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Home My WebLink About0054 HAWES AVENUE - Health Sy awes Ave. bi F4ronis Say /07-7 f -��.. SZ-OE-60 - d9Z =; 3-z - 0-7� SYz- LOCATION � SEWAGE PERMIT�NO. . VILLAGE UA P F9 np I N S T A LLER'S NAME & ADDRESS BUILDER OR OWNER l� v J-,�r,cY DATE PERMIT ISSUED Zz S y� DAT E COMPLIANCE ISSUED � � � 1 cam. i I Vl i a i T TH.F_ COMMONWEALTH OF MASSACHUSETT' BOAR OF HE TH�� ..................OF. / ..... ............................................. for Disposal Works. Tnnstrnrtinn Prrutit Application is hereby made for'a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at !............................................................S.i --- - ....-----------------..................... do - dress or Lot No. ...........•....•• ...... �� O Address a ..................J s._�c..----•--- ....•'....--•--....................................... ----•--•----..........----•---•---------........................... '. Installer Address d Type of Building Size Lot............................Sq. feet . U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type e of Building No. of persons............................ Showers — � yP g ---------------------------- P ( ) Cafeteria ( ) Otherfixtures .......................---------------------------------------------------------------•--------------------------------------••----------... 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pif.................... Depth to ground water........................ ............................••••----•--........... - O Description of Soil....._...._ t-! .."........ ......... ........ --------------.--------------------------------------------------------------•----•---------- x .. .............................. x ----------------------- ---- ....- U Nature of Repairs or Alterations—Answer when applicable_--- _:___0-l.1_,j___...__._ '-___-: PGL......................................... -/-----......___. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:ITTIE 5 of the State Sanitary Code=The undersigned further agrees not to place.the system in operation until a Certificate of Compliance has�beissued, by he board of health.... .Signed. �..... � -• D to Application.Approved By.......... V---------------------------- ------------- Date Application Disapproved for the following reasons:................................................................................................................. ...... ......................................e---•••----------•-•--••......•--•••-- -- ---------- � _ S Date Permit No... ..... - Issued. -2/ Date-.., No............. Yti.. .......L.- THE COMMONWEALTH 'OF- MASSACHUSETTS BOARD OF HE, TH ..OF.. 7tC ...................................................................................... Appliratiou for Uhiposal Works Towitrurtiou thrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal YSK/4/6� Z�es ............... ......................................... ........ --------------I-------- ------- ati, d ress or Lot No. .................. :::��------- ......... ................................. ..............................................L�r............................................... r Address re -------------------"......... -------------------------------------------*......**-------------- --------- Address ........................... J.�t.11er 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 ......................................................................................................................................................... Design Flowx,2......4............................. gallons per person per day. Total daily flow............................................gallons. 1:4 Sep is Tank—Liq0&eaftacity............gallons Length................ Width..._............ Diameter__.__._......... Depth............._.. Disposal Trench—No---------------------- Width_..._....._...._.._. Total Length....__....:.._......"p 7", 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........................................ 4 Test Pit No. I................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........................ 213......... ....................... ................................................................................................. 0 Description of Soil--- ................................ ...................................................................................................................... U ...........................................................................(41-11--------------11--l-,,*-""""",1-11-111,11I------------ ----------------------------------------------------- ...................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............K i .............................................................................................................. ................ --------------- ................ ------ ............................................................ Agreement: The undersigned,agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TILTIa, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bepliss d by h board of health. e e oar Signered- . D Application Approved By........... ........................... .....�11 ?0461------------ ell, Date Application Disapproved for the following reasons:.............................................................................................................. ................................... ---------------------------------------------------------------------------------------------------------7Z --------------------------------------- Date_ Permit ---------- ............................ Issued_....�.F/ ............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,qF HEAL, ,_, ..........................................OF................................... .................... Trrtffiratr of Tomplianri, q . THI,rl-S o CE TI Y That the Individual Sewage Disposal System 'constructed or Repaired by ...................................................................... . ...........................W, �............... ...........:... ........ ......................... /,S at........:�y................................................................ ] ........ ...........................I......... ......................................................... r rn I� T. has been installed in accordance with the provisions of T 5.gjjhe State Sanitary Code as described in the application for Disposal Works Construction Permit .................. dated___....--_..---___---._.-_............_........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................�1):3. ----------- Inspector...----...... ....................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT Y2. .OF.... H _ ......................................... .................. ............................ ..................... No......................... FEE... ion trudion Virrmit Permission is hereby granted...................................... ....../........................................................................................ to Cons epair. anViviaual Sewa Sal Syst&q r at No.... ................................ ---% ................. --------- -------- ................................................. Street as shown on the application for Disposal Works Construction Re=*t No---....... ... ... ................ ........ .... ........ ...�_-i- ---------------------------------------- DATE------------ ----------_------__------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS