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Home My WebLink About0168 BISHOPS TERRACE - Health (2)� i�� a��aPs -�-��, ,nos 7 C � No... .6_ .... Fps... ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................... ..............---....................----...... Applira$iun for 43hpilial Workii Tomitrurtinn Vviratit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..� ..�T J.....I ... .0. ..._:� .C. '.--• d4!�x�1. ................................................................................... ...Lo do -A ress -- ----or.Lot No. .... .�1.JJ.t9. .... .�1..C. ...�1.n...................... .._....................................._.......__. Owner Address W Installer Address UType of Building 3 Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansio�ttic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons........................... Showers — Cafeteria a yP g -----•-----•--------------- P ( ) ( ) Q' Other fixtures ...................................................... ----------- --•---. -- -- - -------- W Design Flow........60.........................-gallons per person per day. Total daily flow..__._.....��.U__......._..._.......gallons. 04 Septic Tank—Liquid capacity].O. _.gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No....._. dth . Total Length Total leaching area....................sq. ft. Seepage Pit No.-IP_L?9___ biameter... t� ................. Depth below inlet.................... Total leaching area...3_ ..L...sq. ft. 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--------------_-------- f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ S O Description of Soil---- z..� x U ..........................................................--•••-•••---•-•-•-----•-•--••----•-------•-•-----------•-----••--••--•------•---•-----•-•---••••••--•-•----•••......................•---...... UW -•-----•----••--------------------------•-••••------•--------------•----•...----------•--•--•--------------------------•--•-----•---------------------•-----------••••••••----•---•-------..........---- 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 Sanit ry de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha &ee4n &sedyt bo ofhh. Signed....... ........ --••-•-•.........._.....-• ................................ Date...•-•........... Date ApplicationApproved By................................................................................................. ........................................ Date Application Disapproved for the following reasons------------------------------------------ ----------------------•---------------------...._...........----••--•- •----•••------•---•••---------•-•---••--•-•-------------••--•-----------•-••-•••........••-••-------.....--••--•----•-------------•--------------------------•------•-••--•---•------••-•--=-••••--•--•- Date PermitNo................................................... Issued........................................................ Date No.....pr.,,,.6..... Flc$............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......._...............I................ O�........................................................................................ Appliratiou for Dispusal Workii Tonstrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .r'^w �y } ,L! 9 q r '-' ..........:..........h :...3..;_. .................................... Location•Address v or Lot No......................................... 1 q.. r Owner Address o .t . r ............... .................................................................................................. 'I n'sialler' Address U 3 Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons.......:................... Showers — Cafeteria Q" Othe�tulfes ....•--•••••-•................•-....---•-...... . +:..Js+ C, W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity./tJ ,'gallons Length................ Width................ Diameter....----......-- Depth................ x Disposal Trench f�To.. �........._ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------- ;i-. >ameter_.._..._..:.__._.... Depth below inlet-_..._.__.____...__. Total leaching area...; .�..' sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--.---.--_--.-.---.---. f� Test Pit No. 2................minutes per inch Depth of Test Pit.............---.... Depth to ground water........................ .........-••-•-----•--•-•..........................................•-•---•..............----------•......................................................... O Description of Soil---- " ,a '`^_ n s, - ---- - ------ U _.•-••..............•------•--. 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 hI of the State Sanit y de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boarrc�of health. fey$t , > � ��.. Signed + t j s o f r�e.c . ........................... ..... _ ................... s' Date Application Approved By.............•---••--........... Date Application Disapproved,for the following reasons------------------------"----"-"---"----"•---"---------------"""--..........._...-------------•---•.............. s ...."-""--...."---"-.....---•--"--......-•---•---•--....---"-".......................•"""•"•-------•---"-I•-•-•-------......••-•-•---•---•-•----•--•--•-•.........-•---•----------•...................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS ...............................I......OF.............__..................1.11,.......................................... Tatitirttte of Tontphatta T ndiv'dual Sewage Disposal System constructed ( ) or Repaired ( ) w ......... '... .. ., .. ...... .. ...... at........---- has been installed in accordance with the provisions of ArticP;0jr qpThe State Sanit xy , escribed in the application for Disposal Works Construction Permit No......................................... daCecf:. ........._....--..--.--......._.......... T E I SU ICE OF THIS CERTIFICATE SHALL NOT BE NST RED A GUARANTEE THAT THE SYSTL 0IION SATISFACTORY. DATE...................... ..................... Inspector..................................................... ............................... TH,E COMMONWEALTH OF MASSACHUSETTS ll�s �t�"' ,• BO OF H No........ ..................................:...OF......................................... .................................. M ........... T r fit ar#i u rrm , • issj�n is;hereby, granted.,................. .. .... �7 UCt°�� r.) `O a 'r J d1V1 gsal SySt at No.........:......:.......................... .................---•--...................---...---..........----- ........... .......... -� ----....... Street as shown o he application for Disposal Works Construction Permit No..................... d.. � ............... A11:2 --"•-•--"--------•--...--•-.••--•-.--•--- ------------------------•--......._--••-••......-----•-- Board of I{caltli ~ DATE...... FORM 1255 HOE38 ;k 4gr3R.N. INC PU'< LIS4£R$