HomeMy WebLinkAbout0071 BODICK ROAD - Health (2) � 1 �► � ��
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ..epplication! hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
Syst at:
13
ner Address
Installer Address
Type of Building Size Lot.-C-7 R� -Sq. feet
el
Other Distribution box Dosing tank al-ze4,4We
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_—______._--_------.—_--._---_-_'_—'___-_-----_-_---_----'--------'----_--_-
Agrccnucut:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sani -0�_ The undersio, et�,further agrees not to place the system in
'
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ate
Application Approved Bv_. _��___
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Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------------------------
--------' ---'--------'------'---'-----------'---
' Date `
Permit No —
Date
PER..... -.. ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEAL.T
.......' .-----.... oF.......:.:... °. ..-=-------...---•--..............
Appliration for Rfipoiiaf Works Tonso`nrtiou Prrmit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
Syst t: { a f
• - , ��e � enj�i
....... -------- -`''-- .....................................................�
�' L ation- ddress or Lot
. �,-, ` = e _;. ; ----------- . -------
ner p Address
-
� � {• 'Installer Address _
U Type of Building Size Lot__ _.��---Sq. feet
a Dwelling,—No. of Bedrooms______________ _Expansion Attic ( ) Garbage Grinder ( )
r24-
p-, Other—Type of Buildin6 No. of persons_____________�*�___________ Showers ( ) Cafeteria ( )
Pa Other fixtures --------------------------------------- -
-
W Design Flow_____________________2_��,_�.___q_gallons per person per day. Total daily flow._..__.__________ ?___ _____________gallons.
WSeptic Tank Liquid capacity-.,�_g-gallons Length------------_- Width---------.------ Diameter---------------- Depth._.-------------
Disposal
x Trench—No_____________________ Width............. .�_� otaI e t .4..._.:_____._._ Total leachingarea-_..___._._..:___.__s ft.
� � � q'
Seepage Pit No.____/_____________ Diameter s____._______ epth low inlet__.___.________ _ Total leaching,(-rea---------- ------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-_-__________________---
f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
---------------------.---•---- d
ODescription of Soil-------------------- --------- ----=� -------------------------------------------------------
x
W
UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
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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 undersigned4urther agrees not to place the system in
operation until a Certificate of Compliance; been issued by t e b-drrd-of-health.
g ,. 4 ,
j� ate
Application Approved BY-------------- ` :9_ _ ---------
Date Application Disapproved for the following reasons----=-------------------------- --------------------------------------------------------------------------•-•••-
..._..._..--•-•-•----•-••--••--------------•-----•--•------•--••----•-- ----------•--------
s� Date
Permit No......................................................... Issued......-- ---- - - ----- ....
�-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.04
(uprtif irate of Tom- hatirr ,� � �
HI IS TO ,�ERTII Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ),•
by � , e,: � ,
y q, Installer
at -- ---------I+����}----- ---------------------------------------------....................................=------•---------------
has been installed in accordance with the provisions of Article XI of The State Sanitary Cod as d-scribed in the
application for Disposal Works Construction Permit No... _ 3_________________ dated____.�°�f_--__ ...
_._____.__.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UE® AS A GUARANTEE THAT THE
SYSTEM WILL FU O - FACTORY.I
DATE.... 7/AT -- --------------:•---._............. Inspector----- - ----------_-------- - --- ------------------------___-------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.? ..............OF.... - '..� � .
FEE_. .: ..........
Permission is ereby gr'anted_:-:, ._.! `tls__ ��� :_� r
to Constr ct-( ') or Re air ( ) • Inch vt,al'S�e ge Disj�osal System
u
at No._ -w -------- - ''�f 't - -
Street
as shown on the application for Disposal Works Construction erm• o----- ______________ Dated_._ .............................
Board of
DATE .
FORM 1255 OBBS WARREN, INC.. PUBLISHERS