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HomeMy WebLinkAbout0201 ROBBINS STREET - Health �o �Zobb�� r�s 5�' rota - a� �- osf���l� LOCATION SEWAGE PERMIT NO. . VILLAGE INS/TA �LERD'SNA E & ADDRESS 4-d' OR OWNER - s - DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �, 4 _ - <a .;� .; �: f ��'�� '� � _._.._ �' �� ,� .- `� I�. -_---__ c� � ��-. ,� �1 .'�,'_ �... ,'� o® N ._�_©C-_26-5 Fis.._..,.?d.................... THE COMMONWEALTH O�MASSACHUSETTS �t BOAR® OF HEALTH ------------------ ----------------------OF.................................................. ApplirFation for Uispaa al Marks Tnntrnrfian Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, fat- n Address of1`otIb. cr/lt .: •• ......................................... ........................................ Ad.. .................................................... a -- -- ------ ----wne °fF-/��•= .�•: .--•-----------• Installer Address QType of Building Size Lot............................Sq. feet U Dwelling Expansion Attic ( ) Garbage Grinder ( )�-No. of Bedrooms----'----------------------•-----------._ Other—T e of Building No. of persons..............._____________ Showers — Cafeteria a' Other fixtures _________________________________ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid Li uid capacity gallons Length................ Width_._._.._.__._.._ Diameter..._..___..._.._ Depth__._.__.______.. P q P Y------------g g 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 ( ) Percolation Test Results Performed by--------------------------------- ------------------------------------ Date--------------......•-•-•-------------. a Test Pit No. 1________________minutes per inch Depth of Test Pit...______._____..___ Depth to ground water........................ 44 Test Pit No. 2................minutes er inch Depth of Test Pit.................... Depth to ground water........................ Ri ------••------ .................................................................. ODescription of Soil....... 2`- ----•----------------------------------------------------------------------------------------•-------------------•---••-------------------- x =, . - - ............... =------ ...... U Nature of R air or Alterations nswer when applicable___ "_� .v_____ __ ___________ �..._____________. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System-in accordance with the provisions of i T':l,;. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the b and f ealth. �'� Signed-- - •-----=- - -•-- =---•- --- .............................. -�-------------•---......._ Date Application Approved BY `---- � 'i.....;, G ------------------•--- --•-- ��'3=- Date Application Disapproved for the following reasons-------------•---------------------------------------------------••----•-•-----•------------ ------------------- ----------------------------•----------------------------•-••--------------------._...--------------...---------------------------•-----------•-------•---•------------------------------•--------= l Date PermitNo......................................................... Issued....................................................... Dati N . �..$ $, F�s......5....p..r....... THE COMMONWEALTH OF`MASSACHUSETTS BOARD OF HEALTH ....... ....... .. --------......OF.......................................-----.......--------:............................._ Appliratiaan for Diipnual Workii Tnnitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or�Repair ( ) an Individual Sewage Disposal In a Sys -d ,���� ................................... ..........................................z - - ................ •- •• - _..... Ica n dress or Lot No. a ... ................. .. ...._....•-•--•..........•-•-••------_.. _ ..... Installer Address Type of Building Size Lot............................Sq. feet DwellingE-No. of Bedrooms..__.�.�.....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Pa Other fixtures ..------•--•••.................... W 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes er inch Depth of Test Pit..............._.... Depth to ground water------.................. --- ---------------------••--•--...-------•---••-------...-----•---........._...-•-......................................................... ODescription of Soil..----- -- --•----•.........:.....••----------••-•---.....---•--------------------.......---------•--------•-•---------------------------------------. x W .............................................................................................................. ... .. �/ R {.__...____.____.__.__.. UNature of air or Alterations Answer when applicable f t. -------- '--------•--.....--•------------------------- ------------•••..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed lb and o ieth. Signed --.... theb - ................. &-- - ~/ Date Application Approved By.............. -- 'r....,, •/•--------------___--•-- --•- = J.......... Date Application Disapproved for the following reasons---------------------------••--•------------•--------------------------------------------------•----------..__ ---.......•••--••---•------••-••---------•--•--•.......................................••-....._.......•--•---------------------------------•--•----•--•------••-•-------•----•--------•--•----...--••-- Date PermitNo.............................................. ---••-• Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9 Tsar ............O F.... = � K ! ! .................................. Trrtifiratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ) by-•-•---•- •------- -•- --------•---•-•--•-•---•--------- --------------•--....--•-•----.....----•---...--•--.........----.....--•------•-------.._.._.. I Instalie at. /....d- . r�-". • ' ' _----------------- has been installed in accordance with the provisions of TIT r 5 of The State Sanitary Code as described in the application'for Disposal Works Construction Permit No..... 56 ....__..__-. ------------ � dated...----------------------------------------•--._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................7 Z—/ J---•-•--•-•-••-•-•---•---- Inspector.__1./ _--�" .......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . /.. C '1?` -.:........0F..... !7 ................................... �n D FEE.....«2 _ Disposal n%!fftrnr�inn anti# Permission is hereby granted----•• ---- -•------------•-•....................•----------............----•----•--......_...---•--- to Construct or Repai ai} Individual Sevcra a Disposal System 1e , Street as shown on the application for Disposal Works Construction Permit No.................... Dated..........................................Board th DATE.._..... ,.�, .. �t�.__.....--•............... r FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS