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HomeMy WebLinkAbout0071 JACKSON AVENUE - Health 71 `Jackson Ave -• Centerville { A = 226— 128 - 004 M F a�G ~ 177 Nol:3 .4i®.... Fizs...el'�.................. y THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............OF........................................--•-----------------------------------.......... Appliration for lhopviia1 Works Tomitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........ ...........).-;tL,.. .-$.ct-r-.-2.......A.a.,----- --------------------- . -------------------------------------------------------- Lo ation-Address or Lot No. Owner �J Address a ... �1 ..__../�� 1.1!�..---- �at."A�,'QF'' �. ............ Installer Address Type of Building Size Lot...fe�J. "c �9!._..Sq. feet U Dwelling—No. of Bedrooms.............. ...... Garbage Grinder ( )Expansion Attic ( ) a Other—Type of Building ............................ No. of persons...........-3_.____.___ (a) — ( ) Showers Cafeteria a Other fixtures ................................................. W Design Flow..........::.3..�2...0.._..........__gallons per person per day. Total daily flow.._......5.-?.....................gallons. WSeptic Tank—Liquid capacity_t.........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........................................ aTest 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 ....................................---••----••••••••••-----••-•--•••-••-••-••••------•-----------.......................................................... 0 Description of Soil..............................................--•--•------------------------------------------------------------......-•••••••----••••••......••--••......---....._.. x V •--•--•-•-•-••••--•-••-•-•••••••-•••--•-....•----•-••••-•-••-••.....--••-•--••••-••--•---------------•-•••••-•-•-•-•-•-•••............•--•---•-•-•-•--................................................. --------------------•-----------------------------------------------------------------•----------------------------------------...--------------------------------------------•--•............-----••-- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLh: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed by the bo d of he;althh..' Sig 1 —....,s �--•-•-•-- ApplicationApproved By -•-• ... ----------------------•-------------------...........•-••-••----•-•--•-. --- Date Application Disapproved or he following reasons: =------------------------------------------------------- -----------------------------------•-•---•----------------------------------------------.----------•-------•••--•-•--••---......---•---- -•--•-•-••----•-----•••--••-...........•---••---------------- Date PermitNo.......................................:__ Issued........................................................ Date LOCATION SEWAGE PERMIT NO. �. 2-b ZAc.icSOA) AVar 12. -- 2.9's' VILLAGE ady INSTALLER'S NAME i ADDRESS l al t. e S U I L D E R OR OWNER D# T;E.. PERMIT ISSUED ,7/GJ�Y DATE COMPLIANCE ISSUED �$� � Y �� ^ �� �� �.�i ._._. _ J � c�-�su � �Vu� �.,.�- I _ ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby ouuie for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: L ation-Address or Lot No. owner Address Type ofBuilding Size _' feetDwelling- No. of Bedrooms - GarbageCriuderZ ( ) Other—Type of Building ............................ No. of persons............'2�........... Sbo~cco Cafeteria ( ) {Jt6cr fixtures .--'---_-----.-'------___.---------.._---.------------_____________.. ` Design Flow.----- 0..............gallons per person per day. Total daily flow......... .................... . Septic Tank—Liquid* -/.--'.gallons Length-....---' Width----- Diamctez------- I)eot6------' Disposal Trench--�No. ---_-----' V��±h-'_----_- Iotu I-cogtb--..------' Iotu leaching area....................mq. f/. Seepage Pit DJo-------. Diaozetec.----..-.. Depth b6m° inlet--------- Iotu leaching uco�--------sq. f t. �� � C�6�rD�o��bo600�u� ( ) Dosing tank ( ) � ~~ Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. l................minutexperinc6 Depth of Test Pit.................... Depth to ground water--.--.--_. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth toground wutec-.----..--.. _- --'_.'---_--'.--__.-_--_----__---.