The URL can be used to link to this page

Home My WebLink About0085 SMITH STREET - Health $5 Smi}l� SF ., }I�.nnS � � AY8 - 03� >' - -� L 0 CATION SEWAGE PERMIT NO. `?c4r �5"NTH �T1R T VILLAGE YPtN N l S M P,55 I N S T A LLER'S NA E i ADDRESS 71 ® U I L D E R OR OWNER DATE PERMIT ISSUED Io , DATE COMPLIANCE ISSUED 31' is 1000 rf)L- Semmc- 31s, �1'rrl K 39` �{3` D�Si�lL�RvTt o� �v6X 3 Fww�r-�y5�25 12� V431a�1�aSZraG W �AppflD��?r`I No...... y:_ .��/ F H i i ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --•---.... .......... ..................OF.........::. `.`.......................------...---...-•-•-----------._.................__ ' ApplirFaft u for Diopm al Works Tonotrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... ` ................................................ ................................. .................................................... Location-AddressCk or 1 . _u Ne -•-•- . 0 'T No O Address .......... L� __.._._.........._..._..___.. 75. Y . .......... Installer Address VVV dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........ _..........................Expansion Attic ( ) 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.._______�._l�_......................gallons. � Septic Tank—Liquid capacitykQO.O-gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No.___3........... Total tfL65dqd 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_-_____-____________---. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit-_.______-________: Depth to ground water................___-_-_- ------------ __________ ______........ •-------------- _-_.... -__--- •----------- ----------------------------- _.... _--- •------ •------ _.... O Description of Soil------...CK t Y!= --- �`-`nn -•------------------------------------------------ U ------------------------------- ------------------------------- •--•--------------------------------------------------------------------------------- W U Nature of Repairs or Alterations—A swer when applicable...... `C -°" _______._�__._ __ v ______________ ----------------------------- �� 4 ��o rz __..__....--------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has the board Signed_---- •--•• =••.'... ... _-•-••- �-O-•-� . Date yy Application Approved BY --=•' �-�fi` Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ ..................•-•-••••••••••-•--••---•-••--•--••-•-•--•••-----•------.....•-••••---•....-•••-...•-•...--•...._.._._...•------••------•-•••---•------•••••---••-••---•------------ -----...--•--- Date PermitNo...................................................-•-- Issued....................................................... Date No.....A�Y:11.19 Fxs. ........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. .------------.._.OF................................_.......--------------------.I._....................._._.. Alip irFa#ion- far UiipnsFai Works Tnnitra rtion rrnti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....... ..Cam... .yvl t: .. :1.-•---•............................... .................................n.A..................................................... Location-Address or Lot No. C.> C {'i G Address Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms.......< __ ..............................Expansion Attic ( ) Garbage Grinder ( ) pl Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a d f, Other fixtures W Design Flow........'CV '�"........................gallons per person per day. Total daily flow......... ..V a.......................gallons. 9 Septic Tank—Liquid capacity 1QQS2.gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No._. ............ Width_.`;__2 LL. TotalI;D�t Jpzf,��:SL95. 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 Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ n+' ----•---•-----•------------------ ......------------------....................--•---••-•-......................................................... r O Description of Soil-•----C-k-ern v"- .._ rG,...... = -----------------------•------------------------------. V ---------------- •••--------------------------------------------- •--------------------------- •----------------------------------- W -------------------- ------------------------------------------------------------------------------------------------------------------• ---- •- U Nature of Repairs or Alterations—Answer when applicable._.... ?__' 4...... !&9....................... --------------------------------• ...... ......................... -----------------•----------------------•---••--------.....---•--••------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI 4 5 of the State Sanitary Code.—The undersigned further agrees not to place the system in operation until a Certificate of Compliance haste, 7-issued by_.the board of-health Signed ��.._•._.-:._... - "'� Date Application Approved BY �' ................... �fJ-/1=49 i Date Application Disapproved for the following reasons---------------•------------------------------•---------•---•--------------------•---------......-•----•----•-•-- .....•••......•...............•.....•................•....•...••...•.•..•..•.....•......--..•......•..•.•.........•..•....................•..................•................•..•..- ............-- Date PermitNo.......................................................- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... r ............ .. C�rr#i�irtt#r ,af� �unt��tnnrr THIS IS CERTIFY, That the-4-nc�,:a,r�d al Se.. age#Disposal System constructed ( ) or Repaired ( ) by...._.... -� - c ��---------�------- • ' r.... `....................................•--•----........---------........-•---------.......------... .a..:. .Installer has been installed in accordance with the provisions of TI T LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..__ `._e�!3............. dated......................._........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOt BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................... ................. Inspector......_:�......-----------------------------•-----•--•-•--------------•--- THE COMMONWEALTH OF MASSACHUSETTS BOAR D OF HEALTH{`! C/ �%/ .... .. <t t 1 l FEE....................... �i� a1�ttl k� � uan rrnti# ?` r Permission is hereby grantgd. e ........ to Construct ) or Repair ( ) an Individual l ewage DI"so System , - _ Street as shown on the application for Disposal Works Construction PermitN/you..................... Dated.......................................... ••---------^ -_'--4_.•___y....................................................................... Board of Health DATE....................� - -' '.,.-idr--------------------- ------ FORM 1255 A. M. SULKIN, INC., BOSTON