HomeMy WebLinkAbout0730 BEARSE'S WAY - Health (2) --- - - �3� � - - -
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4 THE COMMONWEALTH OF MASSACHUSETTS
BOARD O EA_. LT
Appliratinn -for ]Nii oiial Workigi otuitrurtion Vj=ft
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst t:
.. ..... ...... 67�
o tion- res or Lot No.
caner Add�,�s -�
� ••-• - - •-- - •--• ---. ..... --- - --• --�-._�__....-•------------•- -- - --- •-- - •--�----=-/ram//-%---- ----•• � .
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� Installer Address
Q pe of Building Size Lot--^_-? __7 _Sq, feet
U Dwelling—No. of Bedroom ._ Expansion Attic ( ) Garbage Grinder ( )
- ------• -t------------
a Other—Type of Building hit__ __Sr� QVo. of,�erson5:__• ._�.___ Showers ( ) — Cafeteria ( )
�'
Q Other fixtures ----------------------------�_ _P_.._... ..e�' lA� -•---------------•---- -----------------------------------------------
-
W Design Flow........................................... "lions per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank I—Liquid capacity/ allons Length................ Width__-----_.. ----- Diameter_--_._..__---__ Depth.__------------
x Disposal Trench—No-____________•-___-_- Vl/idt11__ .___.___. . _�y tal th_. Total leaching area....................sq. ft.
Seepage Pit No----- ------------ Diameter. .._"I ept ow m et.....-•.----- ---. tal leachil area------------------sq. it.
Z Other Distribution box ( ) Dosing tank ( ) \ nC
aPercolation Test Results Performed by-------------------- --------.••---••--••••---------...................... Date-`--------------------------------------
,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-.------------------ Depth to ground water__-.-_-----_.__--_--__--
w Test Pit No. 2................minutes per inch D pth of Test Pit---------- -------- Depth t�_F.ro
und water------------------------
------------- ------------------ ------------- ------- -- --------•- •. --- -----------•...------... ---------
Descript' of Soil_ _ ...
��4
W -•---- ----- -- --- ----- --------- -- --------- 7 `" --------------------
VNature of Repairs or Alterations— nswer when a icable--------------------------------------------------------------------------- ....................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary — e undersign d agrees not to place the system in
operation until a Certificate of Compliance ha een iss y the oar e
ed---- =--- ---- -- -- ------ -------- -,.._.--- - ------------------------
Date
Application Approved By------- -- ----- ------------------- r-----
Dat
Application Disapproved for the following reasons:-•-- ----------•-----•-•--•-----•----- -----------------------------------------------------------------------
------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------
Date
7
PermitNo......................................................... Issued-------`��------- " . '--- --•-•--
Date
--- ---- ---- _� _ _ - ` ----------------
No.-- Flm...n::-...................
L; THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF--HEALTH
_...... OF.........../t/..' ....��[,, L,+•- -._./ ./it_�"..1.---
Appliration -for Di,ipoiittl Workii Tottotrurtiott Vamit
Application is hereby made for a Permit to Construct ( ") or Repair ( ) an Individual Sewage Disposal
S steT at:f / )
LoZ ion-Adilres. !' or Lot No.
Addr .....
W ` .` V
Installer Address 7` .
UType of Building Size Lot-.:��____7__�____ __Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type of Buildin >*A
t
p, yp g _-_.__.C_:_._w_j .t_i??No. of persons_ -_- '___"�--_'.__ Showers ( ) — Cafeteria ( )
Other fixtures . ;f_�______,, _<'
W Design Flow..........................................,.gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tanker Liquid capacityR' -gallons Length---------------- Width......._.. _... Diameter---------------- Depth----------------
_
x Disposal Trench—No--------------------- Width- ---------------r _-. Total Length . ..._ _. Total leaching area--------------------sq. ft.
3
Seepage p ge Pit No-----:l------------- Diameter... ............. Depth below inlet--------t------------Total leaching area-------.----------sq. tt.
l d �
z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by--------- ------I....... Py
--------------...---...------ ------------- Date--------------------------------------..
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_..---.-.-.--.--___-._..
44 Test Pit No. 2................minutes per inch Depth of Test Pit.----_-__-_.__-____- Depth to ground water__._..._--____._-_-..___
P4 ............................................................ -----------------�' ----------X------...---------------
DA� Description of Soil---------------------------------------- -r ...............c� .r....' f t
U ...................................................................... _......---._.._..__......................._.--...-----'•- _-----------------------`_______,____. __ __.____.
w --.-- --------------- ----- � ��...................... �— ` ��/�• � T--tom
U Nature of Repairs or Alterations—Answer when applicable tltl cable...---------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------........
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 booaarrd/of he/alth. / /l
�Stgned = j'f/I��a!!i/�/ ?'�r'-- ^./"�1./?. /.., 3__i.__�..
��-/ Y %I Piz ,I../ f.CR,�/ mate ----
Application Approved By- �1 ............:•-•--- -----•-- �_ ._.. ----
Application Disapproved for the following reasons:-------------------------------------==-______...............................................
Date---------.....
•----•--------------------------------------------------------------------------------------------•-•----------------------------------------------------------------------------------------------
, / ,Pate
Permit No......................................................... Issued---- - X-----
Datd
THE COMMONWEALTH OF MASSACHUSETTS ,
BOARD HEALTHt� gy
..........................................OF.....................................................................................
Trrtif irate of Tlimpiiaure
T S IS4 CEPLIfTej—i the Individual Sewage ispos 1 System cons ructed ( ) or Repaired ( )
by. -----�t ..�;--- '----'---•-----•----•---•-------•--^.�..---------sta.e-. --` - j ,�-1 //- -c--•- !.'i•• -��-1 j'►(y �f
---- ------•-------------------------••-------•---........-------------•------------------.----------•--.--
has been installed in accordance with the provisions of Article XIW4State Sanitary C�ci�eiI lesq_ii edfin the
application for Disposal-Works Construction Permit No..................:...................... dated.................-------.........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE '� �f / ---------------------- Inspector-•-•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD f HEALTH
U ...QQ.."".�'.. OF........................................................................ ...... �r
No......................... FEE-N-------•.............
�i��o � ork,� ��f� rtiott �rrmtt '
Permi o AXerel granted- . .------•------------------- -- -------- -- - �---------- ..•.----••----.-•---
to Con or� 4L rlifJ 1.Sew os lJv-✓4 �Lt�r / L.�
atNd.--••-------•--•�---------------------------•-----------------� ----------•--- ---•-------- -trek----------------- ------------/---._..... j
A��/z�
as shown on the application for Disposal Works Constructi mit Dated---------- ---- -----------------------
n LLB
............
/0,/ � / Boar-1 of�He�ltn
DATE---------• ..._._._.. ------------------------ --------- / r J/ ' (�(J
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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