HomeMy WebLinkAbout0041 SAINT JOSEPH STREET - Health (2) ����-a-�
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No... ® ... p� I [ — oC
THE-COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........?V*7 w .----OF.......
(�'� ,flip iratiun -fur Diiipma1 Works (nnnstrnrtion Prrntit
` Application is hereby made for a Permit to Construct Repair ( ) an Individual Sewage Disposal
System at:
---------- 'r__J �t..isr.R - -------------------------------- ---------L ------.....-----
Location-Address or Lot No.
cC ',fTrl!Z�G2a177�1 ( ------
Owner Address
Instal r Address
UType of Building Size Lot_._:. . D_______Sq. feet
Dwelling—No. of Bedrooms----------0-----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons-___....b----------------- Showers ( Cafeteria ( )
Otherfixtures ------------- --------------------------------------------------------------------------------------------------------------------------------------
W Design Flow----------- -P........................gallons per person per day. Total daily flow-----_--_Z._2;;k ----__.__.------_--gallons.
WSeptic Tank—Liquid capacity.100_0gallons Length................ Width------- Diameter---------------- Depth----------------
x Disposal Trench—No. .................... Width-------------------- Total Length____________----___ Total leaching area--------------------sq. ft.
3 Seepage Pit No...._.......1-------- Diameter........&-------- Depth below inlet____-_--&......... Total leaching area__z d�---sq. ft.
Z Other Distribution box ( ) Dosingtank ( )--If `(
~ --O.hdk1_u._A,__-,-•-_CtA---- C.._v...._.. ,. ate--- r' 73
W Percolation Test Results Performed by._. '� � �f:D
Test Pit No. 1.... r.2._.minutes per inch Depth of Test Pit_.___�Q........ Depth to ground water---14-0_1A_t_....
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------------.-___----
P4 ----------------------------------•---•----------------------•---•------•-•-----------------------•-•---••----------••---••--- ----_---------------..------
0 Description of Soil----------S_A111-A.--:14-U-VA-v-S.....0_V_tr_ .. ,t _&�1.._ _f s1 2---- ---�+ =4LI-,---�Z:��•G_> .
x
W
UNature 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 be issued bAy,-t}he board of health.
Sigd- ►! '`&............................ --•-•-•
D e ...
Application Approved B 1 6 --- ---- ------ e
PP PP Y � /
----- ---- - -
Date
Application Disapproved for the following reasons---------------------- -- -----------------------------------------------------------------•-------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo........................................................ Issued.......................................................
Date
-------------
Ir
n. THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... ... ..OF........ ! ' - - ............... -
d ------
Apphrtt#tun -fur Riiposal Works Cf oustrur#ion Pumi#
Application is hereby made for a Permit to Construct I- or Repair ( ) an Individual Sewage Disposal
System qat 6
------ - -- ...............................
Location Address or Lot No.
Owner Address
..................... . ...'), ..........Qs-&(e�............ ... ...................
Insta Addres l r
d Type of Building Size Lot.--...Zy.Q.9.0______Sq. feet
Dwelling—No. of Bedrooms-----------Z_......................------Expansion Attic ( `) Garbage Grinder ( )
p`44 Other—Type of Building ____________________________ No. of persons._______4............:__:;;. Showers (4 - Cafeteria ( )
dOther fixtures --------------------------------------------------------------------------------------------------------------------- ------------------------- --
W Design Flow______-____.� ________________________gallons per person per day. Total daily flow----------- -----------------------gallons.
WSeptic Tank—Liquid capacity_A.0�?_6gallons Length................ Width................ Diameter______--_"-____ Depth___-___-_____--.
x p Length __.__. Total leaching area--------------------sq. ft.
Seepage Pit No:_ .Noi_._____ Diameter idth�:------- Dept Total
inlet._._.__6_________ Total leaching area__ _ ---- ft.
z Other Distribution box ( ) Dosing tank ( ) ;-y
Percolation Test Results Performed by---_4.d1.0 In _(_� :_. __ -gig 1'"--� - _:___�_ i)ate....E -
a
Test Pit No. ___minutes per inch Depth of Test Pit-----1 ________ Depth to ground water-_-N_E}_NU;_...
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
D Description of Soil........---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
.. t ' � "►}c ` -?1_>- -- ,- !'_n_ t_ ._.. _ � _.2_... ,- 3 +. _!^ :
x
U
W ----------------------------------------------'----------------------------------------=----------------------------,------ •------------------------------------------------------•------------=-------
UNature 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 ben issued by the board of health.
Sig Raj l t_h���-.. -" _ -------------- 1^-E t`'
Application Approved
Date
eApplication Disapproved for the following reasons-------=-------------------------•------------------------------------...----------------------------------------
r
___________________•---___---•------------------------------------------------------------•--
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF, HEALTH
..... .........OF........ �'. r .::..
err#if tra#r of 01.11utplitturr
TH S ISM 0 CERTIF , Tha� -the Individu wag osal stem constructed ( or Repaired ( )
b - --- •---•--------------•-•••••--•--••-••-•••-••••---
Y
r
T to er t.
has been installed in accordance ith the provisions of Article X Qf The State Sanitary Code as d scribed in the
application for Disposal Works Construction Permit No----- ----- ........................... dated-.... ..: ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r - ' �... :.....OF ✓'" ------------------------------ a
No. = -•-••--••-- FEE-----•�2-•------•---..
�i����tt�: larks Cn>artt�#rttr#matt P'm
-- �-a--• � is hereby granted-.-•-----•--•---_..__._..----•-- - �. .. .....::...... ---------- -------
Permission
to Construct '�or Repair ( ) an Individual Sewage Disposal S st
at No.----------- 's + ".-----" ..3----��r �- .t? ,.f.{ :��7` �,'f-�''7t._- - -- -------------- ------ --•----
treet
as shown on the application for Disposal Works Constru6 :)n Fe it No. ated------
-- _____________
' '••`"' ''�..� - Board of Health `
DATE•-- ---------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
DOII/ALO ✓. MARTEN
REa/STEREO PROFESS/OVAL. ENGINEER
P 0 Box. 14 Pcr, ourN� MAss oz.�so
74
5- Z7.3.3 yc
Z DONA] J. rn
TORN -�
o MARTEN
PR
OPOSEDi .i SEVERAGE
�` FSS N0
- �01NAL
Crown to divert surface water
Cover at grode Pefcolotron rate z min.. per .
2' Peastone I;
0 00 o p G u
SIIJ :ao ;j
dr ♦ II f/ r � L
U
3 to 2 Clean stone �,
�4
o 0°
�°v rv�n 100 {
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nearest pit to` wel/ +
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nearest wsH to pl z y f f� 4
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