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Home My WebLink About0029 PRISCILLA STREET - Health (3) _ � -a5q I I I i i G I IRV 11Iw-- UNV-10504 MADE IN use► A w" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v .....OF.....•.. ................................... Appliratinn for Ropmal 18orks Tonstruttinn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at:.a _�.l_....... n .... -S .............. ........................`} -:4--cam wor=L1o.t.SN{o. ------------------------ Location-Address ............................................................. ............................. r ..._-•.... . Owne Address Installer Address Type of Building Size Lot.............................Sq. feet U 3 Dwelling—No. of Bedrooms------ ............:...............Expansion Attic ( ) Garbage Grinder ( ) '-� Other—Type T e of Building a yp g ............................ No. of persons............................ Showers ( .) — Cafeteria ( ) 04 Other fixtures ............................................................ WW Design Flow........... .................gallons per person per day. Total daily flow..... _2ID......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width.................. Diameter................ Depth................ x a Disposal Pit No...... Diameter....Jc�'...... Depth below inlet.....`f........... Total leaching-area............__....sq. ft..Trench—No................ ... Width.._.............__ Total Length.................... Total leachingarea....................sq. ft. See 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........................ a •--•------------------------------•-. -••---........-•--•-•--••-•-•---......---------•--•------•----............-----....---................•.........--•_.. 0 Description of Soil........................•---------...........-•------------•---•-•---------•--------------------••-------............-----------........................-•-•••......_... W ----...•--•--------------•----•--••----------------------------•--•------•------•...••-•-•------•...-----•----••--------•-•-......----------------..............-----••-------------------- UNature of Repairs or Alterations—Answer when applicable.............V. .10.......e .........Ykc `I71='' �I�1G xz r i�..__L' ,S,Sta;Qutr = -------------- .....___•4-- .. •_•_•.............•___..........._...................._... Agreement: a The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIE 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. Signed.- �"� -- --' . .. Date Application Approved By... Application Disapproved for the following reasons:---•-----------------------••-•---------------..........._..----------------•------------------•----.........._ ..----•-•---.......-•---•------...---•--...-•----•-------•--•---•--------•-------•............................----------.............------•-----•-•---•---•------------•-------••---------••---•---••- Date Permit No............................ Z 2 9- Issued.....----•`j g� ..._....--•---•----- . Date --••---•............... '^"'f`�..a„L,�r„i,.,....�i.•:.,,y^v«-.�-`.:,_.._�.��.... � +J.- ,.. .- ems_ -.. _ y ..«-.�{.. �. ••,y„-,._,�,•.., �.. Now.........2:3 g �� F>nc....��d A. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -` ......OF.........�...V.2 -b�_ ._._... ... --..._ Allp iratiun for Disposal orko C9unotrurtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .....................?_...... G:t ` t4_..5.1. ....................•• ------•-•--•--•--- --- ---- .......................... r Location-Address ` or Lot No. !'� ..r�::.:-........................... .....................-��--- -�n=-+=' -..................................................... Owne Address .... .. • Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........................... .. .....Expansion Attic ( ) Garbage Grinder ( )�+ `4 Other—T e of Building No. of persons............................ Showers — Cafeteria W Other fixtures -------------------------------------------------- ' W Design F .. ...................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...../e)_........ Depth below inlet......y......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( Y? " \,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........................ 04 ---•----------------------------------------------------------------•-••---------------••--------•--•-••---------------•-••-_--------•--------•------------ 0 Description of Soil........................................................................................................................................................................ W W -•••..........-•------------------------------•-----•-•-....-•---------------..._.....•••••••••---_;._._.....------......_.......-------•-------•---••--•------------•......••----.............-•-...... •--•-------------------------------•----•------------------------......------------------•-----------------------------------------------------•-------------•--------•--------------- ....... U Nature of Repairs or Alterations—Answer when applicable.......__...�-Vy).....__a"t:` ____.___ 4` ____. i_ 7�� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 71T1 is 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. ned--- !___----- -=--------•---•-----•--•--- -- `-�-a-��----�---- '"` Date Application Approved BY . Q.................................................... .................1r.7/t'.�. Date Application Disapproved for the following reasons--------------------------------------------------------•-----••--------------------------•------.............__ ......................................................•-•---•-------•---...----•-------....-•----------•..-------•--•-•---••-------•------•---------......__----...--•---------------•--•--••-----•------ � 2-9 7 � �3 Date PermitNo......................................................... Issued_--•------- --a---L bate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... ` ' ........OF Y�c►2V�S`C�-� .. Trrtifiratr of Tautplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( C_)_, by................_'.....L-=-V w�...S'-e v? .:...................................................................................................... Installer at... �� 2_!_c....................LL�4 C......... i wvy 7---------------------------------------------------- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code a descr bed i the application for Disposal Works Construction Permit No` __'__�-3`1___ dated___.____-� �1- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DAT .................. ._......................•-•-------- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2 �' ��hv.........oF..:.... _5.. }_!'Lv�-St.� � .............................. IVO._._....... ... FEE..................•..... Eliopnoal Works Taanotrttrtion unfit Permission is hereby granted------.G. .......................' �,... t T r _ -•---•----------••..............•---.............-•---...---- to Construct ) or Repair ( /�n Individual Sewage � ' Disposal System - :vr at No------------- � "- -r, Street Z-3 �/� as shown on the application for Disposal Works Construction Permit No..................... D'ated__________________.......__ ._ ......... ------ Board of Health DATE. J(7 g.