HomeMy WebLinkAbout0082 KENNESAW AVENUE - Health (2) 8�l ���inescw� f�ler�e� .
ay`�Ivaa.
WE_.......
THE.COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
5
Z
a oZ , pphration for Disnnsttl Works.Tanottatinn Prrmi#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage'Disposal
System.at: ,
............ .........---
(_Location dd`r ss �or.Lot No
C:�.k ` _... ........................... .O_M. �:`------------------------------------
Address
:.............................. ....-- . - - ----- ......
Installer ,/� Address
U Type of Building Pt<O1 ', Size Lot.. ._...._ Sq. feet
►.. Dwelling—No. of Bedrooms...a .............Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type.e. of Building .................. No. of ersons....................._ . Showers Cafeteria
a YP g P - ( ) — ( )
Other fixtures % .............•-
WW Design Flow..6.(5 ________ _________ __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.
3 Seepage Pit No..../.-_.............. Diameter._..I._. :........ .Depth below inlet.... .........Total leaching area.................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.........................................:...:--............................
Date.-......,................._.............
Test Pit No. 1................minutes per inch Depth..of Test Pit................... Depth to ground water..__......___....___...
w Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................
•-_••--- .......•. . ... ....... ........... ... .... . •---_. ._..... ..----......
0 Description of Soil �� - 1 •--•...._.. ...: ......... . ....---• ----
0 . �- --------
W _ --------. -•_.... .............................................. .......--
---•----. ......................... ........................................ .................................
U Nature of Repairs or Alterations Answer, when applicable .&90 / � ✓ xZP ...
- ��c• -. ......76 ''l. ; --_--•-G-4-.--v-- 4• ! �" '_.._ .....
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI'AI 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 tli oar
-�-----
f Signed..----•- ••
-
Application Approved By................ _•- •.. . `......... _ .......... JC`f
---•-
Date
Application Disapproved for the following re n :...............:......................................................--........................._........___
...............................•••-•- -------------•---•--••--............ . -•-- ---•------...------• ....
Permit No ---•• - ---------------- ...........................
Issued. ......... ....n�u...
• Daft .
L^t.'.r-.++•...r./..:..r_.-...�r.�+^.,.r-�.�`.�cYr..�,,..,r��ti.,.dal'.e^r.v..r.r..o.-.'.�.�.......�+...y'�..r�.-_..y....�..w.-�^ter'-4..++,.�c ....../W ...-F..�_r•}Y••`A._...-...r\r'..y��.}.��-+_�
THE COMMONWEALTH OF MASSACHUSETTS
'BOARD OF HEALTH x
... ------.....OF.......��,� .!v5 t` `E' ....................................
Appliration for Disposal Warks Tonstrudion Frrutit ;
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System-at:
- ��~� M� Location Address Y' t or Lot No.
......T: t a f\i t7.......��........ 'Z....... .........................:�;_n wi g' .........---................. .... .....
W �-- �-- Owner Address
!Q!,!r•g- S ........ a "rsc.c�cJ., ...y/�s9*lcF/.....................
Installer Address
Type of Building Q�d�, Size Lot....:.......................Sq. feet
U Dwelling—No. of Bedrooms...L......I.............................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type of Building .............. No. of ersons....._..................._.. Showers
fir yP g .........-•--• P ( ) — Cafeteria ( )
dOther fixtures .................••--------••-••-•-••------••.
WW Design ;Flow_._ !• ............................gallons per person per day. Total daily flow.... �1...� �-�h {.��....gallons.
WSeptic Tank . Liquid ca.pacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft.
3 Seepage Pit No....1............. Diameter... .. :.......iDepth below inlet
�...Z:_............ Total leaching area..................sq. ft.
I 4 Do� ..
Z Other Distribution box ( �) 1 'Dosing tank ( )
Percolation Test Results Performed by--.-:�...........I.......................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test(P'it.................... Depth to ground water........................
Test Pit No. 2................mmu se per inch)Deptlf of,Test Pit.................... Depth to ground water....--..................
D Description of Soil........` !!� .._s::: � 4-�
.. ••• ...... .. -----•-••-------------------------------••••.....................•...
' ........ j,......IF...y.Ty...................%�.....y.�rr..... ...... ............ _...__.._..._......._.......__..........................._..... ------------
...................................... v;._......_.......__.........._.....__......_............._....... ................ ........
U Nature of Repairs or Alterations-Answer when applicable.. -1'7l�_.. ��. .....4.............................. ........
.. n i.T —7 ....6 Y.GtT'✓L 4 / a�S�eF1/+�+ .t..V. 1... / :/a ti.
Agreement:/
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be`e�[n`issued by the booa�rC,d,of-health./\
g --• _.._ ........_.
Application Approved By•••••..._••••-- • ••• ••........LA31,•-•------•••-----------------------_ ..........
Date
Application Disapproved for the following re :..............
.:....•-••-•................--•-•--•--•--•--•......................
.... -----------------------------------------------------.------.---.--•-------•------•-•--•-----.----------------------------------...•---•-------------.....................•••.........._._...
Permit No...... - - -1
2= .............---. Issued..........................................D�..
Date
———— —— ———————————————— ————————————————————————
d
,4 THE COMMONWEALTH OF MASSACHUSETTS
BOARD_ OF HEALTH
......OF..., vfN `T,,. .fSr'. ...............
Gr#if utttr of Toutplittnrr �
THIS IS._TOXERTIF.,Y, That the-Individual Sewage Disposal System constructed ( ) or Repaired
by.............•............... ..� A�, �,i C.....................--- - ............_.................._..._.._...._..._
Installer
at......................... == I F?.W,�sY In/....... _ iQ._.. - ...... .._.....
��
has been installed in accordance with the provisions of TI 5*11? 7 State Sanitary Code as described in the
application for Disposal Works Construction Permit No..... `..co..................... dated........."..-.._._ .................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................................... ......... `�....................... Inspector • .........! .......................................................
----------------------------------------------------------- ---------
Z� �Z THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH(
�� cr ,,#
No. ....... FsI.........................
701spo's-t1 Works Tattstrudiott Vrrutit
Permissionis hereby granted......... \c '._ �-. ......................••-•----•-•---•-•-••--..........................._.
to Construct ( ) or Repair (L) an Individual Sewage Disposal System
at
No.:... G ................ a-
Strcet
as shown on the application for Disposal Works Construction Per it No..................... Date ..._�-..1.4-.:�...........
o ----•••••..•••• -- ...--••••••••..............._
oard o Health
DATE................................................................................