HomeMy WebLinkAbout0073 MICHELLE AVENUE - Health 73 Michelle Avea�%�--
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L0 CAT I9/N a fir SEWAGE PERMIT NO.
VILLAGE
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I N S T A LLER'S ItAME i ADDRESS
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0 U I L D E R OR OW ER
b<211011A LA
DATE PERMIT ISSUED 9�.�-`
DATE COMPLIANCE ISSUED
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No..7....LI ..-7 ....
$05' FEiz V.......... .... .....
THE COMMONWEALTH n OF A�'SSACHUSETTS�E
BOARD/)DJF, E TH
...............0 ir........................................................................................
Appliration for Miposal Worko strurtion ramit
Application is hereby made for a Permit t0L Construct i or Repair an Individual Sewage Disposal
or Repa
System at:
-� c--------------------- ------ ...... -----------��---------Z ------Lot No. ..............
--*......."--------
.................................. ................................................................. .....
---------- ------
A 4 04 jer.. ............
ress
.............................................................. ........ --- --Instal-1-er ...... ..... ................... .......... Address
Type of Building Size Lot.....OV, _6M).Sq. feet
Dwelling—No. of Bedrooms........:3..............................Expansion Attic Garbage Grinder (
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria (
Other fix_________________gallons
rr --------*
..........g-a- o-,n-----per ----per-,-day.;-------Total-----------daily- -----flow-___- ..__._._.......-----------
Design Flow........... -
9 Septic Tank—Liquid capacity,7/00-gallons Length................ Width_............... Diameter-_.---__-___-._- Depth................
J
Disposal Trench—No..................... Width ....... Total Length......_
-........ Total.leaching area-__--_...-__... sq. ft.
........ Depth below inlet___.._.....__.............. Total leaching area.Seepage Pit No....../------------ Diameter.....9 Z 5--------------sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
.j
Test Pit No. 1________________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........................
......................I........................................ ............. ............................................................................
0 Description of Soil--- :Tr:.2,-'....... ..... . ... ........................... ..............................................
............... ---I------7z-r------_----------------14------------------------- __F---- -------------------------------------------------
------------ .,o
ZI ............-------------- .......... ................7�.. . ... ................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
----------------------------t------------
the provisions of TITIE 5 of the State Sanitary Code—The pydersigned further agrees not to place the yste in
operation until a Certificate of Compliance has Vbee iese bye board of health.
:7
ed.. .... .................................. ...................................... .....I.. ....... .... ....
ApplicationApproved By........... .... ............................................................................... ............. ...... ..--------
Date
.e ellowing i Date
Application Disapproved for reasons:..............................................................................................................
................................................................................................................................. .......................................................................
Date
PermitNo......................................................... Issued--------------------------------------...........------
Date
-----------
---------------------------------------
N ..... Fimz ....................
THE COMMONWEALTH OF.MASSACHUSETTS
BOARD,,0F HE4, -TH
- .1
...............OF...../... ".4,
. .. ...........................................................................
Appitration for Dhipasal Vorkii,�Doustrurtiolt Permit
Application is hereby made for a Permit,to Construct (be�oi Repair an Individual Sewage Disposal
System at: (/ I
I. ......................................................
. ..........................i................................�t:...... ........................... ..........
Location-Address 01
or Lo;
...................................i.............................................................
R........................* I , 14) t No. . i,
n X
xy ,
............Jci4 -..................................... I..........r�6� --------- ---Address
........ .............. ...... ---------
Installer I
Type of Building
U 14 Size Lo t.... iL._ Sq. feet
1-1 Dwelling—No. of Bedrooms..........:�.............................-Expansion Attic Garbage Grinder
4
A4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
P4 Other fixp ..............
.................................................................................... .............I ............................
Design,Flow.................rt..5......................gallons per person per day. Total daily flow..... ........................gallons.
9 Septic Tank—Liquid capacit&/.; ).gallons Length ............... Width.............__. Diameter__._____-_:.---- Depth.............__.
Disposal Trench—No................ Width..._._........... Total Length....... Total.leaching area----- sq. f t
Seepage Pit No...../............ Diameter..... Jr.
....... Depth below inlet... ............. Total leaching area.V.............sq. f t
.
Z Other Distribution box Dosing tank
Percolation Test Results
esults Performed by........................................................................... Date-."'..........."------------*-----------
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth'to ground water.._.....___.__._..._.__.
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.............._...
.......... ---------------------------------------
---------- ....... ...............................7--------------------------------------------
0 Description of Soil../T='_ .....61 I ..
.......................... ...............................................
....................................t--------
U ..........................V...T............ ;........Y... .................................................
.......................................... ..........................................................
/_*..........---------------------
U Nature of Repairs or Alterations—Answer when applicable........................................................z......................................
.........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal'Sy9tem in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The Kfidersigned further agrees not to place the yste in
t tj I r
operation until a Certificate of Compliance has bee is )Y, ti�e board of health
Signed .......... ....................... .......... ..............................
to
Application Approvef:iy;t;`�t/...................................................................................... .... . ...... . ..............
/,04te
Application Disapproved;for/ihe following reasons:.................................................................................................................
.......................................................................................................................................................................................................
Date
PermitNo........................................................ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD AbF HI�LT
............................................................
....... .......:........OF....../........." � 40 ��
Tntifiratr of TI-Impliattrr
THIS IS TO CERTLUY,Lhat the Indiv*, al S age Disposal Systeirt constructed ( ®r Repaired
by ..............................................................
...... ..........................
7., a --(at.._...---
/'7
at.......... .. ........ --------------�A.Oul,"' C7_4(A_,
..................................._6:& 7..................................................................................
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 PermjN,6.it_.
7,14..................... dated_...__....._...____......._..__...._...._..__...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
TE..........................................7.......Z.... ............ Inspector........----- /L
.....................................................................
TH WEALTH OF MASSACHUSETTS
BOARD O� HEALYTH/
........ ..............................................
No....................
71,7 FEn...... ...............
Raps orka (InArWtiott Permit
Permission is �eby granted........ ... ................
............ .................. .........oj r. "e'" rage isposal System
to Construct or-Repair an IndVid
...........at No.................. 1-:3......jq.ji. ..... .............
r Street
as shown on the application for Disposal Works Construction Permit No .. .............. Dated..........................................
................w... ............................................................................
Board of Health
DATE........................ 'r�/
................... ...................................
FORM 1255 A. M. SULKIN, INC.. BOSTON
II
I ��i►�G�C- FAMIt_N{ - B�URooM _
IJO GARBAGE 6p-kJpEiL M ( (7- � � Qt) -
Dia►��( F�oW 110 x 3 = 330G.Po
SEPT 1G TAtjK = 330x 150% = a 9 i b.R IZ"-. Gc.
u5E- %000 GAL.
I0 00 GAS.
D15 OjAL PIT u5E o
P \
5%Dr-WALL AP-SA, - 1 5o S.r
150 5.F X = G.PR
BOTTOM AREA' . �o S F,- A � C�
I 1
5 o S.F x I• o �� 5.o G.P o• � as� '��i'• � q�,
'TOTAL. DESIGN t: 425 G.P0. 1
'TOTAL 'PA 1I-`(. FL-OW ' 330 G.P0.
1
PE2COL.ATIW4 RATE = I'lIN 2MIN 09-LE55
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