HomeMy WebLinkAbout0138 THORNTON DRIVE - Health (2) -2-Rlo- d t g
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No.....2.O.y........ ���p" Ql C� FiEcim..... .... ....._
THE COMMONWEALTH OF MASSACHUSETTS
g -BOARD F HEALTH
.. .... .....OF......... ...
I, ppliration for Ditiposttl Iforkii Tomitrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
—�— Yam+.-/ —CJ Y 4 — z G}re /es
...................•-••- •---------•....--•--•----•------•--•-- •......-----•............-•••--......•..... ........
Location-Address or Lot No.
Z_
^/ L sti ��iZ
...........C/�........•--------------•- --------------------
Owner ..............................................
ddress
.......,�
� Installer Address
Q Type of Building Size Lot----------------------------Sq. feet
aDwellin�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a _Type g . 1 I-----------_-_--- Showers ( ) — Cafeteria ( )
Other—T e of Building _��xi.uT�+®�s�„ No. of persons__._ _
Desi Flow•
W- Other fixtures --- lions er erson er da Total Bail flow.:..........................................gallons.
WSeptic Tank 1 Liquid capacity...te!,!cRallons Length................ Width................ Diameter................ Depth-------------...
x Disposal Trench—No..................... Width.................... Total Length................. Total leaching area--------------------sq. ft.
Seepage Pit No._____1_----------- Diameteni�c"_'__s i below inlet.................... Total leaching area...3 ... -.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..---.----_--_-____-..-.
44 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water_---_______-______--...-
9 .........................................................................................................................................................
ODescription of Soil- ` `_---------•-------------------------------------------------------------------------------------------------------
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 een issue by the d health.
Si ........................... •------ ........................... -- ----------------------------
a a
Application Approved By---`�� ----- •.........•.../- �f�
7.5 — ate
Application Disapproved for the following reasons:_______________________ ___ ___ ----_ L � -H,_.- ,•__•
--------------•---- ......-----------------
Date
Permit No. ---------------•----------• Issued._ . ..--- 7-• ...
Date
No.--- ....... F��.... .......... ....._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F . HEALTH
Appliratinn for 11i iposat Vote Tomitrnrtion Verntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
j el. ram:,..4 i"?_ s�,...r;ti?�'^ ! - 4 -y. #
Location-Address or Lot No.
G. ..z ..... s ...
Owner Address
14 .............................................. ns .. ..... r.�
M Installerr. Address
� Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
p`�., Other le'type of Building + ` '+__ _ _ No. of persons...a 1.................... Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------------------------•-----...----------------
W
Design Flow....................... '°_______________gallons per person per day. Total daily flow.._.._.....=: -'._......_..._._........gallons.
Septic Tank e Liquid capacity...ef:� "t`gallons Length................ Width---------------- Diameter---------------- Depth----------------
W Disposal Trench—No_____________________ Width-------------------- Total Length-------------------- Total leaching area....................sq. ft.
Diameter_'_v:_!`-._ .'``lie th below inlet____________________ Total leaching ft.
area..._`_ a_ a._s Seepage Pit No.------=------------ P g q-
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----__-_-________-------
f� Test Pit No.,2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------
•------------------------------------
D Description of Soil-__ _.-
---------------------------------•------------------------••------------•----...-----------------------------------...------------------------------.
x .
tJ ---------------------- ------------------------------------------------
W
x -----------------------------------•-------•----------•--•-•-•---•-•------•----••---.....--•----•-------•----------------•--------•--------------------------------------------------------------------
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 XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ss ed by the`bo�rd_of''health.
Si -- '/& �....'U .�, �, .
------
'�' Date
Application Approved By_tM�_ ; .__ __t � -:_ /Za
Application Disapproved for the following reasons:...................... _-:_-_--.---___--__-__--______--_______---•-...._._.______.Date.........____.
-•---•-----------------------------------------------------------------------•-•-------------.I......_._..--•--•--•-•------•---•---•---------•-------------•----•---•-----••......--------------•--------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1
t� t...........OF_ '
Tntif irFatr of Tonapliaanr
THIS IS TO C.ERTIF } That th` I orndividual Sewage Disposal System constructed 4 Repaired ( )
----------- ---- ---------•---------•------
a., Installer
at. -• --- ---- V/1;47�44/ - s ------- r
has been installed in accordance with tie provisions of Article XI of The State Sanitary Cod as escribed in the
application for Disposal Works Construction Permit No................. .. ... ...._.. dated. ---
- -
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION
P `SAaTTISF CTORY. -7
------•------DATE
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
¢"`• L.............OF. � ,.....� .............
No..... �----• FEE... ................
�i��al�atl� �a-: � C�a�aa��x�tr#ivat rraatif
Permission is hereby granted.___._.. . .
.f ----------------------------------------------
to Construct,�, r Repai )_ an dividual -S wa�.Disposal System
at No... y
Street
as shown on the application for Disposal Works Construction PpFiFit No.--.............._`Dated._. _ .............
-•
oardf.'of HealthHealth �s i
DATE---------------------------------
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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Y �E,i..sri4g�J— iLJ1�
7, -el If
001 7- ALL SURFACE WATER MUST BD SELF CON-
TAINED.
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