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Home My WebLink About0121 ESTEY AVENUE - Health �a � �S�e�, ale.,Cahn, S I� 3�C�I2c� L O C—Q—T11-1 O N 5E—W-&-6-E—P—sR_M1T tom►-O. N/I-L—L 4 G►E--, — — — G— D i-N T- N E--R - -m&- =E— L D AT_E-G.O KA-.P L l-D,.t`I CE--i-SS U El7 �-�� _ ,; .. .,. � � � ,^. . :�- :r ;�. � � � � __` .. �. � , , No......................... FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 F... ........................................... Appliration for :43iiiVasal Worko Tottotrurtion Prrmit Application is hereby made for a Permit to Construct or Repair—C-4) an Individual Sewage Disposal System at: r ---04,q.! . ............ n, .. . ... .................................................................. Locatio -Address or Lot No. ....................................................... ----- ......................................... Address .................. .................................................................................................. Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( P4 Other—Type of Building ............................ No. of persons.__......_.........._...____ Showers Cafeteria ( P-1 Other fixtures ..................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length................ Width.__..._......__. Diameter---_-_____-_.-__ Depth---------------- Disposal Trench—No..................... Width__...........___.__. Total Length-___._______________ Total leaching area-----------------_sq. f t. > Seepage Pit No..................... Diameter.............._..___ Depth below inlet...._..__.._........ Total leaching area------------------sq. f t. 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._________-..____-__._. f� Test Pit No. 2................minutes per inch Depth of Test Pit.__...._..._........ Depth to ground water------------------------ ................................................................................!�........................................................................... 0 Description of So1....................................................................................................................................................................... .................................................................................................................................................................................................... ------------------------------------------------------------------------------------------------------------ -------- 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 Article X1 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bpdff''ssued by,the board of healt Signed/ 7 4 .... ................................ 9 Date ApplicationApproved By---- ..I.. .................................................................. ----------------------------------- Date Application Disapproved forie following reasons:............................................................................................ ................ .........................................................................................-............................................................................................................ Date Permit No. ......................................... Issued....... Date ----------- ----—---------- No...... ....... FEic............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --------------------------------------------- . ............. Appliration for Rapaoal lgoikfi Tonstrurtion Pumit Application is hereby made for a Permit to Construct or Repa_2—(' ) an Individual Sewage Disposal System At: ------- ...... LL�-/ .. .........................................................................-------------------_--- A_'f, Locatiofi-Address or Lot No. frh Om ...................r. ................... ............................................................................................. er Address ......................... ................................................................................................ Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ____________________________ No. of persons__.____.____________________ Showers Cafeteria Otherfixtures .................................................................................. ..........................--------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity------------gallons Length________________ Width_:____.__._-____ Diameter____.___-___..__ Depth...._.-..._._... Disposal Trench—No_.................... Width________.____..___.. Total Length__________________._ Total leaching area....................sq. f t. Seepage Pit No_____________________ Diameter-------------------- Depth below inlet______.___________._ Total leaching area------------------sq. f t. 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_________:___________._. L� Test Pit No. 2................minutes per inch Depth of Test Pit____.._.____________ Depth to ground water__.___._.._._-___._..-_. P4 ............................................................................................................................ ................................ 0 Description of Soil----------------------------------------------------------------------------------------------------------------------------------------------------------------------- x U ....................................................................................................................................................................................................... ---------------------------------------------- --------------------------------------------------------------- t -------- ----------------1/------7------------------------------- U Nature of Repairs or Alterations—Answer when applicable._6,- ---—---- ------------------- ...................... ......................................................................................................................................................... --------------------------------------------- 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 beeff-,issued by the board of f health SigneZ.Z' ................................ Date Application Approved By_______ I__.__._.... ______________ ---------------------------------------- Date Application Disapproved for;the following reasons:......................................................................................._...................... ........................................................................................................................................................................................................ Date PermitNo.......12'..... ................................... Issued............----------------..._._...................... Date '-Z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................�74/&,�/��.......OF.............. ................................. ........ ..... Tntifiratr of Tomplinurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by................ ...................................................-------.................................................................. at................... - I Installer ------------- --- -- ------- _pc .................V....... .................................................................................. 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..____.__.e s�............ dated._-____.7-`�Y.......7_3................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A-GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........-7 97 ........ --------...... ------- ..... ............ Inspector. ..........................7 .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......... ...... ..........................................OF.................................................................................. . ... FEE........................ Permission is hereby granted.......... 5 - ------------------------------------------------ --------------------------------*----------------------------------------------- to Construct or Repair an Individual Sewage Disposal System at No.........../:2.../......1-.4 ........... V/71/ &-l" Street ' , 2 as shown on the application for Disposal Works Construction Permit No--- -------- Dated______________P',/....,................. .. .............. DATE_ :�_ , / , ) 7 Board of Health --------------------------------------------------------- FORM 1255 H013BS & WARREN. INC.. PUBLISHERS � . � �' ��' �� . i � � � � � '_ Ii i I i ��! � i .Y _ � � � `�� 6 t � G� � � �' �' i 1 �� , . � �. �� } �f� ��._ � I