HomeMy WebLinkAbout0108 ESTEY AVENUE - Health .?ail � o bti
LOCATION � SEIIItAGE PE *MIT NQi /
VILLAGE
/ SAN F FP?
I N S T A LLERR'S. NAME i ADORE
-1-L-O-E-R-;. OR OWNER
- sTY
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED � _���
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
. - ,
7W..n-----.....OF.... .
Appliration for UinVntia1 workii Tonstrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
---.....J k._.... - I--------------•------ --........__.............------------......------. -------------•----................---•-
d.Tess or Iot.No.
Ow r ...........................................
A ess
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................. .....Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Ga 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. ft.
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........................
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a . ---------- ----- ........ .... ...........
Description of Soil............... J----- -0_� .....-------------------------•--•-
x
U .-----------•...........................
----------------------------------------------------------•------W -------------•----------------------------------------------------------------.....----....------------------------------. •... --- ••.
UNature of Repairs or Alterations—Answer when applicable---------r. _ _� __-�..p_. .:'_ .° ..._ .....__�._..
.....................-................-..........................................................:......................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witli-_
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has Ken issued by the board of 1 ealth.
sign .../'°?....
Date
Application Approved By......... ••-••-• . .... Z= ®-:•-•-
Date
Application Disapproved for the following reasons: •-• •--•-•.....
...............••-•-•--••-----•-.._...--•----•••--•--••-......----•-•-•-•------•--•--•-•-....------•...•.•-••-••----•••---•-•-•---•-••••--•••......••-•---•-•---•---•••-••--•--•----•••......-•...--•---
a Date
PermitNo......................................................... Issued.. � ----------•-•----------------=--
Date
r — —
�? r
No. �'' °=•r- Fps: }:?....!.....:.......
THE COMMONWEALTH OF MASSACHUSETTS
�. BOARD OF HEALTH
( (1..�.L ...........O F..........?/-1 . i _ I �( 1----�................................
Appliratiun for Bi-spas al Works Tontrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
...........:....__ ...---..:..:..... .:... - .............. ............_...........•.................. ••-- ---•-•-••-----------...._.........._..........
Location-Address or Lot No.
ltl� ," 1 l
Owner f / ♦ Address
W t - f /� 7 f 1 i . 1 i k
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ..... No. of persons............................ Showers — Cafeteria
QIOther fixtures ------------------------------------------------•---•--- -
W Design Flow...........................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capa-ity............ Length................ ).Vidth................ 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. ft.
Z Other Distribution box :( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1.......
..........minuteszper inch Depth of Test Pit.................... Depth to ground water........................
L,~ Test Pit No. 2...............minutes.per inch Depth of Test Pit.................... Depth to ground water........................
0 Description of Soil =..........................................................l ' ------------------------•-•---------------.............................-----------...------.
x
FWy ------------------------------------•---------------------------------------------•--------------------------------------------------...-----------.-----------...------.---------- -=--- ------
U Nature of Repairs or Alterations—Answer when applicable.:_____________________________________________________________�.._�lrG=___ ........
---------•-----------------------------------------------------------------------------------•--------------•--------------------------------------------------------=------------------...........•.•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance.with
the rovisions of IT �'
p 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.
.. 4 1 I l' '.: .Sign r f
Date
Application Approved By 6L -------------------- !E = ,.
Date
Application Disapproved for the following reasons:.................... ...............................1---------------------------------_..._...._.______........_
:
.................1.........................................................................................................------------....._...--------------------------------------------....-•---
Date
Permit No................. . ......-=------•-------........ Issued_ -----....................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......! f..t::. .... `...........0F....................................t...........
.. ..............................
watifiratr of Toutpli tnrr
t
THIS IS TO CERTIFY, That the Individual Sewage_Disposal System constructed ( ) or Repaired ( ,)
bY..........................................................................' ! t > r.....................t -t- ... ----•--•--•---------•--------------•--.......----........_.....-•••-----••-•••--
5tauer
-_.... .
has been installed in accordance with the provisions of T j of The State-Sanitary Code as`described in the
application for Disposal Works Construction Permit Nar !"r- .......... dated..42!t./7t.&....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE... *, spector.........---•----------
THE COMMONWEALTH OF MASSACHUSETTS
->, BOARD :OF HEALTH
.. ..d.�.... .........................0F......
N �-a
...... ..... FEE S..t' ..
Biupoa�I Voiks T-14instrudian Pgrutit _
Permission is hereby granted? -... . �f- . •r'3...-)- -`1- } 1-_2.')1............. .................................
to Construct ( ) or,-Repair ( an Individual Sewage Disposal System ; 1
?at No.......� r . -r. �._ __.....1 ........ s... !._7...................................................................,: ?`` . ;.------......... .
7 Street
v
i as shown on the application for Disposal Works,ConstructiW
ry iit . o._ __ __ ...... Dated_..�J'- ......................."
� y— --------------•.----
�/ / Board of Hea
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS