HomeMy WebLinkAbout0055 CHASE STREET - Health $S CHODo. Sk., iS
LOCATION : SEWo,C,E PERMIT MO.
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D AT--E - CONIPLI-b NACE -ISSUED : . — —
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
- --.. ..... ... .................OF...............................................................
, ppliration far Ditipaiial Works Tottstrurtion Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair (4-ran Individual Sewage Disposal
System at: `/
--- ------------------------------------------•---------------------------.-...----'-----
oca ion•Address- t Vie-
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...............................
i�'/--------��f ----�'��_._d....%.../ , fvd
ess
.............................................................................. ---•---------•---•--••- ••----••-------------------------••••---
Installer Address
d Type of Building Size Lot.._�.___:_.._010el-_.Sq. feet
U Dwelling—No. of Bedrooms............... 4_______-••---------.__-Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building Awn,91........ No. of persons..........A------------- Showers (f ) — Cafeteria ( )
Otherfixtures ............................. •-•-•-------••--------------•--•----••------•-•---------=----------•----------------------------------------•----------
W
Design Flow---------------J0___________________--gallons per person per day. Total daily flow........16#----------------------...-.gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Widtli................ Diameter---------.------ Depth................
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 ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
(i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
----------------------
•-------------------------------------------------------------------------
--------------------------------------------------------
0 Description of Soil-- _-- ________________________
V -••----•-------•---- ------•-----------•.................................•--•--._...--•-••---------------._....-•-•-•-----'-••------------------------------._.._..._..-----..-.._.._...---•------- ---
W
U Nature ofepairs or Alterations—Answer when applicable....1. _ 'T.9i�------® ' ' ...^__..............
sLIM/�C C� ---------------------------•----•-•-----•---•-•-----•-•--•-•-
Agreement: ,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witli
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.. ----
VO��fT �jCi3 vyJ �-/Mr'z
-------------•- ----- ............................... •--•
.....................
Date
Application Approved B `
Date
Application Disapproved for he following reasons:---------- ------------•------------------------•---•-••------------------•-----_••••-••-••-•-----•-•••---------
--••--•..._..-•-•-•••-----•-•---••-••-•------•-----------•-••-•••-•----------------•--•----------•--------------•-...--•--•-•--•--....-•-•-•------••-----•••----•---------------------.__...---•--•-•---
p Date
PermitNo. -------...-•--"-'•---•••--•----------. -- Issued-------=--------------------------•---•-• ...........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_... . ._ _ ------.OF.....................;::.............
Appliration -far Bitipwi al 10orkii Tontitrurtioaa Vrrutft
Application is hereby made for a Permit to Construct ( ) or Repair (6-711an Individual Sewage Disposal
System at:
..................................... ------......--
o.tion-Address
�
.....•..............•............................. ...... .................................... - 1� .
........_ ......._....--
f��Caear�tJ�fI� Cr% C�sFitleV���cjress
Installer Address
Q Type of Building Size Lot---- __ .._ n__Sq. feet
U Dwelling—No. of Bedrooms_ ______________ ._----...__.____--.___Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building _ $_ ...... No. of persons---------------------------- Showers Cafeteria ( )
Q' Other fixtures --------------- -------------------• -
W Design Flow............... __Gt_-___._______--_-_-_gallons per person per day. Total daily flow------._60().._-_-...__-__-__-_-__---.gallons.
9 Septic Tank—Liquid capacity---______-_gallons Length--_------------ Width------.......... Diameter------. -------- Depth-----.----------
xDisposal 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 ( )
aPercolation 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__._--__-_____-_--_____.
P4 ---------•-----------------------•----------------•------------------•----------------------------•-•---•-----------•------•••--------------------- ......
D Description of Soil-- .F e' ¢= �' --'a` -- - -----------•------••--------------------------•------
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---------------------------------------------------------------------------------------------------------------------------------------------------
V Nature of Re ,rs or Alteratio nswer when applicable.._. _>_r?% � _______ r �f1 t--__ / - C r3 -.d t-_
,,J-�-t-%'iE / 1/ Q '"� C --•----- -••----- -------- -------- ----•---
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_ "` "
Date
Application Approved By------- -------------------------------------
/ _
Date
Application Disapproved fovAllle following reasons------------------------•------------ --------------------------------------------------------••---•-•--------...
--•-•----------•---••-•--•---•--•---•------------------------------------------------••-----------_.....-----------------------------------------------------------------------------------------------
Date
PermitNo.-. ,4 ` Issued........................................................
U
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........J...... -'t.................OF........�..� ?.. }M...r....' ,s
Q.,rdif irat a of 0-Mmptiaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
< Installer
at......................... •--••---•---------------------------- -•------------------•---------------------------------------------------------•-•-•---
has been installed in accordance with the provisions of :Article XI of The State Sanitary Code as described in the
application for Disposal Works,Construction Permit No-----_-----------....................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE S A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE = 8 { ---------------------------•-- Inspector--- . ----- . =- _ ._ ................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................... ...................O F--.......-----------.....------------......--------------------•--............---- ,1.
No......................... FEE........................
i� tt� irk Toptrurfign Permit.,
'Ly .may
Permissionis hereby granAd-------------------------------------------- -- ----.. ...----•--------------------•--•--••--•-----------•------•----•-----------.-----
to Construct or,4pair (,f )/fan Individu ja Sewage Disposal,Sy,tVny�
atNo......................................................................................................... �-
street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
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. -'�'-----------•--------------7S B t :Healh -
DATE.---•--•-----------------------------------------------------------------------• /r
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FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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