HomeMy WebLinkAbout0068 CAMP STREET UNIT UNIT 1 - Health 60 eaoyo Sfiut, }� ann,'s
No..... .
'07 ®
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
g�
..- OF..............hl ...!Il�..-'�....------..................----
�/11 Applirafinn -for Biapoiial Works Towitrurtion Punift
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
................... -• ----------
�� Loea Address L )rLot No.
6 �s-
w er Address
------- ---------- Y---------------••------
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.._______..___________ _____________Expansion Attic ( ) Garbage Grinder ( )
p`4-, Other—Type of Building ____________________________ No. of pel sots.-______--.-__-_ -----•_.-- Showers ( ) — Cafeteria ( )
Q' 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. It.
Z Other Distribution box ( ) Dosing tank (' )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date.......................................
W
W Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.-__-..--__-.._-.-__--
f4 Test Pit No. 2................minutes per inch Depth of Test Pit.-________--__._-_- Depth to ground water-----._--___-_--___-.._.
�+ P --------------------------------------------------------------------------------------------------------------------------------
O Description of Soil----------- ..-!------------------------------ -----------------------`
x
x ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
V Nature of Repairs or Alterations—Answer whe �plicab ...______. �..____.I _�_.__ 1.: __.__-- � _____-'_...
P -LZ h. -----• -- -----------� ------------_,-,-------------='=`---- ----- ----------._
Agreement: ,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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 the board of health. /
Signed_-- L� 5
( = ---------------- -
/ D to
Application Approved By------------ ;9 ??5
r bate
Application Disapproved for the following reasons---------------------------------••---•-----•------------------•-•-•-----------.............-•--••......--••-----
.......................••-•-•---- ---------------------------------------------------------------------------------------------------------------------------------------------------------------.......
-2 Date
Permit No. = �� J �7S eZj I-V N—
. --------••• Issued.---- ------ ......................
NO Fss...a' .
THE COMMONWEALTH OF MASSACHUSETTS
t BOARD OF� HEALTH
oollI,E.... .----OF.............. +!1 1a....................................
Appliration "for Uttipoiittl Works Cnomitrurtion rani#
Application is hereby made for a Permit to Construct ( ) or Repair (�} an Individual Sewage Disposal
System at:
.Loc •Address �3 or Lot No.
w er • - Address -
--- - ----------------------------------------- -------------------- d -----------------------
Installer Address
Q Type of Building l ,� Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...._.___._`..`...........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
04 Other fixtures -----------------------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
USeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter_-.--...-_.___ Depth-----.___-._.
xDisposal Trench—No.....:............... Width_--__-____-_-_-___- Total Length.................... Total leaching area_.__._-.--__...____-sq. ft.
3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area------- ----------sq. ft.
z "'Of fier Distribution box ( ) Dosing tank ( )
►-' Percolation Test Results Performed bY-------------............................................................. Date-----------------------------------------
W
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to'ground water.--.___----._-_.--------
fX Test Pit No. 2_..__j.........n1i-nutesper inch Depth of Test Pit.................... Depth to ground water_.._________-__-__--....
a --
DDescription of Soil---------- ---- --------------------------------------------------------------------------------- ----------------------------------------------
x
V
W _ _
V Nature of Repairs or Alterations—Answer
whe�.applicable_ _ .. �Q -�-0ou A-L,._._._->
i ` ?� ' --- I------ -
..__ ____...
�A . � w ._-------------------------- -- ------- ------ ----------==- --------- --------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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 the board of health.
G w a
�Signed.__• �� :--- ----
• � "�'��++ � 7 T
------.12APPlication Approved BY = ate
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
---------------------------=-------------------- ---------••------------- --•---------•-•---•-•-•-•--•------•---... .----- ------
Date
?Pvk
Permit No...... +� '* Issued_----- _ . _ _�.._
---
�!«•�`"; - ••.rrY -" x•`:<: to ,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...0 0.`!!....1...............OF............
Trdifira#r of 01,11utpliaurr
b THIS IS T CETI Y, That e Individual Sewage Disposal System constructed ( ) or Repaired
Y ' ...........y...- h C Q -- _--- ------- --.. p>
_111to-4 CAW
............................ .....-----•---•:.
has been installed in-accordance with the pro//��
visions of Article XI 01 Pie, State Sanitary Code as describe in the
application for Disposal Works Construction Permit ---- 1- dated__.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATA . _f �� ---------------------------- inspector
------------ - --------
THE COMMONWEALTH OF MASSACHUSETTS � sf ONE
BOARD OF HEALTH
�" "� w.N................OF..........�1�.M3'.d1 .�. ........... 00 a
NO------•----•-• FEE.. ww►e�b
`�la���r�r�i�u
Permissiotii is',hereby•granted___ ___n_-.-- a M .__... _
r -------------------------------------------------------------
to Construe ( ) o�T Repair ( Individual a age DiisT sal ,System
at No..•-----WAr--•---*�: f -•---•--{ .4fw............ ---------------•-------
Street
as shown on the application for Disposal Works Construction Permit Noz-1-�� D�ted___d.
.
Board of Health
DATE
t�
FORKf 1255 HOBBS & WARREN. INC.. PUBLISHERS .: .
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