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Home My WebLink About0120 CHASE STREET - Health /�D daDt S�• , Nynrmrs LOCATION �v SEWAGE PERCIIT W0• Co T 56 VILLAGE INST-A LLEWS NAME b ADDRESS � � 7 UAW F 0 72 23 &�elz,� -5 �i9/liyov D WI L D E EI OR OM63 ER 23 Wit E P ERMIT ISSU D D A_T E C 0,GI P-L 1 A N-C E I S-S U E D �� N Zc 4A No.... z..: Fxa... ....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH , r .............OF...... Appliratiun for Dispvii al Works Tomivaartiura 1hrmit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System at .................. ............ . ...........................................•---------------.........----- . L` t'n- dress .or Lot No. pa_ T:7:� ------ ............... -•-.......................................... . .... ........ Owner Address a ................... • •-•--------------- ••-••••--••••-••••-•••••••-•--•---•------••-------•••-•••...-••••.................._.........•... Installer Address �. Sq. Type of Buildir�gr Size Lot.�`? Jj(�--_ ---- feet k ., Dwelling—If"No. of Bedrooms..._.__..............................Expansion Attic ( Garbage Grinder ( j } aOther—Type, of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) f Otherfixtures -----------------------------------_-------------_--------------------------------------------------------------.--------•-•-•--•---•---•-------• j Design Flow..................... _. ........gallons per person r day. Total dailyflow_____-_--_:_�.3... ............ lons. W 'id capacity..Septic I U.gallons Length .. ' Diameter________________ De th_._ _..___ W 1 / Width__�)"w x Disposa� �c0. .................... Width_._.�"a?- 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 (rA. a Percolation Test ResuI Performed by--- . ..VLQ2• Date___ 1..._!-!...-- ----�. > ,a Test Pit No. 1.. .z.minutes per inch Depth of Test P �1 .._. Depth to ground water__ . . ............ f=, Test Pit No. 2................minutes per inch Depth of Test Pit........ '...___ Depth to ground water.. _l.. .......... �+ f ---- O Description of Soil . i ... ..._� ----- UV�.....Q3,---- ..... �iJ... x V ----------- --------------- ----------- •------------------------------ •----------- ... ------------------------------- •-- ---------------------------------------------- .--------------- W 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 ITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ` su the boa ealth. €'/`�/ Signed.._. Date Application Approved By........ t � d� �e knA Date Application Disapproved for the following reasons:.......................................................... .............:.............••----•----------•------•----------------------•---------•---------•------------------•-----------------------------------------------------------------------------.-------- Date PermitNo......................................................... Issued......... ............................................ Date k No.... ��.:: .t' �, Fxs.—A THE COMMONWEALTH OF MASSACHUSETTS k BOARD OF HEALTH !. .'C ............--.....OF...... Applirtttinn for, Eli epos al Vorkg Tnntrurtinn Vamit Application is hereby made for a Permit to Construct Aor Repair ( ) an Individual Sewage Disposal System at: ---- ..................: .__........... - L at n- dd ess or Lot No. le- ........... h� ::�..._ t-.. �::..... ................ .•----...--------•--......-•-......._._.... ...... •......... Owner Address .................. ......•-•------------........-----.......................••. ^. Installer Address _ d Type of Buildi?gam- Size Lot. . cLJ_. 7. ..Sq. feet U Dwelling—No. of Bedrooms.........Z............................Expansion Attic (1_ _ Garbage Grinder (k—)6 WOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------------•--------•-•------------•-••-------------------------------------------------- d _ -----------------•--.--------- W Design Flow.......................L...' ............gallons per person ger,day. Total daily flow__----.--_.___2__�,r__---0............ jons. WSeptic I ' uid capacit'.� 'U_gallons Length_...Lf_.� -. Width__.. =r�Diameter____-__.....•__. De th.- �_. x Disposa c 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 ~' Percolation Results Performed by.___V_.._.:__ _ ._ . .__` _.._ ._...!_; x�1__..!:'. -_-- Lt : Date t f�•-.�-- W 1.4 Test Pit No. 1•-----•-..---_._minutes per inch Depth of Test P .......//42.... Depth to ground water--_� __...._.. (3, Test Pit No. 2................minutes per inch Depth of Test Pit........4.._..... Depth to ground water... � -4----- ................................................................-•-...... D Description of Soil------- ---------- -q- --- � 'f 4 - -?,� r� ........ V• ...................................................•....................................................................................,.............................................................. W VNature 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: . 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i su the boa , ealth Signed ... ............................... Date Application Approved By-•-----..... ?" .. . ...w...I....._ .. . ._ ........................ /• Date Application Disapproved for the following reasons--......-........................................................................................................ ..•-•-•-....•••-••-••-••••-•---•-•---••••-•••-•-•--•-•--•••-•--••----•-------••-•••-----•-......•-------•--•-••-•••--••••---•••-•----•-•--•-•---•--•--••••••-----•-•••-•--•-•-•-•------••••-••••-----... Date PermitNo.................................................... - Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......................... ....................... C�rr�ifirtt#�r of Tnntplittnrr � THIS IS CE IFY at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-••-•-•••-•-.....1& ----- ....--••------- --------- -------•---•-••---....---------------------.............---•---•----•---------- st er at_.... has been installed in accordance with the provisions of TIT-13 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... __7__::.2_,o(Y.............. dated................................................ THE ISSUAN E OF THIS CERTIFICATE SHALL NOT BE :CONSZTRD AS A GUARANTEE THAT THE SYSTEM WI ' NC ON SATISFACTORY. DATE....l® .::......-•-------•-------•------•--.: Inspector- - --- ----•---------------------------•-•----------....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................O F....................... ................................ No.. .-.:_~!w... FEE....�j............ ispnstt1 Worhp T.ttnstr inn .rrmi# Permission is he by granted f --------------•--••---------•-------•---------......._•--•........................ to Construct ( or Repair ( ) an Indiv' ual Sewage Disposal System atNo... ........ ' ems.. . ..... ..... --------------••---••-------•--••--•---------------•----------------•--- S eeY�r t as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .'"B ar of Health DATE................................................................................ FORM 1,255 HOBBS & WARREN. INC., PUBLISHERS 1 "Dl,S L6l.I -DaTA r3ttIt; 1= P—AMIL-f t..10 rrzlLIDE2 AV&, V:Low is 3 z t 10 GPI � i S�rlc -rA j f 14 33o it1Zo yo • A% G,Pa ' ' use t000 • L�.c+-1 F'�� • uS t=:2_ �ivw of FFUS5o25' : � - : :. : ' : : : : : : : :. : : : : . : : : ' � : , } 5t DSWA.L.L. &CZ EA (%A+Q.8X1•o8)(_2.5) = tq4. G.RD. ' . . .`.., J1 POTTOM I TOTAL. 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