HomeMy WebLinkAbout0306 MILLWAY - Health /
Bamstable
fs 306-031
i
e
F ._.._....._ ......,,,.___ ............. .........._...
No....... . ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H H
Alip iration -for Uiopo,ittl lVarkii Cnonotrurtioo Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at*
--------... .� • '•jr,-11' ..-• -- ...... --••---•-•---- s. ,.
Location ddr s or Lot No.
•.. lL. . ... -- . -• .......................... .......
wne Address
...
PQ Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow........................................---.gallons.
R; Septic Tank—Liquid capacity------------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 ( )
Percolation Test Results Performed by-------- ----------- ----------------------------------------------------- Date----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-.-.--_-.---.--.-----
L14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.--.---------._---.--.
a -•--------------------- -----------•----------------••-••••-•-•-•--------------•-••-••--••--•••.......................................................-
ODescription of Soil------------------ --------------------------------•---------------------------------------...------...._---------------------------- ----------------------------
x
V -------------------------------
------------------------------ -------------------------------------------------------------------------------- ---------- - -- -
U ZNature. pairs or . ltel ati s—Answer when appli e.. ._ __ ________________ _A slXordance
--------------
t.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a with
the provisions of Article LI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issued b the boa o
Signe ,� � A4 ..........�
Date
ApplicationApproved By---------------------------------------------------------------------------------------------•--- ••••----------------.... ...............
Date
Application Disapproved for the following reasons:................................................_---------------------------------------------------------------
'
--•-•-....--•-------•-•--•-------------------------------•----------•---••-------------•-•-•--••---------------••...•---•-------••-•-----•------••------....--------------•-----------------......•••••-
Date
PermitNo......................................................... Issued..------. 1-------------------------=------------•.....
Date
Lc �L1Tl�h.1 ' j SEWaC,E PERMIT U0. �
`/ILL-AGF- - - 3L
Ih1S LLE 5 �P/lE ADD ESS
BUILDE hIME DRESS
1-- - - - - r
DQTE PERMIT ISSUED '- - _ P-23- 2
DATE COKAPLI A ACE
x
No.........................
F�s.................�
THE COMMONWEALTH OF MASSACHUSETTS
/BOARD OF HE
/ v .....-......0F...460-:411 ........ . ........... ........................
Appliration -for Uh5pvottl Works Tonitrnrtion Prrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
------------------------------ r tJ� `---------------------------------•--.....---------------------------------------
;)
Location- ddre or Lot No.
, -- .r_ .............. ....... ---------•___....................................................................................
Owner ..........Address
Installer Address
d Type of Building Size Lot__________________________Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons_..-____.._--__________-__-- Showers ( ) — Cafeteria ( )
Pa Other fixtures --------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity---____-___gallons Length................ Width................ Diameter_----_-_.---_ Depth----------------
x 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------------------------------------._..
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........---_-__-__-.___
P4 ....................---•--------------------------------------------------------------------------------•--------------•------------------------------------
ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
U ------------------------------------------------------------------------------------------------------------------r';....--.............._.....-------------------------------------------------------
� -------------------------•------------------------------------------------------------------------------------------------- -- -------- -----------------------_------
V Nature airs or iterati s—Answer when appli e------ . -- - --- .---__---- ___�........................
filly `z - % -- ---------------
=nt: '
� ..:.,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a rdance 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 ssued b the boa of
Date
ApplicationApproved By-------------------------------------------------------------------------------------------------- ---------------------------------------
Date
Application Disapproved for the following reasons:-------•-------------------•-------•-------------------------------.....---......-------------------------•---•.
•-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
................ ✓y...OF............�... .. .... . ...... ............... ............:........
Tatifirate of 00.1omplionrr
THIS S' TO C RT That the Indiv' al Sewage Disposal System constructed ( ) or Repaired
Installer
at... 1.. v d
has been ins led in accordance with the provisions of cle XI of The State Sanitary ode as described in the
application for.Disposal Works Construction Permit N ----
�__....3 _�1....__._._. dated--- ---------------------------------------
THE
ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL CTION SATISFAC ORY.
DATE <ff-------------- � Inspectors.. .. ..... ........... ....................
THE COMMONWEALTH OF MASSACHUSETTS
G �. ....
fBOARD F HEALIB
.. O
�
No. FEE...........................
Permission
---•-•--
Permission is hereby g�rain�te�d-o----�---ttTVr--- �J�-------o----n-- --x-n- rt io$t
-- -- ---------- ------"-..............................................
to Constr '),,-or Repair Indi idu ewa isposa System
at No.'.. ...{- .1. `........6� � � = - ----- -- ----- •. �Li�''�t
Str
as shown on the application for Disposal Works Construction Pe No..IS-...._ool-_... .�__ ted__ ,�"- - .- ........
------------•---
�^ 7 / Board of Health
DATE.... --_. --�-
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS