HomeMy WebLinkAbout0586 FLINT STREET - Health FL ✓)T- srVct.O--+
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LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTAL,LERB'S N; E i ADDRESS
OR OWN ER ,
DATE PERMIT ISSUE -a
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DATE COMPLIANCE IS SUED � � ,-Vic' - �
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. ...................0 F.............................--......-.----.--------------..............................
Lp Appliratiun for %gpviial Workii (> outitrurtiun rantit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
stem
:...:...� ..t'G�L[.... .....1 Zj
.. ......................../.-/ ..._......__...._.......................................
........._._._........_...._.._......_....
yl,L�ocation-Iddress or Lot No.
.. ..................` L�_ /!�„f c / /y ............................... . ................... ................... ............
caner - ress /9 s
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Installer Address
Type of Building Size Lou'_ p a......Sq. feet
U Dwelling kNo. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
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........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
------------------------------- !.
0 Description of Soil... ftll-I ..........., _____________________ _ .
V •-----•--------------------------------•------------------....-----•------•---------...---•---•-----•-----------------------•-------•---•---
....................................................----------------•------------------.......---••---------- -------------H .� ---------------
U Nature of epairs or Alterati s— nswer, w en applicable f___..._:. _.-._, .D.om---.�._.�.a......—.......................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of III LE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has tDeeid b the�oar health.
Signed .................................................. �
Application Approved By.............. ... -- ----...............................
........................................Z Date, S
Date
Application Disapproved for the lowing reasons_......................... ____________________________________________________________________________________.
---•--...-•---•--•................................•----•-----...-•---•--•--•--............-•-------...------•---------•............-------••----------------------------------------•-•----•---......_..
Date
PermitNo......................................................... Issued_.......................................................
Date
No... �. .��.4 Fxs............._............
_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................:... ....................O F..............................-..........._......-----...--......................._.......
Appliration-for llispusttl Works Tonstrnr#ion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
ystem ,-- ....................... ..........................................
tLocalio.n- ddres or Lot No.
................... ............................. .
ner re
W ........' ...
Installer Address
f�d Type of Building Size Lot�_.2...�..!.............Sq. feet
U Dwelling-ONO. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building ..... No. of persons............................ Showers — Cafeteria
04 Other fixtures ------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................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..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.--................. Depth to ground water........................
1:4 •------- - -------------------------- ....................................................•---•....-•••••--.....•----......._.._...................
0 Description of Soil-• '"` ---•-•--------------------------------------•--.......------•----•--------------......-•--•--•............--•
W .................. .................... ............................................................... . _
VNature of liepairs or Alterati nswer.w en 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 s ed b Vhear health.Signed--- ---•: .-•- ------------------------- ..........................
�� .
1I.Dater' ` hJ
Application Approved By.............. :... .. .. • --••---•-.....---•--•....••. ..
Date
Application Disapproved for the f wing reasons-----------------------=-----•---------------------------------•----------------...----•------•----........ .._
....................•---...--•---.............---------------•-----..........------...---------------••-.---••_--•------•--------------------•--------...-------•-------..--....--------•--•-----••••---
Date
PermitNo..................................................._._. Issued_.....................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Trrtif hate of Tomphatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed �) or Repaired
by-----------------------------...-�----- c :t:. -
Installer
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-----4.7.t � .. . ................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAJANT E THAT THE
SYSTEIoA'WILL FUNCTION-SATISFACTORY.
M : TM„o�
DATE............ ry ,. ;;:` "_ Inspector ................
....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......OF................................................................................... .
No..... 5__..1... , FEE....
Div, osal fu�11.11C.R Trrn r#Uan Fermi
t.
Permission is hereby granted..........41_ _....
-•....... ..................
to Construct ( ) or Repair an Individual Sewage Disposal System'
at No...........................QV-6.........� I.A)l...-.L-T.-----•---•--. -- ..
15 . Street l 1 4
as shown on the application for Disposal Works Construction Permit No. _`....... Dated......
........................... . ... ....._._. _
.✓DATE...:.. oard o
- � - � -------•-------•----
FORM 1255 A. M. SULKIN, INC., BOSTON