HomeMy WebLinkAbout1986 Jan 08 - Initial Application for Septic Permit; Engineered Plan - Rev. 1986 '�
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No.-------••------�.._.... F�s............._............_ '
THE COMMONWEALTH OF MASSACHUSETTS
� BOARD OF` HEALTH �'
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� Application is hereby ma.de for a Permit to Construct (�r Repair O an Individual Sewage Disposal �
System at: „
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�ation-Address �y d o Lot N
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UType of Building , Size Lot__���5��.�_Sq. feet
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Dwelling—No. of Bedrooms..................�___._.__.___._______Expax�sion Attic ( ) Garbage Grinder (qf(�
a� Other—T e of Buildin
YP g ---------------•----------.. No. of persons------------•--------------- Showers O — Cafeteria, O
� Other fixtures -------••--------------•------------ ' f r . � . , - - � .. 'I�
• �SR��I--•----------•------------�-------=---------------------------------------F------.....--------
W Design Flow__...-•-•----------..�.L_�-------------gallons per per day. Total daily flow----:-------•-------•• d-•-----gal
WSeptic Tank—Liquid ca.pacity�D.�allons Length__S._�a__.____ Width._.__._��._ Diameter_....._._�_De th__�._4ns. �'
x Disposal Trench—�,'o.__..___.�'__________. Width_____.__�?.__.____ Total Length__.____�.�...__. Total leachmg area___._�_2�►____.sq. ft. I�!
� Seepage Pit No_____________________ Diameter.____.___.__.____.__ Depth Uelow inlet_____.____........__ Total leaching area..._________._....sq. ft. �,
z Other Distribution box (.�) Dosing tank O ',
`"' Percolation Test Results Performed by..___[z_„��._._�?�_H�!��__.y__���_____________ Date.____._..�./��?���______.
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; � Test Pit No. i..__.L_______minutes per inch Depth of Test Pit_____!��_____. Depth to ground water__1Z-�a_____________
� (s. Test Pit No. 2________________minutes per inch Depth of Test Pit.___..________._.... Depth to ground water_._._.__..._____._______
(� .-��----���"Z-`-��----�P�.�t�'�st���=-----.....
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� Description of Soil---••--------•--•-•--�¢�176"....��".'�.`�...>.`'!�?aE3!�J?---------------------------------------------••--•------------..._..-----------•--• '
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V Nature of Repairs or Alterations—Answer when applicable.--------------------f-----------------------------------------------------•---•--------------.
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with '
the provisions of iIT� 5 of the State Sanitary Co — undersigned further agrees not to place system in '
operation until a Certificate of Complia.nce h een ' e y th a d lt . e f A '
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, Sig ed- -------•••---- • ----- =------- •-------•----- - --- ---�f---- ���'
� .. Date
�. Application Approved By....•------•------------------------•------...... •-•---------•---•--.._......---•------ ---- . ------. _....-------------•-------•---
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App i tion Disappy�►ed f he foll wing reasons:_�!�T.�. ,��-��--------�.�.�1tPii�---���1Gr,,��_ .
�p� --
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r' O�� �'a�
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Permit No..-••--.....-----•---------------------------------_.__ Issuec�.-------------...--•-------•--•-------.......--•------- ,
Date
. _ _ _ ------___--- -- — ----------__ _ — ---�.-- — ---�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................O F...........................................................................•••••-•...
farr�tftrtt�r nf (��rttt�r�t�ttrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal S�stem constructed ( ) or Repaired O ',
by_..._._..._._..-•-------------•---•-•-----------•-•-----------------------•------•-----•-------- -----------------------•-----------••--------•----------------------...---------------------•-- �
Installer
at----------------•-•-...-•-----••--------....._...---------...-----------------------------------...-------------•--------------------.....-----------•-------•--....-------•------------------•------
has been installed in accordance with the provisions of TITI� 5 of The State Sanitary Code as described in the ',
application for Disposal Works Construction Permit No._______._______________________________ dated_._...__._.___._..______...____._____.__..____..
TF�E ISSUANGE OF THIS CERTIFICATE Sh6ALL N07 BE CONSTRUED AS A GiJARANT@E THAT TNE
5'YSTEIoA WILL FUNC7'ION SATISFACTORY.
' DATE----•---------------•------------...--------.._.....--------------------------.. Inspector.--•-----------------------....----...-----•-•---------------......------••-----•---
i __ _ . . __ _ _ '
THE COMMONWEALTH OF MASSACHUSETTS
+ BQARD OF HEALTH
i
; ..........................................OF...........-•-•••••••.....•-••...•••••••....•••••••..._.........••-•.....••••••••••••
No.................••----•- F�E.._.....--••-----....---
�i��ru��t1 �nrk� ���t���tr#iun ��eruti�
Permission is hereby granted______________________________________________._
--------------------•--------...------•-----•----•----._.---...--••---•-•-•••-•------•--•-----
to Construct ( ) or Repair ( ) an Individual Sev��age Disposal System
atNo---------------------------------•--------------------------------..__...--••--------....------•--•-------
--------•--------•---------------•-------------•-•---•-------------••--------........
Street
, as shown on the application for Disposal Works Construction Permit No_____________________ Dated.___.___.____.____.__...__..._..__..._....
------------•---------------------•-----------------------------•----•-------•-------•-------•-
---.._..�
DATE_ •---•------•-----•.......................•--------...--- Board of Aealth
--------•----•-••----• -
FORM 1255 �HOBBS & WARREN. INC., PUBLISHERS � .