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HomeMy WebLinkAbout0057 HAWES AVENUE - Health 5#7 Rawle s. A ve:, r JO3 / 00 (a I M1 ZBA - 05-27-15 i i 0 Lniversal. www.myuniversalop.com phone:1-866-756-4676 UNSV12110 MAMwUM LOCATION SEWAGE PERMIT NjO- VILLAGE �yWr FQ) INSTTA LLER'S NAIVE i ADDRESS i UAL DEIII OR OWNER ownrv- 9 - 2-f/ 1e,cXur-1 N4vcy r5"7 DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 1V0 J b �o � 3 C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH b)c................................ ..........7,0.W.Y.?.........OF...... Apptiratiou for Dhipaaal Works Tomitrurtiou Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Z4VC.............I................... .............................................................................. .................. L:Wn Address ,or Lot -at ............. -t)-asom------------------------- .....C -j*= oVW Address P41 . .... .........................MU.0471. ------------ Installer Addire"s's' 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 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 ( )c, Percolation Test Results Performed by.................................**...................................... Date------------...............--------..._. Test Pit No. I................minutes per inch Depth of Test Pit.....................Depth to ground water..______.............__. Test Pit No. 2...............miinutes per inch Depth of Test Pit............___.._.. Depth to ground water._...___................ .............................................I...............*........................... --------------------*-------------------- ------ 0 Description of Soil........................................................................................................................................................................ W ......................................................................................................................................................................................................... ....................................................................................................................... ...... . .............................................. U Nature of Repairs or Alterations—Answer when applicable------------- .....:7-)9 .......... 040.0..9 ----------------------------------------------------*-----------------------*----------*----------------*----------------------------------*------------------------------------------------...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T'11, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in A.- operation until a Certificate of Compliance has en issued by the board of health. Sign ......Signed. .. Da. . .... ............. ....... Application Approved By......... Date Application Disapproved for the following reasons:................................................................................................................ ...........................o............................................................................................................................................................................. Date PermitNo......................................................... Issued....................................................... Date I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ........OF....... c,4' .; _-- '�`' APpliration for Uhipn ttl lHorkg Towitrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( man Individual Sewage Disposal System at: ............................... -•..............................................•..............---................:......... or Lot N/(©_ /g /p y�f�/j .....'................ ............ 7 .YiL.:G.f.6.: ............. Opvner r X"\ p 'Address W .._. ..-�.... :.......��''rC`. t.(:J M'_r�'. 'f:. .c`�C ' ` .�: a i t-_...f. 49..............................................•... a•' Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................. _Expansion Attic ( ) Garbage Grinder ( ) p`4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.1 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•----------------------- ....... -.........................------- •........... ._._..---.-•------------•-- ...... 0 Description of Soil............ ..............................•-••------•--•------•--......------------------------------------ ......---------------------•--•--•-•.............._.. W -•-•--•-•-••-- ....................................................................................................................................................................... UNature of Repairs or Alterations—Answer when applicable..___.___ ___p`. __ _° _: ".___._. ................ V<... ....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiTI,z'. 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 Signed.----- t .... Date Application Approved By.......... s ` ---•• .............. .......,/�,1�/ 0......•••- Date Application Disapproved for the following reasons----------------•------•----------------......................................................................... --••----------•--•-------------------•--.....----------------...-•--•-----............_..-------------------------------------------------------...----------------.................................... Date PermitNo......................................................... Issued_....................... ............................ Date THE COMMONWEALTH:OF MASSACHUSETTS BOARD OF HEALTH P d �rr��f grtt�.r of f�nut�lt�anrr THISJS TO CERTIFY, T the Individual Se&wzg�Disposal System constructed ( ) or Repaired b ............ ` -`--•-- -=. --. . �' ............................................... . Instal at ........... .. ........ ........ . _.._has been installed in accordance with the provisions Of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-__-.g =_. x ............. dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............................................Id.q N....•......._.... Inspector...................... .�_ _ ..........._....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..B `d"$ ........ % .' ......OF._.......�f to 1�`��` .;��.�`. � ......................... FEE ........................ �i��.uu� n�k� �.unu#rltr��rn rruti _ Permission is hereby granted.---. -�' c .. .. ... .... '.._. -' - -............................. -,. .--- to Construct ) r Re air� i,,�--ap... ndividual S -y.,age Disposal System at No. > Street as shown on the application for Disposal Works Construction Permit No...................,: Dated... _-____----•__•--- ............. DATE.................. y� _ /r.......-----------. Board �eali FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS