HomeMy WebLinkAbout0010 MAGNOLIA AVENUE - Health F
0 Magnolia Avenue
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enterville
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No. ...................... FRs...............cC ...
O THE COMMONWEALTH OF MASSACHUSETTS
BOAR® 9F HEALTH
'..............OF........
illel ,
�-� �Appliratiun for Disposal Workii Tonstrurtion Prrutit
Application is hereby made for a Permit t nstru ( ) or Repair k--Nan Individual Sewage Disposal
System at: w�u 1
W l / NLocatin-Address r L o.
...........4 ------•-•-- ..... .....................
-••----•--------^. ........
n Address
.-'... �Cd�.--•- ... j...... .. `... -------•-------•..........................•-----...--•--
Instal ler
Address
Type of Building/ Size Lot............................Sq. feet
U Dwelling No. of Bedrooms.............................. ... .....Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type e of Building No. of persons............................ Showers
Pa YP g --------•-----------•-----•• P ( ) — Cafeteria ( )
a' Other fixtures ................................................. ---
W Design Flow............................................gallons per person per day. Total daily flow...........................................gallons.
WSeptic 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 ( )
aPercolation 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........................
� .
O Description of Soil------ ----•--•-----------------------------•-•---•---•••-•--• -••••-.-•......_.......---...
x
V
W -•--------------------------•--••-----------------•----------------•-•--._..._.............------•---•-------
U Nature of Repairs or Alterations—Answer when applicable_.. ..°': _
l�5.. ..
---------------------------------------------------------------•-------------------...-••--....•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI IE 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 thp board of health.
igne
�1 Date
ApplicationApproved By. ............................t--......................................... ....... �--9....�----
Date
Application Disapproved for the following reasons:..............................................---...............................................................
------------------------------------------•-------•----...---•-----------------•-------------------------------------•..
Date
PermitNo.------•---••--••---------------------------------------- Issued----------•-------------------------•.................
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^C&L
DATA
No. .. %.f....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® - F HEAL7TH
Appliratiaan for Mipasal Works Tottstrnrtiaan Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair 1(. an Individual Sewage Disposal
System at: ;:�.,. '
..................: 9F rf d j r tt. .. r�.. �..-1
... .....
r' Location-Address or Lot No.
..................+ - ............................................... .....•-•.....................•............ ..................._.
Address
W L✓ .`.... .."..N., .... .... ...v . r.
Installer Address
Type of Buildi� Size Lot............................Sq. feet
I••-I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building g ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic 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 ( )
aPercolation Test Results Performed by.... ---•••••••••-••--••••••--••-•-•--••-••-•--••-•--•---••......••...... Date----------------------------=-----•....
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.___..._..._.__......_. .
44 Test Pit No. 2................minutes per"inch Depth of Test Pit.................... Depth to ground water.....__...._........_...
O j.
Description of Soil ...
U ..••.•.
W ••-•••-••••-------------••-••--••••••----•••-••-.....----------••-•••-•••------••••......-••--•......--•-••.
r^' ------------ f . ..............__
U Nature of Repairs or Alterations—Answer when applicable.__.,j�_'___�_ -Pal.__:._• '••t�- 11 21, .....................
......................................................---------------------------------------------.------- ----------------------------•-•-•--------.._....-------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of`FITIE1 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 t,4e boaro of health. J
Application Approved By`�csm 'a ?_..,`-�.__... � :_.._.__.. r Date
Date
Application Disapproved for the following reasons:--------•--------------------------•-------------------------------------------•---------...--••-...........---
........................................................:.:_..............:..............................................................................................................................
Date
Permit No.........................................................
Issued_
Date
THE COMMONWEALTH OF MASSACHUSETTS
/a- BOARD OF HEALTH
...............................
.9rdifirab of Tamplianrr.
T I l p �GFfR�Til '✓, That the Idual Sewage Disposal System constructed ( ) or Repaired ,, )
by = - . ... f ................... -• ••-•--. •-•-••... _----•-_
Installer
at ---------•------- _ -----------•--_- - - -------------------------------------------------••-••=-•_-•......---....-••--•-----•••--
has been installed in accordance with the provisions of TIT-•1 j of she State Sanitary Cod .as escribed in the
application for Disposal Works Construction Permit No.._7L-.._I.-_ii.aI_._..._... dated---i.-e-iRANTEE
`�..... ............•.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............................................1 1 ........................... Inspector..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFj HEALTH1
f f r .. r,. A
- No. .... ............•-- FEE.::....:_..............
�i��aa��tl; aark� ��rna�#rixt anti#
Permission is hereby granted------------- ---------.--------------•--•.•••-......-•-• •• ----_••. ..-=-----------•-...------------.........-------------
to Construct ( yx r:Rep�tr ) an Individual Sewage Disposal S stem/
p .
� t f �1/j✓ w+ F Ad s� j4
b
Street r w
as shown on the application for Disposal Works Construction Permit Noc4;.WL- : . Datedl.. =. __j._'11/. . ..................
DATE................................................................... Board of Health /
FORM 1255 A: M. SULKIN. INC., BOSTON '