HomeMy WebLinkAbout0039 PRISCILLA STREET - Health 39 Priscilla Street
Centerville
A=246-060
IN I S M EAC?
No.2-153LOR
UPC 12534
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0
LOCATION SEWAGE PERMIT NO.
39 Si
VILLAGE
INSTA LLER'S NAME 1 ADDRESS
e
S U I L 0 E R OR OWNER
D ATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
107�1 BOARD (2f HEALTH
...........-OF...... ...................................
Appliralion for Dispaiial Workii Tomitrurtion Funtit
Application is hereby made for a Permit to Construct of Repair (A-,)`_a_n Individual Sewage Disposal
Systemat 7.. ........... .. ........ ...... ........................................................
..........................................
Address
144
.... �on ...........................6 ....... . .. ....e -- --- ---------------------
..... .
...... ...................
Installer 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 -----------------------------------------------------------"*......*--------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
r4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter------.......... Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. f t.
Seepage Pit No-----X............. 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................minutes per inch Depth of Test Pit.................... Depth to ground water....---.............---.I
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 ...........................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
U .......................................................................................................................................................................................................
.......................................................................................................
U Natu of Repair's or AltLerations—Answer when applicabl;0:4��___.4_ 1_
I ..4.44...........
...............................................................................................................................
Agreement:
The' undersigned agrees to install the aforedescr4*,b e n ividual Sewage Disposal System in accordance with
L L ers* ed
C,
the provl�ions of'I'LL 5 of the State Sanitary
0�e r _.Jjrther agrees udi to place the system in
operation until a Certificate of Compliance has been r oft a t
Signed..--- — ............... . ........... . . ..... . ............I....--- ................Dat
ApplicationApproved By........................ L.k................. ......................................... ........... ..............
Date
Application Disapproved for the following reasons:.................................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
No.... .1 ...Z.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Of" HEALTH
- ..e:fWA .............OF...... 1 .f�J/- .....................................
F Appliration for Dhipasal Works Tontrurtion 11amit
'Application is hereby made for a Permit to Construct ( ) or Repair (A,-)"ar Individual Sewage Disposal
System at
6j'A15.:... .............
tion-Address Q or Lot N�yo
�tY r✓ �. 1 ......
Owner/1., J Addr ss 'L ®� /�
................... G.l f!/..._.!!il,� ... !.lam..�C/..�4��[_..........
� Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( )
....__._.. No. of persons............................ Showers —
p,, Other—Type of Building ................:. p � ( ) Cafeteria ( )
04 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.....X------------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date.........•----------........
----------
Test Pit No. I................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........................
----•------------------------•--------------------------...........-•-----------••--•------•---••---..........................................................
0 Description of Soil........................................................................................................................................................................
t
1
U Nature of Repairs or Alter tions—Answer when applicabl �� ..._..... i17�=i..""..
<.•r(Cr/ .............................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed/IQvidual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code %T udders �i'ed rther agrees of to place the system in
operation until a Certificate of Compliance has been is ued>b 4he-board of h lth. ,
Signed......-- .="!--•...... .............. .. ...... ....................
Application Approved By. �, ;
Date
ate
........--•------------ --••- ---^ >y D
Application Disapproved for the following reasons:__...__..=.'.":..............:..... .............................:...................•..._......._...__.......
---------------•'•-•-......--•-•-•-••----•--•-•----••-••----..............----•-'•-------.................--•-•-....................•--......-•---•-••-••----••-•-----••--•.........---••---••-•-'---•-•
Date
PermitNo......................................................... Issued--•---•---•........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
0 !!/...............OF.... .. ................................
Trrtif iratr of Toutplianrr
THIS IS TO CER�T;ITY, That the IA,vidual Sewage Dis osal Sy_�e constructed ( ) or Repaired (A.-r "
f
by--• :. 4'! '.. '�:La '!� �...! 4-ram ._ -:.ae., .... ...............................................................
�� f Ins alley
has been installed in accordance with the pro, Ion of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Per it N0........`r5 S, ........ dated--------- _AK 73..................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH.OF MASSACHUSETTS
BOARD OF, HEALTH
//�/� �r�........OF. _ ...... �'��z.��......................
No.....Y FEE.._.........--.-.....
Movo a dorko Tonotr ion rmit
Permission is hereby ranted.... ....f�7_C�0 ... � L 4 2.�,.............................................................
yg
to Construct ), 0�),Repairjj(/fin Individual Sewage Disposal System
at No.._ /"-/ii i, 17,if--...s.??� ..-•----..��"� y ,
Street
as shown,gn;the application for Disposal Works Construction Permit No.__f�`............ Dated.._..�...__ `..._�-�
•------------•----------•---••---•--•--------- :....................................
Bo of Health
DATE -- --- ---
FORM 1255 A. M. SULKIN, INC., BOSTON