HomeMy WebLinkAbout0051 SAINT JOSEPH STREET - Health (2) .� �� e --a.�� _ _ _ _ _
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1
^ `r� THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.�pphratinn f ax i u tt1 WorksC� n r�t rti nn rra�it
GQ� Application is hereby made for a Permit'to Construct ( ) or Repair ( ) an Individual Sewage Disposal
ccJJ System at:
Sr------V.O. .sr_�.�4E r...................... ................ r " =
Locati -Address or Lot No.
..................�&P1l.LN_-..t&Dl_z ------ ......................... ........... �,F_7�._y ,�A�f:H.........................................
W Owne Address
--------•------- , \Er�'�
I sta er Address
U Type of Building Size Lot....L-.,_9_®4----Sq. feet
Dwelling—No. of Bedrooms.......... ...............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons....._..__.6--------------- Showers Cafeteria ( )
Otherfixtures -----------------------------------------------------------------------------------------------------------------------------------------------------
W Design Flow.............a�.__.........................gallons per person per day. Total daily flow________-_-_3o a---_--_-__-..-._---_gallons.
WSeptic Tttnk—Liquid capacitv_LQQQ_gallons Length---------------- Width---------------- Diameter__----.-----_- Depth-----_-_--.-----
x Disposal Trench—No- ---------------•___- Width-------------------- Total Length_--_-_____._--____-_ Total leaching area--__-__-__._----_---sq. ft.
Seepage Pit No........)----------- Diameter........S........ Depth below inlet-------fir_......... Total leaching area-_Z.0—P...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
`-' Percolation Test Results Performed by. .....Rf......... Date.........
a
Test Pit No. ___minutes per inch Depth of Test Pit----- c>........ Depth to ground water.._ ®N_F....
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_._---_____-_--.-_-.--.
x Description of Soil--------- `� -�er.D-`{--��v_ v s------ ..... .L.CAr__:%AL14-A---- - ..... 7ylo OA---5
V --------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------
W
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------I--------------------------
U 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 bee sued b the board of
of health.
Signed--------- CP.i----------------------------------- ---
ate
Application Application Approved By-------------------------------------------------------------------------------------------------- ---------_---_-D-
----------------
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
C
No... `. .... Ficxg t. ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ° ..............:OF......al �f d .. ............................................
Appfiration -fur Mfipofitt1 lgorkii Tomitrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
--••---��--rx r — E:� .a -s r ....•.........................................................
Locaq Address or Lot No.
Owner � i. %� .1/( t Address
�1_
aller Address
QType of Building Size Lot....l._ .=..O.P_Q....Sq. feet
Dwelling—No. of Bedrooms..........A------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons----------- .............. Showers — Cafeteria
a
Other fixtures ------------------------------•----------------------------------------------•--------------------------------------}-------------------------------
W Design Flow............ ........................gallons per person per day. Total daily flow............: _ . _._..............._.gallons.
WSeptic Tank—Liquid capacitv.IADA_gallons Length................ Width----.----------- Diameter---------.------ Depth____----.-...._-
x Disposal Trench—No..................... Width-------------------- Total Length__-_______--____.... Total leaching area--------------------sq. ft.
Seepage Pit No________ ___________ Diameter,........ ........ Depth below inlet------- ........... Total leaching area._ 0.pt___sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by. Date....
Date....��!. _ 'R_ r..°°a _ ._ r
Test Pit No. 1.__.`"°: -__minutes per inch Depth of Test Pit----- _i`, -------- Depth to ground water....6- ....
f14 Test Pit No. 2____•-___.---___minutes per inch Depth of Test Pit---:................ Depth to ground wa ter........................
R+ ••----------------------------------------------------------•-------------------•----••••-......----.........................................................
0 Description of Soil---------- ------.Q--M-.'a%----- .----- 'rt•.- 40 �� = �' '
U ----------------------------------'-------------------------------------------------------------------------------------------------------------------------------------------------------- --------
W ----------------------------------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------
VNature 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 1XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the board of health.
Signed... =�'----------------------- -- l �
t -----------
Date
ApplicationApproved By------------------------------------------------------------------------- ........................ •--•--------•-•----• ...................
Date
Application Disapproved.for the following reasons:-----•-•----------------•-------•---------•----•------------•--------------•-----••----•------•----••-----------
----•----•---•---------•-•------••--•------------------------••--------....••-•--•-••-••...••-------•-- ---
---------------------- Date
PermitNo.......................................................... Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF........
f'C, u � ..............
wrtifirate of Tontphatirr
THIS IS TO-.CERTIFY, That the Individual Sewa isp Y constructed (" _`or Repaired ( )
Y---------
p A r✓` ns er Il ti
at........... 4„ ''- ' ." em s^v€ ).................•-•----•---
has been installed in accordance with th` provisions of Article XI of The State Sanitary Code as escribed in the
application for Disposal Works Construction Permit No------- '- 'Ile.................... 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
?�. ...... .O F i�'»Y 3` .c•!t . 5 ,fit �Q.-'�.-...........................
No......iV4............. FEE. *
Di-rupiniat Vorkii Tlpnitr rtion ramit
Permission is hie]r�by granted___-_ hA C-5
'k----------------------------------------------------------------------•--_--
to Construct( )Repair ( ) an Indi i ual Sewage sposal System f
No. ..
••-•-- --------------�-----•--•--- ------------------------------------
atStreet -�� �_� � ;�d• � . � F---•--------•^-
as shown on the appnc tion for Disposal orks Construction rrt No...!' �_ __ a d__..._.._. %�-¢ �.._.._..
_' "' -------
............................. Board of Health
DATE------ --- - ----- --- ---- _.�----'
FORM 1255 BBS & WARREN. INC.. PUBLISHERS
f
�J
DOA/ALD J. IWARrEN
RE6/srERED. PROFESSIONAL 'ENGINEER
P. 0 i Box 4 : PcrAfovrH� /OAASS OZ360
OF/ygSQ�
746- 27s.3
X DOI\ALD J. R' I
- TOWN_ OF..��._ h/?A/5,r—A MARTEN 3 I
PROPOSED SE`YERAGE
crsTE�`
FSSIONAL Eat
LOT` 41
_ Crown to divert surface water
Cover at rode Percolation rote per
9 ;
s 1 a l j
2;: Peostone j ,
T
Uppp 600 G
5 to 2" CI®on. stone it t
.
i
o ' II
' c
nearest pit to we%/ ►om'� ca
nearest well to pit �2+'
/ C�x8l.
z / 1000 Ctac S.
I Ij
1�uWIVS 3i3drr..s �I ¢
i
I
� t t
t
6 C�ea 5sand t
10' 5 ►atE S 'an�. f goo' 'I �;
.. "6 -sp_✓a sew 1, �,�4�.� - _ F'
I
.Scala
No water