HomeMy WebLinkAbout0015 FLEETWOOD PATH - Health L O C_QT 1.O-N SEW-&-(:�-E P-E-R M- 1T-1.1-0.
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THE COMMONWEALTH OF MASSACHUSETTS
d' BOARD O HEALTH
_... . ........OF........... ..... ....�'✓iZ�k 1�1 '.Z.If. — "l � �- `r
Appliratinit -for Bhipviittl Workii Towitrurtion Prrutit
Application is hereby made for a Permit to C n truct or Repair ( ) an Individual Sewage Disposal
Syst at:
--- --iJ---�--- 9
ocati Address or Lot No.
I
---------- ._. ....
a �.. caner of- �� •- vim !.......................................
Installer Address
UType of Building, Size Lot............................Sq. feet
Dwelling d—�No. of Bedrooms-------------- -.-----___Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building _.......................... No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ----- ---•----- ----------------------------------------------------------- -------------- ---------------------------------------------- :
W
Design Flow------------------------S:� ..........gallons per person per day. Total daily flow------------ezk.L--------------------gallons.
P-41 Septic Tank--Liquid capacitylJ_._ allons Length________________ Width------------.... Diameter_--_----_--- Depth.__---.___-__.
x Disposal Trench— o. _-__-___ -_- Width----___-_-_- �__ otal th....._ .._ Total leaching area____________________sq. ft. a
( � "^ �er �
Seepage Pit No____________________ Diameter. . .--.._._...... epth w in Total leacliin, area..__.__.._______sq. tt.
z Other Distribution box (� Dosing tank ( ) � — 3�� �17 ._
Percolation Test Results Performed by.......................................................................... Date------------------------------------
a
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
(I, Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water...--...._____.___-_.__.
c�
Description of Soil f �� � �*--------------------------------- -
O _ p` ..
'� r,�✓J� ° ` '- ----- ----------- c3 cam,
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 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 board,00ffphealtth.
Signedl ---- . f" --------------------------------
Dat
Application Approved By......---- --- f �j ........ -3/
ate ..
Application Disapproved for the following reasons:.................................................................................................................
•-------------------------------------------------------------------------------•---•---------------•---....-------------------------------------- ---- .............. ...............................
��Date
PermitNo......................................................... Issued.. ._�7._..` .e.............
Date
No...... - ....... Fus...........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
_..... ... .------OF........... /
8 ...... 14
Applirtt#ion -for Digpuiittl Workii Tote #rurtion Vamit
Application is hereby made for
r a Permit to Cope truct (�or Repair ( ) an Individual Sewage Disposal
System at: Pat
.._ !r .!:_. _.. ... ..._ 4_� ..�...... ("' "^ "Z.✓.-�' '� {_!:ors__ .••.-_8C._:Y...__P1. _S e9 -�...............
�f Locati. -Address ,+ or Lot No.
1d
.......... .. .! - ------
W � caner -
7..._-- .r,............. _�_.... .. - --------------------------------------
Installer Address
Q Type of Building Size Lot____________________ _____Sq. feet
U Dwelling—No. of Bedrooms------------- -__-Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
0.1 Other fixtures ____________________________
W Design Flow........................:5��__--_-_•._gallons per person per day. Total daily flow....... .Al'.7—a----------
04 Septic Tank I Liquid capacity-/ allons Length__-t�--------- Width_.....--------- Diameter................ Depth---.----__.--.-.
Disposal Trench—No--------------------- Width._. ._.___. -TotalL th ..
.....!. Total leaching area--------------------sq. ft.
3 Seepage Pit No______ ____________ Diameter_��"��__``�Dep-` okw in�et.....�.... ... Total leaching area-___-------------Sq. ft.
Z Other Distribution box ( Dosing tank.( ) 0 .0 y �✓' "' �7 7
Percolation Test Results Performed by--------------------------- ........... Date--------.--------_---------_------------
Test Pit No. 1................minutes per inch Depth Ioff Test` Pit..._............__.. Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth'of Test Pit,.................... Depth to ground water__.__.-__.-_---_____.--.
- --------------
W e p = ------------- //- .. f
D Description of Soil_ .,./,' .. 1 �- v a-r. - ?a `v r .✓ I"
(xj ': •------=" ••-••-... ...................-•-----------------------
W
U Nature of Repairs or Alterations—Answer when applicable.............___-------------------------------------------------------------________________-.
-------------------------------------------------------------- .......................................... --------------- ----------------------------------------------------------------------
Agreement: r 1
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 board of health.
Signed- ---------------------- -------
2` Da�tF
Application Approved By.. Jt A._--�!� �t� = �'` .. �
Date
Application Disapproved for the following reasons----- --------------------- -----•--------------•.:_._..........................................................
.................•-----••-••----••--•-----•-•-------•-------••-----------••••••...........-•••••••--•••--------•--••----•--...--•--••••-•-••-••-•-•-----•--...........••-•-----------•••----•----------
ate
� ��: A
Permit No......................................................... Issued.---- --•••---
Date
THE COMMONWEALTH OF MASSACHUSETTS �� Y
BOARD Z HEALTH
O F.......... .
err#iftr�#r gf-f�nnt�lt�nrr
T- rIS IS CER' FY That th I d v'dual Sewage s stem tr d or Repaired ( )
Y
sta+le
at f--t ------ - ��1 ( -_�t�� r�'✓�1__"'f _�
has been installed in accordance with the provisio s of Article XI of The State Sanitary Cod ,as described in 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................................................................................ Inspector...............-------•-----•--------------------------••......•-••-•---•••--------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 7
t ��..r........... ...
OF..-...-. --.--•--------------------
No.---�-f �--- FEE...--------•-----.......
orkii ans#r #roar, rr '# -
�..� .f . . ....,.E _
Permission is hereby granted.......
"'" a�' . . .. ..... ....•
to Cat onstruct ( or Repair ,( ) „&n Individual Dis 6sal Sy em
� ..
�.. ,. . �
Street r
as shown on th application for Disposal Works Construction Permit?No._ _ :-- --------t__ Dated___._.. - ----
-- f: :... { ------
DATE._ _ Board of Health
•..--------_
FORM' 1255 HOBBS & WARREN. INC.. PUBLISHERS
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