Loading...
HomeMy WebLinkAbout0053 VICTORIA STREET - Health �3 V�c�roclA ('e�tcrvi�ce I k 8 -Oo4 /// SMEAD No.24 53LY UPC 12934 smaad.com • Made in USA 7 SUSTAINAe�F WffL4WE riMl dFhYS,,,mW L No... 3. !! - Fxs. .......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ................ .....................O F.....------.............................-------------------:.....-------•----------------• Appliration for MipoiiFal Works Tontitrnrtinn ami# Application is hereby made for a Permit to Construct (L/�or Repair ( ) an Individual Sewage Disposal System at: l Location-Address or Lot No. •...............................•^.........--•-•-------^----........_........................... ..........--...................................................................................... Owner Address W Installer Address Type of Building Size Lot............................ t U Dwelling—No. of Bedrooms------------- ..---Expansion Attic ( ) Garbage Grind r 114 Other—Type of Building ............................ No. of persons.....................--.---. Showers ( ) Cafeter WDesign Flow-Other �es - --- ___'gallons per person per day. Total daily flow....................30 ...........gallons. WSeptic Tank—Liquid capacity/QM-.gallons Length..Sj....... Width---Y-j...... Diameter................ Depth... ......... x Disposal Trench—No..................... Width.................... Total Length---................. Total leaching area....................sq. ft. Seepage Pit No----------/-----.-- Diameter.A.t6....... Depth below inlet._,4f.0.......... Total leaching area..-a 1 ...sq. ft. Z Other Distribution box (V) Dosing tank ( �) _ 64 '-' ;. Percolation Test Results Performed by------"Ib...G...��t!: !f 10.C............ Date...... 3........ ,aa Test Pit No. L.4,�---minutes per inch. Depth of Test Pit---C! '__._ Depth to ground water---�0!�E...... GTq Test Pit No. 2................minutes per inch Depth of Test Pit..----.---._.------- Depth to ground water........................ a •---•-----------------------------------------•----------. ---•--•. Description of Soil � ��C S!E�• �- ------------------------- -------- ---------------- - - - .-- - -• •---- ... x w UNature of Repairs or Alterations—Answer when applicable..............................................:................................................ --------•--•------------------------•------•----------------------••----------------.....--------............--------------------•------------••--------------------•--------------•-----------....----- Agreement: T dersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the p vi o I of TITLE 5 of the State Sanitary Code The unde igned further agrees not to place the system in op ati u 1 e ca Compliance has been iss by the b r of health. igned.... ......... ��� ................................................... .... ........ te----.......... 44 APi PProved By r = --•--.------•-----------------•-----...••--------••-•-......_---------- ....--.. ---.d'.. - Date lica.tion Disapproved r t following reasons:................................................................................................................ ----------------------------- ------- --•----•-----•---•-•-------------•----•---------••...•-----....-•-----•---------•-•----------------------------------------------......-•--- ......•-••------ Date Permit No. Issued....................................................... Date No.._V...! f .,� Fes$....... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..• ................................OF..................................._...-.-------------------.._...._...................._. `$ ApVftrtafilaat for Bispoa al Workii C ontitrurtinn rd tit Application is hereby made for a Permit to Construct (V/ or Repair ( ) an Individual Sewage Disposal System at: .... Location-Address or Lot No. .................................................................................................. ...........••-.......---...-•--••---...--••-.._................................................. Owner Address w Installer Address UType of Building Size Lot..................._........Sq. feet Dwelling—No. of Bedrooms_____________3__________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ------------------------------------------•---••- w Design Flow....... _____________________gallons per person per day. Total daily flow..................,_ _O...........gallons. WSeptic Tank—Liquid capacity/Q------__gallons Len th__- ....__._____ Width_. -)____._ Diameter________________ Depth...Y__.__..-. x Disposal Trench—No_____________________ Width.................... f_._._______. Total Length._.__.__._._______ Total leaching area....................sq. ft. Seepage Pit No.........e......... Diameter_J/L.