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Home My WebLink About0390 WIANNO AVENUE - Health NIianrio,Avenue' . 3 � A= 001" 140� °1 " o a ° O 0 o N L0CAT10N a SEWAGE PURMIT NO. Mete VILLAGE ' / V STA,LLER'S NAME & ADDRESS BUILDER - OR OwNii r A . 00 DATE - PERMIT ISSUED D,AT. E CO,MPLIAPCEl. -I.SSUEQ .9 t�S 4 a 3 s� c 1 No.. .....v. FEa...l...::.�.... ..... - THECOMMONWEALTHF FHEALT ETTs O �� ' � _O0' BOARD r _�"* "-o w,� s �� - u fur Uhipuuttl Vorkii Tomitrnr#iun ramit 0' Application is hereby made for a Permit to Construct -�or Re air an Individual Sewage Disposal PP Y (r 1 P ( ) g P System at: .........................................OC3 .Wress_.................................. ...........................................or.Lot............................................... -� -•-q��klddress / •--or-Lot No. ...................... ----•----!.lam --....................................... ............ ......_.. �g /& ._....----.......................................... ner /j/� �•/ _ _�; Address Installer Address d Type of Building Size Lot....�-.�-_UQ�_---Sq. feet U Dwelling—No. of Bedrooms.......... ................................Expansion Attic ( ) Garbage Grinder (�! aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' OjhU fixt es . d ..... ...................•------------------•-••-------------•------- Design Flow............................$5.�__..gallons per person per day. Total daily flow..............:? o gal W ............. ......•----- Ions. WSeptic Tank—Liquid capacity!�.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length..........j......... Total leaching area.._................sq. ft. Seepage Pit No.....4..._...... 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................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...�----------- ............. . ----.--......_.._.. Description of Soil 7 fi. t-FJQ/K [1 ��. ......... PY. . y ----------------------•------------------.......-•-•-------•-•----------..._.. 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 Cod — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' d by t rd of th. i 3_. D Applion Approved BY--------- "---- •......-----•--------------------•-•-......................................... .....X ..1 ---•-- Date Application Disapproved f o the following reasons: ..........-•---------•.....................................................•--•-•--•---......------...........-----------•---•---•--•---•---•----------------------------...•-----....................--- Date PermitNo......................................................... Issued........................................................ Date Y'.°:� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT .. ...................oF.....: :/ ' ...................... Apli ration for Uhipaiittl Workii Tonotrurtion ramit Application is hereby made for a Permit to Construct ( II), or Repair ( ) an Individual Sewage Disposal .System at: --------------•._... -----•-. ------------- .•. .................................................. •--------------- •....... ------- •---------------- Ltoca'o .Address or Lot No. ........---- .................................................... Owner a Address a _ ....:...: br ............. ..tic .l1 ........... Installer Address Type of Building Size Lot....t 4.j/6t0 D.nSq. feet D.welling�—' No. of Bedrooms.......... .................................Expansion Attic ( ) Garbage Grinder (N6 aOther—Type of Building .......................... No. of persons............................ Showers ( ) — Cafeteria Otherfixtures ...................................................... �T W Design Flow ... .._.. ___.gallons per person per day. Total daily flow........ :......:.. .._._:.+f_Q......gallons, WSeptic 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..;P..X_....sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY........................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2..:.............minutes per inch Depth of Test Pit.................... Depth to ground water........................ . ... _ . ..