HomeMy WebLinkAbout0133 PLEASANT STREET - Health - 133 Pleasant Street j
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEA TH
i.'.til.`-�:.. ........OF........ . . ._..:..................
d
, �ir�tti�a�t for Bwpaval Works Cnoust ulr#ion ramit
Application is hereby made for a Permit to Construct f or Repair ( ) an ividual Sewage Disposal
System at:
L tion- dress or Lot No.
J✓A ,�s . ..... ......... f ee h....Address----•----------------------
------•---•-•-
wner
..... ZZ �� ------------------••--•------------ ---------.__.---..--------___-----.-..-----.------------------.---------.----•---•-----------•----
lnstaller Address
Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Q, 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..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
PercolationTest Results Performed by.......................................................................... Date........................................
�4 Test Pit No. 1................minutes per inch Depth of Test Pit..--.--............. Depth to ground water...._...................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
- --------•--•--------------------•----------•----•--------------•--•---------------............--•-•-.........................................................
0 Description of Soil........................................................................................................................................................................
- ----------••-- ---------- --------- --- _•---•----•---•--•------------------------------------•---
= =
.1
V Nature of Repairs or Alterations—Answer when applicab e.__::;��1_ .�... .. _...^��.z_.
-----------------------------------------------••---•---•-••----------------...-•----------------------.......------------------------------------------- . ..•--. -----•--...--•----•----...__.....
Agreement:
The undersigned agrees to install the afo scr` 'dual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sa • — lndersigned further agrees not to place the system in
operation until a Certificate of Compl, as is th board of health.
Si edr
r
Application Approved BY. ,-- 2 1 _- - ..
Date
Application Disapproved for the following reasons:........... -----••---•- ---------•---•---•-----------------..........................................
•--•-•....................•-•-----•--.......-•--------------------------•--•-------...---...---•--.....----•-•---•--••-•-•----------••------------•------------•--------------- -••--••--.........
Date
PermitNo......................................................... XZV7Issued---. ..�.......--------•-
a
Ai k, ,. =
No .�2_ ...... FnE ..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F i IEALJH
, ppliration for Btgpmial Works Tomi#rur#ion rumit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) anj n vidual Sewage Disposal
System at
........................_.. ... ------ •- •- -
Loo4tion dress �_ .
{� or if
No.
--Y s..�. a, . . 'r .... _.... ��, - _•_.�j�_... -... �� .. ------------------- .....................6wner ��'$ ---- -------------•---- Address
#fir
a ....... r; f'` ,
Installer Address
Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
pi Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a 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........................
G Test Pit'No: 2—.............minutes per inch Depth of Test Pit.................... Depth to ground water...................
a ;
ODescription of Soil.................................................................................................... -------------•---•---•------•-••---•-----•-----------•---•••.••----
-------------- ... rr v
U Nature of Repairs or Alterations—Answer when applicable._. ?' «h ?.. `x.. .
•---------------------------•-----•-------....-----•-•-•-------•---•--•----••---•--•--•••••--••••--•--•-------••-•--------•---•---------------------•--••--•-----•----------------•-•---•-......._---•--
Agreement: .
The undersigned agrees to install the afored'escribe&I"n_div dual Sewage Disposal System in accordance with
the provisions of Article XI of the State San$lt- ro ew"`—,Tho dersigned further agrees not to place the system in
operation until a Certificate of Compliance" , is u'e*d^"by the-board of health.
Ir
,.� r
Si
- .
D e
Application Approved By---. .
Date
Application Disapproved for the following reasons:..........................
------------ .........................................................
•----------------------•-------•--....-----------•---•---•-••----•-------•------•---.....--•------•---...-----•-------------------------•--•------------------------------------•-----------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
"...........OF........
................
{ Owfifiratr of Tompliatta y
T 1,S IS TO 04,RTIFY, That the Individuar Sewage`] isposal System'constructed ( ) or Repaired
�� •• , .
by....
,9 Installer
at. '1` �I- -'� .................................. ---•---•--------- .--- •-•--•-•-......_._..----------•----------------------•-•---
IF
has been installed in accordancq�fth the provisions of Artide XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. I.....lb .......... dated__._. ' - . --------._.
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT RE CONSTR S ��9 9�TEE THAT THE
SYSTEM WILL,F NC ON S SFACTORY.
DATE............... /•••••. --.�.. ..... ..... Inspector.......... •-----------........................ ................-_.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD , F HEALTH
4 .. �,
FEE..
No.........................` i ....
%'u muptrurtion ramit
Permission is hereby granted--•-- 7_11., �* ....................................................................
Individual Sewage Disposal
to Construct ( ) or R pair ( n Syst
at 4
or Disposal Works Construction P rm t No ?!!._r .._. Dated_.__ f_....� . ..........
as shown on the application f
^' � `. .. .. - -
Board of F eal h
FORM 1255 HOBBS 8e"WARREN, INC.. PUBLISHERS