------------------- Depth below inlet.................... Total leaching area........._......_.sq. ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date----_--------------- -�---_------ --
aTest Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water-
Test
'�.....
!s Test Pit No. 2................minutes per inch Depth of Test Pit..__._.._........... Depth to ground water------------------------
...........'' .... .... ....•• --------- - f
Description of Soil---------- / ` ! -` . '� "_ ` ---------------------------------------------
x --•---•----••••-••----••--•----•--•------------- r,z-- --- --
--••---•••---"......• -----------------------------------------------------------------------------------------------------
UNature 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 bee isssud'bby the boarde of health. 2 ,
v.
Sig ed. := ` ' = -..
t/f' '�i' / V Date
Application Approved By...-�,' s ---------------- =- � K l�.�f�i._ilr.?° /.'��T----------
/ Date
Application Disapproved for the following reasons:..................... ---------•-------...-.---•------•-•-•---.-.-----.--..--..---• -"---.-.-.---------
.........--•--•-••'•-----•--•---•••"---------•-----------------------------------------------•-------------------•-••----'-..........._------------------. -------------------------------------
I late
PermitNo......................................................... Issued._.y am' --------------•----
ate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... :k'��..........O F.................BA-IMS�'ABLE..............................
Qrrtifiratr of f"nntliliattrle
T S-IS ERT FY, Th t e Individu Sewage Disposal System constructed ( ) or Repaired ( )
by...... -' .... -•-•- --•.......... '-- . ---
' Installer '0
----------------------------------------------------------
at.....-- C2.d . ....... ----------
has been installed in accordance with the provisions of Article XI f The State Sanitary CAde de ribed in the
application for Disposal Works Construction Permit No---------- .._..._r.............. dated.....
.............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE
SYSTEM W LL UNCT ON SATISFACTORY.
DATE. (� y3 Inspector
THE COMMONWEALTH OF MASSACHUSETTS
_JOARD OF HEALTH
vim"'
No.-�.0...`s B"A-RNSTABL.E FEE.,=.................
Cnn�tx' Jim
rrtttit
Permission is hereby granted----' ----`-- f�l `' .. .. .1_ ..............................................
to Constr ( �or epair ( }n Individual Sewage Disposal System
at No a _ =' _ ^�-`�-----' ` �fE.I j f*--=" = -- ......
as shown on the application for Disposal Works Construction Peet No..-_5��+1_--Dated_-_.`_......... .....
DATE..... -'-----------•-------'----•--------
Board of Health
�r
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS