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Home My WebLink About0081 HAWES AVENUE - Health 4'i F�aats �., N�arn�s --- - - - 3a3__/_ oo�- - - - - -- — -- - -- - - -- ZBA - 10-14-15 0 Lavers www.myuniversalop.com phone: 1-800-756-4676 UNV12110 MADE IN USA LOCATION SEWAGE PERM13 NO 8/ /yac�es �Jvt VILLAGE 14 iUJ ` IMSTA LLER'S MA/ME &Q /}ADDRESS L u {.! U d U I L D E R OR OWNER C/I rl 57.*J" f� Hew Qs Arc .OAT.E PERMIT ISSUED ®:A;, COMPLIANCE ISSUED / , j 6 _ ,.: �;• -"� � '� a - . _v \ � � ;, � . .. �, . � i. l' �_ ,,. y n� YNo.. 61.......... _,� FEs......LD................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF............................................................•------..._.._..........._..._ Appliration for Uiupuuttl Workii Toustrudiurt Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -------------------------------------------------------------------------------- nLocation-Adkess or Lot No. u ho !F.......... c:n,(.................... Qt ..GQa�11�_� .�..... o Owner [!!d ess w �Yrv.--Ci3�tc�.... .... ...... ��►�--c��....��... ��-iro�. . .....----•---- t............ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.._.___.____ Expansion Attic (WQ) Garbage Grinder (fO4 Other—Type of Building�C I N A.._...... No. of persons-_2 .................... Showers ( ) — Cafeteria ( ) 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---•-----------------------------••--•-------------------------••------------------...........•----......................................................... 0 Description of Soil......................................................................................................-----------•--•--•-----------•---•--............................. � ----------------------------•-------•------•----•---•-•----•-------•••••---•--------•---------•-......-• ................................... ....... U Nature of Repairs or Alterations—Answer when applicable..........I ., .......1111-—------ .. .. Agreement: -N The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLYIPLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en i ssu by th board of health. Sign ...................•---•--...........------------...................--- -•------------............_ Date Application Approved By.._..----•-•--- ¢-- �� •..................•-••-•---•... Date r Application Disapproved for the following reasons:-------•----•-•.....................•------------------•--------••-•-•--------........• ---•••••.....•----- ................••-----•---••-••••-----•-•.-••--•.....•-----•.....-•------•....................---•........----•---------------------------•••-••....----••-•---••••... Date PermitNo......................................................... Issued........................................................ Date 1 No........................ Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF..............................I................................................... Appliration for Uigpniittl Vurk,5 Tomitrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......................................•-------...............-•-•----------...............•--..... ...--••---••--.........-•---•-----------------••--•---•----......---------••-•---...........--.... Location-Address or Lot No. ......-----•---------.............................................••-•-.......................... •...........-••.......--••........._....---------...------------------............................ Owner Address W Installer Address dType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------- ••••••••---•-•--••-•--------- ••••-•---------- •........ ------------ --------- •-----------------.-.._.................... 0 Description of Soil.........................................................................................................................--....--------..........••-•••._..........._.. V •••.._.....-••••••••---••-••........_...••••••••••••••••-•-----•••-•-••-••-----•••-••-...-••--•••••-•-•----••--••--•-•••••...-•-•••••-•-•-•-••--••-••-••-•-...•-•••••....•-••••----•----•••----------••. -----------------------------------•-------------------------------------------------------------------•---------------------------------------- ............................... U Nature of Repairs or Alterations—Answer when applicable---------. L------- ...----`-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 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)beniss by th board of health. Sign ..................... .......... Date _...Application Approved BY T� ' .. r ...................... ....D .1/ .•... Date Application Disapproved for the following reasons:...............................................................................................I................. .....................•--•---------•---------•-----....-------------•--------•---.......---...------........--•-•--•----•-••-••••••-•-••••••--••-•-••- ---••••. -•••••••• --•--...._..._ Date PermitNo......................................................... Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......:...................................OF...................................................:................................. Tatifiratr of f omplittnrr THIS IS,�O CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by •. �! Installer at...................•--�d... ._ ..-......' -=--••.••••••---•••-----•--•••------••-•--•••-•-•-••••.......•-----•------•••----•-•-•--.....•••...._. 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.......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................11�..a.�.A-3......_.........-_.... Inspector------------•-•-......�_'.Z-!A�---•----•-----•-----•--•----•-•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.................................... No..��..........c1�7 FEE...6.............. Bisvolsia nrk� /Tons#.rudivit rrmit Permission is hereby granted••••..... -• ....... - !V.-................................................................................................. to Construct ) or air ( an ndividual Sewage.Disposal System atNo. ........ Gam. _ = - - ------------------------------------------------------------------------------------•-••------ Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Board of Health DATE------------------••----......_..�J L?�Z FORM 1255 A. M. SULKIN, INC., BOSTON PRECAST LEACHING CHAMBER r---- - _ GEj.IE2 AL.. P10TE S ALL. E Lre�J. S MG � w� Aft A J f ME •4.! 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