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HomeMy WebLinkAbout0172 WALTON AVENUE - Health /7a Walhin A�e•, 14Wgnn;r -- 31l - 084 -__ of L 0 A T IO f S E WAG E PERMIT NO. VILLAGE dam_/ INSTALLER'S NAME & _ ADDR,*S f,P-8� t U I L D E R OR OWNER DATE PERMIT ISSUED z ze2 -- f�� DAT E C 0 M P L I A N C E ISSUED 1 C c 5b d c No..0 /0 ......... F�a... 3................THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----------------------0F...... .. ............................................. Applirativit for Dispusa1 Workfi Tonstrnrtinn Vanfit Application is hereby made for a Permit to Construct (,K,� or Repair ( ) an Individual Sewage Disposal System at:.......... . .a...�... .... .��...... ...................... .........� . .... ----•.... Locatio ddr. or ot .... _.. .-- ............... -------•....................... Ow r . � Ass W Installer Address Type of Building Size Lot......_ k1j0_Pa....Sq. feet V Dwelling—No. of Bedroo ____ .____Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building _ - ............ No. of persons......... ________________ Showers (>e—) Cafeteria ( ) 04 Other fixtures ---------------------------•••-- ... W Design Flow___________ S_____________________gallons per person per day. Total daily flow..__._.__._ 30_.�................gallons. WSeptic Tank—Liquid capacity__/Q.c?4_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 (Y) Dosing tank ( ) /9 4• Percolation Test Resu is Performe Test Pit No. 1._ d by. 1 ___.�P�1 � ____________________ Date_ v.. 4, _ .o� a.._____minutes per inch Depth of Test Pit____________________ Depth to ground water_. �____ . ,..1 LL, Test Pit No. 2................minutes per inch Depth of Test Pit_ _ ._____...____ Depth to ground water________________________ /� _ 0 0- 3 3 ? 1 �..?_... �- Description of Soil_�Qa��4m >- c.4 2--- V ....................................._............_......................................... .....................................-................. W UNature 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 TITLE 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 bA e oard of health. Signe _ _...... ..._'-------------------------- a°�� -•-------- Application Approved B D e Date Application Disapproved for the following reasons:...............................................................'.....................................---------•- ....._._..-•--•-------•----------•--------------------••--•---•-------------•---•-----•-----....._._.._..----••----------•-----...----••----------------------••--------•-----••----.....-•-•- Date PermitNo......................................................... Issued......................................•................ Date 4 0 #1 No.................... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................OF....... . .. 11-4............................................... Appliration for Uhiposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct ()(), or Repair an Individual Sewage Disposal System.,at ---------------------- .... ........................ ..... ......­ ­-------- ----- Location AddrZ or Lot o f .................................... .... .................I-------------------------------- Owned Address .............. .......................................................... .............................................................................................. Installer Address Type of Building Size Lot........ZYi2ZM...Sq. feet U Dwelling—No. of Bedrooms_...............%................................Expansion Attic Garbage Grinder 4 %�­­W P4 Other—Type of Building ...ems-. . No. of persons.........!�............... Showers Cafeteria P4Other fixtures .................................................................................................................................*...................... < I . Design Flow__________.. .........................gallons per person per day. Total daily flow..................*...:,- � `..........__________.gallons.W Septic Tank—Liquid*capacity...Z�i.��igallons Length.........�i..... Width................ Diameter--- ..... Depth..............-_ Disposal Trench—No..................... Width Total Length___.........__ Total leaching area.._ .........sq. f t. Seepage Pit No........../---------- Diameter.........!P...........Depth below inlet..........4 ...... Total leaching area...02....sq. f t. Z Other Distribution box Dosing tank ( ) P ei, 1-.4 rl� I S Date...e�l. Percolation Test Resul Performed bv.., e" , �7 4 � e.� .. ............................................. ............................. Test Pit No. I...Z9......minutesperinch Depth of Test Pit.................... Depth to ground water... rL, Test Pit.No..2...............::minutes per inch Depth of Test Pit ............ Depth to ground water.1........................ .... .. ... .... 7 ­'JA ... .... ............v................ ................................................ 0 Description of _0,4 Z.. ................................. ............ .... Z I-------------------- ...................................................1........................................../..................................................................................................... ....................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer.when applicable.............; ................. ................................................................. ............................................... ...........................................................m........................................................................................... Agreement: The undersigned agrees tc.Jnstall the aforedescribed Individual Sewage Disposal'System in, accordance with the provisions of TITLE, 5 of the State Sanitary t6de— The undersigned gned further agrees not to place the system in operation until a Certificate of Compliance has been ssued by the board of health. 0"1�7j, /............................... Signe_....... 7..��/.......... Date Application Approved By............. / 0� 'Af--"44_ ....................... .... ---- Date Application Disapproved for the following reasons:............................................................................................................. ....................................................................7.................................................................................................................................... Date PermitNo.................................... .................... IssuedL.............................. ......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 F.......... ................................................. ................................. Tatifiratr of Toutpliattre THIS IS TO CERTIFY, hat the Individual Sewage Disposal System constructed""(-/I or Repaired b] .................................................................................................................................................... -,Jnstaller ..................................................................................... at.......... . ..... .......... .......... has been installed in accordance with the provisionseff T 5 Qf The State Sanitary Code as described in the application for Disposal Works Construction Permit No.. I..................... datedL..3..-.A.......:71 ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS/A GUARANTEE THAT THE SYSTEM WY, L FUNCTION SATISFACTORY. . ........... D..I E................ .. ......... ...................................... Inspector-- ........................... ... ----------------- THE COMMONWEALTH OF MASSACHUSETTS O(� BOARD OF HEALTH ................. ..................................... N FEE...e.................. 06�........(4c.,...... ----------------------------------------...................................... Permission is hereby granted...__(1,1_Z :Zat, T�' to Construct or Repair an Ipdividual Sewage Disposal System atNo......I AJV....4 ........11N1ei!�'1vZ11'1----------------------------------------------------------------------------------------------- /11 Street as shown on the application for Disposal Works Construction Perpit-jNo Dated.... .......... ....... ...gnwv------- "'-;V ­--.44444'a"'`------------------------- DATE......... ........................................... Board of Health • FORM 1255 HOBBS & WARREN. INC.. 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