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HomeMy WebLinkAbout0206 OAK STREET (CENT./W.BARN) - Health 0 �l /// S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR OORES N ' MIN.RECYCLED INFIXIVE CONTENTIO% CerdfiedFberSouroinp POST-CONSUMER wwwAproWaffLap SR011e0 ^��p/���MAADDE IN/�UUSAAMM I r No�Sr�..` `.:.7 Fps.. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... . ----------------OF........................................--------------...---------------.._............... Appliration for Dispntial Works Towitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 44, ...... �� :�`h .-----•-------•-•-- ------------------•--------------•-•--------._.......... "'� Locati •Addres - or Lot No. ..................`. ......._ -!!�995-------..._.........._...._.._........ ......-----••-----... ....._................_..................---•-- Owner Address......--_--•......-•--..------.• Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder a 'Other—Type of Building __________________________•_ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfi tgres ...-••-•--•-••-••-••-••-••-••••••••--••--••••-•--•-•--.•••--•-•-•--••--------------•------•------•••••••••-•--•-•-•-••••••--••--•-•-••--•----•---•-••. W Design Flow............... ...........gallons per person per day. Total daily flow.............. ...............gallons. WSeptic Tank—Liquid capacityl�e__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 (y4S Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a 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........................ R+ ---••••--•----------------•-•--••-........-•-•---...----....•••••••--••......_••-------......_----•-......................................................... 0 Description of Soil........... -•-•---------------------------------------•-----•-•••-•--••••--•.........__ x U ...•-•-•••••----•••-----•••-•-••••-•••••---•••---•-...•-•-••••-••-•--•--•••---•-•-••-•-••-•-••-----•...•••••••--•--•----•-•-----•••-•----•---- ......................................................... x ................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----•-----------------------------------------------------------------••-•-.---.................................. ---------•-•••------....----••••-••-•-••-•-••---•-••-•......••-••••-___._...••-- Agreement: The undersigned agrees to install the fored scribed Individual Sewage Disposal System in accordance with the provisions of iITI. 5 of the State Sani ary od —Th undersigned further agrees not to place the system in operation until a Certificate of Compliance ha b n is ed health. ApplicationApproved By••••••-••••-••••-•_•••-•.--••-• ••-�•-••-- ................... ................... D fe Application Disapproved for the following reasons:------•--------------•------•-----------------------------------•---------------•----------_...••••••-••---•---- -----------------------------------•----•-•-----...----------............------------.....-•--------......------------------------•--------------•------------------------•---- --•-••---•-•••----•--- �� Date PermitNo...................................................--.... Issued_....................................................... Date 1 Z 4-- 7 gs l 7 3— LOCATION SEWAGE PERMIT NO. Isz�' VILLAGE I N S T A LLER'S NAME i ADDRESS -rt \/J S U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED _ � a uJ, -<-� `a8 ,� \ ��� � 3d �3 O y6 _ r . 1 v No...... .........- 17 s Fims..—.�.-�.. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----------- -- .............------..OF............................._......... ...... Appliratiun for Disposal Works Toustrurtion Frrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 40 ! ---......---• --------------------------••--•-•----- Locata Address or Lot No. -••-•--••----•--...'........ '............................................................. ------------------------------- W owner Address a ---- �. ----u -=----------------------------------------- Installer Address UType of Building Size Lot............................ fept I—I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder CLI Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherres ........................................ W Design Flow........................ ...........gallons per person per day. Total daily flow.............�-:�..................--...-__gallons. WSeptic Tank—Liquid ca.pacit�-_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 ( ) IH W Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. 1................mmutes 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........................ x -----------------------------------------------------------------------------------------------------------------------------------•••-••••..........__...... Description of Soil........... ::a.._..5........ '�°* t x V .............................................•=........................................................................................................................................................... W -----------------------------•-----------------•-•----•-•--••---------------------•------------•-- ---------•-------------•------•---•--•--------•--------•••-•••------------•--••----•..........---•- U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. ----------------------------------------------•--•-•---------•-•---- ...................................................................................................................... Agreement: The undersigned agrees to install the fored scribed Individual Sewage Disposal System in accordance with the provisions of T I IL LE 5 of the State Sani ary od — Th undersigned further agrees not to place the system in operation until a Certificate of Compliance ha b n is ed ar o health. (J t S . .............. -I . ..J "`~ :_._.".""".......�. '......'....._ Application Approved BY ............................. ......... ...........1 �` __........ a�J� ` `_ .. Date Application Disapproved for the following reasons-.....................................-----------------•------------------------•-------.....--••----•-••-----•. ----------•-•-------------------------•--------•--------------------•-----------------------------------------•-••--------------•-•---------------------------•----------•---•---------...---- P Date Permit No.................. ...._-?. = - Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............................................... Trrtif irate of Toutpliaurr b THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Y r Installer has been installed in accordance with the provisions of TITLE 5 of The _State Sanitary Code as described in the application for Disposal Works Construction Permit No......__ .__ .:;. +r! ..... dated......................... ...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. .. .. Inspector ----••--- ---E&Ivu�- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No -• � FEE........................ �io�ru�u-1. urk� �un�triun rrutit Permission is hereby granted. -��Ale................:............ ........................................................... to Construct ( '`) or Repair ( ) an Individual Sewage Disposal System at No...__Z...L i.---- ? -' n =t` •--------------------------•..........._........--•.-----_.....------------••---•---------•---•-•-•--•-----------•••------••----•---•----•--...... Street f— as shown on the application for Disposal.Works Construction Permit __.. D ted ................................../`�... -------•--------. •------- -------------- /JY-4LKIN, Board of Health DATE....... ----- -= ----------•--•-------.. . FORM 12S'5 A. INC.. BOSTON SINGLE F,41M Y 3 BE0.2aoM A10 (5Q,2B.4 GE G�/tiUE.2 LOA/LY FLOW = //D X 3 = 330 G.P.O. 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