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Home My WebLink About0676 SCUDDER AVENUE - Health (0-71. Sucdatrw Ave-. asrn,., S T W F STABLE , LOCATION &76 a SE AGE # /®�� VILLAGE lil n lLT ► `� ASSESSOR'S MAP & LOT "?,f7- 0i) n J INSTALLER'S NAME & PHONE NO.,) L ¢,� 5� hi� SEPTIC TANK CAPACITY f, L� /' ) i Sva / fS f4 LEACHING FACILITY:(type) SC f L 00 CL size) ) 6 U� y� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: f D�;p 01,6 DATE COMPLIANCE ISSUED: l0 hl �S VARIANCE GRANTED: Yes No ., �.- � I � j , � ;� �I . �� lam/. I i' S -- � ,� +� _ V `. - --�� .�� _� �. ;, - �'� # ' � i d�' � •��. 1 •? ti,� � �S7y ��'�' (F �' ft.. ".'�. 1 1r ... iSSESSOPS MAP NO: THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �leVr671---I-------OF...... .. Appliraatiou for Dispatiaal Works Tomitrurtion Pumit Application is hereby made for a Permit to Construct ( ) or Repair (,Gan Individual Sewage Disposal System at: _.. � > . . vIdol '----------•------------------------------------------------------------------------------- s i .Address or Lot No. ,, '1,�.r . I._.... . on 41 - --- ------- -------- wn Address aD - . . .. ---- -•------- Installer Address Q Type of Building//�� Size Lot............................Sq. feet V Dwellin �No. of Bedrooms.............................. .....Ex Expansion Attic� g -•---•--- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ..-•-•--•------------------------------•---•--------•---...----•-•-•-•---•••--•-•••...__ .. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity-________-gallons Length................ Width................ Diameter_____.__--_--_- Depth___--__--___-_-- W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_______------_-----sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----------------_------ r14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil.......................... -- x 1914 / --------------------------------------------------------------------•-------- U Nature of Repairs or Alterations—Answer when applicable.___/.-�fO�Q:__ ... ---------------_________________ •---------------------------------••------------------------------------------------.........---------------...-----------------------------•--•••••••-•--•--•---•--•--••-••----•-•-•-•--------......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T`jE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued b tho�oarS health. / Sign ... lr •----- ------------•--••• AAfP .R�. Date Application Approved By----••......•-••••--.•.....-• ................... Date Application Disapproved for the following reasons:.......... ..................................... - ------------••-•----------•-------...-•------•----'•------------------------------------------•---------------•-••-------..... ......-----•---- Date PermitNo......................................................... Issued....................................................... Date No......................... FE$..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF. ♦ mot: f •._. . , pplira aan for Di_qpnsal Works Taamitrnrtinn jimnit Application is hereby made for a Permit to Construct ( ) or Repair (f.—)an Individual Sewage Disposal System at: / 1,Y/ �, f / /"; . v •-••••........----......-- .....--•-•---••-•-•..................................•---•-----• •-••--------•...------•-•-----•---••••••-----•----------•-•...••-•---•--••-•--•--••-----•--•----•- Location-Address or Lot No. Owner ` Address Installer Address Q Type of Building, Size Lot............................Sq. feet Dwelling'-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) W Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. R: Septic Tank—Liquid capacity------------gallons Length_............. Width................ Diameter................ Depth................ Disposal Trench—NTo. .................... 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 ( ) aPercolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ------------------------ a -------------------------------------------------------------------- 0 Description of Soil..................... .........:. ......--------...........-----•-••------------------------------------------------------------------------------------------- x V 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 T T p `5 o£ 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. x / /r 1 ` Signed :....:......: .�r.. / Date ApplicationApproved BY.................................................---- ---....�.............................. ........................................ Date Application Disapproved for the following reasons:........................................... ..............................................••-------......---._ -------•--•---------•------••----•-------------------------------------------------------------•--...-•--'-----------------------•---------•-----------------------------•----------------••---•--------- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,e i rt C.5rrtifiratae of Bunt r�i nac>e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (. } - e I f "�: r . by •----••.._...--•------ --�------------ --••-•----•------•-•-•-•-•-•---•-----•------------•-------..__.....---...-•------•---------•••. Installer s. has been installed in accordance with the provisions of T!TIE 5 o£/Fhe State Sanitary Code'as de cribed in the application for Disposal Works Construction Permit No--- 1 ��... dated...t-f1 .�� __� ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA TEE THAT YHE SYSTEM WILL FUN9T7 1N S.Ak i ACTORY. L� DATE............................... -••----. Inspector.................................................................................... >_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.................................................r r r ?� -� — .......................................... ._.................................... 1VY O.. ....'..........tC.. --� FEE......... ............' I DisposFa1 Workg Taanotrnrtiaorn rrnait Permission is hereby granted..........................:...................I-----•-= :..... ._............ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at T Street as shown on the application for Disposal Works Construction Permit No.. 7'.�':-Dated.............. j__�f a... ----------••--f--- • ....................... f Board of Health DATE-=---------------�-�-�---;�•--�--------------=�-`- (E// FORM 1255 HOBBS &WARREN. INC.. PUBLISHERS