----'---'-----------------'---'---'--_. � 0 Description of Soil....................................................................................................................................................................... ....................................................................................................................................................................................................... � �ii --'-_-----.---_.-_----_-.-_.------__-_._-----_----_-'---'_---'—.--_-'-------' U Nature of Repairs or Alterations--Answer when applicable............................................................................................... | ---'--'----'--------'-'—'''-'----'-----'-----'------------'--''-------'----'--''--'------- � | Agreement: � The undersigned agrees to install the afo/edevcribc6 Individual Sewage Disposal System ioaccordance with � the provisionsofTIT LE 5of the State Sanitary Code-- The undersigned further agrees not to place the system io operation until a Certificate of Complianc has been iss,"e'd by the boa of health. Date Sign . .......W"�a�e...000"el/il Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD� OF HEALTH ,_�,CERTIF'V, Thaethe Individual Sewage Disposal System constructed -eT or Repaired Installer ribed in the has been installe9n-grcddance with the provisions of TITL� 5 of The State Sanitary Coduas cr THE ISSU ��OF THIS CERTIFICATE SHALL NOT BE CONSTRU D A GUARANTEE THAT THE SYSTEM �W�L FACTION SATISFACTORY. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ee%�...... 9..... -_ __- �Z 'e, 0� Street as shown on the application for Disp, WA 0 s Construction Permit Nolfln_­ .,.... ated... ........ Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS � � U Q N Ot a00 Co 23.5 52' 2 N PR o PO`j[Q i 3P.7svKoom 1 N BAR ® 2 IKA 24' ! 10'4"5o«v� I � Q�;. �t I . lb 02 qDK TCR tj L �C �O II�� I✓' G LET LJC tom"' � (`✓�T"S�"j . ►J C�R A.5,40t ►) G k� `/1J��� .:^t �:.. :;.:4t .Fd ,.f -h# � ¢ a6Ayt er` `,Y<k '.t}.1.� ��i 1 '�`•-�r � �'���f���� • s a • tr t.a�try t �+s i �,e �� � � [, � � y �f. ti It �' Y 1 •A[.rY ;�`t LL Y.,� •' l M '.asl� �1' 4,r t 7 2 P r oil A � '�' .Fr ♦tpr. 'Y .F {i.• J eTrl � M • di tee/ !f . far. Per CVA 3 = ---"�--Z s «t� „`""_""t�4'` c�► ;;�►�t`ttn� ' "-t ,,' icy k Veto a A4'51 K t ' • t ► i ! 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Sz r r IZ L4 Z3.y V Z r-°` _ QD 0 � s 9L 4 9o.S LAWRENCE E. HUGHES , REGISTERED LAND SURVEYOR 56 MAIN STREET.. REAR 747-0232 KING�TON. MA. 02-lt64 `iM� r � 'yy f' VW � , FEs....ear....'................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -------------7------------------- Applira#ion for Disposal Works Tons rnrtinn Prrutit l Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: • f.:_ ....._ s: � �/04•� z....... ✓-`s _ f�c? �JC............... ...-Address /� or ILyyt No. �i<f x. �. ................................... y...l .�l'Q .Win......rp T l J..���,/c,�._ tom: ner / Address . Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..........__ .Expansion Attic ( Garbage Grinder ( ) Other—TYPe of Building ------------•---•------..... No. of persons......._ 7............... Showers (Z) — Cafeteria ( ) Otherfixtures ----------------------------------------------------------------------------------------- -------------- W Design Flow............................................gallons per person per day. Total daily flow..��-.+ .._.__. . gallons. 9 Septic Tank—Liquid capacity,/000.gallons Length................ Width................ Diameter________-____- Depth................ W Disposal Trench—No. .................... Width......._............ Total Length.................... Total leaching area.........._ ......sq. ft. x Seepage Pit No------- ........ Diameter..._46_ Depth below inlet.................... Total leaching are Zsq. ft. Z Other Distribution box ( ) Dosing to k ) '-' Percolation Test Results Performed b � /� _J40 Date.../� --y.. , ---------------- ,/-------,/----- a Test Pit No.j/exe......minutes per inch Depth of Test Pit........ _ Depth to ground water' y�� f= Test Pit No. 2 ....._..minutes per inch Depth of Test Pit.................... Depth to ground water. ....... P-B. ------------------------------ O Description of Soil.......S- ........ n SK.`-`--�--•---•-------------------------------------•----------------------•-•----.----------- U -----•---••----•••••-••--------------------•--------•--------•----•---•-------•-----•..........•-•••--•-••--•--••-------------•-------•---••--------•--•------•---••---------------•-------------------- W -----------------------•--...------•-•-•----••-----------------•---•---.----•-------•--------------------••-••----------------......