Loading...
HomeMy WebLinkAbout0016 MADISON AVE - Health (2) � � ad .__.. �. _ . . .�,. ___� ..__..��. __.._ __ ��. �. .P ____.a._ _ � w ... �- - ,,.� ,. � �' 4-, _ e. „. ,„ .. - � '.1 • .. r .� a .. � ." rY' .. � .. ,. i .r, s ._ � ,; � - �, � .. .-. -.. � .t� _ � 1 .. .... c 5 � 4 .. ., - 4� ry � _ .. _ .;. .- ;�, S � � - � � ,. ,. �. �, ,. - ... �c :. s, i _ �. .. � _ . � ,. .. c _� - .. e � .j, t� .. _ .. ... c r �, - r .. �� .n ... j .. u .,� � , . _ _ - a ,., ,. � _ ,y r j �� v. .. ♦ .�. �.._ _ ., a �. ,, 'r .. j, :, a �' �:. rr' No.._. . ------ Finc...�iGd................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OX HEALTH 1......._OF...........Ij.. ... ----............................. Appliration -for Bi,ipofitti Worko Tonotrurtion Vrroiit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, !l� - five . ........... -•--•�-j�-----�-S r=!.._��.----�--- .............................-•------...-.-.--------� v e t ddr s or Lot No. 14 s -........ ........... ._�..z. .: ------------------------------------ 3 . Owner Address W �-1 Installer Address = U Type of Building �� Size Lot_, .Y.. " "feet �-, Dwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( LO f aOther—Type of Building ____________________________ No. of persons..____________.___________ Showers ( ) — Cafeteria ( ) a' Other fixtures ......_............................................... W Design Flow__________________�d------------------gallons per person per day. Total daily flow---__._ ?1------------------------gallons. WSeptic Tank—Liquid capacity/07772� lt allons ' Length________________ Width_.____.._...._._ Diameter___._....__-____ Dept _._.--_--__---- x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area--------------.-----sq. ft. Seepage Pit No--------------------- Diameter-----------........ Depth below - let____________._______ Total leaching area........_.__-____sq. ft. r' ` z Other Distribution box ( ) Dosing tank ( ) ®!�0 �2-of—76 Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------=----- ----------------------- a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water_....-_-_-_-.--_--__-- fXA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__._.__..._..______..._. G -----------f. .r---------------- . -------_.._..._..-••-••--st----------1-•••- -, Description of Soil__.:- `__�_ /Z __ W --------------------------r _-_..�_.�... - ��..----.._..% - ---•----•--- ---- - x •-•---------------------- -------------------------------•-----•----•--•---•••-•---•-------•------------------------------•••--------•••••-••-•--•------•••--------•------------------------------------ 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 Article NI of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b is ue by the board of ealth., Sig �.. /-b ---- ... -•----. ---._._... Date Application Approved By_------ -- ------- ---- = ............... --- �7e--------- Date Application Disapproved for the following reasons:-------•-------•-••------•------••--•-----------•------•------------------•-•-------•-------•--•--•-•-•-•------- --••-•-...--•--------•-••--•-•...--•..........................•--•-••••-------------•--------....•••--=---•---•--••--------------------------------•------•--•--•------------------•---•••-------------- Date i PermitNo......................................................... Issued........................................................ Date t; r; ...... FEE....,©. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ........OF............ .. ...C(/L1l t.-:.....+......---*.........._.....-------- ApplirFation -for Utspoii al orkfi Towitrurtivaa Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at n r-•.. • _...-•-------------- I Locat' _Add � or Lot No. —t .------- ............................................... W '\ Wner Address -----------------------------=-...------...------ ------------------------ 14 Installer Address U Type of Building '� Size Lot... _`1.-----. --�"�:"feet .-, Dwelling—No. of Bedrooms-----------------------------------_........Expansion Attic ( ) Garbage Grinder (°9) rIA Other.