HomeMy WebLinkAbout0040 CARL AVENUE - Health �0 Court A'��• _ i S
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LO CAT IOqc�w 90 SEWAGE PERMIT GO•
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I H S T A LLER'S HAVE 8 ADORES ❑
1
GUILDER OR OWNER
D A T E P E IIA V I S S U E D
DATE C0. MPLIANCE ISSUED
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Noo. ..Y.�`�. psi► (� -- FEs.... ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH (y
.................................OF..........................................................................................
Appliration for Disposal Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
6 .. .•-• - . ............. ... --•------------------------•---!�-:r. ........ _.. ...........:.....•.
L Ad e ` or Lot No.
Ow r Addres. ... ...... Tj:;.�j... --- ' *s
................... ...... . .. ..... ................................ ---......----•-............................ ...........................................
Installer Address
U Type of Building Size Lot.. .. `5 ...Sq. feet
Dwelling—No. of Bedrooms.................... ......................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria
Q' Other fixtures .----•---------•----•--•-•-•-••. -
W Design Flow........... ....................gallons per person per day. Total daily flow..........- a.!?................gallons.
WSeptic Tank�Liquid capacity/®Q(J.gallons Length•...!.-.... Width........ Diameter................ Depth-_ ........
x —No. .._......I....... Width..... Total Length...2-z.......Total leaching area...S_..�_..sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box oo Dosing tank ( )
'-' Percolation Test Results Performed by......4--C>`!1......1... s.�L�. _fiV ,_. Date....
Test Pit No. 1...'5._7n..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........................
O
` Description of Soil......c ��......../`9' -�yL.= ----------P -•-•-----------------------------------------------•---------------.
Ir ----------------------------------------------------•---------------------------------------------------.------------------- ---------------------------------------------------•----------
-----------------------------------------•-•-•----••----•--•-----------•---•---•-•--•---•------••----•-------........---.._....----•----•-------...---•--.......-•-----•----------------------••--_....
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 TITI.S 5 of the State Sanitary Code—The under 'gned furthe agrees not to place the system in
operation until a Certificate of Compliance has been 'ss ed b t b ark of health.
Signed•..... . . .... ... .... ..... .....• ..................... ....-----•-----
ate
Application Approved By..............P�.. ...--••-• . ••-----•-----•-----------•----------• ..........
Date
Application Disapproved for the following reasons:..............................................................................................................
-•--•..........-•-••-•--------•--------------•-•-----•-••---.................--•---------------------------•...._....•-----......•-••------•-------••••-•••-•-_••-•.._...----••......----•-------...--
_ Date
PermitN�_ ` ............... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH �
oCc.6c. �!3111'J 7b� Pp 6r
O F................................
..............................I......................
Tertifirtttr of Tontpfianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by_..._.../?.LG 7............. .............. ..........................................:
Instal
at--- _......-•--••......•-
- ---------------------------
has been installed in accordance with the provisions of TITLE_ 5 of The State Sanitary Code as cfescr' d in the
application for Disposal Works Construction Permit No----�S /�'dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FU�P-CTION SATISFACTORY.
DATE....... ......................................... Inspector....................................................................................
-- - - --
Fizz.....s ..............
k THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Dispvii al Works Tunstrnr#ion amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.. "r!R-A::..... _.:.- ... `.� !4�1..5 ........-•----. --------------� �� ...............................
Location-Address or Lot No.
............ --................. ................. --•-^-•----•-----------........_.._._.........------.........---•-•..................ti...^-•-••
Owner Address
W
r� ...............................................I Add ....
- .........._......
nstaller ress
Type of Building Size Lot__1-3�.:_1:5�___Sq. feet
a
Dwelling—No. of Bedrooms................."-.....................Expansion Attic ( ) Garbage Grinder ( )
_ p,, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a
;,. Other fixtures .........................
............................................................... .............................................................
f,. Design Flow...............s __...__......__.____gallons per person per day. Total daily flow............ _a.-4 ...............gallons.
04 Septic Tank—Liquid'capacity,ld4.gallons Length..... Width........ .�_ Diameter________________ Depth.... '_._._-
W
x �o P T enc 2 No.----------4...... Width._.... ...... Total Length.___ Total leaching area__2__0__.-.-;C..sq. ft.
Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (X) Dosing tank ( )
a
Percolation Test Results Performed by --� ...___ :_._•_ L __�tUL__ Date._..__-..�_7___- �..
Test Pit No. 1...15�._Z--___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..............a:__.__
O Description of Soil___...���..........
U .-----------------------•--•-----._.._..---•----......----•----------------.......---------•------------•---------------------------------------•--•----------------------•--•-•--••--------•-----------
W
UNature 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 TITLL 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 the board of health.
`.. Signed...................................i................................................... ..........................
i
. Application Approved BY................ �✓°��--�" .!' -------------_---•--•-- ----------
Date
Application Disapproved for the following reasons:................................................................................................................ '
:., .
�. ` � '
Date
Permit No
-•----------------^-•------------•---.... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'elUa�L �/ JT/9 bL
,�............................O F................... .................................................................
4. : ... Tntifiratr of Tomplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ich.:... / . _ --G/c Instal ----------•---
f,
-- --
----•-•••••--•-•--
at � ------------------ ------
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_.: _;�'________________________ dated___..__ __...................................�7'f'
THE ISSUANCE OF'THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUh CTION 1SATISFACTORY.
DATE...:. -•-- Inspector...................................................................................
.tAi .'"�«.��KJ 6L x9: ... - ti.u._-...m.dw.^i-�•,w. �ui.?'ti p•.' a. : F+` ..
THE COMMONWEALTH�OF MASSACHUSETTS
t ' / BARD OF+'-HEALTH 4 4 "O
,! fv .. ....... ......................OF.......��. .............:�....-_....-..._.......-_......_.._._.-_.........
No......................... . .o w• FEE.........................
Permission is hereby granted......�'-------------'--�-�--• - -- ---------------------------------•-............................................
-•---.
to Construct ( ) or Repair ( ) an Individual Sewa e Di§posal Sys ,
at No.----------- ---..... '-_. .47 ............... G � '�
✓" .... Street
asshown on the application for.Disposal Works.Construction Permit No. ____ �L_"'_Dated__________________________________.._....
.,
.:`::. ......
1 . Board of Health
DATE----------- = . • ------
FORM 1255 HOBBS & WARREN. INC.,'PUBLISHERS t,,.y:
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