HomeMy WebLinkAbout0036 WEQUAQUET AVENUE - Health (2) 3� lc�gqrae� Cn., �n�-,
No... .; -----• Flan. ..`d .. ._
---------- THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
ra ...............OF......�,� k�z.STD, ........................................
. pphration flar Billpaual Workil C ontitrurtion Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
4.........-&;,4........../_0.................................
eLocation-Ad res or Lot --
.............................. SFuc�s --
caner / Address /
--- -
Installer Address / l Type of Building Size Lot--- 01 . feet
Dwelling—No. of Bedrooms............3...............:...........Expansion Attic ( ) Garbage Grinder
P-, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
PL' Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gall ons.
WSeptic Tank—Liquid capacity/Ut?-O..gallons Length................ Width................ Diameter................. Depth_...._......-.
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage_Pit NoJ"-0--6-a LDiameter.................... Depth below inlet.l- ............. 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........---_--_-_.---.
rZi Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water-..._..--...._._--------
P; ..•••--••--------------------------•-------••--•--•-----•-•-••-•••-•......-•••••......•-•--•--•••--.........................................................
0 Description of Soil----------s-� -----•------- #.IdIA"4..........
-
x
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 Article XI 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 board Ahe �Signed. — � to
Application Approved By----�--- - --= --------------- ----- ---------------------- ........ ---------
Date
Application Disapproved for the ollowing yeas s:.....
Date
Permit No......A--yj.................................... Issued-----�-��'7-?--------•--•---•-----------
Date
9
.a Al ...
THE COMMONWEALTH OF MASSACHUSETTS
BARD OF HEALTH
.::......OF..... •t 4�. t!
A p iration for Mipa a t'Noma C vW34ruk ivu rr�t
Application, is hereby made for a Permit to Construct,( :) .or Repair ( ) an Individual Sewage Disposal
System at
} Location Address or Lot No s
............. rr"r�• ...... `.iv°,w' I
e ' Owner. Address
f-......' .... �' °- -zr.----------------- •� :.ZCJ,ze ysPi.- -c"=---'�^1- t.}.._.._$-. '•ac 9 `..•- �
.- Installer' Address ��
f r F /
Type of Building t, Size Lot_,,_, __.__ ..___Sq. #eet
Dwelling No. of Bedrooms .•--Expansion Attic
Other'—T e of Building ---------------------------- No. of persons____________________________ Showers ) Cafeteria
Other fixtures ...................--------------------------------------------------------------------------------------
------------ -
W Design Flow..__........................__________________gallons per•person per day. Total daily flow...............
----------gallons.
WSeptic Tank Liquid capacity4 :_gallons Length..............__ Width---------------- Diameter ._ Depth.----_--_-_-_ -
x Disposal Trench—No .................... Width............ leaching are__...... Total Length.__._____._..____. . Total a-----------------...sq. ft.
Seepage Pit No_yf a 4_a.bl)iameter________________---- Depth below inlet :_ _______:_:Total leaching area------- _---___-_sq. ft.
Z - Other Distribution box ( ) Dosing tank ( )
Percolation Test.Results Performed b�. Y•----------- ---------------------• -------- Date----------------------------------------
Test Pit eNo. 1.---_------------minutes per inch Depth of Test Pit..................... Depth to ground water._..___...------ --.
rX4 Test Pit No 2_:........._.____minutes per inch Depth of Test Pit____________________ Depth to ground water--__ ---. -_.-_-_-----_
n - . . --•----•- --• -•--••-•--.................................
Description of Soil f �'�" ----- ;-- ----- ---------------
---- ---- ---- �� ---- ••... •-- - •--- . _ --• ---------------- .
w :.
----- ........... ------ ••... -_-- . --
U Nature of Repairs or
Alterations—Answer when.applicable.____:_____________________________________ __ ____________________K
------------------------- --- --- --- -------- -------- ------- - ------------------------------------------------------------------------=-------------- --:--
Agreement:The undersigned agrees to "install the aforedescribed Individual Sewage Disposal S stern in.accordance with
the provisions of Article."XI of.'the State.Sanitary.Code -The undersigned further agrees r of to place'the system in
operation until a Certificate of Compliance has been issued by the board of health
Signed _ % t `
r t All)
ate '
Application Approved BY = t z - - -- -- -- ---------
r `Date
Application Disapproved for tlaelf ollowng re¢so
�.-•
------••--- -'--•-------•-•-=------------------------------------•----------•-------
Date
Permit No. ` K ..................................... Issued......�"�....e5- -.............................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
: s 44, ...'..................OF.... ...... �" :....t..
Trr#if irate 'of T•outpfiattrr
THIS IS TO CERTIFY, That the Indirid.�usal Sewage Disposal Syste constructed (Y) or Repaired ( )
by........./✓ f}._. f?e1 :3 ._ f'p' �Ad_t 4 el"�Cef�C _ e"4.✓. t 11�-1-w—L,�-------•-----------
O� I
Installer
at
�. 9.. .
has been installed in accordance with the provisions
visionsof Article:XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit`No r f dated �._.___ ....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT�BE.CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
DATE- -•-% --------------------- .....-- °..., `l -�W_ ._ A
_._ Inspector ------- -j"� ----
THE COMMONWEALTH OF MASSACHUSETTS
.t ®A►R:D OF HEALTH;
e
t A OFF, R�X
No ,G ....__ x FE
= ---
Permission is hereby.granted_._.. , `.. �:r �,��_. -------------------------
to Construct or Repair ( ) an Individual Sewage Disposal System
at No...........4 r.A........
-------------------------------------. _
r Street
as shown on the application for Disposal Works Construction Permit No--- -_- .__. Dated-._. -_ F _.._ __k__
?��DATE '' soar tl
FORM 1255 HOBBS,& WARREN::INC., PUBLISHERS -