—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.1 d Other fixtures _--- ---------------------------------------------------• ............................................................................................ Septic Tank—Liquid ca��city tullons Length..._•-----____-- Width............... Diameter•---.--'•.• •- ....---•-•-•---- W Design Flow................ t_.--.--______-___-..gallons per person per day. Total daily flow---------�`'�?%.......................gallons. W t q 1` a ---------------- Depth-------•------- x Disposal Trench—No_ ____________________ Width-------------------- Total Length_----__-_.--._.-__-- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter---__________---_-_ Depth below i let___-_-_____-__-----_ Total leaching area-------...........sq. ft. z Other Distribution box ( ) Dosing tank ( ) e _ Aj_.z Gf 7� Percolation Test Results Performed by-----_-------------- -------------------------------•-------------------- Date-.----------------------------------.... a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water........................ !11 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ p ------U--'-:----- ••------• - ........................... t....--r.... --------------------"--- Description of Soil__.-..__.... _ _ . xc_."..._j � _�..._..l - _.. ? .____ c�te}!..//_._____L� r' _ __- ----------------___. U !/ 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 Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee fh issue by the board of health. gel .� ---�-- --------• •- Date Application Approved By------` ,�-£--- Lll -. ..1�'.g.. .:-_... Date Application Disapproved for the following reasons__________________________________ •-••--•...........................•-------•--------------------••------------••-----•----••--•-------•---I--------•----------.-------.---------•-----------------•-------------•-.-----•-•----------_---- Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J .... ...........O F...7 .G...'t.......L.............. .................................................... Q'Iff.,rrtifiratr of 0.11ampliaurr _ THI�IS'-K0 CERTIFY, That the Individual Sewage Disposal System constructed (�r Repaired ( ) by.............. ............................. .= �s Installer ,4 :____ �_ V has been installed in accordance with the provisions of : t',V- ac NI of The State Sanitary Code as e- in the application for Disposal Works Construction Permit No----_____________% _� ...... dated--..._......." __ _ ..._......... THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. DATE---------- ---...•-------- f �--- `5.................... Inspector•--• ----L4-. -�THE COMMONWEALTH OF MASSACHS BOARD OF HEALTH 0714� .............�.. OF............. `" c -,, ............................... No........... FEE.= (� 3 �iitrurtioaa rrmit Permission is hereby granted.__- !'__.__._____ .�C__�- _ __________ ____________________ ___ to Construct ( ') or ?)air ( ) an- ividual Sewage Disposal Syst �.- ----- ------------------------------------------------------------------ Street as shown on the application for Disposal Works Construction Permit�._.__�_"Bffad � Dated-__. _._..__-__._---------------------- of Health DATE----------("--�--------------------•----------...----------------------- i FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LOCL.TION ' 5EW6,C;E PERMIT UO. _lzlii 11J5TNLLER*5 IJ&ME ADDRESS BUILDERS Q &VAF- ADDRES5 DATE PERM T ISSUED - - - - - - - D ATE COMPLI &MCE ISSUED ; - - - 9. a -7 5 x � a x' a M C A a o t� i 9� FN� Q 2vol oO M QOr) F I Er�> LOCATI 01,� �oT 5 T7-1A T T/acs 7Ov.Vp,4 TIO�C I p ,ram WiTi-� T'NE t �' �IL 03 !'Co S3 S/DEL/.CIG ,� SETBAG�C /ZEQUi�t�1�'NTS s�29 174 �sre✓�u.� • M S s P�rlrl�IJ�a� Trzo ST ,l in ----------- .— :.► I ------------ J� aa �VA� s �J 5 FND i n 41 M vi A e, ,VLA17�J Az «n7-iF�� T/SAT 7'//e-s \Lo7 �o��iJ �i��Fnv �r»��y� WiT�-� T-.c✓E ��, kif� 30 a RAY.ram � rNG: rep ui V Cc' /3.-OW cJ-l�r,4,3e 4 5/26/7G `� Or>T'C G✓I t.t G MA S� I/a ST