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Home My WebLink About0300 STEVENS STREET - Health 3au �WM3 Atki Iis No..� _5......... Fss.... ..............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD F H EA T ...... ............ OF....... . ..... Appliration for Disposal Murks Tnnstrurtion Prrmit Application is hereby made for a Permit to Co struct ( ) or Repair ( ) an Individual Sewage Disposal System at:•-• . .. � L�. a�e - .....v /. ..... .,... ...-.Iof.N Ow .o....... .... roc n- ... ........................... e ................. 0 Address .... ... .......... ........................................ .................................................................................................. Installer• Address UType of Building Size Lot............................Sq. feet e. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `P�f1 Other—Type of Building No. of persons............................ Showers — Cafeteria Other 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 ( ) aPercolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..,---.............. Depth to ground water..................... .-- f.,Lt Test Pit No. 2................minutes per inch Depth f Test Pit.................... Depth to ground water................... (4 ........... O Description of Soil..................................w ° x ----- -- v--------------------- - - = U Nature of Repairs or Alterations—Answer when applica .-- ------------_------- <. 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 further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe .........................................••...---•---•--•---•-•-. .... ............................. Date .... .. - � ___..A Application Approved BY � ... Date Application Disapproved for the following reasons---------------------•--_--- -_ ........ -----•------•-----.....------.....----------.........--•......•...... ............................•----....------•-----------------.....-----••-•-----------.....--•-•--••---....-••-••••-••-----•••-••-••-•--•------------•---•-•••-----------•------------•-•-•••---••••-••-- Date PermitNo......................................................... Issued........................................................ Date No.. : .............. Fx$....t .................... _ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEA,� .� ..'r�".�•'�'.d'al "+...............OF....... a,..e. . .':'3:"`.F.!r.�r "'�f,F7�''.'.^.'.a_�.'°Y .....-•---...._._. Appliratian for Biaposal Works Tottstrurthin Uerutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: j j +' Loc tionq/•Address JI��/9� or Lot vo }�! �' ''e^ j•�•-5 .u..'A �'Gri.i�L A.' :.. ......................... pOwner K Ad rmesS +.z ^� :{'.1.:.........�}.::a+v' "7Y.a'. ......................................... ............................... .... .................................... M y ,.,,EJ�..7 3 Installer •Address VType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ Into. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ...................................................................................................................................................... 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 ( ) aPercolation Test Results Performed bv.......................................................................... Date........................................ Test Pit No. 1................rninutes per inch Depth of Test Pit.................... Depth to ground water........................ (1, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... 9 """•.....................•..................... :......._.. Description of Soil............................-: -6= ^i:..t,�;_._. V ........."-•---•..............................................•--•---••--••--•--•--......._.....•--.....--••--...._•--"--......._......--"......_......•. W ------------------------••------•"•---•-• ••---•--.......----...._.....---•••-••-•---....... .........---- U Nature of Repairs or Alterations—Answer when applicahl ..._: ...___ , '_ --- ---------------- ... ✓ ; r A= - r� ..............•-•--•-"••-•-•-........................................._.._..._... Agreement: `5 ` 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. Srgnec ..................................... ti r f J Date Application Approved By,'. _�j.. ' ``'rysY•--......... . 7' Date Application Disapproved for the following reasons:........................................................................................... •........_......... -••-•.............••••-•-....._..............---------...•••••-•"----••......-•-••-•.......--•-•-•-.......--•••••--••......••------•-•---•-•-•---•-•••---••----._.----...-"••-".._..."""-•-_............. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,QF HEALTH Tnttfirate of Timptitture THI�`fS TO yORTIFY,�That the Individual Sewage Disposal System constructed ( ) or Repaired ) by. , ............:.....41` __.......---•-•--"--• ----••--•-•--•--.......-•••---------•--••---------------------------- ................. !r O /. Instal r r_ t /� at. -----------------------------•-------"-----••------------••-- has been installed in accordance with till provisions of Arti e XI of The State Sanitary Bode as de/r bec�,.jn the application for Disposal Works Construction Permit No.........pZ.�.o�............... dated.- .'^. :_``_ ' •'.." THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ._wf'_9�, DATE................................................................................ Inspector •-- ............. ,.. ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD ,,OF HEALTH'"`{ NO :�:... . ......... �. �.. _ EE..'"'�..t................ rante � x Y g . �._...._^� -b_.cf.....rac:c. f_.... �.............Permission is hereby to Construct ( ) or Repair,r(il'j an Individual Sp-We Disposal System atNo... , .f., ........ 1s f ''* " r ", �.. ...........� .--�r.... ._...._:..............-• ...... 'Street '• //-- S r { y as shown on the application for Disposal Works Constructionejmrt No !Ct / Dated .......... Board of Health DATE = .......... .................... FORM 1255 HOBBS & WARREN. INC.. Pll^oLISHERS