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HomeMy WebLinkAbout0095 GROVE STREET - Health Cis- GKO OVO sf��e-f L_ LO CA T ION S EW A G_E PE RMIT No. VILLAGE INSTA LLLER'S NAM i A RESS R.U1CD 0R 1 6 RtPA"( DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ���-� �� Y�..._,�.._._�..___.�..____..,._________.� __. �� �� �� �� � t a 1 y 1 � �. ,�: �. � ` s �, -�,. �� � �� E�� �� `.�....- 41 No..-q ................... /. .............. THE COMMONWEALTH.OF MASSACHUSETTS BOARD-OF HEALTH ...... ... ........._0F...... .. ..... .. .................................... Appliration for Uhipusal Works Tonstrurtion VTrot Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sys at: ............... ........................ ................................................................................................. t3c a lo d 1�1 or Lot No. .... ............ ...... ... .......... ................................................ ................................................................................................. Owner Address ... ........ .....................T­---------­-------­-7....... ................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___________________ __.__Expansion Atiic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons........................... Showers —.Cafeteria ( ) Otherfixtures ............................................................ < ---------------------------------------------------------------------*------ ---------Design Plow............................................gallons per person per day. Total daily flow..........................................gallons. P4 Septic Tank—Liquid capacity............gallons Length................ Width_______________ Diameter................ Depth................ 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------------------ Test Pit No. 2------I.........minutes per inch Depth of Test Pit.................... Depth"to ground water_.._._._________.__.__.: ----- ..................................................................................I.........11............................................... 0 Description of,$,,.oil....... ....................................................................................................................I................... ---------------------------------------------------------------------I------------------------------------------------------------------------------------------------------- -------------------------- ....................................................................................................................................................................................6................ U Nat=of Repairs or Alterations—Answer when applicable. ................................................................ L ....... ----------------LOW...qa.�. ........... ........ .................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I HE 5 of the State Sanitary Code—The undersigned further agrees not-to place the system in. operation until a Certificate of Compliance h bee ssued byt4eboard of health. ihe .. ........ ........ ................... ------I/Date ApplicationApproved B�................................................................................................... ....................................... Date Application Disapproved for the following reasons:.............................................................................................. ---------------- ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued...................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) 1 m --A-01� Xk&" L DAATA y r 'k THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ij .. a.1 ay f OF 4 Y ..F 1 4 J S •ta' ApplirFation for UiipooFal Works Tonitrurtton ramit t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal .!.. System at y - .. ---- _--- 3 f`. ...... Address... or Lot No. ..............•................... --•-•--•-......-••--••---•--•••----•------ . --------•••---------••--......--------•-- .Loc ation `• Owner Address W Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...................:........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------•---•------------- ............................................................................................... Design Flow............................................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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 1-� Test Pit No. I................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........................ 43 '.....,_,_.....-.....................•................................................_.........._....__........................................................ Descriptionof Soil.. :..... .:.......------------•-----•---••---•---•--•-•--•-----•-----------------------------------•-----------•----------------------------•--------••--•-•--- x w U Nature of Repairs or Alterations—Answer when applicable...._..............:............................................................................ .. a ................................. -------------•--•----------------------------•------••......-----•.......-------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the,provisions of TITI,I^. 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 board of health. Signed -- •-•-•- •-•....................................... .•... -------- Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons-------------•------------------•----•-------------------------...--------------•----------------•----........._ ........................................................................................................'............................................................................................... Date PermitNo......................................................... Issued•..--•---•-----•--•------------•-••-•-•......---•••... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... TrrtifirFa#r of (Inntpli anrr THIS,jS TO CE42TIFY, That tl-lq Individual Sewage Disposal System constructed ( ) or Repaired b j/ , y :.........:.... __ _ ;Installer'• ....... - •...--------------------------------------------------------------- at................. .............&........ ............ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No:........................................ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. (3� DATE................. l J v.. ... .-.--..... Inspector........ ....... ..... .................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..........---•--..............................--_.................................... ©� FEE....... Uiopooatl orko norion rrntt� Permission is hereby granted............... r to Construct ( ) or Reppr ( ) an Individual Sewage Disposal System atNo............... ..............., . ....---5-1..s.. Street as shown on the application for Disposal Works Construction Permit No� _-fh6 Z__ Dtea..___...7__..!._.._ �. .............................. --- ---- .•----............................ oard of Health DATE...--•-.-•-•�---- JARREN, ..-------•-......-•------•-•---••--.•---- FORM 1255 HOBB & INC., PUBLISHERS