- ............ ..-.-......i........'-?•--••-��••-.-�....-/9_-------------------------------•---•-------------•-•-----•-•---•-•-•---•---------•---•--••-_--•--••-•-•------•••-----ODescription of Soil--- . ------r------ h _' L -------------- ..........--- U � .................................. W Z. -- ---------------------------------------------------------------------------------------------------•-------------------- ..................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... . Agreement: ." The undersigned agrees to install the aforedescribed Individual Sewage Disposalyss¢t� e dance with the provisions of LITA i, 5 of the State Sanitary Cod — The undersigned further agrees not to pla e'�"ystem in operation until a Certificate of Compliance has been i d by t rd of hea h. Signal`........ . •••••-•••......................... .......................... __ . ...... D App lc�ow'pp oved BY ,� .--------------------•-•--•----•-----------------................ ---. /'� � r•• Date Application Disapproved f o� ollowing reasons:------•--------•..............•--•--•-----------------------••-•••••---••..................................... -•-•--•--••••••-•••-••••-•••-•--••••----••-•------••-•••-••••...._•••--•...••--••.....•-••-••--•--•••••--•-•---••----••••-•••--•-•••-----•-••------•-•-•---•--•.....-•• -•••-•--•-•••-•••••-__________ Date PermitNo.......................................................... Issued.......................... .............................. Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7�cu art s C9rdif iratr of Tomplittnrr THIS IS 0 CERTIFY, That the Individual Sewage Disposal ;stem cons ructed (P"f or Repaired ( ) b t -- -•� - --------------- Installer at... r 1 ----- --• . ------� •------------- Sv-2 has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code /dc ribed in the a lication for Disposal Works Construction Permit dated.. PP P 3'�✓ f l ------------------•-- THE ISSUANCE OF THIS`-CERTIFICATE SHALL NOT BE CONSTRUEDAS A GUARANTEE THAT THE SYSTEM WILL, �XCTION SATISFACTORY. DATE--••••rl /7r ................................................... Inspector----- --- ---•-----.•............•-----------......--••---•------•-•••••••...-•--- l THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA T �— A.... ..ki.............. .......OF..........-.-- 1. ...........-... ..........................No......................... FEE--,6 l6............... %popal rks To strttrtim Prrutit Permission i hereby grante --• -- -- ............ ..... ............................................................ to Construct O or. Repair ( an Indivl al Sewage Di System/ :_. .. Street DD as shown on the application for Disposal Works Construction Permit No........... ted......7__ i6 4 � /• r _________________________ _'_ -- ---•---:----------------------------------------------------- Board of Health DATE---------------- _..:............................................... FORM 1255 A. M. SULKIN, INC., BOSTON ` f ,� y �' .�1 �{ � `�. �, 3 1 .1 3 �, - - - -- ?3� / Vil Z7. 3N. ZZ.G,x� 57 • •�� -�f„�, t 1 � �^ Fib./✓ �Q.Q�x ; � 1 '�' 6 • 31.6 \� o,1�I ZZ•c. • t � - 30, cf ' A . 1 • a 3L•Z, j t `ZN OF M.4 • ; y��'�= or ALAN �G EEC}IAMn 4G;t w, i yt JONES NaSAVER 24046 No. 25100 . j. n s I Al C-Wi 7ANK:•= �f�0 X/�Svy =• GG� 6• .o�. : .. , - 4 L f -J j . 1 O�G� 6'A L. i Aq6A ' �• '"',TOTi4t . :a�S/Git/ - 8SD GP D. �;� =3Z.f r Tar'iJt4� N / e• •TEST ,/Z�S/ . f G '•Ha+�IE m ,4 L. � s 2 aO�C ZZ•� 5C�� NI >y b W// ly Z •2>/%t ! •Si4N.Z7 W�.S// `H OF MA �N Of Fi1CHA ALAN SG r, � W. .� # BAXTER �+ v (ONES y No.24046 Q a 25100 / • 1 t ° i NC o f, 8 LLf! Z' Q ACV T 7W fk�.G�spQSL�L� /� ; • :,ySE �ShvN/�!N6,P_„Eo�C/ G�l�LYS os�-��!//L.!_•F /►'.�S :f w/T-H. ?'Hh' ,5, r�E.z/,c%� s�i✓n .SErz ' . of - -,q Tots/,✓ -:z '� ► rA L..6- AVz;l . W")'N/40t/ Ti�Lc I c A L- f} Sc �. .S A/t/ ,�EG�ST 'ED 1.4iv�i -�vQ✓EYoeS rZaAj,6,V7- 54Je •/ovoo' AN1D T/1G GZST��✓/LL,� o /vlASS • }` t r ` S L0CAT10N -SEWA,.CE PERMIT NO. V'ILIACE S T A LLE It's' NAME b KDD'RES.S N IJ fL D E N OR OWl1_ 10 QA:TE-: PERMIT . ISSUED DATE COMPLIANCE. ISSUED � ICI