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Home My WebLink About0022 KEEFE COURT - Health (2) Zz fCee-Fe CT cen� Society St. Vincent Food Pantry c r i I i l I S M EAD KEEPING YOU ORGANIZED No. 10334 2-153L wry 61w.RECYam INITMVE CONTENTtog. GrgBedRberScurcinp POSTCONSUMER maw.0Vr.grenwrp SFFO M MADEWUSA GET ORGANIZED AT SMEAD.COM NoB.......`.77,7 Fims.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................O F............................._..........--------------------................_...._..---•-• Appliratiun for 13iipuuttl Works Tonstrur#inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •- =a�� C uZ�....................... ....•--•----------•---------------....Z.._-s�................................................ -cation-Address or Lot No. ..... 21 -..- ®v�. -............. r.A.... ............................................. (Iwn r FW-1 .._._.....\................ .�:'.r........ ... I_ L .y� ✓ � Address......... ............ .... ...-_-j...... �py� � -....__................ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......��..........................Expansion Attic ( ) Garbage Grinder ( ) 4 Other—Type of Building ............................ No. of persons............................ Showers — Cafeteria a' Other fixtures -------------------•--••-•--••---••-----•-•-- W Design Flow................5...`5..................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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-•-••••--•--•------•-•••--•-------••--•--•-••-•--••-••.....••---------------------••-......----•-....-•-------•--------•---•-................._..--------•- 0 Description of Soil....................................................................................................................................................................... W V ......--••••-••---••--•--•---•--•...._..•-----•--•-----•------•-•-------------------------•--------••••------•-•---•••••-••-••---------------•--....--•••-------------•--•---------------••-•----••----•- W x •---•••--•--•--.._...._..•---------•--••----••••-••-•-••••••-•-•-•---••-•-------•---•-•--•---•---------••--•••--------------------•-•--•-------•--•-------•--•--••-......---------------................ U Nature of Repairs or Alterations—Answer when applicable.........(0_ct_C7........ .....�a.J__�....a�-...�C?_r�.._. ----------------------------------------------------------- -.......... •---------------------- --------------------------------------- ------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'L U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance issued b the bo ealth. ned.... Date ApplicationApprove ............................................................................................... Date Application Disapproved for he ollowing reasons------------------•------------------------------------------------. ...................................... -•...............••••---•--.....--••----.....---•• •-•---...........•-•---. ----------------------------------------------- Date Permit No......................................................... Issued.................. ------•---•-•-•---•-•-•---••------- Date L 0 CATION SEWAGE PERMIT NO. 2 K lc-E`rr VILLAGE CI AIr7E-zVtLu-s- INST ALL ER'S NAME i ADDRESS S U I UV E R OR OWNER DATE PERMIT ISSUED � ,� . ex DATE COMPLIANCE ISSUED 7 / LOT NO. : 2Z ADDRESS (sxotzT��sr��"�� -OWNERS , NAME: ; SEWAGE PERMIT NO. : NEW: REPAIR: DATE ISSUED:_ DATE INSTALLED: � �g ^ INSTALLERS NAME: INSTALLATION OF: WATER TABLE : — FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE : ' 7 IN 7r�` yp9 1 PiT food 4ad G�aPPED W PRofmTY LiNr-S rye 1� Siov� "f �/ I lop No......................... N FEs...........:.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......................................------------------.....--------..............--- Appliratiun for Disposal Works Toustrurtion Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...........(��.. ......�C... . ......... .............. ................................................. Location-Address or Lot No. --7. ...•.............Owner -`••) Address --- ..........................................................................Installer Address d Type of Building Size Lot.................... ......Sq. feet Dwelling—No. of Bedrooms...........................................................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........_................... Showers ( ) — Cafeteria ( ) Other fixtures ................................ W Design Flow................ `...s...__.-..............gallons per person per day. Total daily flow___-____---ra'_... ........................ .. ..................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 ( ) 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........................ 9 --••--......--•-••-----•••••-•-•--•--••---------••••••------••----------------•.....---••-•---•----•........................................................ 0 Description of Soil....................................................................................................................................................................... W U ••--•••-••-•--------••--•-•--•••••-------...-•................•----------...------....--•---...........-------•••---•.......-----.....••--•-----------•--•-------•••--•---------•-----•----•........... W x --••----•--•----••••••••------•••--•--•--•-•----......-•••-•-••--••-•-- 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 TIT114, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance issued by,the bo4rd-of_health. qSh�e d.... Application Approved=$�"::_.;/.___f._.... f �- Date .. •-------------•-•---------•-----•-•------...... Application DisapprovedIflorheowing reasons:..................... .-----•--••---••--•----------•---•------••...........................Date•------------- -•----.....-•-•-----------•------•-•-_•_.. ------------------•----........----.............----...........---------------•---------•-------------------------------------------•----- Date PermitNo....._....E ----------------------------------•-----. Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF........................................... CIrrtifiratr of (-ontpliatta T�O CERTIFY, That the--individual SewaV Disposal System constructed ( ) or Repaired ( ) by.............. ....... _'_.__................................................................................................... Installer 52. c st f r . 'J- C_--r-.--•,-�- '-• has been installed in accordance with the provisions of TIT F 5 of_The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-__�.__ /.-:.:�1_ .......... dated----- .......................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................,1,a' ...,.-Z..'.-8- -••-•--•--------•-•-- Inspector........A.- -O-:................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................0 F........................... `. No.l.f.......-...2. FEE...../_;n..................................... i fro 1 0 onotrudion rrutit Permission is hereby granted ::; ...__...._ ............................................................... to Construct ( ) or R�Oair�. ) an jndividual Sewage Disposal System at No........... _r Street as shown on the applicatio for Disposal Works Construction Permit N ........ Dated.......................................... /� .................--..... --= -•--•-----• --------................................................... Board of Health L SG / DATE--- / FORM 12551 A. M. SULKIN, INC., BOSTON �'f,