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HomeMy WebLinkAbout0014 ESTEY AVENUE - Health AK, Rymi S 71 --92 --- LOC&TIO SEWAGE PERMIT MO. VILLAGE AA- - - il�►-S QLL 5 �AAE AD RE BUILD R , _►.1. AD.DRF.SS DATE ._COMPLIAKICE.. ISSUED : I- .f No. •.-4/......... F�$.............................. THE F Ts BOARD OF HEAc TH �?J� lyl�. .............OF...15& !'l,, Appliration -fear Uiiipuiitt1 Workii Tonotrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (VI-an Individual Sewage Disposal System at n-Address or Lot No. -Vst� ( ! ------------- 6 /y —,� Owner Address Installer Address Qype of Buildings Size Lot----------------------------Sq. feet U Dwelling No. of Bedrooms________________ ________________________Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons---------------------------- Showers ( /) — Cafeteria ( ) QOther fixtures --------------•-•-•--------------------------- W Design Flow............................................gallons per person per day. Total daily flow-----------------------------------------.__gallons. P4 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 ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date-_------------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.--____-_-.__.______---- Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.__-_____--__.____-. - P 0 Description of Soil_... _... V � •---•-••--------------------•--------------•-------------•-•--------•---•---•-------------•---•--------------------------- --- -- ------- -- -------- . . U Nature of Repairs Alt tionVf swer when a , ble---------- ..�+....- '._f---©�_�________ ------•------------------------•- --- --_-.----- 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 b n issued y y t. bard of heal ` Signed` _ � .__ ti °-------- � ���-_-- / Date ApplicationApproved By-------------------------------------------------------------------------------------------------- ---------------------------------------- Date Application Disapproved for the following reasons:................................................................................................................ .....---•---•--------------•----•---•-------•----•------------•-•-•--•--------•--------•-•••-•--•-•••---•...._ Date PermitNo......................................................... Issued...................... --------------------------------- Date ISIO...........�/ .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EA " TH /..�1 l9 l... ._..... . OF. — ,Appfiratiuu -fur Uttipaiitt1 lVarkiTowitrurtion PPrutit Application is hereby made for a Permit to Construct ( ) or Repair ("<an Individual Sewage Disposal System at:' At ------... . ...... . .­ . ............ ................................------------------------••------------------- a on-A'dddre-ss or Lot No. ..... ...+s✓............. . ---._...•-------- -------------- -------------- --------- � - . ..Oner ` Address `. Installer Addre d ype of tuildinV S' ei�.............:. �,"�__.Sq. feet a Dwelling No. of Bedrooms.__ ------------- -__-Expansion tic ( ) „ Garba ffnder ( ) Other—T e of Building No. of persons _____________ YP g P •--------• S� .ers (/ ) �teria ( ) Other fixtures ----------------- W Design Flow............................................gallons per person per day. Total daily fl ..: gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width--------- ... Diameter-----...-_--- ll---------------- x Disposal Trench-- No- -------------------- Width:__.•--_-____---__-_ Total Length------ " otal leaching area.:_- sq. ft. Seepage Pit No--------------------- Diameter.....................Depth below -___ --.,dotal leaching ar4l � sq. it. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed'by..._... .. .--_____________________ _________ ...... Date....._..^ Test Pit No. L______________minutes per inch Depth of "Pest Pit---------- _.... Depth to ground w- -_____-_-__.__._.. G14 Test Pit No. 2--------?-------minutes per inch Depth of Test Pit.................... Depth to ground 1' ­---------------------- y„ G ......................................................................................................... DDescription of Soil--- --- - -----------------------------------------------------------------------------------------------------------------------=---=------------------------ x U ---- - -- t ----- / w f ----- V Na ure of P.epairs or Al ation swe>;when a ble._.____.. '" .i '—. - - . D�9 ----- •-rt. - ----------------------------------------- ----•-----••--•••--------..------------------------ 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 b en Issue y e oard of heal Signed..: �.. ---•-- ........... 10 Date ApplicationApproved Bv--=--------------------------------•---•---------•-=-------•-------"-•--------•-•--•-•--•--••--- ------------------------ --------------- Date Application Disapproved for the following reasons: --------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued.............................. Date THE COMMONW5,�,LTH OF MASSACHUSETTS RI BOARD OF HEA T OF.. .... .. ................. .......... AF Tntifiralr. of C11mVIiaurr THIS IS.T C TIF " ' hat thepI' vid a;l-.,Se age spos al System constructed ( ) or Repaired, 4TM by.. ... - - - - —a--- Installer, at--- -4 r J-• t ......-=•-----•-•-•--- has been installed in accordance with the provisio , of . e XI of The S to Sanitary Cows des rilied in the application for Disposal Works:construction Permit.No,.:_T� 3 --------------------- dated_._.. ..x�. --------------------- THE ISSUANCE OF THIS CERTIFICATE SHRLVNOT BE CONSTRUED AS A GUARANTEE-THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------------------- inspector ------- ---------<......................................... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH 7� ,/� QQ// ?..... f...OF.:.! ......... : ............................ No._..:__,.:=.-,f!t....... FEE—....... .......... i>n:VaIndi k riu$t root Perrriission is hereby„granted- ---- "�"`" � � to. Constru�t� ( or air ( al Se�osa m atNo..Z-�----- -- ------- ------- --• ----------------------------------_-- -------- - -------as shown on the application for Disposal Works Construction ated__-. _:_ .._____.._ �.. Board of Healt DATE........•---• •-ot•F - 7 ------------------------------------- FORM 1255 HOBBS &-WARREN. INC.. PUBLISHERS - i`