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HomeMy WebLinkAbout0364 PLEASANT PINES AVE - Health l 1 / � � I ; s s pO LO CATION LQr S /e4 ahr P,:.,e 5SEWAGE PERMIT NO. . •o YILLAGE I N S T A LLER'S NAME & ADDRESS JOH N A. AALTo RaCKWog GER4 I(m�e W lmut-street _ es d U E R .....�0R ONIN E e✓, rl,aLY-t s 0 DATE PERMIT ISSUED - _ a �'=8� DATE COMPLIANCE ISSUED ��� . i // /� i'' ��,� �? /w / � � `ls�� �5�. �J r .. ..3"Y� � gyp• THE COMMONWEALTH OF MASA ............CHUSETTS BOARD OF HEALTH 0...............0 F...... ...................................... Appliration for Uhipmal Works Tonotrurtion runfit Application is hereby made for a Permit to Construct ( or Repair an Individual Sewage Disposal System at: A 1(:;;;1!& X ....... ........................ oration-Address A-00 -5ftv, IgD . 14 ...... ......ORIAR.Ty........................ ..................................*,*,,,"*.. ...................F............ _1wner Address , 11,111ir-r d-t- - pels .............. 7........................................................................ ................................................................................................. Installer Address Type of Building Size Lot..' feet U o, of Bedrooms DwellingL ............Z.....FIAK.........Expansion Attic Garbage Grinder d-,Jn nOther—Type of Building ............................ No. of persons.........._................_ Showers Cafeteria aOther fixtures ........................................................................................ ............................................................. Design Flow.............................4!5i5.......gallons per persojr4a,X. Total djily �ow.................- ..:5..6....... g-elons. , .W Septic Tank .............—Liquid capacity.L(jr-O..gallons Length._............ Width.A:-!P... Diameter................ Depth.t-- ­ Disposal 'Trench—No. .................... Width.....I.............. Total Length.................... Total leaching area................ q. ft. Seepage Pit No.-..-__ ------------ Di eter....A�?......... Depth below inlet...Z...%�.... Total leaching area..0.7.4-�X.sq. ft. Z Other Distribution box ( i�� Dosing tank 1-7 . 1-��_1­4 s Performed by. 17- Percolation Test Resu ....UY_V1U4... ......... Date....k-S:......................_2�_. Test Pit No. I........-7—..minutes per inch Depth of Test Pit.1?2........ Depth to ground water----a.V .... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................___. .............__**............. U0U .. ......... ----- ---- Descriptionof S ........................................................................A. ...... .................................................... W .. . .................................................................................................. ................ .....................I................................................................................................................................................................................... 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 TAITIL- 5 of the State Sanitary Code—TI ce the system in ,�e undersigned further agrees operation until a C tificate Compliance has bT21:11 th 0 p f ed.X .......... ................................................ ......... ........ ..... ............... ApplicationAp roved ... ... .... ............................................................................. ....... Date.. .............. r t lowing r so .......................... Application DisapproveWde lowing reasons:.................................................................................... ......................................................................................................................................................................................................... Date PermitNo....................................................... Issued..........----------------.........._.............---- Date ----------------------------------------------------------- < GP; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..`✓ �.14 ...............Of!......&. : ...................................... 'Appliration for j3iopoii al Workii Tonotrnrtion Prrutit Application is hereby made for a Permit to Construct ( ' or Repair ( ) an Individual Sewage Disposal System at 5... ! - , _ t'7 c ocation-Address _ 1.....` _ .... --..,.� .... s= - y-••---•----------------- •--•----•---•------------------- .- v----. ..•...�.:5Pz L................................. Owner Lta \7,e � &hG T, I��JFTI+c Address ....... ..........................................•........................................... l4L.S Installer Address Q Type of Building Size Lot.. G�,� '.�'.__,..Sq. feet Dwellingo. of Bedrooms.............�, ...._.1.MX.........Expansion Attic Garbage Grinder (Pn WOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures ................................................ ..---... --------------------- ---------------.----...-------....... W Design Flow............................: ��.__gallons per person pGr day. Total daily flow ........._�._.��..e:) ... Ions. WSeptic Tank-Liquid capacity.)()C��-g,' Ions Length._.... . Width,}` piameter................ Dept11�� ��._. x i Disposal Treitch'u,'�10 .................. Width............. . Total Length _ Total leaching area... .:Rsq. ft. Seepage Pit No-------- _...._____-- Di eter.....I..?........ Depth below inlet...ZtS,...... Total leaching area....L4,.:..sq. ft. z Other Distribution box ( (,�)' Dosing tank ( ) a, rcolation Test Results Performed by._•-_LA—)'YJ,A..�� I'-. � 1• ......•-• Date....1.2_.•�.2.... _.. a Test Pit No. 1... --__.'--__minutes per inch Depth of Test Pit..\. .___._...__ Depth to ground water....r?�.ne..__.9 �-) f Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R; •.... O Description of Soil . ^ 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 TITIZ- 5 of the State Sanitary Code— Th undersigned further agrees n twt ce the system in operation until a C tificate 9f Compliance has be is y t r f ed .......... -............................................... Application Ap oved . •--•••-----•-••••........-•-•--•....•••-•....................•-.....••• . ..•. --•1`....... Date Application Disapproved t e lowing reasons:................................................................................................................. ..................•••--•••-•---••-•-••................••••••...........•••-•••--•-•---•-.....-•••--•..............•••••••---•••••...----•-....---•---•••••••.••--••------ --------------------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (9rdifiratr of Tomplinure 31 ERTIFY, That the Individual Sewage Disposal System constructed ( �orRepair'ed ( �) by.. - r' ---` •--------•----------- -------- ( r Installer at.... . :f. �. ........ .................. has been installed in accordance with the provisions of TITLE `"of The State Sanitary Cod as d r in the application for,.-Disposal Works Construction Permit No.- �����_,................. dated :__-_..�/.................. THE'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAICT RY. j t DATE....................................................... -•-•-•• Inspector........................ . ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � yd OF.......................... s FEE..:n................... Moir rrmii Permission is hereby grante 'r. �. : .--••••••••• -••••••••--••...•--•••••••••••..........................•...................••- to Construct ( �, epair n ivi' DisRosal System atNo ... - ?s_ - [ c ..................... . ....................................................... Street as shown on the application for Disposal Works Construction Permit �... ................ Dated...................y............._........ SA .................. ..... ............................................................................ x Board of Health DATE----------------- FORM 1255 A. M. SULKIN, INC., BOSTON p /!/v • .. N C> qq i0 S P�III 471le 3+1,�3 ems.S.S ,' 79 U / 3 GA L . 7-1 _P4s/©l:�Is.4 C.. 4:57A4-.o 1, /3 z. x 2. _. K hv- Jit/2!•j/�Sl 49 LLB.,s' A41- to a14 <64 7 7 -1-/NA7- 7",y /�' �ivT>' ;�, ?. ', .. �A/✓� Sc J�'Y�", �, 0,9::" 7-/-45' -,rn /W ✓ Gam" &4eo4 ` ,�► ">',. Q , % '� / 171JA- ✓ � � -7w ' ` :