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Home My WebLink About0072 SUFFOLK AVENUE - Health (2) �a '� Pmmu -,, No..... �' Fimic.-...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration -for Bispooal Workii Tonstrurtion rrotit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .. � ca on•Address or Lot No. ~' ......... Address ner ...........I........................•...... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) PL'' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Widtli................ 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............. ----------------------- aTest Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water___._____-__-.---_-.___. (Zq Test Pit No. 2----------------minutes per inch Depth of Test Pit.----_-.__-____--_- Depth to ground water------------------------ P4 --------------------------................................................................................................................................... 0 Description of Soil----------................................................................................................................................ -------------------------- x W -------------- ------------------------ ----------------------------------------------------------------- V Natur of P.epairs or Alte ionso—Answer when applicable. . .. C" __ .__.._. t'_ ________ Q Z�' .- - 4relement 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 en ssued y the bo o hea Signe -- _ . ,€ ...__ Da Application Approved By-------•_...--- -... ......../(Q'4J 7__7.. Date Application Disapproved for tli following reasons---------------------------------------------------------------------------------------------Da.t.e--------•--- . - •--•••-•••••---•-----------------------------------------•--•---- Date PermitNo......4 -----------------------•--••----------- Issued........................................................ Date No.... 0................ Fizz......... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEAL;Wj 0 0,4," .,A4 ....... ......... .0 F..................................... ................................................... Application -for UiBpasal Workii Tonstrurti rrutit AP plication is hereby*made for a Per it to Construct pr,Repair an Individual Sewage Disposal ',t System, �at-:-7 ...................... .............................................................. ................................................................................................ or Lot No. ................................................................................................. r Address ... . . ........ ........................ ........ .................................... ....... ..............................;......................................................... nstaller Address Type of Building SizerLot Sq. feet Uh�.' o "*------------------------ Dwelling—No. of Bedrooms............................................Expansion Attic ( ) 11' Garbage Grinder PLI Other—Type of Building ----............1!.......... No. of,persons....._': .Showers"a( qi,,,,afeteria P4 Other fixtures ---------- tlt..... ------------------------------------------------------- ------- ----------- ----------------------_- - --------- Design Flow............................................gallons"'p'er-pgrson per day. Total daily flow......................-------_---------------gallons. P4 Septic T-,,.iik—Liquid capacity__'_"n�t,f -gallc�is Length F Tot al ............. Width..___........_ . ri eten-'%�k.,,.... ................ Disposal Trench—No- ---------- ............. T6tal Length-------------n _ Total leaching area ...... ------S' ft. _'Jj�p Vv inlet______.____.__._.__. Total leaching area._-----------_--sq.'ft, -�eio Seepage Pit No--------------------- Diamet r------------- *Depth Other Distribution box tan N Percolation Test Results Performed by...... ......------------- ................................... Date----------------------------------e-------- Test Pit No. 1................minutes per inch Depth 'est` .................. Depth to round water.._---_.----.-------_ ........................ r14 Test Pit No. 2................minutes per inch Depth. esr ----------------- Depth to ground water -----------------__----------------------11...................... ---------------...................................................................... 0 Description of Soil------------------------------------------------------------...................I.. ......... x % r..................... --------------------------------------------- ..................................... ........................................................................... ............ .......... ------- U t. ----------------------- -- ----- --------------------------------------------------- -- - ------------- --------------------------- iv UA - -- ------------ -------------------- .............. ------------- - ---------------------------------------------------------------------------- ------------------------------------------------------ --------------------------------------------- /�a t greement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanita de—The undersigned fu er agrees not to place the system in operation until a Certificate of Compliance hVb a o th. Sign .... ------------------- ---------------------------------------- ................................ 