HomeMy WebLinkAbout0391 BRAGG'S LANE - Health 4c� n �
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_. .... __.... . .....-..OF....................................... -- -.----.....-.-.....----------------- i
Appliratinn -fur Di,spood Works Towitrnrtinn Prrutit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
- � ...---........1A S t._..._.....: � .._.
............
-�
lsC/ l 1: ocation. ess [�L _ 7 or Lot No.
Ownepr� !f Address
Installer Address
/d Type of Buildin -; Size Lot-_.4____..._-------_ _ _S q. feet
U Dwellin -No. of,Bedrooms __ _Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Buildin p•, yp g No. of persons-,____.. Showers (:24__— Cafeteria ( )
P� Other fixtures -----------••----••----------- • - .
W Design Flow__... ._ _____________________gallons per person per day. Total daily flow________ -_____-._-_:_gallons.
WSeptic 'lank Liquid capacity 1gallons Length_,_.--_. Widt......... Diameter................ Depth._--__-__-____.
x Disposal Trench—No_____________________ Width.................... Total Length_____ .............. Total leaching area_-_____-_____.._-___sq. ft.
3 Seepage Pit No--------------------- Diameter__._______-______.__ Depth below, inlet.................... Total leaching area-__._.._-_-.____sq. It.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by--------------------------------------------------------------------------- Date---------------------------------------
Test Pit No. I................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_............_-______----
•-.._-•--•--------------- ..........................---------•--•-------•-•--•--•------•---_-•-•-•-....................................................
0 Description of Soil--------- -- _------------------------------------------------ ----------------------- ---------------- ------------------------
-
�v �- /�>�' - �?_i:pow C�e9y y:-�vG-- -;--____-b-_ _�
UNature of Repairs or Alterations—Answer when applicable......................................._____________.____.------------------------------------
---------------------------------- ..
Agreement; c
The undersighed agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI ofthe State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bW n issued by the board of healt
Signed........ l. -------- -------------•• -----------------•--------------
• v / Date
Application. Approved By•••• Pf�---_--------------------------------------------------------------------------
Date °
Application Disapproved for to following reasons-----------------------------------------------------------------------------------------------•-----------------
_-......-• ••----•-••-•--•_---••----•--•----.•._--••-••--•-------------•---•----•-•_••_-----•------•••------------------------------------------•---------__...._._...----..------------------•-••--
Date
- a
PermitNo._Z4. ....................................... Issued.................. --------=•--........................
Date
l_— —— ---------------------------------------------------------------------- - ---,_....-"=---------------------------- -----
THE COMMONWEALTH OF MASSACHUSETTS
• BOARD OF HEALTH............. ... . ...... .........OF.....................................
..................... -.......................
,Npli iratiun -fur Uiipuiittl Eorks Ton5trurtiun prn�it
;a4 `
Application is hereby`made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage •Disposal
S,VSte>�at,
,
a Location ess f or Lot No.
f ............. ----•- ----------------- -
r" Owner ♦! Address
Installer Address g�
d Type of Buildin Size Lot_. `- -----Sq..feet
" 3
Dwellin -No. of Bedrooms ._ ......_.Expansion Attic ( ) Garbage Grinder
Other—Type of Building _..__ -
a g .���w___._._. No. of persons------ "•""'----_---- Showers ( Cafeteria ( )
d Other ures ---- -------------------
---------------
W Design Flow___. _____ ________gallons per person per day. Total`daily flow... -- ...gallons.
WSeptic T:.nk Liquid caua iity_ _gallons Length ____ _________ Width . �:: Diameter_.__. ._-._-__ Depth----------------
Disposal Trench—No ______________ Width.................... Total Length________ --- Total leaching area_..._._.__._.._____sq. ft.
Seepage Pit No...................... Diameter--------------------- Depth below inlet.................... Total leaching area------------------sq. ft.
z Other Distribution box ( )"_ Dosing tank
aPercolation Test Results Performed by............................................................-•--•--•- Date-----•___------------------------------
a 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-_._:.:--_____.____...
.: 4 ______________ _ ____________
o Description of Soil-------- --------------y
U _ -------..... rft Ta — - czr�y ,
----------------�vlt-- �'----t----- +6 -- ' � w -- C�.�y--"'a�00e---- y�E� �.�� '-----,� - --------, -
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 Article N) of the�Sate Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Co"mplt nce leas :.N n 1ssued22by the boatel of healt.
' -�� ✓a, .�4 � �.�oJ ,i'- r 1C> ti a tY _'k� 5�3� -
Sigr
ned ........ mot_ x
Date
APPlication'Approved By----- ---•------- -• -------- •-----------• •••--- .......................................
Date
Application Disapproved for 0ie following reasons: ...__:..: - =f = ,
----------------------------------------- -----`----------------------------•-•-•-••--••-••----•---------••--•-------------••--- ---------••-----••••---- --------------------------------------
bate
Permit No. -._...� Issued
i - Date -
7'i)6COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF c: .........................
' Urtifiratr of f"umplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ------------
Installer
has been installed in accordance withthe provisions of Article XI f The State Sanitary Code as descri ed in the
nstruction Permit Nb:r --------------- dated'.'. .c `4?.'
h
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM, WILL FUNCTION SATISFACTORY.
9
DATE_: .. Inspector ,
THE COMMONWEALTH OF MASSACHUSETTS
J, . BOARD OF' HEALTH 4
..............................
No........ ....... FEE........................
%spacial Morhq dun.5#rurtiun Vrrmit
Permission i hereby granted___.__ ._.l!l�IQ�--K t'_____ �- -�
---------------- ----------- . -- .
to Construct ( X) -._or Repair ( ) an Individual wa e Disposal S�s$tem
at No.--- �_k .! q iV f� fF�' u�
--•-• -•-•- -------------- _
as shown on the application for Disposal Works Construction Permit;No._____'_s_. .__ Dated_____ Ll_ t�-.
`f
' -"I
F E
!) Board of alth
DATE. 1. ! �f
-------------------------------•-. .. ,
;,
FORM 1255 HOBBS _& WARREN. INC.. PUBLISHERS.`.>..,,
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