HomeMy WebLinkAbout0132 PLEASANT PINES AVE - Health (3) 3 � oo5
Fims... _=.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
--- �. .........OF.....I&AeVT..%951.4 ...............................
Appliration for Ilh4pniitt1 Workii Tnnstrnrtion rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( 1,r"an Individual Sewage Disposal
System at:
....lm.._-2 Jre` -.r.....i!!�....-•--...-owT ................................................................
Locatioy�-Address/ •-• or Lot No.
...1 f�. 1(2...-.--.t1L1avi.G-'a-V--.----•-•---•-•-•---------- ------------------------------------- •--• - ......................... r
��j'�y//��Ownez � /�+ -----Address
�C�f!LC/wC . ...........
........_V. A........................• •......-•-••-.......................... .........................w
Installer Address
UType of Building Size Size Lot............................Sq. feet
,.., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................. No. of persons---.-----.--------------.--- Showers ( ) — Cafeteria ( )
a' Other fixtures --------•--------------------- --•--------- "". --•-••
W Design Flow............................................gallons per person per day. Total daily flow........................� i
....................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width------_---_--- Diameter...-..-----�� Depth........... � .�
xDisposal Trench—No. .................... Width.................... Total Length.................... Total leaching area......._.........zsq. ftr-`
3 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........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--.
x ..............................................................................................................
ODescription of Soil --•-••-•----•--•---•----•-----------••------------------••--•-------......------..........:!!t...............
...........................................................
---------------- ----
W ----••-•••-•----------------•-••••-•••-••-•--••-----•-••-•-•------• - ------------......�c Z . .
UNature of Repairs or Alterations—Answer when applicable - J.._........��..e - ....
---------------------•--------------------•---------------•------------------------..........-•--•-............•--•- '-----_-------Jd dL
Agreement:
The undersigned agrees'to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of iITLL 5 of 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 and o /health.
D e
Application Approved By....... .. .. .... =--••......:....... ��----------
Date �+
Application Disapproved for the following reasons:.............................................................................................................._
....-•--•-•..................•---•----•-----•-----------......---••---•---•----•--•.-------•-------..........-----------••-----------------..............................--•------... ..........•-
Date
PermitNo................................................ ... Issued__`.....................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
tfr ........OF... ....07..0 .................................
Appliratiun for Disposal Works Toustrnrtion V rrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (1. an Individual Sewage Disposal
Systemaa,,,,��rr at
,, .l.. ......fd d:jse° '. �.y. Ej.�f.."Fr.................•.....-. ....................................................
� e Locate Addres3 or Lot No.
..{.:d� .. °tF�...e.?t.-'{t✓`.�tr.. :1*`�r.•l:f :I Z........................... .............. r ......................................... .....
O nez Add ess
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling=No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type of Building No. of persons............................ Showers — Cafeteria
alOther fixtures .------••------------------------------•---••-•-•-----................--- ................---•----•--•-----------------------•-••••--•••-••-•••-......
d
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
Septic Tank—I:iq�d capacity............gallons Length................ Width................ Diameter................ Dept h................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft.
3 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water.......................
Gi, Test Pit No. 2..........te......minutes per inch Depth of Test Pit.................... Depth to ground water........................
a a.-----•---•- ...................... ........
...-------------•-•-... ....--------------------------
--------------------
....
Descriptionof Soil...... a ='.............................................................................................................................................
-------•------------------------------------•------------.-.----..-.---•------- •---- •---------------- ------,' ,, �,'
U Nature of Repairs or Alterations—Answer when applicable r` "�' `��' '_ :r .........................
- `.`.....:�=- - ----------------------------------•..........----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIS 5 of 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, oard of health. s
Signed. '!'>� trot ..112 �- sZ
Application Approved ...:'�� � d .......... .................
Date
Application Disapproved for the following reasons:.....................................................I ......_............_.._.____.__.....__..____._---
..•-•---••••••--•-••••...._..•••-•-•-•--•--•---••••--•......................... --------..............-•---•--------•--.......--------.........••-•••••....---...........--••' •-•--•-•-
Date --
Permit No.......... Issued......................................................_
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
?..........OF..�: ; F
(Irdif iratr of Toutpha rr
THIS I&TO C FI T)iat�the Ind v 1 Sewage Disposal System constructed ( ) or Repaired
�'
by..... ."..`.a ' % ,3 ......••... •-•---.....••-•..................._
14 7 J.r✓+'Installer . 1
.- aF�� a � G� f / $`.sue 'Lf' dYA.di3•!A•� -
at .. ... °� ..... `... ... ....... . .......
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code,as de cribed in the
application for Disposal Works Construction Permit No.....�� >.:_.::: :... .. dated....:- ':..F.::_-1. ----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM W L FUN TION SATISFACTORY.
DATE.:..... .... ......... Inspector....... •-.....••--••-•-•-•••••••-•-•---•-•---•-....••........----.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Disposal Works Tons In rrmit
Permission is hereby granted... .--- ............fs .-....................................................._.._
to Construct or R r ( an Individual,=..
e Disposal Syat
steiYi
••• •....
Street
as shown on the application for Disposal Works Construction Permit --- Dated.:'A�Z//54.
__ . --••------- ....
�> ,/ Board of Health
DATE...`�' —'� .............................................
FORM 1255 A. M. SULKIN. INC.. BOSTON
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