HomeMy WebLinkAboutApp-Permit-ComplianceNo. M6. -----
THE COMMONWEALTH OF MASSACHUSETTS
'POARD QF HEALTH
.. ....................OF.............. ........... a v 7—
Appliration for Disposal Warks onstrurtion thruat
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
9 System at Y/
• •••• Locat n -Address
_Owner
FW1 ---._.5�.9t<!!<<'1?!1..............................................
Installer
U
P-1
P4
W
W
a
a
w
x
U
W
x
U
Type of Building
Dwelling — No
Other — Type
or Lot No.
Grp.--
AddreCss
Address �
Size Lot__ et
of Bedrooms ... _._................................. Expansion Attic ( ) Garbage Grinder (�
of Building ____________________________ No. of persons ............................ Showers ( ) — Cafeteria ( )
Other fixture-------------•.•.•-----•---•-------J�c ��s�t------------------------------
--____----•---•---3 d -•---------______---------
Design Flow----•-•-_-- //-- •---.........gallons perp �y. Total dai� o�w___________ .7__________________________gal}ones/
Septic Tank — Liquid'capacity-/ _______gallons ',J,ength--- __________... Width._._..___ Diameter______ ________ Depth --.';.7
Disposal Trench — No. .....l____________ Width ___.__......... Total Length ...... Z4�---- Total leaching area___ . ._. t.<=�-
Seepage Pit No ......... .......... - meter____________________ Depth below inlet .................... Total leaching area .................. sq. ft.
Other Distribution box ( Dosing to Percolation Test Results Performed by.____.:'._-i"'..�` _______ Date_..�. ---/rg'..
Test Pit No. 1_4_2 ____minutes per inch Depth of Test Pit.__.__ 7....______ Depth to ground water ........................
Test Pit , No. 2.. �'_�-._minutes per inch Depth of Test Pit____,12 = a._ Depth to ground water__________
:riptionof?_o/C------Z-:�`_.b._G'�!�/U�(.--5-j......_.
cl r3f o / �� 2 =`S' =....._ C Z_- o..._:'" ` ' �' / u &.- $-
---------- f ' ----------------
----------------------------------------------------------------------------------------------------------------------------------------- ------
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 TITI.I; 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has_,DAsqi�5ked by_�c (d , health.
Application Approved
Application Disapproved for the following reasons:--
Date
Re
Permit No.. V .0 r! ! .. Issued D I ft_ ...
tll
THE COMMONWEALTH OF MASSACHUSETTS
1.0
BOARD OF HEALTH
1.0!�_1.
1 ......................... 0F.Yq.eqq% tl......._....._..................................._...
Trrttftrair of Toutpliattrr
HIS ITO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ()
_9�%�iC�'P1z'tr
.................................. ----------------------------•-------------------...-•--------------------.....------._...------_....
at�CD ••; ' J�.,.��1-nst
/ Ialler
llt°�ztLt':_ �C''!_`z�-----'�-!----t_t��;'V ----------------------- --- ----------------------- -
has been installed in accordance with the provisions of T �'I,E..,. of The State Sanita. Code ,desgi efl in the
application for Disposal Works Construction Permit No. _
" date ,yam '1._i
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E STRUED AS GUARANI THAT THE
SYSTEM WILL FUNCTIO
---/ TISFACTORY.
DATE ........ �`•l Inspect •-•- -- ----- ---------------
V -----------------------------------
_......