HomeMy WebLinkAbout0033 WALNUT STREET (M.MILLS) - Health 4q- �� 1
33
LOCATION SEWAGE PERMIT NO•
VILLAGE
INSTALLER' NAME i ADDRESS
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0 U I L 0 E R OR , OWNER
DATE PERMIT ISSUED
. DATE COMPLIANCE ISSUED
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No..- - • GCS.. YYY Fzes.... ff..�..............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
77D.k(_Al............OF.........
Applira#ion for Dhipoiial Workii Tomilrurtinn Vantit
Application is hereby made for a Pe mit to Construct (,V<) or Repair ( ) an Individual Sewage Disposal
System at: S 3 l )CA .
................ -------•-......... .. ...........................•------•-•. --•---•---------•--- - ------...Z. .........................................
atio ddress or Lot.No.
�:. .. �----------------------------- ------------ /9_L AJ,(17'.....s�-7-...-----...................---....
e �J Address
1�. ''1a ,1 �1 s -,�J- ....................
Installer Address
�Q
Q Type of Build' Size Lot_2Of---D61Q_..Sq. feet
V Dwelling 7No. of Bedrooms___........3...........................Expansion Attic ( ) Garbage_Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures _________________________________ _
W Design Flow..........SS".......................gallons per person per day. Total daily flow-------... .....................gallons.
WSeptic Tank—Liquid capacity/�flllgallons Length...._.y..'..... Width____. ✓.�... Diameter................ Depth.._.4.1.._..
x Disposal Trench—No..................... Width--_--------------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......../---------- Diameter-----I o.._..__ Depth below 'nlet._. 3-_.15..... Total leachin area._,69....sq. ft.
Z Other Distribution box (�) Dosing tank ( ) _ ��o�-� D
Percolation Test Results Performed by----- ....�__.<'O-r_... Date_...-.z _'_8-0..__..
Test Pit No. 1_--e_-'?—____ '
o,
minutes per inch Depth of Test Pit___��__...__._ Depth to ground water..jl/.PT_.E__.1 —
LL, Test Pit No. 2..-4.. ___minutes per inch Depth of Test Pit--- ----- Depth to ground waterC.O0.(v .PuT�
P4 •-••---•------••••---••---•••--•-••...............................
O Description of Soil.*/.._�...._.
x AP? A._...�S. A,.7P....w�c.�'M.�8-.-•---•_*..Z. - c��l'VI_�,L..................................................................
W
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 1 i:'" y g g p y of the State Sanitary Code—The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has be iss ed b he board of health. 01
ha
`. .."...%1�-�''e�
Sign .
Date
Application Approved By--- ---- ,-� ----- ------- - ...1/y/• ........... ----- r =------------
Date
Application Disapproved for the following reasons:-•----•-----••••••-•-•--•--•----------------•-----•--•••-......--...---•--------.......-- ----•-------------.
..................•-••--•-----•••------------•-••----•-••-----------•--••--••-••------.......••-----•----.••••-•-••-•-••--•••-•------=--•--•.----.........................................................
Permit No................................ Issued._ A� 4.... .--••-•••-------•--..._.....Date
Date
No. ---.._... - •-- •..-='+r t FIe$..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
U-La..1lL............OF.........4A�AZs7'`7./ L_C'................
Appliration for Uhgp Baal Works Towi rnrtinn frrutit
Application is hereby made for a Permit to Construct (,V or Repair ( } an Individual Sewage Disposal
System at:
................-----••---:........ ..._ ......_...........---...._............ .......---•--........4Z... ....---Z......................................................Z
....
Location-Address / /�^/ 1 > or Lot No. _
....-•-•...............•..................... ......._......................................- --.....--•--F�_.v..!.=_�-.!-:•:-U....1.. ..��..........---------------------•-------Owner Addres;
..................................................................................................Owner Address--
Installer Address
i
Type of Building Size Lot_. ___._-_-.b�1_..Sq' feet
., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons___-________•--------------• Showers — Cafeteria
Q' Other fixtures ................................. .
W Design Flow._.__...._j._Z.......................gallons per person per day. Total daily flow.......__.4-�✓� ...................-gallons.
WSeptic Tank—Liquid*capacityJUQ_Qgallons Length........ ��Width______`��. Diameter................ Depth..__ _......
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........../_......... Diameter.....t 0 Depth belo)onl t � T tal hi rea_./..! '_..sq. ft.
r f.
z Other Distribution box (�) Dosing tank
'-' Percolation Test Results Performed by ...... ...........G ....LU __ _.CU Date... .....
as Test Pit No. 1_ _Z__-minutes per inch Depth of Test Pit___ Depth to ground water._ ✓v?__tN
Test Pit No. 2_ __.Z---minutes per inch Depth of Test Pit... 4-1.9--- Depth to ground water-6v
- = ----------
O Description of Soil */.t'. _------ - '.._��--e...... --•-•-----,St.i S:b/L rr ..
V .11 72 D,.._5/ /�1! _.__ c/ 4s Tr�_!v_C a_........_ _ L_ ...................................................................
W ----------------------------•-----•------------•-------•-•----------------------------------------------------------------------------------------------------------------------------------------•-----
UNature of Repairs or Alterations—Answer when applicable.__-............................................................................................
--------------------------------------------------------------------------------------•-----------------•-----------------------------------------------------------------------------------------.-----
Agreement:
S
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of f-1T Pt'T 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 by the board of health.
j *
St e ••--------
�';;;�: ...............
Application Approved By.....-- r ---------------------- ---•---•--------------------
Date
Application Disapproved•f or the following reasons-----------------------------•---------------•------------------------------------------------------------.--••--
X..
?, Date
PermitNo......................................................... Issued•.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEA .
%Trrtifirttte of Toutphanr y
ri LJT E T FY Tha the Individual Sewage Disposal System constructed ( ) or Repaired )
( --- .....154. .......
� vs /v -
--------------------
has-been installed in accordance with the provisions of ,99&e State Sanitary C2?Lajrc -'l bed in the
,application,for Disposal Works Construction Permit N ......................................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WIFUNCTION SATISFACTORY:
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DATE......... ....G..._.-!7�`..--...-.... Inspector :.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARDO�
No......................... FEE........................
1110�Wrudion rrntit
Permission�,A erebWgr
t d ^----- ---------------------
to Cons c ) o .R ,)�.4 I i al Se� I s �' l" ,�
at No � '�
St et
as shown on the application for Disposal Works,Construction P �Ngt ���a�.........._ ____________________________
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" ........................................
--•.................................. Board of Health
DATE----- ------ --°�--• ---`
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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