HomeMy WebLinkAboutDisposal Works Construction Permit 81-88 •
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Apvliratiun fur Disposal ' urks T nstrurtiun 4rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ($s) an Individual Sewage Disposal
System at:
�esa � „ef--4-.4...--, //...24.71e2s:2 </',44-0
t No.
Address
.wa iiti Gt_...._-...-__--...._-._
fastener Address
U Type of Building Size Lot Sq.feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
pas Other—Type of Building No. of persons Showers ( ) —Cafeteria ( )
0.. Other fixtures
d
Design Flow gallons per person per day. Total daily flow gallons.
W Septic Tank—Liquid capacity gallons Length Width Diameter Depth
x Disposal Trench—No. Width Total Length Total leaching area. 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
,aj Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
• Test Pit No.2 minutes per inch Depth of Test Pit- Depth to ground water
a
O Description of Soil
1
U
W
UNature of Repairs or Alteration —�1n wh pp' ble -- 7-U pi 7 _�
s.
Agreement:
The undersigned agrees to install the aforedescribed Indivia...t '-wage Disposal System in accordance with
operation until of Certificate o of the State Sani ary ode The unr ersi ed further agrees not to place the system in
op provisionsaf Compliance i , d by ;boa-.ofdrealth.
the Si - -..: 4 -=ut
Application Approved By...- -..(� 4- / /
Date
Application Disapproved for the foil 'ng reasons•
Date
Permit No _..._.__..___ Issued.
Date
1 \
No ✓ - FEE..../._.., '
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Appliration fur Digpagal Works Citultrurtion 1rrmit
Application is hereby made for a Permit to Construct ( ) or Repair (IS) an Individual Sewage Disposal
System at: I / , / / ;/ -7
Location-Address or Lot No.
`- 1 . -.- Address
41 \(
/j Installer Address
d Type of Building V Size Lot Sq. feet
U Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
b`'1-, Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
a Other fixtures
gallonsperpersonper day. Total dailyflow gallons.
W Design Flow
W Septic Tank—Liquid capacity gallons Length Width Diameter Depth
x Disposal Trench—No. Width Total Length Total leaching area 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
4 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
g
0 Description of Soil
U
UNature of Repairs or Alterations—Anfs�6vey wheal appl'1 ble r <' ... _.(.1 f-<� ( /.<< <<- `C ,'-
lam ," / L•L`
Agreement:
The undersigned agrees to install the aforedescribed IndividuafSewage Disposal System in accordance with
T r-1'•••
the provisions of TITLE L 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 r ,
Date
Application Approved By
- Date
Application Disapproved for the following reasons:
Date
Permit No Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOF
Trrtif tra .r of T.antplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (-r)
by .f- . ,..� J` /
/ �r / r Insta'er --,/
at - .
'
has been installed in accordance with the provisions of TIT ...,-Tr'' 5 of Tk State Sanitary Cc s des ibed in the
application for Disposal Works Construction Permit No 1l C�e dated /--:".,
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED ASA G ARANTLEE THAT THE
SYSTEM WILL UNCTION SATISFACTORY.
DATE 41-i- .- g! Inspector./:.. .