HomeMy WebLinkAbout0042 SAINT JOSEPH STREET - Health (2) �e�
a��� - . -
/ \
'No...-. ...... 22-0
Fimic ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD EA
...�OF........( 4 . H .T.. ... ...............Appliratilan for Ditipsal Works Tonstrurtion Vantit
Application is hereby made for Permit to Construct or Repair an Individual Sewage Disposal
S st at:
........%Li -- --------&..... I---- -- - -11.....................
ation- ess or Lot
.. .. . . . .......... ..
.. . . .. ......... ....... . - - - .-....a. ol. ...... .. ..
................................A..d.............s---- --
er f es
Installer .
.........................-.-.-------------.-.-.-.-.-.-.-.-.-.-
Address
Type of Buildi , Size Lot___ ______ ..............Sq. feet
U 25
Dwelling—N� e2L .. l?6ge Grinder
o. of Bedrooms............................................Expansion Attic Gar.
Other—Type of Building ............................ No. of persons---------------------------- Showers Cafeteria
Other fixtures
Design Flow.. gallons per person per day. Total daily flow___..._......... ..... ........gallons.
-----------------------------------------------------------------------------------------------------------------------------------------------------
9 Septic Tank-�- iquioc-'apa-c-it:y/;4/llg"allons Length---------------- Width-_--.___....____ Diameter_.__.--.-__.__-- Depth----------------
Disposal Trench—Vo..................... e-, en Total leaching area__--___ -sq. ft.
e 0 et.. .. .....
Seepage Pit No......I............. Diamet�r et....... .....!4!�'Total leaching area-----------4------q. f t.
Other Distribution box ( ) . Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date----------------------------------------
Test Pit No. I................minutes per inch Depth of Test Pit.............._.___. Depth to ground water__.___._______________-.
f=, Test Pit No. 2................minutes per inch Depth of Test Pit_______............. Depth to ground water___._________________--.
9 ....k................................................................................................ ------------
0 Description of Soil________________________
�4 411----------------------------------------------------------------------------------------------------------------
U .......................................................................................................................................................-------------------------------------------------
W
.............................................................................................................................................----------------------------------------------------------
U
Z 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.
Signe ............ ---------------------------------------------------------------------- --------------------------------
ale
Application Approved By...... ----- ..... . ..............I...... �_7------------
Date
Application Disapproved for the following reasons:.......................... ................................................ -----------------------------------
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued........................................................
Date
----------------------------------- ----- --------------- ------
NO..... - F��..,e�..........:.....:...
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® 9F H EAj jH
f
Apph ration for Uiivosal Worko Tonstrnrtion Prrmit
Application is hereby made fors Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at; y`7
{ !_..............4s Ca ;I°E sy ---. ---•
g t Aocation-Address � I Y �g` or Lot No �
i{ (BCvner Address
W6;��
Ins aller Address
r
UType of Building ' „, Size Lot---L.2.r.'�. ........Sq. feet
.—I Dwelling J` No. of Bedrooms...................°" ....................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons-_--•_---_____-_----____---- Showers ( ) Cafeteria ( )
a Other fixtures -------•------- --------------- -
W Design Flow.............. : .._gallons per person per day. Total daily flow....,: -` 5 __-__.._.gallons.
Lei Septic Tank./--Liqui capacity4� � gallons Length................ Width.. -_-- Diameter__- :_._-___ Depth__._-_.---------
Disposal
Trench No..................... Vl Width _-- �l Lengtllt� ;� Total leaching area___ _...sq. ft.
Seepage Pit No.... .:........... Diameter Fs. c. _ Dep`t �boAdfllet___._.. .�. Total leaching area__ :__: _. . ft.
Z Other Distribution box ( ) Dosing tank ( )
W Percolation Test Results Performed by-------------------------------- ............... Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water........................
VA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth.to ground water........................
-------------------- -- .............. -•••--•----•••••---------------•-•---•••---••-••--•-•••..........................................................
0 Description of Soil--== •.....•---- ,� '�1
U ------------------------------------------------------------------------------------•--...---"----------------------•-----------------------------------------------------------------------------•---.
W
------- -----_--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
V 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.
Signe
Date
Application Approved By = - ........
Date
Application Disapproved for the following reasons---------------•----------- -----------•----•---•---......----------------•--------•---------------------------
--•-•--•--••-•--•-----•-......---••-•----•-•-•------•----•-----------•--••••••---•------•--••--•-•-••--••----•------•••••••-----••-•-----•-•-•-----------------•--.......•-•-----------...•------•-"
Date
PermitNo..............................................------------ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALJH-
-�' s ,
6 J OF J[(y'
7 fi se
... w' d' { .....L....
Trrtif irate of 01.1am0aurr
Z'HISI IS
t "' sf+'TI FY, That Indiv'/n Sewage
-- osal System constructed ( or Repaired
-------•--- ..............................................................( )b In�taller
T
at
------``------•----------------------------------------------------------------•--"---
d `�
has been installed in accordance with the provisions of A'fticle XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.......................� __/_____-- dated...... ----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. -
- , 1
DATE Inspector.--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
4
OF
.:.... ....`.........._....
No... 4-- --------- ,
lyd
FE>
f /� • �t��i�� .� �`�f`y��gl' �A�t�t tY�l -rntit
Permission j sF ereb y granted__,: <G'"''
to Construct' or/Repair (f;') an Individual Sew ge posll 'stem
{� ---------- •j+s•-s .- F .--Z.. --•ai.� F ----•-Street ^ -
T
"afs shown on the application for DisposWorks Construction ermit N 1..5!_�____. 7---- ........
Dated--- _-. -- -
Boa Health
DATE................................................................................
I FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS