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Home My WebLink About0036 HARTFORD AVENUE - Health � � �� 0 r anuQ S M EAD O] i No.2153LEE UPC 12034 amead.com * Vade in USA �Y� L/ L0CATI N SE GE PERMIT NO. VILLAGE INS TA LER' NA M E ADD ESS I U I L D E R OR OWNER LoQt! r1� DATE PERMIT ISSUED ,. i _ g,5 DAT E COMPLIANCE ISSUED s I No... THE COMMONWEALTH OF MASSACHUSETTS /`. BOAR® F HE L /.. ......OF......... .. . ........ .. . . Appliratinn for Disposal Works Towitrur#inn 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........fib__- Ar:>4o. t Location:Address or Lot No. ^' z•�! "` -- ---------- .--.------- -••-•------------------- ��" Owner Address �1.4 Installer Address Type of Building/ Size Lot............................Sq. feet U Dwelling�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' 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 ( ) Percolation Test Results Performed bY................e.•---•...-•......................................................... Date........................................ ,_4 Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.....--- - --/-----------. 4..d,-", W •-•-•-----------•-------------•--•-••-••••--._._.._..•-••-----••-•---•••--•••---•-••---•-•-•--......----•--•--•--•-- ----- UNature of Repairs or Alterations- 'Answer when applicable......... _ �`.....®U -d"-_0�................. ..........................--......................................................................................................................... ---------------------•----•---••-••-•--••-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.I 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Com liance has been 'ssued by t exbo,,rd of ealth. Signed•... - .......:....... `9-r . ....._ Date Application Approved BY •--- -------•---......................... ...............•---------- Date Application Disapproved for the f o l wing reasons----------------••------•---••---•---•---------------------------------------------------._.........--------•-• --•-------------------------••---....................-----------------•-----------------......--------...---•----•---------------------------------A--_=-----------------------•--------•---•--•--.----- Permit No...... -'---®� ....� ate ----------------------- Issued....-----° ` •----.... -----• Date ------------- s1.71 THE COMMONWEALTH OF MASSACHUSETTS FEE A _ BOARD OF H EALTFe x ..r. / i..... . .. .:........OF....r..._...:............ _.......................................................... Appliration for Disposal Works Tontrurtion 1pamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at � J � t Location-Address or Lot No. .... ............•---•........................._.... ..... ...... ............ .... ._. + t' Owner Address 1 / Installer Address d Type of Building,: Size Lot............................Sq. feet U Dwellin No. of Bedrooms..............................:_ .._..Ex Expansion Attic_� g-� -------- p ( ) Garbage Grinder ( ) WOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ...................................................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal 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 ( ) a Percolation Test Results Performed by.................................................................... ...---- Date.......................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (14 Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rl a�'-� __•. ... ..............6------------------------------------------------------------------------------------------------- F s / O Description of Soil....... A r� ..� ,l t".�' ............................................................... .............................. •. 7 - r \ ......................................................................................................................................................................................................... �/� .................................................................................................................... .._ .. ._._......._........ ... .._.. V Nature of Repairs or Alterations—Answer when applicable__....._.=~ `s:` �'`!` */� � ��- _ o................. •-------•-----•------•-•----•--•------------------------•--•-------------------------•--•-••------------•--•-•-----•--.--------------•-------------------------....................................... ' 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 been issued by the baprd of health. Signed. �: i d .. v ! fs f ..x�wf'....... / -•--•-- ---•-------. - Date .. pplication Approved By----....--• - 4. ---•-= . .. . ....................... ' +'D ee o-1 Application Disapproved for th ollowing reasons---------=-----------•-•--------•----•---------•----------------•-------------------------------...-------•---- Date i Permit No ► . Issued--.....•• - � . THE COMMONWEALTH-OF MASSACHUSETTS- BOARD OF HEALTH ... ..................OF....::. ` Trrtif iratr of Tomplinurr (_1_ z TH„ ,Y ISj TO CERTIFY, ,That the Individual Sewage Disposal System cons "u to ( ) or Repaired by- r a :Y �... ........................... .1•:?s.....__......................-----------............................................•........ 1 Installer ........-� ..... >--------------- -_----•--------------------•-...•----------------•--------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary.Code as described .in the, application for Disposal Works Construction Permit No.._ -----_---.-_-. dated_------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT SYSTEM WILL F NCTION SATISFACTORY. DATE...-•--••-•• - # Inspector----•-----• -- ---- C---t `FHE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :. ................ r Disposal orko To otrnrtiop rrmi# , Permission is hereby granted....a ' 1f,. '"y'' %�'` ? ' 1... s::<: to Construct ( ) or_Repairs `'n Ind>'ldual Sewage pqs System at Street as shown on the application for Disposal Works Construction Permit A.7— . ...__ Dated"- __1. �}.............. .....:................... - . ................................ and o ealth DATEIII ......-----• • .............................................. FORM 1255 A. M. SULKIN,�,INC., BOSTON -