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Home My WebLink About0019 CAMP STREET - Health 3Sq N .. - •__....••. Fps.. U.................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH iN.h......................OF..... .Q:r.h:... •...ti---------------------------------------------- Appliratiou for Uiipniial Workii Tomtrurtinn thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: S ................��....�t .. _.:... .._:.: y:12�.5...-•---•-••----- -65;c rS•_�a�. ....... 1. I tiQn tAddress y �y` Lot No.P Owner dress ...................k 0l."r !?"t v... c Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms______ _________________________________Expansion Attic Garbage Grinder *®) 4 Other—Type T e of Building No. of ersons---------------------------- Showers � — Cafeteria P� YP g P ( ( ) Pa Other fixtures -------------------------------- - W Design Flow___:�5__________________________________gallons per person per day. Total daily flow--.--- ...........................gallons. R: Septic Tank—Liquid capacity)+P___-®--gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width------------------- Total Length.................... Total leaching area--------------------sq. ft: Seepage Pit No.-I---------------- Diameter.- .............. Depth below inlet.....6............ Total leaching area.- ®_____sq. ft. Z Other Distribution box ( ) Dosing tank ( `" Percolation Test Results Performed by--------------------- -��iP �I/ ---- --------------•---------------- Date------------- / aTest Pit No. 1----------------minutes per inch Depth of Test Pit---------__----__-__ Depth to ground water........................ G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --- Descr>ption of Soil__ ------ ------ --- ------- ----_t^ h .--_ -.._�-------- r--•- - x U 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 i-:`:p of the State Sanitarype— ui ersigned furtl er agrees not to place the s stem in operation until a Certificate of Compliance has b e oard of health. Signed •�----,,�� DateAPPlication Approved By- -y-/'---.r. --... - ---- D----- Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ -----------------------------••----•--------•----------------...-•---•---=.:.----•----------------•--•----•-------------•---------------------------------------------------------------------------- Date PermitNo......................................................... .................... Date AR _ e� .1..................... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _-�r?-�V.h......................OF......`Y'aY'Vt S � I C- App iration for UWposal Works Toustrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ars is 32`�_19t t n-Addres�.Skmti r Lot Noy, SIP 14 ... .......................................................... -••-----•••••--.'L. �h Kit1.: M� t Owner �I t r, r hHdress Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms__.....................................Expansion Atticj Garbage Grinder ©) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ..............................................d W Design Flow...5.5.................................gallons per person per day. Total daily flow.__'?3.a...........................gallons. WSeptic Tank—Liquid capacityIP9__gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Widtp_----____...-_-__--- Total Length........... Total leaching area.........._.........sq. ft. Seepage Pit No..�___-_-____---- DiameterAr--------------- Depth below inlet....6_............ Total leaching area.Z¢Q......sq. ft. Z Other Distribution box ( ) Dosing tank ~' Percolation Test Results Performed b V. � .......................... Date........ ....... a Y a 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........................ •• .. t �.._.�DDescri Description of Soil ----••••. ==--�-h .I � q � )t` � ..-- W ---- � � x ` �� - - ----------------------------------------------------------------------------------- --•••=-=•-•••.-•-••-•--•----------•-•=......••••••••,•- 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 T i i L p 5 of the State Sanitary 6— The u ersigned furtt er agrees not to place therstem in operation until a Certificate of Compliance has b one oard of health. 1 � Signed ------ - .......... Application Approved By--_.,... ,,�...... f at f �� Date Application Disapproved for the following reasons:-----•------------•--•--------------------------------•---------------------------------------------•--•---..... •----------------------------•---...------------------------••---•-----•------•-------........----------•......--...•-••----•••--•--•-•••••-••-•••••.....------•---------•-----••-•--•-••--••--.......:_ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS- .BOARD OF HEALTH ......u .!!�..............I....OF....... .,t. ...a . .........K , ZeT (9r if><ratr ,af Tnrntph anrr THIS IS OfERTIFYA That the Individual Sewage Disposal System constructed (� ) or Repaired ( ) --------------------------------------------------------------------------------------------- � r Installer has been installed in accordance with the provisions of s j. f The State Sanitary,.Ggde as described in the application for Disposal Works Construction Permit N _'t5.............. dated_- . IM4�.......... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUEAASGUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--•---. � ` ...........................••-----•-_..._. Inspector...._ _ ... ....--••.le i._°. C. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EA TH �pp / ''. ..................OF.....3'4-'V�y.. l � ................ ......................... y ^. O..Q .. .4T FEE. .....°................ Disprrsa1 &rkii ftnutration rrmit Permission is- ereb ranted_....: t.�_ . ^� - ....__._..._ -hereby to Constrc ( _-gr Repair ( a Indivi 1 S Tage Disposal System at No._._.� v3c1 S `�-----•--I-�-- # F-�2.t. . � ----------------•----------------------------- Street as shown on the application for Disposal Works Construction Permit No. _.______......-•• Dated.....A ��_��.................... ,.. ...ram -------------------------- ........................... Z .�' Board of Health DATE-------------•----•-•_...... ' �� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS { i i P: V k*LL v�( if 205,Q-z- P.eop. 15T�►�c. p f �r A?ZA 1 zo GAS ILL •� Fa r`k=- 'i' 1 ITE! � i f 1 _ 41. OF s A FG 99 l , _ `>F l..o A SAT-_,� ¢• d --) e u I N�/• � r.a �,G'"(`i�L7�,j; �'�:.t�-� - r�'� �i�` SO x,e LSKr "`9y1s 9 �� !uJ dam• -Tcn ' Ic �� 425 0 I .7r IP�C? 1ltd, 1uJ. 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