-•----•------••-•-•-•-•----........------•-••------.....------..... U Nature of Repairs or Alterations—Answer when applicable--------------------------------................................................................. ------------------------------------------------•-----------------------------------.........................------------------------------------------------------------------------...._..........---- 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 Compliance has been i d by the oard of heal Signed _.... ------- - -------------•-•-•--•-- Cr ..... .--- ......� mate Application Approved By......................... . •..... I..--.� -------------------- -------- ......... ate Application Disapproved for the following reasons:................................................................................................................ -•----.....-•-----------------•••--------------•------•---------------•-•....----------------•-----------•-------------•--•-•-•----------••-•---•---------•---••-•••-•---•--•-••---•---•---••-----._.... Date PermitNo........................'-------------------------------- Issued....................................................... Date Fics..... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................ .....:............OF........................................ Appliration for Uiopu,aal Worka Tonitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address �t or Lot.N , ,e Owner / Address r� W Installer Address Q Type=of Building �f Size Lot............................Sq. feet Dwelling—No. of Bedrooms.:........7----------------------------Expansion Attic (t..) Garbage Grinder ( ) a`4 Other—T ype of Buildin g ____________________________ No. of persons............................ Showers Cafeteria ( ) QOther fixtures -------------------------------------------------------••••---------------•••-•--•-..... W Design Flow............................................gallons per person per day. Total daily flow__._.- -----0...................gallons. WSeptic Tank—Liquid capacity./OeQ.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_ kiW...sq. ft. Z Other Distribution box ( ) Dosing tan ( ) a Percolation Test Res test yy Performed by....... �..41; Sete. �..-_ .... .............. Date..��ater ...� __, , a Test Pit No. 1 .......7.rhmutes per inch Depth of Test Pit..............�Depth to ground .__...._�_-. L ri Test Pit No. 21......_....minutes per inch Depth of Test Pit.................... Depth to ground water...... ;�(.�-... ------------------------------------------------------------------------------------------------ -•------------•----•----•-------------------------------- O Description of Soil .f ... �► ` •t•yr-------------------------------------------------------------------------------------------------- x V .....--••------•..............•-•-•-----...-••••-------•--------•---•••-•--••-------•.....------•--••------•----------•-----••-•-----••-----•---••-------•-••••--•••---•-•---------••-••••------•-------- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•------------------------------•---------------•-------............---------...._..----............---•---••••-------.-••-•---•-•------------••----•---------•-•---•----•----------•-•-••---•-•--•.--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by the board of health. 0100, Signe •--- -• --- _:. ._.... Application Approved By---•-•----•--•------•-- . ".._. _ ----...................... ............. Ye ...._.. ate Application Disapproved for the following reasons-----------------------------•------------------------------------------------------------------•---•--.......... ....................••----.................--•--------------•------------••------•--.....--•---•----------••-•----•-•-•-•-------------•--•-•-••----•••-----•--------•......---------•••-----------•-•--- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... C9rrtifiratr of Tomphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby ( ) ------------ --•--- .- ----------------------- ----------•----------.------------------ Installer 40 .................................... ------------------------------- has been installed in accord e 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 SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT SF , 'TO Y. _... DATE.............---.,......-•--------•-•--.........1 /. Inspector...-•---- .. l............................