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Home My WebLink About0052 SAINT JOSEPH STREET - Health (2) 5:2, aC+V6- or—� s 7 No.----1 ........ 291 " �, / Fsx...r2.... THE COMMONWEALTH OF MASSACHUSETTS 1 ' BOARD OF HEALTH OF...... .. ...... ...... .. ..........---------------------- Appliratinn for Disposal Workii Tomitrurtion Prrmil �,� Application is hereby made for a Permit to Construct (v ) or Repair ( ) an Individual Sewage Disposal system .t: ..../ # Locat Addre or Lot No ------ - - -- --- ------------ -= - a-------- ------- -- --- ..... ....Y.1411.rAddres n t e Address QType of Buildings Size Lot.:)_ ._ �_.'_.Sq. feet V Dwelling No. of Bedrooms________________ _.._.Expansion Attic ( ) Gar age Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures •�.---------- --------------- - W Design Flow......................�-._.......___gallons per person per day. Total daily flow---------a..O' "._........____:__.gallons. ' WI Septic Tank Liquid capacity/-gallons Length................ Width-------------._. Diameter................ Depth___--____-___--. x Disposal Trench—No..................... Width--------- Total Length..................... Total leaching area--------------------sq. ft. Seepage Pit No....j--------------- Diameter_-//1-12) .. ______ Depth below inlet......_6ra._......... Total leaching area_.37.e_;?! sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water._-_-_-________-______.. fL Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ a ........ 0 Description of Soil________________ x 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 XI of the State Sanitar Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasV' nssued by � of health.Sign -- -- -- --- ----------------- -------------------------------- Die Application Approved By------.. �'�--•---------•--- Application Disapproved for the following reasons_______________________________________ --------•--------------------------------•-•----.-_.---------------- bate Application --•----- ••--------------••---------------------------------------•---------------•---•------••------------------------------------------------------------------------------------------------------------------ Date PermitNo--------------- ``- ---------------•-••--•-••---• Issued..._.................................................... Date ------ -------------------------- ----------------------------------------------------------------- ----- ---- _1_ w • p�f�� P,e+r'yr No._ I- fa:::............ FEE.. r........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH Appliration for Elispos al Marks Tonstrurtion rranit Application is hereby made for a Permit to Construct (V ) or Repair ( ) an Individual Sewage Disposal SysteffiAt q , fi I p1 Y Loca a Address/ or Lot Nq ram. `L�w 99..lt� -- C... tlddres �'` .�_.... i Address d Type of Buildi ✓ Size Lot_ _ .__. " " __'__Sq. feet U g �-, Dwelling No. of Bedrooms________________ .......................Expansion Attic ( ); Garbage Grinder ( ) `4 Other—T e of Building __ No. of persons__________________________ Showers — Cafeteria W Other fixtures ---------------•--------------------------------- Design �____�..___..__-.gallons per person per day. Total daily flow......... `_?_"..................gallons. W flow.-------•---•---------=_ Septic Tank-Liquid capacit/4r___gallons Length________________ Width---------------- Diameter---------------- Depth__._.____.___... Disposal Trench—No..................... Width _ .. Total Length.................... Total leaching area..................__sq. ft. Seepage Pit No...I--------------- Diameter_/!).44?' __'� Depth below inlet________________ Total leaching ft. z Other Distribution box ( ) Dosing'tank ( ) Percolation Test Results Performed bY-...:?...................................................................... Date---------------------------------------- Test Pit No. 1.................mmutes per.inch Depth of Test Pit.................... Depth to ground water...............__-_---.. fLl Test.Pit No. 2.................minutes per inch Depth of Test Pit..................... Depth to ground water------------------------ P4 ----- °- D Description of Soil-----=--------------- .. ., � - ------ - ---- ------------------------------------------•-------------•-------------•------------------------------------- Pw rt-� ----------•----------------------------------------------------------•......----- 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 been issued by the board of health. Signg.d .............................................------------------- ................................ y! s E t e D to j� e 6 Application Approved B •__- „i._.__ tl.- � _______________ `- a mx cD ate Application Disapproved for the following reasons----------------------------•---=•-------------------------------------•---------------------•------------------- -•-•---•---------------------------•---------------•-------•----..-------••----_••. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTF w ....,... ".- o : ...., " .... f ................... Tprtif irate of Tompli ana THIS ISTO-CERTIFY. That thPIndivi Sew Disposa ystem constructed ("t) or Repaired ( ) by , �- - ----� ----------------------••-- " .�l r ,e �1� Installer e- at - -'•.r;_�.__..____.._ _2 ._____y „z .:_-�y-tRR: '_._ _______-- -...._. r._Y_ � __ __ _. .___._ __v_ _____________ ___ __ has been installed in accordant with tKe provisions of Articled of The State Sanitary Code as desclibed in the application for Disposal Works Construction Permit No__________________ k Y._._._______ •'`_ PP P ..`' dated A--�-=--�-='-----------•--- 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 f pya�+ .......t �-:1y:...a .........OF.......... van, .........a; �.......�.�.':...... ............ � ..,..•, FEE ..... iij-poii a1: P. vrkii nstrurti Vatuit Permission is hereby granted___- } , to Construe or Repair.,( �) asp Individual Sewag s&s� sal System !!at 77 r KrIl eetas shown on the application for Disposal Works Construction }ait N f_ �f __ Dated-_ i_ __________. r 1 }f ........................ ' Kdrd bf Health DATE............--- ---•- ----- FORM 1255 H BBS & WARREN. INC.. PUBLISHERS