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Home My WebLink About0151 PRINCE AVENUE - Health I�► Pfullcc 0 ,— YnQ rs 7"u n_S LOCATION T`�i�►�� ,�t, SEW » PERMIT NO. VILLAGE / I N S T A LLER'S NAME i ADDRESS 1-7ea& i UILDE R OR OWNER DATE PERMIT ISSUED DATE C0M ►LIANCE ISSUED l i i /OOp _s 5q u Fms........ ................ THE COMMONWEALTH OF MASSACHUSETTS .t. BOAR® OF HEALTH ....................O F..........................._.............----.------------------------------..----•--_.... Appliration for Bhipaii al Works Tnnitrur#iun 1hrutit r Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Systen3At. V -M ...., f`I....:.-5 -------------------------------------- cacation-Ad'drenss or Lot No. .... � ._.......1...:.-4J .�11._._.... ............................................................... /�L�gO�wner Address a ®R( i.--h A w- .............•............----•-............ ...------................................. Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.......................................Expansion Attic ( Garbage Grinder 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. 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----_-----------------_. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' ••••••----••••••-------•-••••-•-----••••.....••--••------•-•-•.....................•--......._-'•--•'•••••-•---••-•--'----...••••••......-•-•-•••----'•-•-••. 0 Description of Soil........................................................................................................................................................................ -------------- •----------- -------------- •-----..---.------•---•----------------..._......------------ ----------------------------- --------------------------------- •------------------- ••-------------- W ••-•••----••-------------- ............................................................................................................................................................................. UNature of Repairs or Alterations—Answer when applicable..._ . ___ .LD_._. .�'' __. Agreement: ems" The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'i U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuqLq t board of health. Signed ---- . ---••-......----'------ ...................... . Application Approved By........... ..._.._. )JO Date Application Disapproved for the following reasons:................................................................................................................ --------------••-----------••---------....----•-------------------------....----•---------••----..........---------•-------------------------------------------•----------------------------------•-•--- Date PermitNo......................................................... Issued....................................................... Date No.. ' FEa.......� ........ THE COMMONWEALTH OF MASSACHUSETTS t� BOARD OF HEALTH --•......................................OF.....-..-..-.-..--..........._...........----.--.-..--..-...-_......._.......:_..-......_. Allpfira Lion for Uiopog al orks Tonitrnrtion Famit Application is hereby made for a Permit to Construct ( ) or Repair ($--) an Individual Sewage Disposal SyStem- t ............... ..... ...••---•-•-•-•-•--........_..----- -......•------•----•---•-•-------..__._....-•-•---••--••........_.... ...................... "'\ L'Kation-Address _..-•-----------•-•-•'----.......-•---•---or Lot No. .............` t'1 ----•-.{-. ' .41. �.1 -..---•----•--------------•-------•- --------•-•--•-----••-----------••---•••--.... ..... r Address Installer Address QType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms_____________A.........................Expansion Attic ( Garbage Grinder ( )' Other—T e of Building No. of persons...____,$_............... Showers — Cafeteria -�-' Q' 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. 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........................ n+' .................------•--•-------•-•-••••-•--._....__........_.....-••--•--••-...................-----....-------..__...-•-•-•-•---••••----•-••-•----•_-•-- 0 Description of Soil------------•--•-------------•------...-----------------•-•----.....----•-••------------------------------------------------------------..............................x W ----•--•----•-----------------------------------•-•---••-------------------------------•--•------•------•---•--•---------------------- ----------------------•--• ................ x _ r`i U Nature 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 TIT!L- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha been issued•by the-board of health. Signed. Na - ••-••-••••-••----•. __- - --------------•-----•--...-----•---•--------- ...=•- -- '_--�••`-- ,✓' �y Date Application Approved. By............. - _"' _�_ � d. t.............. ,- ............................... Date Application Disapproved for the following reasons:...............•------------•---------------------------------•----------------------------------------•-----• --....-•-•-•--•----------------•------•---------......---._....--•-•----------•------------•--------------------•----•-•--------------------••--•--•--•-•---•---•-••---•-•••--•-••-----•--•----........_ Date PermitNo.......................................................- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....I::..................................OF.................................................................................... Tnrtifiratr of TontpliFanrr THIS I,�,,TO CERTIFYY That he Individual Sewage Disposal System constructed ( ) or Repaired ( ) �,.�Instal at...................----•-=. ..'=•'�--------��'""'=---"---- has been installed in accordance with the provisions of TIE UTE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ."_� ______________ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Zh DATE......... .............. Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................:.................O F.:-:..:..-........._._....---.....-...--••-•-----------.............._.._.._...._._.. N o. /3 FEE ................... Disposal Works T.Coatlitr ion unfit Permission is hereby granted l , " r 't ... -! : ----------------•-----------•------------------••--------.................--•-•--- to Construct ( )--or-,Repair ( an Individual,Sewage Disposal System at No. " :'?.c•= .'C'�-' '_._: +® -------------------------......... r_ Street as shown on the application for Disposal Works Construction Permit No..................... Pated.......................................... w Board of Health DATE.............................. ',/ .t'�._----••-•-----------•---•---- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS