HomeMy WebLinkAboutApp-Permit-ComplianceNo... ._ .3 Fitz ..... \\\
THE COMMONWEALTH Olt MASSACHUSETTS
BOARD OF HEALTH
` 0' ?1..OF....Ya3it.Uth..............................................................
Appliration -for Disposal Works Tonstrnrtion Vrrmit
Application is hereby made for a Permit to Construct ($.) or Repair ( ) an Individual Sewage Disposal
System at:
%t-��} � t
Rachael Road --•-------•-----...--•----•- 9 _..---- - 'r., v�r�>�.�J._. � M `�Q_).............
{ �, ............................... ............ ..... LAM __..___T__
Location •Address or Lot o.
-._.___"Creative Housing Co,.c...Inc.----------•---------------"- ............ 386_ pepnt. x)a� ".B�rc)ugr- ta---------•----
- -. Owner
Address
W Daniel Spealanan Depot_Road, North•-Hash,---Nf�-----------•-•---
................•-••------•....____•• .._...____--•-•-----
Installer Address
dType of Building Size Lot....19_,.0a ......... Sq. feet
Dwelling — No. of Bedrooms ............................................ Expansion Attic ( ) Garbage Grinder (Ido)
aOther —Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria ( )
a Other fixtures ...............................................
W Design Flow .........
__55............................gallons per person per day. Total daily flow --------------- 830 ---------------------- gallons.
WSeptic •r.,nk — Liquid capacityly 000 gallons Length.8.'__7.6.. __. Width.4' =10-'.'. Diameter ................ Deptll5I_...4!2....
x Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No. 10x22 Diameter .................... Depth below inlet .................... Total leaching are:t_..28ayg__-sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by ........ Robert -Ej.d'j.dge.•Eng....Co.......... Date..Febru'ry••6,---1980
1.4� Test Pit No. _....minutes per inch Depth of Test Pit ...._6'.f------- Depth to ground water ....5 -9!! .........
L% Test ,Pit No. 2................minutes per inch Depth of Test Pit ....... ............. Depth to ground water..._....._____.._._.....
----------•-------------------• - --01-011
---------- -"....... J440EM.................... ............................ - - .........
Pd -
O Description of Soil01-311. .-_-"" 2! _6"...._..,Sib.,q iL---•------"-"•--•-•---•------------ A��fl ----
21-611
- Mq q
x 2 1 -611 -- 6-1 +- ...... Nledillln._ta..caarse_.sand t� D()R1Ai=D ��Gr
........
LOUIS
U ----• ....... ater"_ at 51-811 -"--------- ..
UNature of Repairs or Alterations —Answer when applicable........................................................ �_ ._..No,••285.74••--• -`-?-
'��57-�°
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System S fx tth
the provisions of Article XI of the State Sanitary Code — The undersigned further agrees not to place ystem in
n until Certificate of Compliance has issued by the board of healt .
Signed "
—mo6--1
�..� naTd""p irI et P . E . A ent
Application Approved ................... -•• ..... - --. . . •................................... g ---/ f'� .....
-
Application Disapproved for the folio ng reasons ---•-•--.------ •-----_-----_-----------••--••• .............•------------•••-----•••......"t"c".....•....-"""-
.._....----•-•-• •---------•• •........... .....•-------.......___ _.--•---_.._.._..._____. ____.______.....__..---..._...__..__..------.....--_-----•••--..........-•------•------....._......... _. _...._._ __
Permit No.. -... 4 )" f
.............................................
Date
Issued .------•---- � ate ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF....................................................................................
(9rdifiratr of Tomptittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----------------------------------------------------------------------------•--•---------- ---------------------------------------------------------------------------------••--•-_------•---_-----
Installer
at--------••-•-------------------------•----------•-----------------•---•-------•----------------------- -------•-----------------_..-------------•-•-----...----._...-•------------------------•-------
has been installed in accordance with the provisions of :-article XI of The State Sanitary Code as described 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 SATISFACTORY.
DATG....---•----------------•--------------••-----•--------------------------------- Inspector ....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................................... OF.................................•..................................................
No......................... FEE ........................
Disposal Works Tonstrurtion Xprrutit
Permission is hereby granted ..............................................................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo ...............................................................................................................................................................................................
Street
as shown on the application for Disposal s't'orks Construction Permit No ..................... Dated ..........................................
•-----_____--•-____..._
DATE ----•-_. Board of Health
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS