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HomeMy WebLinkAbout0044 LONGWOOD AVENUE - Health (2) �y ��5�� ��,� - � ' a�'�- a � q � - -- r. a � I LOCATION SEWAGE PERMT NO. w P,� CA nl�W�u k -7 VILLAGE INS ALLER'S AME&ADDRESS /0 l� BUILDER OR OWNER M(LD( eQ Q n eltL, DATE PERMIT ISSUED DATE COMPLIANC.SUED �� ����a� �y E��� �y ,� Srn� �' s � ��� �c�a a ��� Sa-n,� 7`S �'�v � ��--� �Y ASSESSORS MAP NO: a — 2 c PARCEL NO: ' ?�t7 No. . - -� Fps.... .......�............... THE COMMONWEALTH LL MONWEALTH OFMASSACHUSETTS RD OF EALTH ------ -................OF........... ............................. .44311ra#ion for Diipoiia1 Works Tonitrurtion Prruat pplication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ---......._•----. -�-�.__ ------- -------------------------------------------------------------------------------------------------- Location-A re ( � or Lot No. Owner �• a .'� ©....................... •••-/at G.... ----•-----••••••••-•----/••-•--.....-W---l--------=/-----I-`------�-------------------------- Installer Address Q Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................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. Septic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter---------------- Depth................ 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. I________________minutes per inch Depth of Test Pit.................... Depth to ground water..--_-_-_____-_______-_. Lr, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------.............. . P4 -•-•--••---------------•----•----••-••-•-•••-••--•--...-------•.....------------........---...----•-......................................................... 0 Description of Soil--------•--------------------------------------------•-•------------------•-•---------------------------------------------............................................ W V ....-----•-----•----•••-------••-••--•-------•--•---•--••------•--•-------•-••••-•-•-----------•-••---•------•-•----••••••-••--••-•-••------•---••----••-------------------•----•--••••-••••--------•--• W U Nature Repairs or lteratioons—Answer when applicable.-----1*0------ - -577 �^--- --- ----------•--•--•-......_....••-•-•••----......••-•-••-••--•-•-••------.........:•---•---•---------------------------•-•---••-----•--...--•-•-----•---••-•---•-••----•--•-•••-------..._.._.. Agreement: The undersigned agrees to install the aforedesc ibe Individual Sewa Disposal System in accordance with the provisions of ii'":.E 4 of the State Sanitary Co The undersigned rti, r agrees not to place the system in operation until a Certificate of Compliance has been i ued by the oard S ......... ---•--- ------ ---- -----------------------•------- --- • - 0 � to - - Application Approved B Date Application Disapproved for the following reasons:---• ..............•--------------------•--------------•----------------......-•---------------------------•---- -------------•--••••.........-•---•------•-•••----••-••-•-----.....•• -••--•--•------...---•••-----•-----•---------••-•--••••---•••--•--•••-••-•--•-••---------•---•••-•--.........-----•......-------•- Date Permit No................................` Issued-....................................................... ....... -•--- -------•----------Date No.... ...1�� - Fps../..f .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH U`A I- ..OF.......... ? <c/5 4-d Le ... . .... .......................................... Appliration for Disposal works Cfou,strttrtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location- fliegs /' or Lot No. .......... -=s...•..... - . :: ../i�c ..r>_�---------------------------------------------------------•-----------...•..... OwnerAddres/s a U ..-•--•-�-----�`-`_-G..... ..................................................... Installer Address Type of Building Size Lot...........................Sq. feet V Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( } aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ................................ W Design Flow............................................gallons per person per day. Total daily flow----_.......................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ 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........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------_-_---. GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-_--____.._-__.______- a -----•----••-•----------•--------•----------------••-•---•••------------.......................-----.......................•................................. ODescription of Soil.....................................................................................................-•----------------•-------------------------------............••-- x U ---•----------•---•-----••--•----•-•......---•-------------------•-------------------•--.....-----------.....-----------------------------------------•---••-•------•----......----•---------•---------. w -- ------------------- - -------•---------------•----------•----------------------------•--•--•-•-----••--•------•----------------•---------------•---••-•-------•-------•----- ----- U Nature of Repairs or Alterations—Answer when applicable.._... !�_._... .. `�-� 5 n�.�� �-�'} �e 0_ -------------- -------------------------------- -------- ---���-(rzf-v------••G'-ST-------------------•--•--------•-••---•---•------------••------------------------•-----•-•---------------------------------------.........---•---- Agreement: The undersigned agrees to install the afor edesFrib Individual Sew 9001Disposal System in accordance with the provisions of T?T : j of the State Sanitary Co —The undersigned 'urt r agrees not to place the system in operation until a Certificate of Compliance has been ' ued by th board -----------•- --- --- -- ---------' ate Application Approved By---------•-----•--•--•ti--••---•---- --------•--•-------` Date Application Disapproved for the following reasons:----------•----•--......----•--•---•----•-•-------••--•---•-----------------------............................. .............•----•--•••------------------•-•-•----•----•----------------••••••---------••-•-•---------...---•---•-------•---•---•------------------------•-----•--••------ ............................. Date PermitNo................................•--.. ............ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD v �HEALTH+�N ..........................................O F..................................................................................... C�rrtifirate of Toutplianrr THI C�VtJ'F TIF � he �Sewa Disposal System constructed ( ) or r2epaired } by--•--•---- ---_-------------- ;----•---------- -----.. .. ...I- � .._. " '.. ......................... at.....•---•----- ---•-----•-•-----••--•••------ ---------------•------• ----•--------•---.... ----••-•...-••-••......•-•-- has been installed in accordance with the provisions of TiT�r' _-)-,'Pe State Sanitary Code as described in the application for Disposal Works Construction Permit No �...... �................. dated..... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O Y: ^HEALT N ..................................._OF..................................................................................... BYO......................... FEE........................ Dispos 1 Works Tnntr ion 7 it Permission is hereby granted---•.----•�� r S ---•-•r 1 to Construct )Jot Re air ) a . iv d�(ial Disp al ,Vs Q e . atNo.................................................................................................. _.._._. _.__ .....------ ..._....... street 37 t as shown on the application for Disposal Works Construction Permit No.,_;,.4,,........... ID-ated.a-!. .__ ,_�� ___._.._. - - - of - --- •-•••-•• Board of Health DATE---' - ........................................ FORM. 1255 `OBBS & WARREN. INC.. PUBLISHERS \