HomeMy WebLinkAbout3480 MAIN ST./RTE 6A(BARN.) - Health &wc..
CL.i Vt G .Y Y'1 -
No.•••. Fxim ;. ...
THE COMMONWEALTH OF MASSACHUSETTS
�`II BOARD O t-IEALT
_�t........_.oF........... �............... :
Appliraiinn for Ehiposal Wvrkii Tnn#rnrtion Prruld
Application is hereby made for a Permit to Construct (,_ ) or R air ( ) an Individual Sewage isposal
Sys at:
�... ...................
Location-A dress or Lot No.
... .... —.............................................. ----------
Address... .. ..... ........
Owner Address
... �.. ,.... ��........................................ ...... .. .. ... .............. ......................................................
Installer ddress
Type of Building Size Lot............................Sq. feet
Dwelling,,,--No. of Bedrooms- „ ..................................Expansion Attic ( ) Garbage Grinder ( )
C14 Otherl�-"hype of Building.- No. of persons:............ Showers ( ) — Cafeteria ( )
PL'' Other fixtures _
W Design Flow •....ice gallons per person per day. Total daily flow-----------•- —gallons.
d� _��$ �� -----
WSeptic Tank( Liquid capacity.�'e�ll.gallons Length................ Width................ Diameter................ Depth...............
x Disposal Trench—No..................... Width—... y� Total Length........... Total leaching area....................sq. ft.
> Seepage Pit No._... '- ...... Diameter_ 'De th below inlet........ Total leaching area... s q. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by................................................... Date..........................•---------
Test Pit No l•-..... ........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______.__-___-:-._____--
••-••-•... ............................ - --•• - ------c---------- -------------------------•-------
Description of Soil,..... .._ �J � �Cc� ---------------- ------
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—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signe ............................................................... ....................
Application Approved By......
--- 1 _ --------•....._-... c!e
Application Disapproved for the following reasons:---•---•-•----•-----••-•......... ---------------........................................................
...-•-------------------------------•------------------------•--•----•---••••••••-•••••--•••••--..._......---•--•••--•......••••-•-••......•---•-••----------••-
Date
PermitNo......................................................... Issued.........................................................
Date
'r THE COMMONWEALTH OF MASSACHUSETTS
``
BOARD O HEALTH
�f V
OF.......... . .... ........
atifiratr of Tout hattrr
T IS 0 ERT ,.That the Individual Sewage Disposal System constructed (/--) or Repaired ( )
.
.nstall...... ... ... - V ._... ........
has bee installed in accordance with the provisions o Article( f The State Sanitary C de describ d the
application for Disposal Works Construction Permit No...........F dated.._., .�fl. __ .. ....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTE THAT THE
SYSTEM IW4 FUNCTION SATISFACTORY. r'+
DATE............. !"`..... �.................--•--...----........... Inspector.... '< .........
No.... -- --
Fzx
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® O I-iEA 'Lj
2 . . ... .....o ......... �` k 'r .....: ...:
Applirativit for Di-sposal Workii Tomitrulrfturt rr it
Application is hereby made for a Permit to Construct Allor Re air ( ) an Individual Sewage isposal
r
Syste I at: #V ; r
Loc hon-Atss or Lot No.'
w
rOwner e+ Address
............................... $.a+...
l Inst�alley a 7tHdress
�i
Type of Building Size Lot.....................:......Sq. feet
V Dwelling No. of Bedrooms..•... ...Expansion Attic ( ) Garbage Grinder ( )
aOther- Type of Building 01-4 W No. of persons............ --_- Showers ( ) — Cafeteria ( )
Otherfixtures • - ------.••--------------------•-----------••-•--••---------•-••-•-•--••----•••-•--------- _..
Design Flow.-•_ -.__•-_._____,__: _ _ .. :_gallons per person per day. Total daily flow.............. e�""�-_.L --- --gallons.
04 Septic Tank Liquld cap allons Length................ Width---------------- Diameter................ Depth................
T Disposal Trench—No..................... Width......... �r Total Length.................... Total leaching area.................... q. ft.
Seepage Pit No.. ...2 -------- Diameter. r _.° 'I3epth below inlet.......--...... Total leaching area.._--e-,¢ q. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by................................................••- ............... Date.........................
a Test Pit No. minutes per inch Depth of Test Pit......... -- Depth to ground water,.
GLi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------.•_--__-__._-
1x ••• -
O ----r
Description of Soil.•••. d; w:, '�v ` r� .� e` e ett 5. " ...............................
v ---------------
6
rr"'
--------•••--- --=----- ------ --------------------------------------------------------------------------------------------•
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 of health.
Signet)} �^:,r a.
Application Approved BY - �. ,� - � }, '� , ,,
Application Disapproved for the following reasons:-- .:..•--• ------6
---•------------------------------•-..........-•••---•••••......-•-•
.......................................................................................................................................................................................................
Date
PermitNo.......................--................................ �. _ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH �
....... .............OF......:.. l�P�r�� �'���� ...r u -
Tprftfiratr Of Tompfiana
T IS Tr0 ERT r �Tliat the Individual Sewage Disposal System constructed ( Repaired ( )
by.. t>:. . .:.-- '` --•-•............
e
has bee installed in accordance with the provisions of Article'(��/ �f The State Sanitary Code 46 describ d ip the
application for Disposal Works Construction Permit No.________!.`f..D. ...................... dated..-_ _ . �._,
,.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTES THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................... ..........................................I................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0& HEALTH
No.... 1 .:..... FEE...
....................
....
Permission i ereby granted... ._. .." _ {
to Con t'r;uct ( ' ep 3r ) a fn dual Selvage Disposal Syster�r� -`
�f @ N ..... ........
at Now-- Z r i„ ... ��� �K� 'j'_'. Street A. . . ... .y....
as shown on the application for Di sal.��orks Construction Per nit No.. 'f Y_._. .. .._ ... ..
PP P` ated ' : ,/' <
'•�".t-. '°'�' �. �,.r"--nr�x--s=r � -. ... ......................
Board of I calth
DATE------------- ..........................
FORM 1255 HOBBS 3: WARREN, INC., PVPI-ISHERS