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HomeMy WebLinkAbout0040 LAKEVIEW AVENUE - Health (2) s(,tt Ct^�'trvi�l� 1 r ,. ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........................... .............OF.............................. ..... Apphratioo for Diopoottl Works 000 r r ion �eruti# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Syst at: /..?-•1 ..., vim -N� r G c` ..... ................................... Location-Address - or Lot No. --............. .....w.._ ._................................... .......................................... �• Owner Address aIJ�/Lll�! .----:..-•---•......................................"'---... ....................................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........� ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ------•-•------•------------ P ( ) — Cafeteria ( ) Otherfixtures -•-••-•--•---•--•-•-----•--••----•-••-••---••--•-••---.........----•-•-••••......••---------------••••-•----------------.....---------..........----- W Design Flow............................................J` gallons per person per day. Total daily`flow.......... ..........gallons. WSeptic Tank—Liquid capacit a.gallons Length___.._�`�......._ Width......,_/_ _- Diameter________________ Depth..lf��.__.. x Disposal Trench—No..................... Width............ Total Length...... ..__._. ... Total leaching area....................sq. ft. Seepage Pit No......f..____.... Diameter.. dt. .. Depth below inlet.��.�....... Total leaching area.z ..s ft. Z Other Distribution box ( �}/' Dosing tank ) �k ^�/ �� a Percolation Test Results Performed by--- Percolation -.._. r L= ....................... Date d__z ftY -......... Test Pit No. 1- ..minutes per inch Depth of Test Pit_.13 t-..___ Depth to groun water_. ' Cam_. f14 Test Pit No. 2..'5:. -_..minutes per inch Depth of Test Pit.l3:;L 4... Depth to ground water.........a±........... P4 ....................................................:••-----------------------------------------' ---------------------------------------------- x Description of Soil.._..._ ...._. �t .. C-'R^ c.� -----•-••-••--••--•---•-•---••--••••--------••-•-•...--•••••--.....-••-•----------•••--•------•-•-•-------•••--•---•-•-----•-----••--•-'••-••••'--••-••--•------------------'-'------------•-•---•.... W VNature 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 iI'I U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianncce has been ' e 1 y he board Jlgn ---- ---- ...... ....... ... i--- ....... ------•---•. .... ......................... ApplicationApproved BY------- ----•-•• ------------------ ------------------------------------------'--.._..-- .... .•�---. .................. Date Application Disapproved or t e following reasons:..................................................................................•---•-----.................._ '-------------•-----.......'•----------------------•-----------------------------------......------....--------------------------------•-------....-•-••----•••--•--•-•-............................... Date PermitNo......................................................... Issued_....................................................... Date t y/ Nof3 -•----- FEW............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...----.._....__....._..................O F.........................................--------------•-------•-......._................. Appliration for Disposal Works Tomtrurtion Prrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal . System at: -� --...--•--......... ...-•-••----•-- • . ..................................................... ...........................•-•••••........ Location-Address or Lot No. ........... .............'Owner------•-•--•--_.................-•^..... ...........---.............••••............Address .........-•••-••••••..................--- ... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..........t. ...•..........._ .Expansion Attic ( ) Garbage Grinder ( ) ............... No. of ersons.....__.._........_..__.___. Showers — Cafeteria Other—Type of Building _____________ p ( ) ( ) QI Other fixtures -------------------------------- .... Design Flow...........�_"...........................gallons per person per day. Total daily flow__._......._........_.......�'..........gallons. WSeptic Tank—Liquid capacity .gallons Length_____ ....... Width.....y..__. Diameter................ Depth_.`/._........ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./---------- Diameter... Depth below inlet.!':-`?._ Total leaching area..? 'A..F_-t...sq. ft. Z Other Distribution box Dosing tank (_ ) `''' S � Vy �' - �" Percolation Test Results Performed r_...'..! ._:._. !t` .%j' 'f-_._F................. Date'.' `' ................ ,4 Test Pit No. 1::!fS�:�..minutes per inch Depth of Test Pit_ :.....__.... Depth to ground water..-__:e?.:� ..._.. Test Pit No. 2.__ ......._..minutes per inch Depth of Test Pit_ :.z......_.. Depth to ground water---------i_------------ Q+' ..........---------•••-......•--• --••-•---••-••--•-•-•--------------•••••---•-•-----------------------...---•-•---•--...........................-•.....--•- D Description of Soil........ ------ `I _r i 7........ -`- -=-'- ' xr • -••-•----••-•---•••--•••-•-••••-••-•-•---•------••..............•- 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 TITIE 5 of the State Sanitary Code—The undersigned further a rees not to place the system in operation until a Certificate of Compliance has been y.he board 4f t Sign. ........... .. . .. Application Approved BY = ..............:....................•--------..............-••._..... r- ...4�4 Dat ............ Application Disapproved or t e'following reasons:................................................................................................................ ..............•------------•-•-•--•--------------------------•-•-•-..........--------------•-•---...-----------------•--•-••-•-•-•-------•••---...•------•...•-•-•-••-••-......••-•---••-•---:..:.::.:_ Date Permit No--------------------------------------------------------- Issued...................................................... - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (9rdifirFatr of Tompliattrr TF2 O CERTIFY, That the Individual Sewage Disposal System construct ( or Repaired ( ) by / I ler --•-•••• ... . ...................--•••-. at . • _--• ---- ---- has been installed in accordance with the provisions of Tf .► iaL,The State Sanitary Coyle rjed in the application for Disposal Works Construction Permit No........................................ dated_...._.- ...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM WIIX FUACTION SATISFACTORY. DATE.....1..�.t` -j- ......................................--- ---- Inspect Inspector.. �'.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF.......... c No... -':' ._ FEE........................ �to�ro �a (1onstrion rrmit Permissionis h y granted.............. ••... � -...---.•-•••-•----•--•••••--••-•-•-•••-•-•--•---•••••--••••--•...................••••................. to Construct ( epair an Indivl e ge Disposal atNo. .. = ----•--- ------. ......••.... Street ✓`` as showZonth appli ion for Disposal Works Construction Permit, N ._.....__. ated......................................... . -------------------• -•--••'----••----•-• ------------------- Board of Health DATE ......................................................... FORM 1255 A. M. SULKIN, INC., BOSTON L�- o / r J LOCATION SEWAGE PERMIT NO. .fit :3 1 L LAG E INSTA LLER'S NAME d ADDRESS 40 M a airy GUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED / t 4 foP f fo U.-,�(. ! 4 2 � 40 0 0 3� '2�3 32 3 50 - / _ En:�A-, A! 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