HomeMy WebLinkAbout1990 Aug 21,22 - Message, Permit Copy with Notes • �� Time /f !d'U '� pM
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Message
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' . � . , THE COMMONWEALTH OF MASSACHUSETTS
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� BOARD OF HEALTH
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��#rl'utt#urn f,ar �i��rn,�tt1 �arks Cnnnstrur�i,an �ermi#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
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. ion ddre y� "`_.•...�—••....-•• or Lot N
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� W " "`���11'Y�4�_. � Add�eu _
,a _..-_ '(�a'�..._ _
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astaller Address
Type of Building Size Lot---- --__.. Sq. feet
U .. . �___
a►� Dwelling—No. of Bedrooms..-__.._•___..._....-----•__--•p-F�cPansion Attic O Garbage Grinder O
Other—Type of Buildiug ---...s�1�S1i.7---. No. of ersons.............._..----•----- Showers O — Cafeteria O
� Other fixtures .----_-_....__...............___--
_....---.._._..•--•_-•----•-•••----..--.-•••----••.................•••--....___....._r.__.....
Design Flow_.._._...__..._..--•• ---• gallons per person per day. Total daily flow--------...-••....._..._-__- - Batlons.
_.. ..__•_--
......._
W eptic Tank—Liquid capacity_.----•••--gatlons Length---_...___.._ Width.--•----_.._.. Diameter------------DePth--.__....•---.
x Disposal Trench—No.._-•-_•-__...... Width..............•••-- Total Len
- Sth---•--__••_-_..Total leaching area..---...._._.._._sq. ft.
3 Seepage Pit No.-----••--.--.._... Diameter._--••............. Depth below inlet--•---•---••__-••• Total leaching area.....•--•••-._sq. ft.
Z Other Distribution box ( ) ��ng � � �
a PercolaUon Test Results Performed by--••-----... _- .._. Date....__....___._.__.__�___.._
._ ....-----...--_••-•-_--------....__..._.....__.
.I Test Pit No. 1......_._......minutes per inch Depth of Test Pit................... Depth to ground water..__.....__...__._......
k�-+i Test Pit No. 2______________nunutes r in D th of Test P'
Pe eP ----....---•---_ D th to ground watv--_ -....--•----...
a �-Qf.k�--�-Rl.:..._. . �?.:Tx�;k_�._....�._�t.`.�.�1��_.�_.____�'SYni',�..<._.
� Description of Soil.............__._.._. ...-.
x, ••_----._._......._____-_..._.••_-_•_--------------•-•----•----........_.....___.
..._.....--____._.......__....._.
U __••...._•_-__•_-.�..._.___..__...._..r_�...._..._..__-_____•••-..____...._.....................----.._..--•__.._..._...._...._....._....._....�...._�......--
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.._....__..----------------------------------•__--..._....-----•••--------------------•----..__..---.._....._...._.....---...-_....._....._..�..._.
U Nattire of �(a'�irs o A1t ' ns—Answer when lica le_....___..
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greemmt: .....
The undersigned agrees to install the aforedescribed individual Sewage Disposal System in accordance with
the provisions of iI.i.�. $of the Sbte Sanitary Code— The undersigned further agrees not to lace the
opvation until a Cercificate of Compliance s b � ed b`,�^`.i\, of health. P SYstem in
Y
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---• •- • •-•
Applicadon Approved By,•/�--�•L�
.__ . _:.._ • -_-- -•- -••__---._.._..-_-.._..._.._._
. . ' ""Da4_______.
Applica6on Disapproved fos the following reasons:._ • }
•••---•----...-•_------•------•----...-------•---•�--•---••---------••---••----.....__�___--
_-___.._...____._.._..-•---•--__---...___..__.__.--
p • •-••---..._-_•••-----••--...------•---...... ... ........----...---...--y•---•---__-.__ _._
Permit No..�?-!p'l�j ..__..�..-_.__.._ Issued...._ _�t ��C _. - -
- Date
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P . '"l"'^T%'Cnfer^f?.fi'+���PK'� . i��^'S
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w,� ;. ,�_<, THE COMMONWEALTH OF MASSACHUSETTS '� ''� � `•` ���. -
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� ��i ; •-, ,�, BOARD OF o HEALTH = � �` �� • �
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: fapr#�fu��r �af f�um�rli�tue � � .
� F�IS TO CERTIFY, That the Ind vidual SeK^ige D�sposal S�stem constructed O or Repaired (�(
, , ,by�� �cL9VR.L({.uG, � .} u<, y x �
, F, at_.A ���SS '�ENUE�,•A�(I�3t_:�,1lQqEj( ���wia��� '�. �2 �
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"5'¢has been instilled m'accordance with the rrnisions of T T � �W Y'--
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� :appLcation for Di '� ' p r �#'���°f Tl�e State $amta e
a3 �j��d�m the � .
� �,µ f sPosal Works'Construct�on Permit l�o Sh? ��
, .,. .py'?sdat J�.�_!P � Y .. tr� I
�; ;�-THE ISSUANCE OF'THIS �ERTIFICATE SHALL NOT BE .•STRU S A� RANTEE THAT THE . !
' SYSTEM L FUN ON SATISFACT `� � "� �E m'
DATE_ L���;__i :.�G� "� .:,�`�r � �€ +� �'��,`: : A � i
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