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF...................................................................................... No .171'.Tsr FEE.�&............. Disposal lgorkii Tonotr ion rrmi# Permissionis hereby granted.............................................................................................................................................. to Construct ( or Repair ) andividual Sewage Disposal System i at No........-•014� --- t Street as shown on the application for Disposal Works Construction Permit No...................# Dated.......................................... 1 ..................... OPoard of Health DATE------------------------•---------••---•-��6/A.................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i �QE:A 1 I , 4-1 S, F� LC o L ::DT 27 o Z^7 _CA qj v14 -�r �. + N 37t `m� 1N� c I x'El' l LEACH I I�b p/FIELD- iocl� su � � �:�► �sr � �, � of kILI z Mi,°u 1 o' loop-6AL `p E SLpTiC:Tpd,rtlL .. 21 41 • ��. N �.eoX'I, q'XIo% ion i Lgq[H.1 i.16 M �J PIT N /71 LET .LEGEND : MISTING ELEVATION OsO F^+� CERTIFIED PLOT PLAN EXIST/NA CONTOUR —_— 0 �s```P ss'oy L0T o ALBE,RT. jj/c s T AI X!IlAll-'Fc iz T _ 0401SMED' SPOT ELEVATION _ `f'IMlBNED CONTOUR ---- 0---- � o "' A OVED�,BOARD Of HEALTH ��O 10951�p�4 I N 0 GISTS �FSS/ONAL E��\ DATE AGENT SCALES ; _ � DATE E0Q ENQ/NEEM NQ CQ fftc `� �'s CLIENT:.;_.._....., i CERTIFY THAT THE PROPOSED EGtSTE RE81STLw1'ED JOB N0. BUILDING SHOWN ON THIS PLAN CLViL LAND ONFORMS TO THE tONINA LAWS 0 V OR.BY� OF sARNSTAd !�tmASS. 712 MAI 4 STREET, CM. By C4 � HYANN.IS,, .MAS3. 2 O6e" SMEET...1..Of DATE R G. LAND SURVEYOR IV0TF /F E/TNER THE SEPT/C TA.4/•,� OR20 FT. M/N. �_EACN/wG P/T AA-6 /YORE T AA1 /2"SELOW !O R7, MIS/• �RAOE� f1 24�®/AM ETER CONG'R.ET� COYE.P SNALL BE 9ROUGNT TO 4,TA /✓ EXTRA CO/VCRLTE 4'PNC O/PE 1,6,4VY CAST /RO/Y C0{/ER SElO PERT r /F/N L7R/VEJ4 A Y =: - 2' MAN. CONCRETE co ✓ER C L EAN .SA/V O • BACJL�ILL L/Q[l/D LEVEL t A Z L E Y_ 4 /ROJV PT �t�©.O . o o � �v or MJN.P/TCN D/SF, o WASHED 5701YE .� V4 Pt/s J•'7 SEPT/C TAAIX BaX , s • • • • • • • ?ir,. ., �•° • • •EFFECT/t,'C ' ' . •• 314 e • • i7EpTH • • • ; o o WASHED STONE AP i 3 14 3 G P i a. •. i • • • • • • • • p v PRECAS T SEEPACIE'. 125.E • • • a o P/7 OR ZVL//V_ !NlieR'r L:'L EV�1T/ONs -78.5 x 1.o = 8.S a p . a EL= '94,0 /NYERT AT LTL/ll-DIMCY 99.0 FT. ! T.4 K 48.S FT P rc�PAe rr l 391.8 GAD t o F7. P JM. C(SEB T�tBUL�1 TJ oiv� /NLET "PT IC N OUTLET SEPTIC TANK 98.Co F /NLET D/57RIASIMON BOX 98.4 FT. SECT/ON OF GROUND WATER 7AOZ-E oa7z erDJSTR/BIJr/ON BOX 95 .2 //VL,ET LEACHING P/T 9e.0 Fr. SEWAGE OISPOSAL SYSTEM LEACHI"Cw P/T 7ABULATlDN SCALE % _ /= D' DJMENS/ON A 2 S FT DESIGN CRITERIA 8 4 FT. NL/MLtrER Of L>rEOR04MS 3 D/MENS/ON C 4 FT. Ntt�l GARQAGED/SPOSAL UiV/r NO►JE SOIL LOG SO/L TEST raTAL E.?T//$,crEG FLOW 3340 G.4L.IDAV SO/L TEST 01 SOIL 7L=S7'*2 A(UMBER OF LEACN/NCr P/TS 1 fe[EY. I00•2 rELEY. DATE OF SOIL TEST t1a�/ 25, t`j81 ,V SlOELEAGHING PER P/T 1257 SQ. PT. LAM ITESULTS i•V/T/VESSED BY JBE-IGIFRD�D _ 90TTO1w La4CH/NG PER P/T 15•5 $Q. PT. o-2 S,�a�iL PERCOLAT/ON DATE At I LE=-�S M//V//IVCH TOTAL LEACHING AREA 3 8.2 SQ. FT, FWVCOLA77/pN RATE/bb2 1��N MJN.�INGN -- ` RESERVEGEACNING AREAS 2 -12 OF IH OF M.4ss9°ti ( AV= oa GN �o LBER7 YeL.�ow Tm l-G�/�til�i ISPe't_T � N U , yr � EL 9G 2W4 �No.1095�0� SA C� EL DREDGE ENGINEER/NG GO,/NG. b 9 6lST� 1 N �yo� o�Frs/ONAI-� •o EL gg.2 7/2 MAIN sr. , HYANN/S, MASS. [] NoGROUNv yY,4TER ENG'ouwrE.eEo CL/ENT:&ItctooLAS DRTE 7.82 h GM UV O PVATER AT ELEI/. 90.Q JOB ND: 0121 I SHEET�OF 2 r w Health Complaints 27Sep-99 Time: 10:00:00 AM Date: 8/23/99 Complaint Number: 2031 Referred To: GLEN HARRINGTON Taken By: LS Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 71 Street: JACKSON AVE. Village: HYANNIS Assessors Map_Parcel: Complaint Description: RENTING THIS IN-LAW APARTMENT FOR THE WEEK. THERE ARE NUMEROUS PROBLEMS. THE SMOKE DETECTOR IS HANGING FROM A NAIL, THERE ARE EXPOSED WIRES IN THE HALLWAY, IT IS GENERALLY DIRTY WITH RUSTY STAPLES IN THE LINOLEUM, OLD SOAP AND SOAP SCUM IN BATHROOM, OPEN POWDERED BLEACH LEFT OUT IN THE OPEN, MOLDING ON THE DOOR HANGING, AND WHITE TWINE LEFT THERE SO SOMEONE COULD GET TANGLED IN IT, RUG FRAYED AND PIECED TOGETHER CAUSING A TRIP HAZARD, MASTER BEDROOM HAS PLASTER FALLING OFF THE WALL. THE OWNER IS MR. WILKUM WHO OWNS THE PROPERTY AND LIVES IN THE MAIN HOUSE. SHE WANTED HER MONEY BACK AND SAID SHE WAS LEAVING. SHE GAVE THE KEY BACK TO HIM. SHE WILL CALL YOU FOR AN