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HomeMy WebLinkAbout0105 BONNIE BLAIR DRIVE - Health L'0 ATION SEWAGE PERMIT 00. y 93 VILLAGE ®s i INSTA LLE-tRIS i_ NA jE i ADDRESS S e t o I �e o �1 hr cYl r® UILDER OR 0 NER e o �o DATE PERMIT ISSUED fob a3 DATE C 0 M P L I A N C E ISSUED Lof �i No. - Fps. r. ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD Off' HEAL H Y�....0F.... ::::... .... ...'...... . ----- /�... ,ppliration- for Disposal Workli Tomitrnrtion ramit Application is hereby made for a Permit to Construct 4-7-or Repair ( ) an Individual Sewage Disposal System at: _... a --•6-- ------------ i Location-Addres or Lot No. knr O/n r /��,A�dd/r/e�ss 71• Add ess UType of Building Installer S zerLot.._/._ "..Sq. feet Dwelling—No. of Bedrooms................ .........................Expansion Attic ( ) Garbage Grinder ( ) Other Type of Building ow _ No. of persons.........4-------------- Showers (,�) Cafeteria ( ) Q' Other fixtures ........................... W Design Flow................ -------------gallons per person pyr day. Total dail )low....... _.6.............._.__._gallpns. WSeptic Tank—Liquid capacity/'A'Q.gallons Length-/O.6...... Width----?.... Diameter________________ Depth.._ '.._ . x Disposal Trench—No..................... Width-----__0---____-_-- Total Length.............. _.. Total.leaching area....................sq. ft. Seepage Pit No-------I........... Diameter.._...__-------- Depth below inlet.._..______.____ Total leaching area.z.J�-sq. ft. Z Other Distribution box ( f ) Dosing tank ( ) _ '-' Percolation Test Results Performed by.... ., @'&..... aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-___-__-_-_-_-_-__--___. a ---••-•-•--•-----•-----------•---••-•--•-•-•-•-----•-•..............•-----------------------._...---......................................................... 0 Description of Soil........................................................................................................................................................................ " V -.------------------------ •...... --------------------------------------------- ------------------------------------------------- .._._.....---------------------- .--------------- W ----••----------------------------•-•-••-•••--•--•------------••---•••----•.........--•-----•----••-------•-••-•----------------...•----•••-•-•-----••-----••••---•-----•••••......-••••-•......-----_.. 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 iITI U 5 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. igned.................................................................................... Application Approved B _... ........--•--.......... Date Application Disapproved r th Bowing reasons--------=-------------------------•------•--------------...--••--------------------------------------------•----- •-•...................................••--•---•---------------------------•••-••---------------......-••- Date PermitNo......................................................... Issued_....................................................... Date NOL.tt.._ .`�>.. Fps..... ::..............._ M_r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H EA L�H •;� - � - ° OF.... .. _ ---- Appliration for Disposal Works Tonstrnlrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 1.� �- Location-Addres - --------•---------- .� .--_�.............. . _ ._....._.,._ ..1 .= ter ........................... Installer Address Type of Building Size Lot__L!72 _ ._Sq. feet Dwelling—No. of Bedrooms............... ttic ( ) Garbage Grinder ( ) Type of Building P61g1.✓_r Nf persons.__..____ . ( ) P4Other fixtures --- ---------------•-•---.--------•-••----------------------------------�-j - Desi n Flow_________________ __ allons er erson Pr da Total dail ow____._ tons.r W g �.r g P P p, Y +� - - WSeptic Tank—Liquid capacity;�, +P__gallons Length/_ �j_______ Width_.__. ........ Diameter________________ Depth_E___3. x Disposal Trench—No______________________ Width.......r........... Total Length.............. Total,leaching area_________f___... sq. ft. Seepage Pit No....... _. __Diameter________ _____ Depth below inlet..... ' Total leachingarea_ Z Other Distribution box ( J ) Dosing tank ) _ '-' Percolation Test Results Performed by. _ __?.,.1 . i'r__ +'�°._, /' �e� Date____i ........ ............ ....... W Test Pit No. I..........._....minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W -•...--•-••---------------------•-----•...•-••---•---•-•-•---•---•---....................................................... ODescription of Soil....................................................................................................................................................................... W 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 iIT12 5 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. igned............................................................................. 1 Cate A lication Approved ---•--------------•---•--..Date Application Disap proved or th,��following reasons_________________________________________________________________ _ ((r ' Date PermitNo......................................................... Issued.--•------------ Date THE COMMONWEALTH OF MASSACHUSETTS ( -- —__ BOARD ..0....._..... EALTH ..OF......... .................................. � Tatifiratr of font �i nrr T S,IS TO CERTIFY, That the Individual Sewage Disposal System constructed (/j-or Repaired ( ) by......:- ._.._-----•--..... - _ . •..................................................................•--•--•---•----....---- at. ! �- �f �ti has been installed in accordance with the provisions of TIT r 5 of The State Sanitary Code as,described in the application for Disposal Works Construction Permit NO..`�..,!�_'___IAu_ ________________ dated_�'f_'__ _ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION SA ISFACTORY. �® DATE........................• -��� ..................... Inspector.........l__. ................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rc 7 t` ..................................OF...................... No .,. .. . ............ �. �i��o��r ork� �on,�trnrtion rrntit k. Permission is hereby granted__::-:.-_L.____r-I_e)................. _ to Constr ={ > .j;Repair,(,. } ' v�&.--Sev 45,Disposal System j atNo __�:.. % ---- t;r r_ -.L(=-------------------- -----•--------------••-------------------•---------------................ Street as shown on the application for Disposal Works Construction Permit.- :..__________________ Dated.......................................... - ------- ------------ --------------------Board f - j / Board of Health DATE..................--------•------------._......--••---- •-•--•--- 6 FORM 1255 A. M. 9 LKIN. INC., BOSTON ._ { + ; 0 6" GE►JEQ AL NOTES tom..,. T fl-/ '_) .. i V Gj I I �-A.i_ ELZV S1-1Gv./4,1 AVW_ MEA►S SEA l_-C46L 1BA H? Ci.1 U�JC S SAT u M P��► E Pl3cW arL-,. 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