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Home My WebLink About0072 SAINT JOSEPH STREET - Health -all Fn1...... ............. THE COMMONZALU OF MASSACHUSETTS BOARD O H EALT F... ,�.��trtt�tntt -fux �t�� tl l�xk� latt.��xttr�t�n Pr�tt� Application is hereby made for a P it to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at .. .._- - --- --- --- _... -- — Location•Address Lot No. •— O ner dd�(1 a rC ------------- -- - �Vk- nstalleF Address ` QType f Buildi ___Size Lot_________________________ q. feet U Dwelling—No. of Bedrooms---------�____________---------__Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building --.-____________ -------- No. of persons............._____-_-------- Showers ( ) — Cafeteria ( ) Q' Other fixtures _. ___ -------------------------------------------- W Design Flow....................... gallons per person per day. Total daily flow�eter -- •----- ...... --- gallons. Septic Tank—Liquid capacity..`--__-___-gallons Length---------------- Width..__._..._.-.. epth._____-- xDisposal Trench—No/.---•--------------- NNIidth�' ....._.��W.- Total --------------sq. ft. Seepage Pit No.________/_________ Diameter_____ __________ __ De t _ _ o al le ...____ ______sq. 't. z Other Distribution box ( ) Dosing tank ( ) ��j aPercolation Test Results Performed by------------------------ ............... ----- ------ Date--------------------- ,� Test Pit No. 1____----_---____minutes per inch Depth of "Pest Pit...______.__........ Depth to ground water..-------.-------------- (4 Test Pit No. 2................minutes per inch Depth of Test IP ........... Dep to ground water--------------------- ----------------------------------•-•----------- 0 Description of Soil-------------------------......................................... -- ------- ........ ---•- -•--------•- --------------------------------- 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 Sanit Code—The un sign urther agrees not to place the system in operation until a Certificate of Compliance h n issued the card ealth. ed_ -__ Date Application Approved By------------- . •------ . q � - .... VDat Application Disapproved for the following reasons:....... -------•------ ------ ----------------7_..........-----------------................ ...........--•-•---...... ....................------------......................-.............-.. -------------------------------------------------------------------------------- -------------- Date PermitNo.....-•-......--•---•-.......--.......................... Issued..............................-------------..__...:..... ` Date No...11/.... Fps........�.�.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH--- .......�OF..... ...F�..........................------ Appliratinn -for Bhipagat Works Tutuitrnrtimn Urruift Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at �? ....�...... - .f- ... t ....................................................rr.�/� , Location.Address/ / of. "�. f--�" .IJ /I-7✓sta+ t/.'.f� ,f,/. .b`/./ • .Js� ,.!1y/F__ Owner /f Address a ........• ✓ Installer Address Type of Buildiip,/ Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building .. ............... No. of ersons.--._____--_______-____-_._- Showers — Cafeteria a YP g ------------- P ( ) ( ) Pa Other fixtures --------- :�---------------------------------------------- _ ?...---•----•----- -----•-••----------- W Design Flow............................5_7.7z�_gallons per person per day. Total daily flow............ ---- ._..fj-.--.._ gallons. Pi Septic Tank—Liquid capacity__-__-.__-_gallons Length................ Width.................lliameter_-_-__ --.--- epth................ Disposal Trench—No.j-------------------- Width..........._------- 1TottaallLength---.-_-__�... Total le chingL r _-.-..__--_sq. tt. Seepage Pit No-------- ........ Diameter....r.� Depth below inlet---- Total leaching area--_-_.-_-._-._--_sq. it. Z 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....---..__-._..-._.___- (q Test Pit No. 2................minutes per inch Depth of Test Pif_._-__-____________- Del to ground water........--_-___.__---._. a+ -----•--•-•------------------•---••----•----•--•-----• /� �/---------------- •--------------------------------.-------- DDescription of Soil----------------------------------------------------------------- sy� / -71 -=/,x --------------------- ---------------------------------------------------------- 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 been issued f the board ofhealth. GC, Signed /=. .......................................... --------- ............................... Da Application Approved By........... / `- /a. /I 'Dat/ _-�j Application Disapproved for the following reasons---------------------------------------------------------- 7 •- P ........ •'--'•-------'-----'-------------------------------------------"----•----------- -------------- Date - PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............�4<1. 4.-,........OF..................:/C-?,li�-r......................-------.. Trntif ira#r of f"nntplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ��orRepaired ( ) bn d Y ---_'•------ ------------- ••. ......-_••_•--'••- _/_'_ _/ I',? e Installer at_.R-`•.........../--------- �"'-'----'�---•---•---• ! -�'----•>�i�-r�. /�.� - _: has been installed in accordance with the,proves of ns of Article XI of The State S nitary Code as described in/the application for Disposal Works Construction Permit No .......... :3 ----------- dated____._ ._./. / _.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THEE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................................................... Inspector-----------------------------------.----•-•---------------------------•--•---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...... j.................................... FEE--------................ �i��n�ttl �rk� �nn��rnr�intt �rrtntt ,- Permissionis hereby granted-----------------------------------------------------------------------------------------Z....--...----------"-•------ to Construct or,Repair ansIndividual Sewage Disposal System �� J� '� j atNo.__'.�___ ! L� r --------------- ............................................ v Street as shown on the application for Disposal Woks Construction VPermit'No--------'______--__Dated---� �?r. ..�_--� ----------------- ........ �f I Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y�` i �,.-� r � �. �� t��c o 3'i J66 