HomeMy WebLinkAbout0071 HAWES AVENUE - Health 91 HMa
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ZBA - 10-28-15
_SEWO.C,E _PERMIT MO.
VILLAGE- * -- --_-
_ .IMSTALLER. S-_ IJWE- ADDRESS
1
DATE-..PER.MIT ISSUED
DATE COMPLI &NACE_- ISSUED : -?�
- Q
7Z�
_ r,
No. ....... Fizic 2..................
THE COMMONWEALTH OF MASSACHUSETTS
ABOARD OF HEALTH
App iration -far Digposal Warks Cnonstrurtion, Prrutit
Application is hereby 'made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
.-----A.. -_1.�------------------ �1�.v� r �,�-��=---------------
----------- ---------------- - - -
Location-Address .- or t No.
�- .............
� nJ1.---'- 0-------------------------------- d�-� ---------------------------------------...._..------
Owner Addre53
ava 0. - .Ss_
Installer Address
d Type of Building Size Lot____________________________Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' 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------- ----------ST It.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----____________-_----------------
a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--_-___--_-___________--
G14 Test Pit No. 2......_.........minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
Ix ----------------------------------------------------------------------------------------------------.........................................................
0 Description of Soil-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
w ------------------------------------------------------------------------------------------------------------------------------------ ------------�_.,�--------------- ...............0 Nature of Repairs or Alterati ns—Answer when applicable.- _1� � _L-__-1_l4_Xj_in,--�-�--_—a
U p' � pp• "- - �-
J.�` (4----------v? — '`il-------- STr e:,!!rZ------------JIA6� r_0-------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system n
operation until a Certificc� of Compliance has bee ss b he b d of he h.
Si ------- ------ --�- - -
D e
Application Approved By--- --4 _.. ...... . --- .. .
--------------------------
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------..--------_.._..------------------------------------------------------------------------:_...---
Date
PermitNo......................................................... Issued........................................................
Date
No.. ........ FEx.. ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
----------- ....................
Appliration -for Di.ivviial Worko Towitrurtion Vrrulit
Application is hereby made for a Permit to Construct or Repair 4"a"n"Individual Sewage Disposal
System at:
-----77-/_-_----- -.,S-------A -s-
................................ ........... . ...................
Location Address or Lot No.
J n2...............
--------------------------------- ........ .........................................................................
Ownerlddresl-
C f_j
............... ....
......... ..... .............................. .................
Installer Address
tll Type of Building Size Lot------------_--------------Sq. feet
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. I----------------minutesperinch Depth of Test Pit_.-__-_-________--.- Depth to ground water------------------------
rX, Test Pit No. 2................minutes per inch Depth of Test Pit.--_-_--------_____- Depth to ground water...---------------------
P4 ---------------------------------- ..........................................................................................................................
0 Description of Soil-------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
......................................................................................................................................... ----------------------------------------------------------
-------------- -------- ------------------------------------------------------------------------------------------ ------------------------ ............. ...... --------------------
JCS / �4 ^j
U Nature,of Repairs or Alterations—Answer when applicable- CD /3 L
--------------------------------------------------------------------
1�0
.......... ------r--------------------------------------
.............�,.�./-,j------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 been is ,ed Wthebdard of health.
Si e ... .... .................................................. ............ ........ l---
we ------------
D t
7
Application Approved By-----✓------ - --- ---- ...... - j�7
Date
Application Disapproved for--th'e following reasons:---------------- ---------------------------------------------------------------------------------
........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH—
. ..... j...........OF........... .. ....
101,rdif irate of lImpliaure
T"I IS TO IC Y, That the Individual Sewage Disposal System constructed or Repaired
by----- k-P. ....... ........... ............................ ................................................... ................... ...............................
AInstaller
........ . ....... . . ......................................
---Ir
........ .. .....
at..-- ......... ....... . .. ----------—Z/..
has been installed in accordance with the provisions of ArtiMXI of The State S -- tary Code as described in the
application for Disposal Works Construction Permit Nol "0 ----------- dated' ..............
...7..t�---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................................._.................................... Inspector....................................................................................
---4-IL -----------------------
S itary Code
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF' HEALTH
a,/
...... .......OF.............. )
No..... -------- FEE.... ..............
Dinvolial rk Btrurtion Permit
Permission is hereby granted....... i........... . .... .......................................................................................
sk to Construc9 or Repair ( ZKt Indiyidual Sewage Disposal gtem I
atNo._G ...........................
S et
as shown on the application for Disposal Works Construction Per it ------------ ---- ---
------------ .- . .....
All
..............
6 . .........
Board f He it a h
DATE....7 ....................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS