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Home My WebLink About0034 WHIDDEN AVENUE - Healthr39 Whidden IWt., Irv,ts say / o�► -- — - _ _ -- f Do UD6,40UR i r LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i' ADDRES V t UILDE R OR OWNER I DATE PERMIT ISSUED ® �� DATE COMPLIANCE - ISSUED r � v � I vNll I . ./.............. r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF.......................... Appliration for Uiip.vs al Works Tomitrurtion famit Application is hereby made for a Permit to Construct ( ) or Repair �Q an Individual Sewage Disposal System at: ..... .:ee .................................. .................................................................................................. Location-Address or Lot No. ussAl\vl_�..:.-•---•---------------•---•---------- ........S'_Vk_N-V.—Q ............................................................. ..------ Owner Address y� Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms..........: .............................Ex ansion Attic� g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers a.( ) — Cafeteri ( ) A4Other 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........................................ a 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........................ P4 --•.......................................................................................................................................................... ODescription of Soil....................................................................................................................................................................... w x ------------------ -- -- ------------ --------- Agreement: ----------- ----- - - ---------- -- U Nature of Repairs or Alteratio s—Answer when applicable_.. _ Q .i _v- .�g �2rs3- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b is by b rd of health. 1 - _ -------- •----------- : v D af Application Approved B ._.. '`. ty-------- roved Application Disapp e f ing reasons--------------------------------•---...-•----------------------------------------•---------------------.......--- .-•----------------------------------------.__.......----------------•-••--•-•-•----------•------------••-- Date PermitNo......................................................... Issued....................................................... Date N1..............-- � F/s.............�............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..------. --."-"..........................OF............-.-...........-_..-........ Applira#ion for Dhipos al Works Totes rnrtion Vantit Application is hereby made for a Permit to Construct ( ) or Repair Yam.: an Individual Sewage Disposal System at: ... X. .....'� x.................................. Locatio -Address or Lot No. 1 1�C•� .-----•----•--------------•-•-------- ........2-N.A'hL_-W 0................ .............. Owner � ► . . Address :�. .is. . t . ,V......... .a � ce ....... Installer C Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Buildin yp g ____________________________ No. of persons___.___.._._________.._.____ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------•-----------•----••------•••......-••••-....... .............................................................. 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....................................... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (L, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•••-•-----••••---------------•--•---••---•-•••••••-•---...-•---•--•------.....•.... -----------••------------------------- •-------•-------------•=•--•-- 0 Description of Soil----•-------•--•--------•--...•...---------•-----------•----......-•---•---••----._.....----------------•--------•---------.............................I - x U •---••-•••••••--•••••-••--•••••----•--•----•..................•---------••-•-----•-•-----•-------•••--...--•-••••--••--•--•---•-----•••--•--.........••-•-------••-•=-•--•....------•------------••-••. w U Nature 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 i e'd by t b and of health. ---- ... ........................... _ Application Approve y.............. ------•-----------------•--••--------•---------- Date Application Disapp e for th lowing reasons:••••--•--••••-••--••--•---••----•-•----•-••----••---•••--•••----•••••--------••-•••-----•...............•--•.... -------------•---------------............................................-....................................... Date PermitNo......................................................... Issued.-----••-------•-••-•-••-•. ..._...--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF ............ Trrtifiratr of ToutpliFanrr T IS T ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by.. ........... . •... .---..... ---------------- ------------. --------------------------......------........---------------------------------------------------..... nstaller has been instal ed in a cordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-.----------.................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................=5/ �y •--•------....-•---------------------------- Inspector....... _'..---------------•-----------•--••-----....-----••----•-•---- i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q'q(J '' ...........................................OF...........------•-----•-----...........:---.....-----................._..._........ Jf� No......................... FEE........................ Bil 10orko Tuanstrttr#ion Phrmit Permission > he by e( ; -----•-•---------------------.__.......------------------------------••--------.......-•----•--...•-•••-..................... to Con r di_:.�__ vidual Sewage Disposal System at No. Street as shown'on the pli on for Disposal Works Construction Per .................... Dated.......................................... fJ c .......... -••--- ............---------------------------- DAT Board of Health FORM 1255 A. M. SULKIN. INC., BOSTON �. rin < PAO < x g' ta 91In �. 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