HomeMy WebLinkAbout0118 OAKVIEW TERRACE - Health 118 Oakview Terrace
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THE COMMONWEALTH OF MASSACHUSETTS
pill BOARD OF HEALTH
... ... ----------------_0F....................................................................................................:.._._.._........
a'
Applirttttun for Bwvviial Works Tonotrur#tun ramit
� Application is hereby made for a Permit to Construct ( -1"or Repair ( ) an Individual Sewage Disposal
System at: ,
....:... a.Q Ld... .7-..---.Q J��Z ...' ��r. /Y�[r t!Z�? .....-•---.... ..........................................
_I,ocatioZ.;.lddrW,ss r lot No._�
..... ?> - --.lyt......�?9.....•---....-----•------•--••--•----... ........... �7ylc�� !dl .....................
JI caner Address
a 1,1�3 s ------------------------------------------ --,�. r v
Installer Address
Type of Building Size Lot... A �f�......Sq. feet
Dwelling—No. of Bedrooms.:_:._3..................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( :24 — Cafeteria ( )
P4 Other fixtures ............................
W Design Flow........................: ...........gallons per person per day. Total daily flow..... ......................._----gallons.
Rr Septic Tank—Liquid*capacityl5_.Aa.gallons Length_.. Width..5-0.... Diameter_______ ______ Depth..5.' .._..
W Disposal Trench—No. -----_------------ Width.................... Total Length.................... Total leaching area....................sq. ft.
� x
3 ;Seepage Pit No...____.-�____.___. Diameter.___._�d___.._. Depth below inlet.__.._'__.._._._. Total leaching area..!?_!: ....sq. ft.
Z Other Distribution box (r) Dosing tank ( )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................
aj Test Pit -No. 1...._Z-------minutes per inch Depth of Test Pit....! r_..... Depth to ground water.._.=..—'.......__.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....................
...................................... ..................................................................................................................
O Description of Soil......--•----Z-'- 717�' ...............................
x
U ...............•-•----•-••----
w ------------------------------------------------•--......----.......-- -----------------------------------------•------------------------------------......----------------------------------..._...•.
VNature of Repairs or Alterations—Answer when applicable...........................................................
-----------------------------------------•-•----•----------•--------------------------------------------•-••....---•----••---------•-------------------------••-•----•-----•-•---••-------•.........----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI IL4 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_._. .. ----- D
Application Approved By---- •- .,. :1 `--.:.__...... _,�
a ...._._
te
Application Disapproved for the following reasons_____________________________________________________•-••------•--------- .....................................
•-------------•-----......---•--....-•---•------------------•----------••-------•-------------.....--•------.........-•---------•-----•••-•---•--------•-••------•---••----•--•------------------•------
Date
PermitNo........ `� (QCA2------- Issued-........................................................
Date
N :—l ,z- Fim ..�...-.....:......... ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................:........................OF..........................................................................................
ApV ira ion for Uhywial Workii Tontrnr#ion rrmi#
Application is hereby made for a Permit to Construct ( _for Repair ( ) an Individual Sewage Disposal
System at: .�_...�.7.......0.f fii fir/.... � .. n` G.� �j
..Y y ---....----- .-•--•....................................
�ocatiZ!,�Addr s or Lot No.
.....,��C' 1��w--•-/✓ J O•.. /7 �L�r,�� .........................-•S¢ --a.....................
W Ei•�//S 1l�Yc U�'�/�/C� r / �f"�76ev .. Address
,.� --.----- - //
� Installer Address `/
Type of Building Size Lot---
__.,e.....................Sq: feet
aDwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder`( )
p, Other—Type of Building ............................ No. of persons............................ Showers (Zl-) — Cafeteria ( )
a Other fixtures --_------------------------------
W Design Flow.........................55------_----gallons per person per day. Total daily flow.........c?.............................gallons.
WSeptic Tank—Liquid capacity�`?_�'�_gallons Length_.�d.'_ .. Width_. 'X_... Diameter-_._-_- Depth.>_'-`^.....
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.........�.__...... Diameter......1 ?` ....... Depth below inlet......±.......... Total leaching area._Z_�__..sq, ft.
Z Other Distribution box (1/) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
,-al Test Pit No. I.....z-------minutes per inch Depth of Test Pit----� :_��.... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-------------------------------------•--............----.....-•-•------------------•----•------..............................................................
0 Description of Soil T .�—�...� ............................. . w............................. A...............................................
x
c.,
W -------------------------------------------•----•-------------------------------------------------------------------------------...-----------------•--------------•--------------------•-•....-----••--
UNature of Repairs or Alterations—Answer when applicable............................................................:..................................
-•------•-------------------•---.........-•-----•----------•-----------......------.....•----•-•--••---•--------------------------------------------------------------.......--=-----------....----•---.
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 been issued by the b� of health.
11 Signed----•-_. ..✓.�! ..........._= J .
Application Approved By..... =A... ...
ate
Application Disapproved for the following reasons:..............................................................................................................
---•-•--•-----------•----•--•---...------•----------------------•--------••----•-•----------..........----------------.............------•--------------------•-----------------------------------•----
Date
PermitNo........ I0&�------- Issued--•----------------------------------------------------
r Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........................I......I.,.......OF.....................................................................................
- Tatif iratr of-&- mlilittnrr
THIS IS TO T,LFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----------------------------------------------------------------------------------------------------------------------------------------------
--.-----•-----------------------------•---•------------
at J 1 C.....� f �C'� Gt /)r� ------... --...------•--------
• ------••--------•----------------�-•-- �1 - .
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has been installed in accordance-with.the provisions of TITLE 5 of The State Sanitary Code described in the
application for Disposal Works Construction Permit No...__ ...�-�._.":t......... -.._.. dated..........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUED AS A GUARANTEE THAT THE.
SYSTEM WKL UNCTION SATISFACTORY.
. r
DATE..... 5 ' Inspector ..................................................-----•--c:........
.......................................• :.. I 1 /
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
4-);.-
No......................... FEE}---:�..........
Disposal Workii Tons#rnr#ion Prrmit
Permission is hereby granted-----A=..L1/..�......-•---------.--•••--------•-----•-------•-••----•...........................................................
to Construct ( A or__Repatr ( ) an Indi i�ual Sewage Disposal System• j
rG< J
at No....-•-_,-�' �. !��C.. ...... ...::.----
Street
as shown on the application for Disposal Works Construction Permit_hJ�. Z............... Dated .._____ !-' :__.__.._........
Board of Health
DATE. --------- _„ t�......................
FORM 1255 A. M. SULKIN, INC., BOSTON -
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