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Home My WebLink About0012 SAINT JOSEPH STREET - Health (2) �;�-►"wo -a � -223 7 No.... 2��l 22.E THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 "- HE TH ` �j` ------ -------OF........�94 Appfirativit -for 43iiijimial Works Towstrurfum Vrrutit Application is hereby made f a Permit to Construct Repair an Individual Sewage Disposal system t: ............................................................ Locate s r or Lot No. Ppee ...... .. ..... ......... ....... ......................... ................................................................................................. n r Address .... . ........... ... ............. .................................................................................................. nstaller Address Type of BUl*ldl*vg/ Size Lot--------------------_-----Sq. feet U Dwelling-l-/No. of Bedrooms-_______________ -------------- Expansion Attic Garbage Grinder ( ) ------ ------- 04 Other—Type of Building ---------------------------- No. of persons...____________.._.......... Showers Cafeteria ( ) 04 Other fixtures ------- <� - -------------------------- oVw ------_----- --------- V n s per person per day. Total daily I y flow.......__...___________..__....gallons. Design Fl 'o 0 s /te 9 Septic Fa Liquid capacity.__._.. Length________________ Width............._.......... D i --- Depth.---------_--- S tvy/;.r allons " amet ........ 0 L. .,dpc�l Len;Fp...............4- tal ling area---------_----------sq. ft. ................. o leach* a------------------sq. it leaching Disposal Trench N .......... NVM9 el) e ----- Diameter..,/ . ....... ep e w Seepage Pit No.____-:/ Other Distribution box Dosing tank Percolation Test Results Performed by-----------------_ ...................................................... Date---*------------------------------------ Test Pit No. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water._-------------------- I:rq Test Pit No. 2................minutes per inch D th of Test Pit.-__ -------------- Depth to ground water-_.--._-._-.--.------ ---------------------------------------- .............................. ........................................... -------------------------------------- 0 Description of SoiL.............................. .... . ... ....... . .. .... . .... ................................ ------------------- ------ -------- - ----------- U ----------------------------- ............... -- -------- - -----%-------- ----- W ------------ --- ----- ----------- ------ -------------------------- ------------------ --------------------�A Nature _P�e----- en agoicable...__ ... ... <_ V� -------------- U c, pairs or Alterations—A ,yer 11 ----------------------------------------- ---- -- . ... . . . ......... .. .. - -- -------------------------------------------------------------------- ---------------- 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-thetboard of 4alth. ---7 , ned....... ................................ . . .. . .............. Date Application Approved By----------- -- ----- Z .S- ate Application Disapproved for the following reasons:------------------------------------ -------------------- ........................................ ....................................................................................................................................................................... --------------------........... Date Permit No......................................................... Issued....... -- ------ ....................... Date/ ----------- No...� . F>;a....p ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HE TH Appliraiion -for Bhipviittl Works Tomi#rurtiott Vrrmit Application is hereby made f a Permit to Construct .(+o) or Repair ( ) an Individual Sewage Disposal System t Locati s or Lot No. O r r Address ........... ------------ nstaller Address Type of Building, Size Lot............................Sq. feet .—I Dwelling - NO. of Bedrooms:_.____..___ ----------------Expansion Attic- ( ) Garbage Grinder ( ) Other—Type of Building _----- No. of persons...........----I._ Showers — Cafeteria Other fixture }.. ---- .............. W Design Flow _ or per person per day. Total daily flow... gallons. Septic Tait —Liquid capacity:_ allons. Length________________ VVidthc.__-_. . Di-I t _.__.... .._.__ Depth................ xDisposal Trench No Wid I.. engpt !.... tal c�iing area - sq. ft. Seepage Pit`No .:__ Diameter. eP e .wo leaching area.... ...........sq. it. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---:---- �--------------------------------------------------•- Date-.-------------------------------------- ,� Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water-_-----.------_....... r3� Test Pit No. 2................minutes per inch D. Ith of Test Pit.... Depth to ground water.-..._-.---_---__---.__. ---- ------------------------- .............................. -----------------•--------------------------•------------------------------------- . O Description of Soil-------------------------------- . . ...... ''"" T x ,, U Nature of Repairs or Alterations—A Ayer' en a icable..... .... r___..�_ 4-- - -------------- ' ---------------------------------------- ..�'- --- IG+ ----- ---------------:---------------.-.---------- 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 isstied"b}rtl e 15oard"oall f li"alth ned Da Application Approved BY----- --- .... at Application Disapproved for the f ollowing reasons------------- •---•..--•-•-- •-----------------•-•-•---••---------•-----•------------- -•-•----- -----------------------------•----•--"-•----••----------------------•-••------------------- .. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH OF......... ...a-4✓.... ' ..."'+w'w `........... CIrrfifirate of f"nmplittrtrr T IS,IS'TO C TIFr at the•lndividual Sewage Disposal System constructed or Repaired by..... -•-- -• ... -•--•--• ------------------ -•---------------------------------•----- at - -•- --- 5 --- ---t.. _ - --- t ns _I to 1. +r has been installed--in-accordance•wi the provisions of Artid _ h tate Sanitary Cod as d scribed in the application_for Disposal Works Construction Permit No.--: _ .. ................. dated. ' . ' ___ ___ . THE E ,S;UANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE`THAT THE -SYSTEM ILL FUNCTION SATISFACTORY. DATE " •- ---------•-•------------- ------- Inspector ---•--------.:......-------- r>. _ . ... _.. , , . . . . . . . . . . . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH .106 .........OF........... ... +;�"�.. No.. - � FEE--- �i� 1 Nor n ttqtrttr#ilaairrmit Permission Is hereby granted-- ------- --- --=----------- .............................. to Constr' t ( Repair an I ividual Sewa Disp y al stem at No.._ �� R --------------- • Street �r.,� as shown on the application for Disposa:Works Construction Jklynit N _ Dated__- ,r----- ----: ...... D -- -- rd o Heal ATE/? ..•-- -- . w . FORM 125 HOB S•& WARREN. INC.. PUBLISHERS � l