HomeMy WebLinkAbout0049 CHOLE COURT - Health r
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEAL2— 7 -
�I" l�
ro' Appliration -fur Uhi uiittl vrk� T ttitrurtijan Prrutit
Application is hereby ade for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
systat4 == .......... ..........................
oca Address or No.
. — ..::..........................) ........... ... .. __
W ` r P Address
n alley Address
dT e of Buildi Size Lot... �--.1--------cam
U Dwelling No. of Bedrooms____________Y- _-__-Expansion Attic ( ) Garbage Grinder ( )
�+
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Other fixtures ..... ...............
W Design Flow aer person per day. Total daily flow------------- •_____.._..........__._.gallons.
W Septic Tankk iquid capac' ga ons Length________________ Width_.___._.._.._.. Diameter------ --------- Dept
ll._____.__.-----
x Disposal Trench—No.-------------------- Width__________________ Total L h_-__-__ 6ta1 leaching area--------------------sq. ft.
Seepage Pit No........ :_.. Diameter__.T%!%� __ el9�fie .w m evtal leachiu yea______ ____.____sq. ft.
Z Other Distribution box ( ) Dosin tank ( ) . a d•'T/` ' ✓'"�'"'G"y - ? j -7 'I
a Percolation Test Result Performed by--------------_---- ..................................................... Date------------- --------------
._..
a Test Pit No. I..: �_•_-----minutes per inch Depth of "lest Pit.................... Depth to ground water._._.___.._____._.....
Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_-.__--_-_----_-_-_-----
0{i{ ........_________________________ _______________________ _-__ -_ _�____1 ..w._____ _...___.__..
Description of Soil--------------------------•----------- ����---=-----------�:-
x
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 XI of the State Sanitary Code he and igned further agrees not to place the system in
operation until a Certificate of Compliance has bee ss by the o rd of health.
gned..... ... . KN..-... .. Z
Date .
Application Approved By............ � � --------- ----- .. ... .. ......C'A-�-���
Application Disapproved for the following reasons_................................................................................................................
-•.......--•---------------------•--•-------•------------------•--------••---•-•--•--•--•-•--•---•-••-------.........................-----•----••-•----•........... -----------------------------------
Date
Permit No. Issued _
4----------------
Date
N __/Z.......
FEla......4; ;................
THE COMMONWEALTH OF MASSACHUSETTS
..- BOARD 0, HEALTH --
..._. t.........OF......
Applirution -fur Biu uuttl Workii Tomitrortion Pprutil
Asp�plication'is hereby made for a Permit to Construct ( 4�or Repair ( ) an Individual Sewage Disposal
SysteIIl at.-.'.+. /4. I i f ............. .......�6------
V ! d0j Address f or J*WFNo.
{Grp
_.. Xo
------------------
...- --- -.-''----
a V. wner ""1 /1 .2 Jr Address
bf.staller Address
C, ' `'
Typ�of Building Size Lot....
.s_ ._ _ -_____Sq—. feot—�
U Dwelling No. of Bedrooms-------------r___--•_--__---_ Expansion Attic ( ) Garbage Grinder ( )
�-,
per-, Other—Type of Building ----.-_._-__-------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------• -•.--------____--
------.-----•------------------------------------------------------------------
W Design Flow......... ....... ____.____ all per person per day. Total daily flow--------------�_.--_�%__------_---_gallons.
•----•
WSeptic Tank iquid cap`aci4jtgg@rga1f04ns Length---------------- Width______.-..._._-- Diameter---------------- Depth___._.__._....
x Disposal Trench—No -------------------- Width---------------_pe.Total Length _ Total leaching area--------------------sq. ft.
Seepage Pit No.........2___:---- Diameter...` r%"x?' .t�De thbeLiwnlet .- otal leachin re
ta____
Other Distribution box Dosin nk _ � / 7
aPercolation Test Results Performed bY------_--- ............................................................... Date---------------------------------------
,a Test Pit No. I......I----___-_minutes per inch Depth of "Kest Pit____________________ Depth to ground water._-__----_--.--.--___.
GL, Test Pit No. 2................minutes per inch Depth of Test Pit._-_---__-___----- Depth to ground water--.--.._._______-___-__.
----------------- -- --
O --�
Description of Soil-------------------------------- -----''�--f'��--"'- --`-� �------'�-`----6-------------------- ---- .vl� _
V --------------------------------------.......---.......•-•-........................................................................................................................................ -
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 / he and igned further agrees not to place the system in
operation until a Certificate of Compliance has been ssu ('by the�o rd of health.
,Signed ' l�-"^..-----
A Application Approved B ? ,, ;f! f Dat
PP PP Y r; - /%� " '" Dates e
Application Disapproved for the following reasons:----••---------------------------------•---------=-----------------------_-----..•----------••------------------
--...-•-•--•--•-••-----•-------------------------------------------••-----•---------•-•--••-------•-••••...--------•••-••.... .................... ------•••-•-•-----------------------••---------..----
Date
PermitNo......................................................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ............OF....... .....,....
Tntifirate of Tompliaorr
TS I `TO CERTIF V That the Indivi ua Sewa isposal ystem constructed ( or Repaired ( )
by " ' ' /�+t r �''
� Installer '
at ----;'__,_ _.._ ,, �! � »€�� '�� �----•---- � ^•--•-••---------••-------.----••---••------
4'
has been installed in accordance with the provisions of '.Article XI f The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.................eel- . ._�._.. dated...__. ��..-��.1 .........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRYUP AS A GUAR",, TEE THAT THE
SYSTEM WI�X FUNCTION SATISFACTORY. /
DATE ` - jn---------------------------------- Inspector---°-
i
THE COMMONWEALTH OF MASSACHUSETTS
L„ may BOARD OF HEALTH
No.- 11-1-------- FEE_.�: �__..........
Dispuottl� vrk,i .uuutrudiuit rmi
Permission .is reby granted----.C._-,_ :._ ------- •-_ --A�,--- -- ..�! �-- .-.-
.........................
�.to Construct ((�� ) or R parr ( ) an Individual) Ige Di'sp, *System - ?
Stree
as shown on the application for Disposal Works Construction Permit tNo.___--Z-_-:.:n -__ Dated_... �...............................
�:�DATE---- -------- -- ------�1,71zl----------...----------------
Board of HealthP6
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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