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Home My WebLink About0079 COLUMBIA AVENUE - Health l �-N' •r LOCATION SEWAGE PERMIT NO. / q L?J.4 o`Z I VILLAGE Aflf 7-0415 INSTA LLER'S NAME i ADDRESS Gov B UIIDER OR OWN R / �G �� — DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED p 3C-2._ 7 ? 2r% � as 3V 3� Y THE COMMONWEALTH OF MASSACHUSETTS BOARD l H A TH _ ----.s!i 7-1_1..................OF.......--.! ... C t : -� ,•........................................ Appliration for Disvnaa1 10orks Tnnitrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at•fo" a.... 1 , //" /�..4 . ................................................ - - i _ O A ................_.......---------------•----•-•. Lo d r or'Vo. yr-•- ... A .. ----- d .................................. wn Installer G U e Address Q Type of Buildi ,�gg ize Lot�,2-�OJ....Sq. f Dwelling-�No. of ----------------Expansion Expansion Attic (, Garbage Grinder (1V� ---------- — Other—Type T e of Building No. of ersons____________________________ Showers G� YP g ---------------------------• P ( ) Cafeteria ( ) Q' Other fixtures _•-------------------------------- ----............ - Q --•- -------.-•----•------------------------------------•----------------------------•---------------------- W Design Flow_______________-----*6=• r---------.__gallons per person per day. Total daily flow............. .%��___..____..._.._.._gallons. WSeptic Tank Liquid capacity(A: __gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ..........._........ Width.................... Total Length.................... Total leaching area__ �..sq. ft. Seepage Pit No..... ....... iameter......./p_..... Depth below nlet_._..�.-.-_.-___ Total leaching area.��_(.-.sq. ft. z Other Distribution box ( 1') Dosing to ( ) -� �e7W Percolation Test Results Performed by.____... __ _ _ .........._....................__ Date................................. Test Pit No. 1_ v_.___minutes per inch Depth of Test Pit____________________ Depth to ground 0� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---�. ..--............ -.............................................................. ,... O Description of Soil-----0.- r�cc _ u s_d>. -- ---� �1�.� .�'� ..'ram .s�ti- ... r , . ___._ 3 U 1-r!. �'. ........ ------------- ----------------------------------`J Ear1P -- /� ---- 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 iiTI p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued b board of health. SiV .................................................. -- Dite Application Approved BY . ... � 7�'•----------- Date Application Disapproved for the following reasons---------------------•---------•-----•-------._..._...--------....--------------•--- ------------...----------•. --•------••---•..................•------•-•-•-----•--------....--•------•-_---------......._.__.....---•----•._-__...._...-----------------------•-•••-----------------•---•----•------------•-...------- Date ----_: Issued-- �J? Permit No.............. ----- Date Not THE COMMONWEALTH OF.MASSACHUSETTS BOARD H ......... ..................OF. .................................... Appfiration for Dioposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sys at: 4 . ............................ ... ................................................... or I o, ............ ........ ';.................:4. _ /..........U-1. --—------------ --- ----------- ........................ Ow Ad n,.............4 �//------------ ..................4(.6 ........... / ........ A ...... .......................................... Installer Address o e Lot.j:')............P-0 Type of Building. ISTZ ...........Sq. fe9t U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (A"4 Other—Type of Building ----....................... No. of persons...._.............._.__:___. ShQ*ers Cafeteria P4 Other fixtures .............................. ........................................................................................................................ 7!.!r...........gallons per person per day. ........ ................gallons. Design Flow,...._..._...__....., Total daily flow.._....._.__ 9 Septic Tank Liquid capacity0-..gallons Length................ Width........_._..... Diameter.._..........._. Depth......_......... Disposal Trench—No..................... Width__- . ....... Total Length.......... Total leaching area---1�'.�. ..sq. ft. Seepage Pit No.... ... ..... Diameter.......j...d..... Depth below Inlet Total leaching area..!?`A/k-A_.sq. ft. . z Other Distribution box Dosing to Percolation Test Rest4ts Performed by......... Date..................................... 0-1 " " *---------------- ------------- Test Pit No. -----minutes per inch Depth of Test Pit.................... Depth to ground water A6,Vg............ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...;..._............_... ............. .. ... ..... ............................................. ---------- -------- ---- 1... ........ ..................... ---- --- 0 ................................... .................e.- Description of Soil.....f-, ---- ....... �14tq. ................. . ..... ----------------------- --------- ------- U Nature of Repairs or Alterations—Answer when applicable__________________ . ....... ................................................... ..... . ....'t. �...................................................................... --- ----------I..... .......................... Agreement: The undersigned agrees to install the aforedescribed' Individual Sewage Disposal .System in accordance with the provisions of TITS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ssued b e board of health. Si .. .................... ............ . .................................... ........�/D t TApplication Approved By........... ... .......... Date Application Disapproved for the following reasons:....................................................................................................I............ ....................................................................................................................................................................................................... Date PermitNo.......................................................... IssuedL.................................. ................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F H I EALTH ............. .... ......44.0.�k................................................ Tatifirate of Tomphaur affe onstr T IS 0 CER&Y, T�the Indiv nl Aw. i af1s c tytl� epaired by..... .. . . .... ....... .... ............................................. ............................. n ;J ......................................................................... r at....:n....... ..... ...... - ---has been installed in accordance with the provisions of TIA' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ...... .... ................... dated.....kl.. &- -- ';----------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. .LZ.......... . Inspector. THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEAL OF........... I. ............7- . ......................... Nd........................ . ........ FEE. ............. 14sposa Iforks T tr Wn gran . ..... ... . . .. ........... .. ...... .................................. ..... Permission 1 hereby nted.. 6 4, to Constru or Repai ',an In ividual a e Dj%osal S,' t ... . ..... . ... . ................................................ Street as shown on the application for Disposal Works Construction Per Ji-f7N ated.... 7 ;, 0.,- ID .................. ................ .0 C ............. ............................. Board of Health DATE.........3................... ...... f................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS' f