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Home My WebLink About0061 CUMNER STREET - Health (0� Cctvnney- Skee�, I�nn� 07� No.........'3�� Fxs......V .`--._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................... ._................._. , ppfiratiaan for Dispaaii ai Marks Tomitrnrtuan Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__ __............-. .......... ...... • •._ .................................. ••••••••••----•••.............-•-•-••.•..._................•- Lo a io or Lot No. ....... -... .... .._•............•........................... . ..........__...--•-••.-- Owner Address W Installer Address UType of Building � Size Lot............................S feet a LoIIwelling—No. of Bedrooms............................................Expansion Attic (Rd) Garbage Grinder ()4 aOther—Type of Building P....................... No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other-fixtures -------•---••-•---•--------------------•----•--.....--.----•••••-••••-•---•---•------------------......---••-••-•-•-•-••--•••••-••••-•••••............ W Design Flow.......... S..........................gallons per person per day. Total daily flow........... _c.. .....................gallons. WSeptic Tank Tylquid capacity. ®�n.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Wi h._._....___.__...... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No........I........... Diameter.. _G...... Depth below inlet.................... Total leaching area..;2-,��.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date...............................••••..... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................ mutes per inch Depth of Test Pit.................... Depth to ground water........................ a' --------------------------- ............ ............ O Description of Soil --•- .......... ........ _ x V -• •-------------- ------•-•----------•••••----•--------- -- •--•••----•-......--..............----•----••-•-••••-•••-------- W - V 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 TITIZ 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 board of health. ed-.. •••• .......... ......................................................... .......................... Date Application Approved By-•---•--..... % �''`'L. •• ----• ... 2-1--D:— -------•--- Application Disapproved for the following reasons:----•------••-••-•-----•--------•-••- ......................................... ----•-----•--••...................•.... .........----......._. -•-•-----•-•................•----•----------------....--------------••-------•--------...-•-•-------••---•••--••---••••----•-••••---•--••••••-•••••--------•••-•--••-•••••---------••-••--••-......•---- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ��f /.r/ ........... O�F / ALT ! ...OF........ ....'........ Tutifiratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by•••-•••.••-. -••••••----•..-/ -•----•-----•--•------N.................................... � AA' '- "-Installer ) has been nstalled in accordance with the provisions of r' S of The S to Sanitary Cede as described in the application for Disposal Works Construction Permit N '.-__ _.._. _l�................... dated..�j`—_21-._7 '_.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................•••••----••-••...... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH C ......; N /... ...... OF .... lllld.r............................................... FEE...1E...�. Disposal Marko Tonstrnartion rrmit Permissionis hereby grante --------------------------•--•--•••--•-----------•-•------------•--------•-•-----•---••--••-------------.-,..-------------------•-•---------- to Con st ct ) t�epairan In Ividu eve age Dispos S tem rat No.. �.... r--...a_•-•• G ... Street as shown on the application for Disposal Works Construction P � No.. . ................ ........... Board of ealth ' DATE.................••-----•------....-•-------•----...............---------....... C/ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS N .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................0 F......................................................................................... Appliration for Disposal Works Tonstrurtio.n rumit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ..... V_ ... ............... . ....... . .. ...... .. .................................. ..Z a....0 .................................................... ..........jr!#40024.p Lo . io ddress or Lot No. ..... ... .................................7............... ...........0......0.......................... ..........0............0....................... Owner Address ................................................................................................... ...............0.................................................................................. Installer Address Type of Building Size Lot-------------------- ------Sq. feet U t tBedrooms.__........1.7 welling—No. of .................................Expansion Attic We) Garbage Grinder (4) P4 Other—Type of Building P........................ No. of persons........................... Showers Cafeteria 04 Other fixtures ...�,5� ---------------------------------------------------I----------------------------1-1-1------i..................* Design Flow... 4S.,..........................gallons per person per day. Total daily flow...........-2 2.0....................gallons. 9 Septic Tank 4r 1:iquid capacity!V9.gallons Length................ Width._.............. Diameter................ Depth_...._.......... Disposal Trench_'N o............. W14h-------_--_-_ Total Length..............--.... Total leaching area---_----------......sq. f t. Seepage Pit No......./........... Diameter.O.r.4A...... Depth below inlet.................... Total leaching area.2-0 I.....sq. f t. Z Other Distribution box ( : ) Dosing.tank ( ) I Percolation Test Results Performed by.- Date........................................ ---------- ------------------------------------*------------------------ Test Pit No. I................minutes per inch Depth of Test Pit.___._.............. Depth to ground water.......______........... Test Pit No. 2................ mutes per inch Depth of Test Pit.._............_.... Depth to ground water._..._.............._.__ 1:4 ....I - .... .. -- -----P_ ..........I.....*----------_ ------------ .7--------------- ... 0 Description of Soil.---- ............................. a. V,4p r,. _ U .......................... ....................... --------- ---------------------------------------------------------- ................................................................ ....................................................................................................................................................................................................... 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 Tl=E, 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 board of health. ned 4 --------------------------------- ....-------------------- Date Application Approved By. 4 .......... Date Application Disapproved for the following reasons:......................................../.................................................................... ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT14 . ........OF.... .. ........... Trrtifiratr of Toutotiatirr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired b ....... ................... ........... ............ .............................. y- -----------------------------......... Installer .... - -—------------------------- ............................... , . ............ has been installed in accordance with the provisions of 5 of The Xt� e Sanitary Code,as described in t I he Permit N ! application for Disposal Works Construction .................. ........*..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... ................................... ................ ................................... ..................... Ins pector........................... .... THE COMMONWEALTH OF MASSACHUSETTS y ly k BOARD HEALTH .................................................. . . .......... OF.... No... FEE....\,7................ Disposal Vorko Tonskintion "pomit ................ ........................................ Permission is',hereby grante�------------------------------------------------------------------------------- . - to Con t A an Z, i idu6'ewage Dispo S tem at N ............... ....... . ....... ................. .......................................... Street as shown on the application for Disposal Works Construction P A N;;e ........... V 4 ------ . ......... Board of't Iealth DATE_._ .............. ..............;........................................ FORM 1255 HOBBS & WARREN..INC.. PUBLISHERS. -poll