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Home My WebLink About0068 DANIELE STREET - Health 0 R7 - O 5Co C'_O.TU x T LOCATION SEWAGE PERMIT NO. Lor -I -z- VILLAGE I N S T A LLER'S NAME A ADDRESS N` % A c..\Z �e !- I� B U I L D E R OR OWNER I � ~ DATE PERMIT ISSUED DATE C0" MIPLIANCE ISSUED a,�— �� , 0 `1 ;, No.... �?..�'5...�� o`�, FRx...... r THE COMMONWEALTH OF MASSACHUSETTS B®AR® F HE� TH �(J v ..... .....OF..... ��.... ApplirFation for Dhipus al Works Tnnstrurtiun rantit Application is hereby made for a Permit to Construct ( e Disposal or R air an Individual Sewage P ( ) g System at: .D...... ......................�� -s .... �-� ...............--- ................................................ Location-A dr s t No. ........... . . --..--- ...-••.--.---.M•. � . ............................................ er a ................ -- t .11� ........................... ................,� .-1....'...----------. ...----------------- ----.....------. Addres's nstaller '! Type of Building Size Lot_ . .�TV... .....Sq. feet Dwelling—No. of Bedrooms............V?............................Expansion Attic ( ) Garbage Grinder ( ) a� Other—T ype of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixture --------------------------------------•----------.••••-------•••-----•----•--•---•--••-••------•---••----•---•-•--•-.....---•---•-...........•--- WDesign Flow....................S%5.._..............gallons per person p r day. Total daily flow..........3_&.0...................gallons. WSeptic Tank—Liquid capacity/4Wgallons Length.- ------- Width.....L...... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length..........``._._..... Total.leaching area.___��77�.__...,. sq. ft. Seepage Pit No....../.......... Diameter....---------- Depth below inlet.....�,Z......... Total leaching are;�'(!.5.1.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by._.._. .t..., ,u�r------------------------ Date................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r4 Test. Pit No:2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1. x ----------•• ------•-•- ------------------- ...............................---....................... i O Description of Soil..........0.-...3....._..... :�.... U •-------------•-----•-••••----....... ! 1 }�.._..�. -- •--••---------••-................................................. VW ••---------------------------------•--•-----•--•---••---•----•-••--••------•------•-•-•---............--- ............................................................... 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 TI'IUj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in o eration unti C tificate of Compliance has been is d b the board of health. \ ned...... ---•--•------------ y --•- A tion Approved B ... Date Application Disapproved for the following reasons:................................................................................................................ ......................................................-................................•....................................................-•--------•----•----------•-••------............------------. Date PermitNo. �J_ -�� --------------- Issued-....................................................... Date J �• � � � �i� { �� 1 \ �J �� 9 a�'�� 0 THE COMMONWEALTH OF MASSACHUSETTS BOARDPF H i TH .......... .................OF...... Appitration for llispoiial Works Toustrurtion "rrmit V Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal stem at: Sy J .................... ............................................................... Location-A 0 t 0 ...... ................ ----------------Owtfler ...... Wej 1 -/I.................................................................... g ................ ........................ .......................... ................sy nstaller Address PQ 'P*V�ZY -_Sq. feet 111 Type of Building Size Lot. ....... ........ U Dwelling—No. of Bedrooms............ ............................Expansion Attic Garbage Grinder P4 Other—Type of Building ............................. No. of persons....._.._.__................ Showers Cafeteria Otherfixture ........................................................................................................................................................ Design Flow.................... ............._..gallons per person per day. Total daily flow........_ _..........._......gallons. WSeptic Tank—Liquid capacitVCi4CY gallons Length...k' ......... Width.__........_ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length..................... Total.leaching area-.-.- sq. ft. ZI r_1 - Seepage Pit No....../---------- Diameter....t?�.......... Depth below inlet......4�1?.......... Total leaching ft. z Other Distribution box Dosing rk t .......... Percolation Test Results Performed by.......... .............. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit............_....... Depth to ground water...._..____:_........__. Test Pit No. 2................minutes per inch Depth of Test Pit..............___... Depth to• ground water.....__............._... -------------------------------f---------------/............................................................................ ........... 0 Description of Soil.......... 6 .9�.n... .. .......... ----------------------------------------------------- ---------------------------- ................................................. ...............------------------------------------------------------------------------------------------ ................................................................... U Nature of Repairs orAlterations—Answer when applicable_...........................................:................ ............................... ...................................................................................................................................................................................................... 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 o t' 1 until tificate of Compliance has been issued b the board of health. Signed I XX.4A 1,....................................... .... Date. .i........... r onApproved By........... ........................................................ ........ .................... Date Application Disapproved for the following reasons:................................................................................................................. ....................................................................................................................................................................................................... Date Permit No.-_ Issued......................................................... -----C)............. ................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD/i-OF HFfA TH ...............OF.... ............ ..................... ...... Tprfifirair of Toutphatta THIS IS TO CERTIFY, That the-by Ind,,* PkErual vage Disposal System constructed or Repaired .................................................................------------------------------------------------- �2?K ie's IC1,,at.....:................. /*.... ............... ............... ................................................................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary C de as described in the application for Disposal Works Construction Permit No... ...... date(------ .................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. ...................................... Inspector....i.�....................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEM L ...............................................j - , e.?. .........OF... .6 ...................... No. ... FEE.... Permission is ruby granted. ......... .-ztf. .......... -------------- I....................... to Construct ( Kyrt,Repair1 �,g_ S an Indi�id Sew P1 posa t ............ L.......Z.... ... . , _ .e. ............................................................. 4 #, � Street Z as shown on the application for Disposal Works Construction Permit Dated..... ....... ............ 01 ..................................... DATE............... ....................................... Board of Health FORM 1255 A. M. SULKIN, INC.. BOSTON r S/.uGZ-E AAt1,I/LY ~ 3 0E0, OOA4 A/O GA.28AGE �7. 7 .r/OEW.4LG ,4,eC-:4 ToTA.0 G. ToTAT� �.4/LY�LoW= ,3.34G.Po, `^° �'7 -Z JN 2 4141. O,e GEss /o/ / 3 1 .�F �� 3;y R9t HARD` P.�TER t ✓J' �2o M A. �^ o SULLIVANBAXTER No. 29133 /o/ • 3 10 /�Q Na 2409E3 a 0A. 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