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HomeMy WebLinkAboutPermit 79-412 .xo vF�t f F.....12..__.___ - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF .ppl ration fur Eliiinsai IIc arks htnnstrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair (C.:‹rn Individual Sewage Disposal System at: s17_61 ,,,,st,r2- , '„vim:. -.. .c'*e- � , /� Lo ation-Address ,� / or Lm.Nam. 4 tsVOt !,//5ti/ �I�PvQ.I�7 Y. -e!uiQ..�'1.51..44fz �3!Rllt - .. at O• iZ. Owner W $r O UrZ Co. ,elrG- 4/,2E97 4 rxN Ad ry. • fro• �Y:�!j!9./.L.!'v(4SL -I Installer Address Type of Building cSYS 7e6-71' - y Size Lot Sq.feet U Dwelling—No. of Bedrooms , Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Buildin ela--DT--stFs-... No. of persons Z Showers ( ) —Cafeteria ( ) a Other fixtures-.�� •°.4/VeZeyt.. /Au•<•, / G9�, --/--/ ,2yow *X W s 4-fCst.. t!S Design Flow. ri[ t---gallons per person per day. "Total daily flow / .=+ gallons. W Septic Tank—Liquid capacit}' D .gallons Length Width r Diameter Depth z Disposal Trench—No. ,/ Width Z Y e Total Length .72r Total leaching area-Z.Z-SSo---sq.ft. • Seepage Pit No Diameter Depth below inlet Total leaching area. sq.ft. z Other Distribution box( ) Dosing tank( ) Percolation Test Results Performed by Date. "ij Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water ri, Test Pit No.2 minutes per inch Depth of Test Pit Depth to ground water 14 • Description of Soil J Nature of Repairs or Alterations—Answer when applicable.--/Q6j0‘,1-c s 4;?6,57/'V SST e hr-f4-.r7 FVtcz..:..7 s,424..eZ err-- -car #Pe---g-si Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed? /� �� m ]/ Date Application Approved By C --t--�• / +•- 2'�-�l/-u'�'D te Date Application Disapproved for the f owing reasons• Date Permit No _ Issued Date r . _ . .44t:111 •/• • . s"."-A r • • • - •.• • . -, , , • c f • 4••••• - • rNo� ? ~ ?( :2- FEEY , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Ap, tliratinn for i5pA al Works Tougtrurtion iirrmit Application is hereby made for a Permit to Construct ( ) or Repair (4.11-n Individual Sewage Disposal System at: ..). '.". ....:, lQ.e2:. 1_lf.e._Gl .._ ...7.2.c..) '.0 ,.fQ '0-'5/, Location-Address ,2 --' or Lot No. '' .,�7 Lw/ /'ikAa' 'f 7." 't /r. !✓' Dili ae. ., V Owner _ Addrogs W /rc2 '-7• --•j. c„I,G C o,y ill 4- 4,4 41- �. ,}.=- a.ma'si `',0 I /..�D11 yv/c d a PO Installer � Address Type of Building ti347"'5, 7"*.:"..." f7 Size Lot Sq. feet U Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( ) p`'�,, Other—Type of Buildin A- -?z=_s r No. of persons Za Showers ( ) — Cafeteria ( ) d Other fixture-•'. ,�;r a - ./u•`-'d.• / Q .<. , / c...r✓.p- 1 --/ „ :,a..v ,rr/1C W Design Flow.i.O. 4 --..o.x_k:' ___gallons per person per day. Total daily flow /`l7 ► gallons. W Septic Tank—Liquid capacity. �s_g_gallons Length Width Diameter Depth x Disposal Trench--No. / Width. :?A` --_-- Total Length ?-Y Total leaching area- Z_ _.sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by Date aTest Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water f=, Test Pit N3. 2 minutes per inch Depth of Test Pit Depth to ground water a O Description of Soil U W UNature of Repairs o: Alterations—Answer when applicable.-.."2.a", a 1 S r•'V Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT:.. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed Application Approved By 04 -Z9 ' ..-.. 7 p t,a/mate /j}�{aate Application Disapproved for the following reasons: Date Permit No Issued. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Trrtif iratr of flomiIiatnn 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 TITLE 5 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 TRUED AS A GUARAN THAT THE SYSTEM WILL FU CTI SATISFACTORY. '%� /? 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