�_ _____ Depth below inlet__ _C-�__..______ Total leaching area..'ar l ....sq. ft. Z Other Distribution box Dosing tank ( ,) / '� J /•' /"� " Percolation Test Results Performed by..___�.0th... ___ ..__.._.___. Date.....4—::.2.0 ......... aTest Pit No. 1__ � minutes per inch Depth of Test Pit__1�vy.."___ Depth to ground water---AX-0 _____. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ RS _•---•----•-------------------------................................ ------------- Description of Soil !'h...... .2 -Jez------�-'�� - ---------------•----•--___ ---------------------------------•-••---_____---- x w VNature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------•------------•------------------------------•-------•----------------._...------...-•-----------------------------------------------------------------------------------••---•-••--_----- Agreement: T ndersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the p ovi ons of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in op ati I e f Compliance has been issued by the board of health. ignede''r ---------------------------------------------------------------••--•------ y y' V`'' ............ APpl. PProved By ', G :�. -----------•---•---•---------•-•-•••---•-----------•--------- ';f at�------------- lication Disapproved f, r t e following reasons:----•--------------•------------------------•---•------------------------------•----------.._. .-----------..... ..............................•-•-...----------•-----•-•--•--......_..._.....---••-------•-------........._ -------------------- ---- - --------- ----- --------------------••-•-•--- Date PermitNo......................................................... Issued............................:.......................... Date ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntif irate of Tontliti attrr 4 75 IS TO CERTIFY, That the Individual ewage Disposal System constructed ( Repaired ( ) by -� ------------------------------- ----------------------- ------------------ T�... - .................. ... .... ---- i1 R ....Installer -- at. -._,...........Z e------------- I s has been installed in accordance with the provisions of TITLE �5'of The State Sanitary Codas d e cribed�'in the application for'Disposal Works Construction Permit No. _, '"__ _; ______________ dated__.t�,� "}" .:-1 ..................... THE ISSIJA E THIS CERTIFICATE SHALL NOT BE CONSTRUE S A GUARANTEE THAT THE SYSTEM WILL UN ION SATISFACTORY. DATE.;..._ll_. _..,�? Inspector... ••-•-----------•-••--------•--------------------------•---....-----•--- TJ COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C4a�t e .OF.......... ............................. No.._ .......... '� FEE ork (9om'iirttdiou trod# Permission is hereby granted. �.:----t l •--------------- - --- •-------------------•-----------------------------.......--••--...-•-...._--•--- to Construct or Repair ( ) an Individudl-•S wage Dspos System at No............. '- ! ..._.._%d_ _. Street as shown on the application for Disposal Works Construction Permit No............ "� __-- _ Dated_. _ �"°; et' ----------------------•-•-= ............................................................ DATE.......... Board of Health J kj ./-_~__++.....................................•-.. . FORM 1255 A. M. SULKIN. INC., BOSTON ,,� r r a - !D8 - --- --- -- -- - -- - ---- -- -- -- - __ r U4 - ----- /07 00 `� _ -_- / 6.23 ,• -L E Gc1 2 of_ - /v�. k - /00 94 _ _ - - - - ---- - ------- r__^-- ti/UTE ground Pr-o7c,, -�-- PPsc � / r H02/Z Sc9LE / _ O - S C V EX7-&A./U f L I-- . E - --� O ^ MAVHOLE COV&R5 7-0 /AJ/TH//V F!A//Sk4ED GAE!/gl�E . SCHED. 40 P. V. c. 0,2 EQufiL Tt� SEpT/C (mrnrrncirn %" per- 2 of /2,. Wash&& 5-1-one O • O ° SUrno e ° O 108 /000 GAL. SEPT/C TH,VK `" Of 314~-/� ° ° washed S-for) ° ° O • r j LD E- S / G /L/ 7T� 7- H 0 Z L O G \ o / S hI BED,2OOM HOUSE L.JFC LEA /AJE � t '© l (n o d r sfsosEr� l ¢n PE,2c :e A �-�- _ _� G r .- � r— ��(p L O (n/ 2 f9TE GALS./D/9Y DATUM S E FP T/c Tl,?A-1 CU x 1 Q/j x TEST HOLE #/ TEST HOLE- qoZ r IV EFF. DLo 6 7-07-;-9 L '8/. G. P. D. NJ E✓ D /_ o ob A,/ o �Jr-t ���' Er.eCpu,vT BCD � / T� .� � � / `� � � Q / �'] ^ , P�2 o OO S E D oA/ THE G�2 o can/D f�S (/\/ L_.. �7 /V 5,A-4 0 _V O A./ T H'/ S P L ,4?^J DOE S GO/VF��M TO 7'HE BU/LD/A/G .5E7-- ST �a tr5=% BF�C,� ,2E Qc�/�E ME�/TS ©F THE E -r-e Aa U/ L L B F�2 E P f3.2 E D F(=>2: fi�J �`� �} +j :-'r r �`•?5 S C r9 L E f�S S H o 1-. A J T EFRErT H. /� / / / �Q EV REt(r iG j Wo.178 HINCKLEY O o0 e xIS-f-/nq /evatron BL DG SETB 19c,� �✓f=7 � /� O vTH , 0. 00 Pr'opoSed e /evcf-ron EQU/�E/�EtiJTS '• - - - - - -- — eX /Sf-/ r7,� conf-our-S �rOnf = Eo S / de = /U 0 vE D . re0-r- , U Bo� 2D oF= HEALTH