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Home My WebLink About0188 WASHINGTON AVENUE - Health (2) D S-f-P-ry►11� No......................... Fix ................. A THE COMMONWEALTH OF MASSACHUSETTS OF......... -- --- -- 4�✓ •---------4 AVVI tilon for Mipmal Worms Tomitrurtivat Fiernfit CIA 11 Application is ereby mad for a Permit to Construct ( ) or Re it ( 4�a�_nIndividual Sewage Disposal System at: ............. .�....----�/`�' -- R--•--- -- Locatio -Addre -- Lot Nddresso. ner ...............A - a Installer Address ype of Building Size Lot____________________ _____Sq. feet Dwelling o. of Bedrooms.............._.............................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa 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........................ 01 Test Pit No. 2.............___minutes per inch Depth of Test Pit.................... Depth to ground water........................ 01 -------••••-------•••••-----•••-----••••----••-......................................................................................................._-•--- 0 Description of Soil.............................................................................................................---------------------------•------••--•-•••-------------•-- x U -•••-•-----• -----•-----••----------------•---------------•--•----------•--••-•--...•-•----•------•-•---....---------•••----•••----•----.._..•---•-••-••------•-----------..._._......------------ 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 Article XI 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. gned.__..._ .... --------------------•--.......-------------•------•--------------- - ------------•--------- at Application Approved BY -<� - Dat Application Disapproved for the following reasons:.....................................______________________.................................................... ...................•----••----•--•-------•---•----•------•---•---------------•---•-------•-••-•-•---•---------------•-------•----- ••• •------•-•----•--•-------•--•------•-•-.................. Date PermitNo......................................................... issued........................................................ Date No....... FER49.................. ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH ...........................................OF................... .............................................................. Appliration for Uhipogal &ftii Tom Ar rtiott Vrrutit A fi tion is ereby mad for a Permit to Construct or Re '.r'( an Individual Sewage" Disposal "'c PP _4N System ai- ............... .................... ................. Lot ..... ..... ......... .. .. . ........... .. ............... Locati - ------ ---- 4 or ...................... No ........... ... ........ .... .... 01 Tner Address & ...... ...... ..... . ...... I. .... ...... ... .... .......................................................................... Installer Address U ni ype of B ild Size Lot..... :.............Sq. feet i Dwelling o. of Bedrooms............................................Expansion Attic Garbage Grinder P-1 Other—Type of Building ............................ No. of persons............................ Shower's Cafeteria Other fixtures ... --- ----------------.................I Design Flow:...........................................gallons per person per day. Total daily flow............................................gallons. Septic Tank;—,-Liquid capacity............gallons' Length................ Width________________ Diameter____-_._---_____ Depth__.............. Disposal Trench—No_........ Width___._._._.._._.____: Total Length............._gth...... -.......7t...... Total leaching area....................sq. f t. Seepage Pit No-------------------- Diameter..__:-___._ Depth below inlet..................... Total leaching area...................sq. ft. Z Other Distribution b&*`( Dosing tank Percolation Test Results Performed by.............. .................. -------------------------------*------- Date........................................ Test Pit No. 1................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 .................................................7............................................................................................................. 0 Description of Soil........................................................................................................................................................................ U .................................................................................................................................................................. .......................... ................................................................................................................. ... ------ -------- ... ...../.../- U Nature of Repairs or Alterations—Answer when applicable.- ....................................................................................................----------------------------............. .......... Agreement: The undersigned agrees to install the afoledescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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. .......................................... --------- -------- 7P�------------ a�t, , Application Approved By_ .. .............. ate Application Disapproved for the following reasons:.............................................. -7............................................................... ....... ........:./. .................................................................................................................... ................ ........................ ................... Date PermitNo........................................................1. Issued... .... .......�Z ...... ..................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALTH OF... ........:......... ......................................... Q-TWrtifira of (giant iattrr T S IS 0 CER Y, hat the vidu Sewage Disp s em 'constructed or Repaired AIF by... ..... .. ...... ........ .... ..... .................... .. ... ........ ... ............................ ............. .. ..... I staller .at........... .. ............. ....?Vtt ........... .. ...... ........... ..... ... ..................... has been installed in a rdance with the provisions of Article of e State Sanitary Code ac/desgribed in the or application for Disposal Works Construction Permit No.___ __:_-- ...I.... .............. dated----- !/..7.. ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC O SAS-I.SF CTORY. . .. .. ... ........ .......................1, Ins DATE............. ..... ... Inspector.::.LOS .......... ........... ........77- ............ THE COMMONWEALTH OF MASSACHUSETTS. BOAR F HEALTH/ � A. -, ' A &-e .. .... .......... .....OF .. ... . . . .... No.... ...... FEE...oZ,4, -Dispoll 10 11 i, pr tit Permission isXereby granted...—.---— i...... .............. .... . ....... .................. c ........ i. I 4L to Constru (M R Individual S age DA&os?eSystem l _1yr) e A at N ------------- .... ..... . .....k� Street as shown on app'lition.for Disposal Works Con structio er it N. ............. ....... ....... ------------------ .7 oard of Health,.e.Z - DATE...... ............ 1...7.......... A/11 FORM 1255 HOBS W N. INC.. PUBLISHERS