HomeMy WebLinkAbout0076 COLONIAL WAY - Health 7G C'o1 pn,;aQ
LOCATION SEW E PERMIT NO.
L Or YJ 04PA149L Y
VILLAGE
lAC
INSTA LLER'S NAME & ADDRESS
O UI-LDE R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
3 - •
l
No......................... I FEIC .............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD
..�" �........ --- ..:.. ..'.OF....... !....... .._
Appliratinn -for 4%ipoiial Workii Tomitrnrtinn Prrutit
Application is hereby made for a Permit to Construct (t.-Tor Repair ( ) an Individual Sewage Disposal
System at:
01 . -- --- ..........................................
L anon- ddress . o.
o�" j�
------�•m--•-- a G S�KS..1 ........................................... ...7�` .... 1..e�!--•----- �� 'G12�
Owne ess
................. '(lrt-D , -----------•------------------------.` -. ....���..mf. ----------•----------------------- -----------
Installer Address
UType of Building Size Lot_2®1J-_-_-___Sq. feet
Dwelling—No. of Bedrooms--------C--------------------------------Expansion Attic ( ) Garbage Grinder ( A/0
04 Other—Type of Building ___________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------- --
w Design Flow....._.._....__......:..........gallons per person per day. Total daily flow___.__.____.__._��..........................gallons.
W Septic Tank—Liquid capacitylld�_gallons . Length---------------- Width................ Diameter---------------- Depth----------------
x Disposal Trench—No. .................... Width.................... Total Length.................... g q.. Total leaching 1rca____________________s ft.
Seepage Pit Diameter.................... Depth below )* et-____. _.____. Total leaching area_---_.___--.___--sq. ft.
z Other Distribution box ( ) Dosing tank ( ) � — / X— 71
Percolation Test Results Performed by --------------------•-•-- - Date.........................
�-1
Test Pit No. 1----------------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 round water_-._...--_---.----_--_--
---------------- a� ----�°�------..---•----------0-..........�C.... �.----•-•----• -•----•---- •----•--- r`~
Description of Soil -- _
x
v --------------------------- ---- ........... '�X�� -------
w
V 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 \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ' s> d by t boar of he �h.
Sign( r .._ -® Z1
----
-- -
i D to
Application Approved'BY------ .� ... •. -- .... . - l- -- - -- ------ ...-- --
Date
Application Disapproved for the following,reasons.'........................... ..:......-•------------......._....._.__......-.-.-.-----.___--
--........--•••-•----.•-•.-•••--•----•-------------------•••--------•.....--•------------•-----------.---•-----------------.......••••-••..----•--•-----------------------•--.-_.._..-------•--•--•-•••.
Date
PermitNo......................................................... C> Issued..........................................------------•
Date
_..__�_,___---'--------- --------- -------------------- -�
No......................... Fps... ......................
_
THE COMMONWEALTH OF MASSACHUSETTS
EOAF�D F HE L
Y..6�'f11'1 ... _...-- .OF................................. .. . -' ......---.._.......
Applirtttion -fur Eli,ipuiitt1 Worko Tutw1rurtiutt Vrrutit
Application is hereby made for a Permit to Construct (v)"or Repair ( ) an Individual Sewage Disposal
System at:
}-�— --- ----- -----_-_------•••••:____•----------------•Ln ddress_.__-_`.......................... ........
/--................................... 4; 0-.------/-----�---S--------------------------
,
-------------- ----••• o
-J
a !` Owe Gi � Address
_
................................. =rf.• -•••-••--.----•----------••-----•----- -•---•--•---� �_ ........ .
Installer Address
d Type of Building Size Lot_.z�_
U Dwelling—No. of Be .�z .......Sq. feet
drooms-------_(A _______________________________Expansion Attic ( ) Garbage Grinder ( )A/0
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures ---------- - ------------------------------------------------ --------------------------•-----------_______-----------------------------------------
W Design Flow__________________--7-__�-------..........gallons per person per day. Total daily flow...._.....__....._2-._.��
.........._.gallons.
WSeptic Tcuik—Liquid capacitv/0*4�0_gallons Length---------------- Width---------------- Diameter-----........... Depth---------...._-
x Disposal Trench—No- ____________________ Width-------------------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..&-A-R.---- Diameter____________________ Depth below inlet---___ ____._._/Total leaching area____.__...____.sq. ft.
z Other Distribution box ( ) Dosing tank ( ) - Q,�- C�I�1 - /` i- 7G
P-A Percolation Test Results Performed by------------------------------------------------------------------------------------ Date-----------------------------------.._..
Test Pit No. I................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...-----------.______-
(� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
----------------
.............' (.j
O Description of Soil ® - _._ 7 �'-/� {� `'
r
x -----------------------------------7------- ? `� /U V
W
vNature 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 t e board of health
Signe O/ �.-----.-- �� --Z Cfl
'- �D to F
A lication A roved By------ -PP PP -�-'�'� - --- -- l :---'t--L.
Date
Application Disapproved for the following reasons:............................1- -----_------------------------_--------------------------------------___---------
---------------------------------------- ------------------------•-----_.-____-------•-------•-----•-•-••.._.____-------_-_.-----•-----------------------_....-----------.-.........-_-------------=-•--
Date
Permit No......................................................... Issued.-----.�--�- -��- -------7 G
----------••----•-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEAL H
InL...................OF........ . ..... .. .. .... .... ..... .......'.....................
Qwrtifiratr of fITuutplitturr �-
THIS/IS TO CER; IFY, That the,Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----- r) k�_ ----•--•----•--A-------------------- - .............................................. -- ---------
stiller
has een installed in accordance with the provisions of : 9�leNI of T e State Sanitary Code as described i the
application for Disposal Works Construction Permit Ne .. __. ,l — /
•-------•--- dated---- -�-••-•---r�..•-----��--•-----
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM 7ILL FUNCTION SATISFACTORY.
` - 7
DATE1 ------------------ --- -------- Inspector--------f--- --_.___-_-_-.--_.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
... O F
1
No. -------------- FEE
�i��u�tt� urk,�� �t�trttrttu$t �drrttttt
Permission i b ranted l�2<'1�i.1 ��'----------------------------------------- ---------•-•••••• -
to Cons uct ( ;') r Rep 'rI ) an I-n i al wag tspos S st !G
at No. �Ggag------ J / f �(---�-•...�. �' - .-------------------- �jJ-r f V
Street
as shown on the application for Disposal Works Construction Pt No_.. ....:___ Dated___ed..-Z_� 7_C..___
�� ---- .._r••-••---•--.-••--.-_
/ 2 7 Board of Health
DATE-----{---u----•--Z------------------ --------''..........................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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