HomeMy WebLinkAboutHealth Permit # 5/16/1994 P
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No......................... FEE..............................
THE COMMONWEALTH OF MASSACHUSETTS
�//BOARD OF HEALTH.........rOW l.�..............OF........!..1(.V � ...C9I`!.!JD...U.d� ........................
Appliratillit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
( U P a pgl. ............. ........................71...�i.� (! .Dh. ...l....1 I�.IJ..
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1.No
................ ...
....................IVA6CAl � A .l ......
Owner Address
W .................................................................................................. ..................................................................................................
a Installer Address
Type of Building Size Lot.. 1..J�..68...Sq. feet
Dwelling-- No, of Berlrooms_.........................................Expansion Attic ( ) Garbage Grinder ( )
pit Other—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures ............................... .....................................................:................................................................
W Design Flow................8?1.1.5...............gallons per person ppr day. Total daily flow................34 ...............gallon.
Septic 'Tank--- L.iyuid capacity/5'Ugatlluns Ijength.110.°.6..-. Width.6..—i.8.. . Diameter................ Depth...5'.6...
x Disposal . F/. . ..... Width..- .......... 'Total Length......36........ Total leaching area.....'Y®C)......sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq.- ft.
Z Other Distribution box OC ) Dosing tank ( ) A
~' Percolation Test Results Performed b G1'� IST� ) 5 / .yL.S R.C� /�G�... Date.41716. ? �(. !.q(o..It
�1 Test Pit No. 1..... .......minutes per inch Depth of Test Pit......7�... Depth to ground water......®..
(s Test Pit No. 2......Z .....minutes per Inch Depth of Test Pit......�'�."...... Depth to ground water......®... ........
i1......................................................................................:......................................................
o Description of Soil.......
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� ..................................... ..............................._............_..........................................................----...------.......
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UNature of Repairs or Alterations—Answer when applicable................................................................................................
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Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of;I'i UE 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...................................................................................... ................................
Date
ApplicationApproved By.................................................................................................. ........................................
Date
Application Disapproved for the f ollozuing reasons:................................................................................................................
............:............................................................................................................................................................................................
Date
PermitNo......................................................... Issued........................---.................------......
Date
Town of North Andover, Massachusetts Form N°.3
f t20RTH BOARD OF HEALTH
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Ar DISPOSAL WORKS CONSTRUCTION PERMIT
39SSACHUS��
Applicant ��fo V 'i
NAME ADDRESS TELEPHONE
Site Location
Permission is hereby granted to Construc✓' or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRNTAN,BOARD OF HEALTH
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Fee D.W.C. No.