HomeMy WebLinkAbout0120 WALNUT STREET (M.MILLS) - Health 1 � v)&Wj-+ +
L LS
LOCATION : W8,(:�E PERMIT UO.
It 57&LLER 5 U&ME 6 ADDRESS
BUILDERS V JJ &"F- &. DRESS
DATE PERM VT ISSUED
D ATE COMPLI &&ICE ISSUED : �-
;/
\. 9
�;� 3� ;i
��; i ,c - '
?$i
v � �5
��
Now �
9q c�1`Pao \.
�9
�.9
lsZFps................ ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
---...-.OF.........�.�...... .. ..-. � %� lr.......................
Appliratinn -for Uhiposal Worko Tonmrnrtinn Vrrntit
Application is hereby made for a Permit to Construct ( ) qr Repair (k�'an Individual Sewage Disposal
System A�!�.v� c l..t�.L'r --- �R S/�ais
Location-Address or t No.
Owner B
-�- �� � ress n
----------- - ---------------------------- ----- i''!�s✓a s ®yes' 1
= ---
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms----_-3- ---------------- - - -Expansion Attic ( ) Garbage Grinder ( )
aOther—Type 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 ( )
aPercolation Test Results Performed by---------------------------------------------- ........................... Date------------------------------------....
Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water- ---------------
(4 Test Pit No. 2----------------minutes per inch Depth of 'Pest Pit.................... Depth to ground water-.---....-.--..---...--.
-------------------- -----------•--------------------------------------._....----------------------.._-..---------.... -------------------------------------
ODescription of Soil--------------------------------------------------------------------------------------------------- ------------------------------------------------------------------
x
U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W -----------------------------------------------------•..---.-...-------------------------------------------------------------------------- ------ -----------
U Nature of Repairs or Altera is Is— er when a plicab .---... .-. 0i---- SAS-------------.
-------------------------- ___ i ?: �::--:-:.:::__:_::_.:_/-------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI 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.
Si ......-t-t- ----- ---- -----
Date
Application Approved By..---- --- --- ----- ------- -- ....Ld L %���+ (� ` 7
Date
Application Disapproved for the following reasons------------------------------------------------•----------------------------------------------------------------
------------------------------------------------------ ----------------------------------•---------------------------------------------------------------...--------------------------------------------
/ Date
PermitNo......................---------------------------------- .....................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
_. 4� OF.......... ... ---------------------
Appliratiun -fur JN_npoiittl Works Tunuitrurtiun VPrmit
Application is hereby made for a Permit to Construct ( ) or Repair (k_�an Individual Sewage Disposal
System at:
i. -
Location-Address or Lot No. f'
Owner _ Address
.........
Installer Address
UType of Building Size Lot............................Sq. feet
., Dwelling—No. of Bedrooms_._____�_--_..____-•______________________Expansion Attic ( ) Garbage Grinder ( )
`1 Other—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( )
a
Otherfixtures .....----------------------------------------------•--...............................................................................................
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 ( )
aPercolation Test Results Performed by------------------ -----------------------•-•-••-•--•---•-•-•-•-----•-•-- Date---------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.._..__.__._..__.___..
Li, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_..____.___.-__.____.._.
----------------------------------------•--------•--•--------•-------•••-••---....-•-•--------••---•.........................................................
ODescription of Soil................................................................................................................. -------- ---------------------------------------------
x
W
V Nature of Repairs or Altera 'ons— nn per when a I mble�----- �%_____ 14
Agreement: '
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI 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.
Si riecl
ate
Application Approved By------ -=--G ��f'.. d� �. '� !J Y,.D7 6
Application Disapproved for the following reasons:........................./__...____....____.__._______________.________.__.._.........._...Date__...._.......
-------------------------------------------------------------------------------------•------------------••-----••--------•---- ------------------------------------------------------------------------
Date
PermitNo......................................................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........OF............ -....................................
uprrtifiratr of 'T'omplianr
THIY IS 0 CERT.FY, Tl the -dAdual Sewage Disposal System constructed ( )'or Repaired
:... . > .
-------- -----
at------ ------� �£r' -G✓ ....----- Ij/tan !/��r" �Z-4------•.
has bee installed in accordance with the provisions of Art' e6 I o`The State Sanitary Coe as described in the
application for Disposal Works Construction Permit No. _____________ _Z------- dated...._:___- ..............
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRU. AS A GUARANTEE THAT THE
SYSTEM WILL F NCTI N SATISFACTORY. �C
DATE.... 7 Inspector -------------------------------------•-----------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r7b —��
....................OF.......... .....-2..._..'.................
2 y
No.--------�--�------ FEE........................
isu ,l rk -,trrrmit
Permission is hereby -granted � _. _.__. -J .______
g<< = Ls
to Construct ) or air ( n Ind i i ual Sewa Is Sa] G
atNo. - �-f�1 .............------- -----.._.•-------------------- ----- ............
Street /
as shown on the application for Disposal Works Construction Permits oDd.
__�P'._��_.__-- _--------
t G
G-
-------------lam j •----- ------- -...:.---- ,�. -_�__..�----•- -----------------
/ Board of Health
DATE........L�--f�� (p ----------- ------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS