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Home My WebLink About0041 SMITH STREET - Health (2) ST z 88- o lq THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF........... -ST ,(3c. ..................... Appliratinn -for Btsp nttl Workii Tonntrnrtinn Vaniit Application is herebymade for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ................../--/........6"Aflpl�e......... 7....--------.......------ ........................ .................................... LoCcaation-Address or Lot No. ��/�! . V._o.t mef_-- ---• -----•--•------ •••-••................................... .••--•••--------•••--•-•...................._.......... Owner Address w Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building _________________ _________ No. of persons.___._..-_..._......._..___. Showers (' ) — Cafeteria ( ) aOther fixtures ------------------------------------------------------..................... ------------------------------------- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------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__._-__.________sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY------- ---------•------••-•----..............-----...---•---•-•--•------- Date...............-__------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit------------------.. Depth to ground water-------------..-__.___.- G Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__.__-______________-. - t� -------------•------------ --O 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 NI of the State Sanitary Code— The undersigned furtlier agrees not to place the system in operation until a Certificate of Compliance has beoissubybecd hgned. ----- - -- -- ---- ------------------------- -------------------------------- Date Application Approved BY ' .... . .__ � _'---7.4------- Date Application Disapproved for the following reasons:........................................................................................... ._..__________ ...---•-•-•--------•••---•------•----•----------------------•-••----------------•-----•-•- ------•-------•-•--•---•-------•---------•-••-------••-_...--•----------------------•-•••-----••-------•--••. Date PermitNo-----------------------................................. Issued........................................................ Date No. F$s...... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T '......_.... -OF............ It7� -_ G�.............................. Appliratinn "fax Elhipuiitt1 Workii Tomitrurtion Vautit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: _ T .. Location-Address or Lot No. .. Ownerer-----------•- — ---•-----•-------•-••---------------------•--Addreess --- s;--•--••--•--•---•------•-----•••--•-_------ � �lJ ._ -a-�- /�t_n gr �F.-•------------------------------------•--- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—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..--•--------------•--.._...._..--.---.-.---gallons. WSept'ank—Liquid capacity------------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.--_-.-_-.-.___-_sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No.' 1________________minutes per inch Depth of "Pest Pit--------_----------- Depth to ground water---.___................. �Tq Test Pit No. 2................minutes per inch Depth of Test Pit----_-_-___.____-___ Depth to ground water...................... W ------------------------------------------ ODescription of Soil la-a r ------•-----------------------------------------------------------------------------------------------•---- x ------------------------------------------------------------------- W UNature of Repairs or Alterations Answer when applicable. --` T ..... ... 7` �r � t ?d_.... ... 1-- .u. S.P!!'------------------ -------------------- _.. 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 issue by he bold of h !� r fined._..4; .� - ---`- ----------------....__.._._.__...._... f //�11___�.r— P Date Application Approved By---------- ----'--------------- ------- �------------ ----- --- - ----'-- ---7 -�---� -7-1�-------- Date Application Disapproved for the following reasons:----••-----------------•--------•---- ---•---••--------•---------------------------•-------•--------•-- ---••••...___-----•-•---•--•-----•---•._..._..---•--..----•----•--------._.-•----•---•---------------•-•--•-•--.._..----••-----------------...---------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........OF........ L ../.......:.......... V".1rrtif irate of (W1,11MIlliarur THI TP CERTI , That th ndividual Sew ge i sal S)stem construe d ( ) or Repaired by-------- = = l/' t = InstaIle at.... ...... ............... ...... - -•---'••-/-•- ``�'�-8--- -- - - ----•---_-•-•-•---•-••---- - -.l-G>ti�/� s-�!,,�.---•--------- has been in ]led in accordance with the provisions of :art' XI of The State Sa tary Code as desc i d in the application for Disposal Works Construction Permit No.-_ __.,rZ-_---q___!� ._._. dated...-_7-�..'..7�............. .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM W11, FUNCTION SATISFACTORY. DATE - -----f-- __3------------ Inspector__ �._____._... . .. ... l' .................. COMMONWEALTH OF MASSACH 07� BOARD OF HEALTH ) ........... .....OF........�. ............... ?%'/ .................... ,t�U No......................... FEE----------..................... tt_ .�rk,� n ��tr�trti�$t rrutit Permission is herebyrante _-._ .__._ g �. - "lt d ✓... to Constru•t ( ) or pair ( ) an Individ al Sewage Disp 1 yste at No.____`11S__ '� Stre as shown on th` application for Disposal Works Construction Pe riii No.--. ___/�__ %�i--- t d.......................................... / —��•• �� H DATE.....--/-------------------------------•---..................................... Board of ealth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS \`