HomeMy WebLinkAbout0065 LOUIS STREET - Health _ s.,
_ � _ �
,�
-_-LOCAT_-LON- __ ___ _ -SEW&(C E PERMIT UO. ,
-b.0 1 L-DER S- t.J- - -E- .-b D D R_E SS.- - - --
---D. .T_E-COMP_-LI_W-ACE-ISSUE-C);-�� _
, '
�q`�
1 � n`
�S� ,��
9 ��,
� A
``X-` 1 \
V\v
Fizu
THE COMMONWEALTH OF MASSACHUSETTS
E®ARD E HEALTH
.....OF... ........... . -------........_.....------------
Appliration -fur li,ipuiial Workii Totwtrurtion Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
CL4..... . .....#
oc - rreess /) or Lot No.
.... -cam
Owner Address
W
Inst r Address
Q Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aq 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---------------
xDisposal 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. 1----------------minutes per inch Depth of "Pest Pit.__-______________- Depth to ground water-----.-._-------_.-----
�14 Test Pit No. 2----------------minutes per inch Depth of Test Pit----------_--------- Depth to ground water_._._..___---_---_..__
04 ---------------------------------------------•----_-_--------------------------------•---------- ----------------•---------------------- •--•-----
0 Description of Soil--------- -------------------------- ............................ ------------------ -•-- • ---- ---------------------------------------------------------
x
W ---•-------------------- ----------- ...... - - --------------- ------ - - --------- -------- ----- ---- ---- ----
V Na e of rs or AJV ations Answe w n applicable_._.. ..11"_._ - .Q._t!._ .�.__. __.___._
Agree ent:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code— The undersigned further a rees not to place the system in
operation until a Certificate of Compliance has bee sued by he board of heal
Date
ApplicationApproved By-------------------------------------------------------------------------------------------------- -'--.....---•---'------ ----------------
Date
Application Disapproved for the following reasons:...-............................................................................................................
--•----------------------------•--------------------•-------------------------------•----------...--------•--••--•-•-----.....-----------'----------------------------------...-----•---• ..............
Date
Permit No......................................................... Issued----- ' �,�' 74-
-...... a----'--- '-------•-----------.
too
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F HEALTH
l/y(.I/....-.OF.... ......�... �./!/1n..� ...................................................
Apphratilau -fur Diripagat World Tomitrurtiou Vrruift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: --- -- .._
......... -`-�---.... �1-- ....
rEocat;;;;1Y Tess / or Lot No.
---------------------------------------------------•-----........-----
//''�1 Owner Address
~� Inst r Address
d Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms-------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P4 Other fixtures ------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow...--------------------------------.--------gallons.
P4 Septic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter----------.----- Depth----------------
xDisposal Trench—No- -------------------- Width.................... Total Length..................._ Total leaching:area----.--._--_---__-..sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet-----------......... Total leaching area..__.__--_____-Sq. it.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date--_--------------------- ------._....-
,a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit------:._:_:_:...... Depth to ground water.._.-____----.---.---.
G14 Test Pit No. 2____.____--___minutes per inch Depth of-Test Pit................... Depth to ground water-----------.__-___---__.
9 ------------------------------------------------------------------------------------------------------------------------------------------------------------
0 Description of Soil------------------------------------ ----------------------------- ------------- 4't
----- ----_-------__.-----------
---------------------------
x __
V
W -------------- ----------- ---------------------- - -- -- ------------------- ----- - .'- ' `
U Nature of irs or Alt !t pp C f7 _ �f
ations Answe w n a livable._.___ _rr __ !.. ............. ���,___. -_.-___..
- =
� .
Agree ent:
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 a rees not to place the system in
operation until a Certificate of Compliance has bee 'ssued by he board of health.
Signed..i�.__.!-, __ /i1 / /X1 = -- ----------
Date
ApplicationApproved By-------------------------------------------------------------------------------------------------- ----------------------..----------------
Date
Application Disapproved for the following reasons------------------------•--------•---------••----_---_------------•------•---------•-•-------•-•-----------------
--------------•---•-----------------------------------------•----------•----------------•-----------•-------------------•-----..._..._-----------------•........_....__.......-----•------------.----•-
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
. f y.....t........OF........... ......................................
(1:1rrtifir t ;of 109.1.11mPtiaurr
T S\IS T ERT That Ali ndividu Sewage Disposal System constructed ( ) or Repaired ( )
by __... .-;:... , -----------------------
I staller t
at..• . f.......... -r ----, -----•--�"'s • . ...''----�C_ �•� .E�°"✓� .�y d
has been installed in accordance with the provisions of A I XI of The State Sanitary Co e as des ribed in the
•
application for Disposal Works Construction Permit No.-_.-"____._,�:�_.��- :....__.. dated.._ _-./_.(.......r�;1...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH _
�.....l �(....OF....... .. �
No......................... FEE--�................
Dispotial Mork npuitrurti �t Prrmit
Permission is herebyanted--- ...._C _ .! _.��.�J -•-------•---------•-----------------------•---•--•-----•-----••-------_._
g,
to Constr ( or e 7 (�n Individ QI Sewage Dis(s System
�_ U - -
/ rj7�C.
Street -
as shown on the application for Disposal Works ConstructiAit :___ _ Dated_.._ _...._'_.�_ ' ....
/�
/ _�1_ .� - (�.�t!t• -------------------------------
' /' � Board c•f Health
DATE.... -- `i--------------------------------------•
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
�� It