HomeMy WebLinkAboutDisposal Works Construction Permit 86-505 No... .......... -L� /�/t FasC.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 7D' .J OF ` /t r.1'l't '%:)7`. l
App1tratian far Ebpootti rc irks ( unstrurtiun 1trmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: fi
.-1'3 1/11 ..t\1....�. ki F- P t = i E--- ` _._..
Location Address or Lot N
E• Owner Address
Installer Address
Type of Building Size Lot�.�. y..-. l...Sq. feet
P U Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
k
p'l, Other—Type of Building E .iA/..L No. of persons Showers ( ) — Cafeteria ( )
f: .‹a" Other fixtures
WW Design Flow � i>l.0 gallons per person per day. Total daily flow � - ... Ions.
a Septic Tank—Liquid capacit 761.gallons Length._...,"--' Width=...41 Diameter Depths :1 F�
xDisposal Trench—No. `� Width Total Length Total leaching area sq. ft.
Seepage Pit No ra Diameter I't Depth below inlet Total leaching area`L 70 s« t.0
Other Distribution box ( ) Dosing tank ( )
z . ' 1 JImo/ C 1 ') c� _ ., ? .
Percolation Test Results Performed by..._f:._1:-{C �. .[..i.l�l�t Date 1 Gs..z ?
'al Test Pit No. 1.<..r :.__.minutes per inch Depth of Test Pit 1 T Depth to ground water/V0/
t �.
fit Test Pit No. 2 4-- minutes per inch Depth of Test Pit i1' Depth to ground water.i_ f� .L
:6_
O Description of Soil` # .5 0 S6.4 A NJ 7 F t ., 4 - Co" o `r'.
w ( '-1•L ' JALQ - E-_u ..... lv 0 4r - C '--i-" 7uP 4 U9
U Nature of Repairs or Alterations—Answer when applicable
I
e 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
POIre operation until a Certificate of Compliance has been ii ied,by the bRaa,rd ,' iealth.
E �`' ` - `/-�--
Application Approved By :.. .. ... . 7A 4 I'14 3-C
Date
Application Disapproved for the f olloun reason
�y D
Permit No C S�S Issued. ,l 02`.,
Date
logs /S �b'oli-1 (4-,e6 ' THE COMMONWEALTH OF MASSACHUSETTS
' CJ
IAT/v... ',ck-i� (_v-tirt 4' '
BOARD OF HEALTH
kirOF CCemC'b.i.//1
(ta QIrrtif irate of tlumptianrr
tvet
II IS TO CERTIFY, That the Individual Sewage Disposal System constructed V) or Repaired ( )
by.. . .�!J.... t
'4. $ )% */ _ '' Installer
at. 'J ( �14k' L.Fp�gl ., J. Oh-6
Mt has been installed in accordance with the provisions of T .,T 5 of The State Sanitary C. e„asilescribed in the
(. t4 application for Disposal Works Construction Permit No ` dated ` .P...3 .ue
it- Zi THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS NTEE THAT THE
s :t SYSTEM `� TIN SATISFACTORY. �,� %`