7- ApplicationApproved By------------------i........ ...................................... -----------------------------_ ....................... ----------------- Date Application Disapproved for the followit l,g reasons:-----------------------•--_._--_.-__-__-__.___.---_._-_._.____-.-___"^k,-!"4---------------------V---------- ------------------------------------------------------------------------------- ......................... --- ------------------- .... ------------------------------------------------------- Date Permit No---------- rssued..'..�.................................... ............. ---7f----------------------------------- Date "oi $ 1�-OMi�&NWEALTH OF-'.' THE �IVAS5ACHUSETTS.,' BOAROP OF HEALTH wsr .........................................OF............ ....................................................................... J Z Tatifiratr of Q.-Tompliattre e Individual Sewage Disposal System constructed or Repaired by. 7; ......... ....h4-------- ...................?.................................................................... ..... .......... at--------------------------------------------------------------------............................ -------------------------------------------------------........................................ has been installed in accordance with the provisions%of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit ----------------------------------------- dated.._.....___..._.......___.___.__.._._.._........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTaR-UED AS A GUARANTEE THAT THE vt SYSTEM WILL FUNCTION SATISFACTORY. DATE......... ...... .......... Inspector. ------- ............................................... -----le 7-•••---•-•. �ector_ THE-C-0MMONWEALTH OF MASSAC6TS 8bAOF`' HE FW14 ......................................... OF.................................. ..... .... .. No. FEE........................ it 'isr by ............................ --------------------------- - .............V. ............................................ SeAv4ff Disposal System 'c" n to GrY�t>?uctF�Xqvr P�-'(a----*�171 at ----------------------------------- ------- ------------ --------------------------I------------------I-------I'll,------------- Street "-�' /-/�.. 13-- 7 7 as shown on the application for Disposal Works Construction Permit No..__-______ Dated.......... ... ....................... Board /J� 2 7 gfHealth DATE............. ...............................t.................................. FORM 1255 H0813S & WARREN. INC.. PUBLISHERS N� / /�l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v% ..� .---......o -... ,.�D . . Apptira Lion for Mivaoaa1 Worko Tonstratrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at• �ydd . .................. U—....._...... . -- --k ..... . .....•.. Locati Add r or Lot No. -- ....... .... .- ........................ ........................................... ....•----....--.•-----..................••....... Qo;vn Address a ..... .... .. ................... ...... .--•---......-----.......--- ----------------------.....----------...--------------......----...----------------............... Installe Address � Type of Building Size Lot___________________________S q. feet U Dwelling—No. of Bedrooms-- .........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building _______________ No. of ersons......_...__......__._______ Showers Cafeteria a YP g ------------- P ( ) ( ) Q' Other fixtures _________________________________ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................ 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_____________•_-__--,___ fi Test Pit No. 2................minutes per inch Depth of Test Pit----_............... Depth to ground water-___-___-__-.-_.--.-___- Q+' •--•-••-••-------------•-•••----••--••......------•••-•-.............-•-•--•-•------•------------------------------------------------------------------•---- 0 Description of Soil........................................................................................................................................................................ x v --•-----•-•-••-•--•--•-----•---------•-----------•-----••---•-•................•••--------.....•••-•-......•---•--•--••--•-•-....-••••-••-----•-•••------•-••--•-•-• ---------------------------- x --•••••--•-•------------------•-----------•-•--••-----•--•---------•-•-•-•-•---•••----...-••••-•-------•------- •-----------.... s- .......... Nat e of Repairs orAAlt *ons—Answer when a licable._ __ _ — �U ............ ------ --------------- -- ---- -......---•--••••---•..............•--•--•--•••--••-----------•---•-••--••••••-•-•---•--••-•---•-•••-•••---•-----••--••-------------•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of CVige as b issued by the board of heal .1 ........ = --•-•--- Date Application Approved BY ......-----•---_.. Date Application Disapproved for the easons: .--••--. •-••..........-•-•-----•••--------•... _.....---••-----• ••--•-•••--••--------•--•--•-•.............. ---------.. . -- --•-•-•--•-•--•--•---- DatePermit No-----------------•----- -••-•-•--..... Issued............._.......----••......•-•------••-......---- � to THE COMMONWEALTH OF MASSACHUSETTS BOARD OF E/ALTH G / i!1..........OF............... ...Gl..... ................................. V MurrfifirFatr of Toutphatt r THI 0 C;61 Y, That the Individual Sewage Disposal System constructed ( ) or Repaired b ....... _V....... ....-- -------------------------------------------------------------------------------------------•------ Installer at--..... . --------------------------- ... . ............-.............................................................. has bee installed in accordance with the provisions of TU___ 3."..7/ r The State Sanitar C9 de as descri the application for Disposal Works Construction Permit No.. .......... dated....L.d �_ ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... No..:::..... THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH a ........0 :. Appliration for Dwposal Works Tongtrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System a ............ . . ... ............- ' a. - ................ ..- - - - - Locati Addr { or Lot No. 3 ner # Address Installe " :. a6 Address PQ d Type of Building ;: �Arti•. Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................................Expansion Attic ( *). Garbage Grinder ( ) per, Other—Type of Building ............... .......... No. of ........_____:: _...... 5h` wers ( ) — Cafeteria ( ) dOther fixtures ..................................................... ... ., W DesignFlow...................................... .............................. '"`_. ;. allons per person erda. Total,da11 ,flow.._.... ..gallons. g P P P y y. WSeptic Tank—Liquid capacity .gallons Length ... '� ��Width Diameter---------------- Depth................. x Disposal Trench—No_____________ Width Total Length Total leaching area,_:_._________... sq+ft Y 3 Seepage Pit No..................... Diameter �,. +r Depth below inlet ... f- Total leaching areal°:__._-__.... sq. ff: Z Other Distribution box ( ) > Dosing Percolation Test Results Performed by.;__ r ..... `"� Date........ -•--• . 1 Test Pit No. 1................minutes per inch {Depth of"Te�stpl'Itz.__.:__._ t; gr �.7 � , D�th��o ,. ou�dater -----------. Test Pit No. 2................minutes per inch Depth ,of Testa P't._._._....._._._=f:Depth to ground water. ...��'_..._.....__.. s -,-- .. �7 <.................ink DDescription of Soil.................. °� :_ .. .-- --=-••--•--••------•----•-•-•-••----------•----••-•-•---••--....._......---• V ......---•......................................•--- ----•------•------•. W +�e VNat. e of Repairs=-or-^Alt :S— wer when applicable-- ................. ................... ... . . •-•--- ...--•- _...._.....-----•---•-•----------•-------.. •-•-••---••....------ .----:.........................-•---•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued b the boas d of eat k.... ....... ................. Signe fe� Date Application Approved By................•-•--•----•-••................................................ ;. Date Application Disapprov� for the following reasons:................................................................. r -`ti---------`-=-----•---•---------------- ................................................. •}'. t � :pate • PermitNo---------------------------------------------------------- Issued.............-----------------\-•-------------------- Date w ,,.. s,• ' ' THE COMMONWEALTHVOF.MASSACHUSETTS z4�{ BOARD OF ALTH A r 1' -4 :... OF...:::.......:.. G ............................. t 4 t. (11rdifirat .4 (rnmplianre THI CE That the Individual Sewage Disposal System constructed (*- or Repaired by •----- .................... -,----------.... ---• •-------•- •..._... ---...... ...._... ------•-- Insta\ller , - 1 k has bee installed in accordance with the provisions of T _,jam, 5 he State Sanitary C.}�de�as described the application for Disposal Works Construction Permit No.. ;.__._ ._.. : .._....... da.ted_..._�`.... . ..... .. .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS'A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. f- DATE................................................................--... :._ Inspector........---------•----•-•-----•-.--••----••-•-••---.............--•----•------- THE COMMONWEALTH OF MASSACHUSETTS y BOARD O HEALTH / 1." ..�.....OF............ Z ........................................` -*r•.' No ! .... FEE---- ........... �tl r s- nn#rnr�ion rrmit Permission is hereby grante ." " :_._ to Construct ( * ) R air ( an Ind dualg�e Disposal Sys , Street G as shown on the application for Disposal Works Construction Pe It o. .____.. ... ed.... �..� .._ �.. ---- ...... ••-• ............ ., Board of Health DATE----f -----------------� ---•---,-"/ .....................-----•---• � FORM 1255 HOBBS & WARREN. INC.; PUBLISHERS - -- -