HomeMy WebLinkAboutDisposal Works Construction Permit 88-108 NO.'W/.?t'.... FEE?l.41-
THE COMMONWEALTH OF MASSACH U SETTS
BOARD OF HEALTH
U Lo rl OF....'. .!I..
Applutt#inn for Disposal r r grits (11 n trurttnn Permit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System
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�.._ 't _ q a.� Lation•Address - _�/
v r'G .091" j At/
a °" ,vs- Co . 3 '44/lr4 m s �.cr`"'%z rn .D2473
Installer Address
Type of Building Size Lot Sq. feet
:., Dwelling—No. of Bedrooms -4- Expansion Attic ( ) Garbage Grinder ( )
a,, Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
WW Design Flow .5.5 gallons per person per day. Total daily flow 4 v .gallons.
a Septic Tank—Liquid capacity..[ 0 gallons Length.l U I�" Width..`?:E.'‘ Diameter Depth 4'O„
xDisposal Trench—No. i Width t 2--' Total Length._..3.C., ' Total leaching area `i .• - ..sq,-€t.4P0
Seepage Pit No Diameter Depth below inlet Total leaching area. sq. ft.
z Other Distribution box (X). Dosing tank ( )
Percolation Test Results Performed by 4 w ` `'6 --'2).ih C _ Date. 2- ( [-
a
,.1 Test Pit No. 1 •4 minutes per inch Depth of Test Pit...I.D Depth to ground water...``14 N
44 Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
a
0 Description of Soil >r \Ct r7
W
UNature of Repairs or Alterations—Answer when applicable. s, `'444
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Complia s - 0,. ' by th and of heal
� � � • „ , 4:1„..,. 0 v
Application Approved By !' , • - 0�)
Dace
Application Disapproved for the following reasons:
' ` lq_•— Date
Permit No.t. Q..$ .....�. Issuira q(4! ............
Date
•
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a
„.' ••-y,eA ( al
THE COMMONWEALTH OF MASSACHUSETTS i
BOARD OF HEALTH
O (On OF 1).f.? P.dadr :J. ,
. pplirutiun fur fliupuutti Narks (tunnfirurtiun Pruitt w
Appgcation is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System sr
* 4 Wi IduaocA P4i1N 1,0.�1f±Kno;aTi— 4► V 7 6r•�44ntin i 0a673
Location-Address -- .:.
1 ...- .,f,:�°” ,s
6k2^ (,,, ....._.... 3 V 4/.;//il rag,, ir °" r9 /??itiA 024'"?"'
Installer •• Address a
Type of Building Size Lot------....-_..__- Sq. feet
...
p'' DweEng—No. of Bedrooms _.._. ,,_ Expansion Attic ( ) Garbage Grinder ( )
y Other—Type of Building l4o. of persons Showers ( ) — Cafeteria ( )
pd! Other fixtures
Design Flow 55 gallons per person per day: Total daily flow '4 4 C) .gallons.
Septic Ta11k—Liquid capacity.��`QQ.gallons Length_l S?.�sr" Width.5� ' Diameter Depth__-4'0 r
Disposal '!rench—No. L Width 17-' Total Length__.3Ld Total leaching area_5:2S..?.__..aq,ft.6t PO
Seepage Pit No Diameter Depth below inlet Total leaching area. sq ft.
z Other Distribution box (X) ' Dosing tank ( )
'"' Percolatioit Test Results Performed by._.-1-0L0 s L)Et 12,,P*V..:_..............._....... Dam_-. z_!.-E
a Test Pit No. 1_.‹.:Ze- minutes per inch Depth of Test Pit.._1_ " Depth to ground water.___`3.4
Test Pit No. 2 _minutes per inch Depth of Test Pit Depth to ground water
04
O Description of Soil ....�.?►Cl,:l.) r._.. ....._...._...............�...._.............s....-.
...
6 Nature of Repairs or Alterations-Answer when applicable.... ''.. " sf'? 61 ..-......-�-_-
Agreement: ..
The umlersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation u»ktil a Certificate of Compliagc - 'ss by thed of heal -
1 Application Approved By..--'_'� .s-.... :" ...- /i ... -/ _t A ed
Application Disapproved for the following reasons: ......
Permit No.1311...e.. ........ Is Duerr . /9 Hate
Date
NEEDS 45--Buit i (,441) THE COMMONWEALTH OF MASSACHUSETTS
{
BOARD OF HEALTH
1:(;A,) OF \•' EAVA
ferrtifirldr of Quut rliunn
HI IS TO CEJITIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (c)
by, t.5.hi 'I T-t1f.S -§.Zeli ron) ._...... ....................... ............_..................._....___
atsta.I..2.11..161-.0.14‘20..61//1,...Vika_Ya4417.1/Taner.
has been installed in accordance with the provisions of T- LE f The State Sanitary code d • 3n the
application for Disposal Works Construction Permit No.U_.___�Q4 dat �G7t.
TN ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A THAT THE
SYS NIL FUNCTION SATISFACTORY.
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