HomeMy WebLinkAboutApp-Permit-ComplianceNo.138..??.v..v...... Fss....$....l 5...00....
THE COMMONWEALTH OFMAS ACHUSETTS
BOARD OF Z _T
..................Toxn-n----••...OF......Ya.r.mauth......-----------------...--------------.__...------------
Appliration for DisliniiFal Warks Tonstrurtion tirrutit
Application is hereby made for a Permit to Construct ( ) or Repair kXj an Individual Sewage Disposal
System at:
4 ... Svsnnaer Stxeet...... Yaxmauthpot. - r C� p"(=•'-• (.q! ----------------------------
Location
0! ----------------------------
Location - Address or Lot No.
Norton Nickerson
.............................................. -••-......_...-•-----------•••••--•---•-------•---•-•-•--•.........---•---•-----------------------
Owner Address
J.P.Macomber
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Installer
Type of Building
Dwelling X- No. of Bedrooms.......
Other —Type of Building ..........
Oth fi t
...2..........................Expansion Attic (
------------- No. of persons ----------------.----•-
Address
Size Lot ---------------------------- Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
erx ures-------------------------•----------------------------......------------------------•-•------------------------- -------------------------------------
Design Flow............................................gallons per person per day. Total daily flow -------------------------------------------- gallons.
Septic Tank — Liquid' capacity_..._._.._..gallons Length ................ Width ................ Diameter_________._..... Depth ................
Disposal Trench — No- -------- --------- Width .................... Total Length .................... Total leaching area ..___.----- ------sq. ft.
Seepage Pit No ..................... Diameter .................... Depth below inlet.................... Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by .......................................................................... Date ........................................
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 .__________.____._..__..
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Description of Soil ------------------------------- -S.a&d--- &--.Gr--4ue_I-------------------
-------------------- --------------------------------------------------------------- -----------------------------------------------------------------------------------------•--------•----------------
UNature of Repairs or Alterations — Answer when applicable ---------- ].-1.0.0.0 ... real-lon.._tank----------------------------------
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TTr1' -�
.�. ,�, 5 of the State Sanitary Code —The undersigned further,,iigrees not to place the system in
operation until a Certificate of Compliance has be n issue by he board of lth.
Signe------..1 - -----/ 8 8
Application Approved B .. • . ...................................•---•----•-------......•--•-....------•----•••.. ��
PP PP Y ----•-•--,F -
Date
Application Disapproved for the f ollo-#6ing reasons- --------------••--------------------------------------------------------------------••-----•--•--------•--------
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Permit Nols-1160 Issued
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Dat
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... ::.:....................... OF ................... "..............................................
jr
Qwrfifiratr of Toutpliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
--
_;_fiber
-
Installer
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at ................... ---- --=.---
has been installed in accordance with the provisions of TME > E 5 of The State Sanit y ode as, c be ' the
application for Disposal Works Construction Permit NMb- ..................... date ��� °ry`.°: `��'�It
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A ANTEE THAT THE
SYST WILL UN 1W
SAA ISFACTORY.
DATE._ ......................... %ry .�� p p -
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