APPT., BUT DOESN'T KNOW IF SHE CAN GET KEY BACK. Actions Taken/Results: GH - I went to property to meet Ms. Perdios to do Housing inspection. She spoke to the owner from the fence out front along Jackson • 1 Health Complaints 27-Sep-99 Ave. She asked the owner for the key back. He said that she had given it back to him and to get out of here. I was standing next to Ms. Perdios when he was yelling The owner then closed other gate to property. I could not gain access to the property as I need permission from the owner or the tenant. The tenant did not have the key and the owner would not allow Ms. Perdios on the property. Investigation Date: 8/24/99 Investigation Time: 9:30:00 AM 2 Health Complaints 23-Aug-99 Time: 10:00:00 AM Date: 8/23/99 Complaint Number: 2031 Referred To: GLEN HARRINGTON Taken By: LS Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 71 Street: JACKSON AVE. Village: HYANNIS Assessors Map-Parcel: Complaint Description: RENTING THIS IN-LAW APARTMENT FOR THE WEEK. THERE ARE NUMEROUS PROBLEMS. THE SMOKE DETECTOR IS HANGING FROM A NAIL, THERE ARE EXPOSED WIRES IN THE HALLWAY, IT IS GENERALLY DIRTY WITH RUSTY STAPLES IN THE LINOLEUM, OLD SOAP AND SOAP SCUM IN BATHROOM, OPEN POWDERED BLEACH LEFT OUT IN THE OPEN, MOLDING ON THE DOOR HANGING, AND WHITE TWINE LEFT THERE SO SOMEONE COULD TANGLED IN IT, RUG FRAYED AND PIECED TOGETHER CAUSING A TRIP HAZARD, MASTER BEDROOM HAS PLASTER FALLING OF THE WALL. THE OWNER IS MR. WILKUM WHO OWNS THE PROPERTY AND LIVES IN THE MAIN HOUSE. SHE WANTED HER MONEY BACK AND SAID SHE WAS LEAVING. SHE GAVE THE KEY BACK TO HIM. SHE WILL CALL YOU FOR AN APPT., BUT DOESN'T KNOW IF SHE CAN GET KEY BACK. q e 3 0 ( J�z ylgJ Actions Taken/Results: 1 � 9' q ) I Lo N �-P-- SEWAGE PERMIT NO. VILLAGE INSTAL ER'S NAME i ADDRESS FYI o , B U I L D E R OR OWN ER Ld Rt I—ViChol -ts DATE PERMIT ISSUED ? J . DATE COMPLIANCE ISSUED 1 ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALrTH . ........ . ... . .......*...... F........ .............. ........................... Apphration for 11isposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at, K, r ..... ... Loca 6P 0 ...............4 Fn-.-T�;re to-do . .......... ....J:Z .... ..... . .......... ......... .... Qwner Address .......................................................................... Address Type of Building Size Lot.... Sq. feet U Dwelling—No. of Bedrooms......... ........................Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures ...................................................................................................................................................... �4 Design Flow........;-`.e<L9Aa.................gallons per person per day. Total daily flow...........................................gallons. W 9 Septic Tank—Liquid capacity./6_6�gallons Length................ Width................ Diameter------------_- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area..-Z._.C,_jG'__sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I----------------minutesperinch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ................................................................................................................ 1'�-—------------------------ 0 Description of Soil.......................... ....... .........../................ W r M.../;. _4 Z .......=................... ..............................................% U ................................... ....... .................................................... --------------------------------------------------------------------------------------------------------------- ................ ...... ............V.. ... —Ans er. when applicable------ ... . ........ ---- --- U Nature of Repairs or Alterations )y .;rtKo"IV d - - - - ......... ..... ... ..................................... Agreement: f The undersigned agrees to install the aforedescribed Individual Sewage ystem in accordance with the provisions of TL Ili LE 5 of the State Sanitary Code— The undersigned further�grees not to place the system in operation until a Certificate of Compliance has>been issue the boardof7licalth. Signed.......... ...... .... .....�_;1.07Z4-------- ...... ----------- .... ApplicationApproved By............................... ............................................................... ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo......................................................... IssuedL....................................................... Date —------------- J , No- '.Z. ---- Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH 411-� Applirttiion for Disposal Works T ttrtion Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 09..�:g................................................................... ` 4..... -�.. 7.. Location-Addr Lot N Of IT ner W ress .....' C'if S00 .A..--••----•--••---- ------•---•-•--•-------•-•-•.................. taller Address d Type of Building Size Lot.._lr�__G._....Sq. feet aDwelling—No. of Bedrooms.._...•..........................Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ----------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ...--•------------=----------------- -------••------'-••--------•--------.-.------------------------.-._____-•----•----_....._..._.. .............. W Design Flow.......�G�. SJt_____'______-.;"gallons per person per day. Total daily flow..................:.........................gallons. WSeptic Tank—Liquid capacity]-OQf 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 ( ) aPercolation Test Results Performed by................................................................--------- Date........................................ a Test Pit No. 1................minutes per Bch De i of Test'Pit____________________ Depth to ground water........................ 44 Test Pit No. 2.._.._ .. mifiutes5p �mc D of Test Pit.................... Depth to ground water.................... -•--. t� k,.....................•--...-------._......-------•-----•------------...---•-•-----•-----•---....-- Description of Soil..... !........--------- _:.. U . --------- ��•At. =---�--/-•-------------•--------••-•------•------------•--------•-••---...•-•---•--•-....--•••---•----- W x ------------------------- U Nature of Repairs or Alterations—Ans er when applicable ��!'ira'�___..._�___. .� .. 6 .e , ram - .......Q• ' �'"°' ------- -mod'"-�- „ "----- - ,cry.*...... a Agreement: e Jr 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 ggrees not to place the system in operation until a Certificate of Compliance has been issue the boar health. Signed. --•.. •--- :.: .__ ............ .. .._' .. ,✓ Date ApplicationApproved By--••-•-••••---•••--..._..•-•- ----•___-_--•---------•--•----•---_------ -•-----•------•--- -----------•--___-- Date Application Disapproved for the following reasons--------------------------------•----•------------------•------•----------------•----------...•••--••....._._...: . . 1 .................................•----•-----•-----•------------------•-•--------••-------....-----•-------••--•••--•-....-•-••- ............................................................ Date '.. PermitNo......................................................... Issued-------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF (Irtifiratr of Toutpliattrr THIS, TO CE IFY, That the Individual Sewage Disposal System constructed (-—p o'r` Repaired ( ) fl by-------- �✓t �.:r ....---•---------•-•..............................•-•-----•--------------- at A ,r 't V :- '. „......--•••••---.Installer...............••-•-••....•••-•---•••-••-•---•------•--•••••••......•--•••.........•--••••... 5�� has been installed in ccordance with the provisions of T TLF 5 of The State Sanitary Code as described in the application for Dis sal Works Construction Permit No.__.71 .1:i -Jr-i!7�............... dated................................................ THE NICE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WJLLf UNCTION SATISFACTORY. .� � DATE._... Inspector....-- ---• ••-•-••....-•--•••--••---•-------••--••----....-••••-----••-•-••_•.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l / .............................OF...................................................... , D No. -... :.._..�..... FEE........................ Disposal ork Cron wioat lkwit Permission is re'by gran d � ,. _ ......... _-• .1�.. �� '.......................... to Construct or\Repair ( n�Indiv ual S ., e Disposal System atNo .. --•---•-••-----------••--•-•---- -------•---------------------------------------____----•-- Street as shown on the application for Di posal Works Construction Permit N ..!.............. Dated.......................................... ..................... . "==`=-----------------............................................. Board of Health DATE............................................................................... FORM 1255 A. M. SULKIN, INC., BOSTON