HomeMy WebLinkAboutSingle Unit Floor Plans 1988THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
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, pptiratilan for Di-ripn,-qttl Wurkri Tilm rnrtiun Vrrniit
Application is hereby made for a Permit to Construct (5,,) or Repair ( ) an Individual Sewage Disposal
System at:
r''.%.....1� ............................ ........J4..it
Location- \ddress or Lot No.
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• Owmcr - Address
- , . S_ .....xcA(<!il%!'?(2---.................................... ---.............. ........... --------........ ------......................................... --- :..................
Installer Address ,
Type of Building Size Lot .... 711.. ......Sq. feet
Dwelling —No, of Bedrooms .............. ........................Expansion Attic ( ) Garbage Grinder ( )
Other —Type of Building .49�4#./.�,... No. of persons. Showers ( ) — Cafeteria ( )
Other fixtur s .......... &.a�T.?t....Sb .f?(r.. �....i ..v� /..... -.........................-- .....................
Design Flow.::?-..�7.P.8![4?f.. .....gallons per person per day. Total daily flow....... �� >.. .....................gallons.
Septic Tank —Liquid capacityl. $e?.f�gallons Length` ?. ` 6.:. Width. . _d ... Diameter,- ....... Depth...r. -,e. `
Disposal Trench — No ..................... Width ..... .'.....`.... Total Length ... Z.%..G °....... Total leaching ft.
Seepage Pit No ..................... Diameter.................... Depth below inlet...I...... Total leaching area ....... ___ ... sq. ft.
Other Distribution box ( ) Dosing tank (� 19> .1
Percolation Test Results Performed
-
by.....a"'d..._:........s.......o.!��_'...... Date ................
- Test Pit No. 1.. �.B%....mututes per inch Depth of Test Pit..*.s........ .. Depth to ground water........?..j ...........
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
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Description of Soil....--- . �-- ....- � .F'. e! �' cJJ� ........... ®-.. .......! %.?k �r ... h ��//.. ...........
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 TITL% 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee • su d by th oard of health.
Signed..-..-................ *------
*.............. ............ Date...................
ApplicationApproved By .......................................... ........ ........... .............................. -...................................
Deto
Application Disapproved for the following reasons: ............................. ......... ............. .......................... ...............................
tl�/ y q Hate
Permit No. � 7- ��,,..CO........._........................ Issu . ..... ! _d. ..................... .te
J Date
THE COMMONWEALTH OF MASSACHUSETTS
�^- BOAR+D�/ OF HEALTH
+'
............ OF...
O F....../•'•..L"..1'....'••••....................
Trrtifiratr rrf Toutplittnrle
RTIFY, That the Individual Sewage Disposal System constructed N) or Repaired ( )
-.,..
at31A.- -(-y ... i.CI O!nL).-------...............--__-----_----- _--
has been installed in accordance with the provisions of Ty,}',Ggf The State Sanity das�ylgcXi]>ed in the
application for Disposal Works Construction Permit No. ....'...........( ................... dated...a��..... ff....... ..................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT ? CONSTRUED AS, NTEE THAT YHE
SYSTEM W L//FUN�7CT/IION SATISFACTORY.
DATE_ft" `..1 j l 1 Inspector ...............................�G'' = -- --"°........................
y.......................................................