HomeMy WebLinkAbout0099 HAWES AVENUE - Health � � tees ��v
� _ � O - 3a3- b1Z
�r_� ��°�
4~ �~� ----'................
THE oomMomvvsALTn OF wAssAoHussrrs /
BOARD HEALTH
�� &(�' _
"-^~^�^''-----' --+���-�"_~���^==+-------'---_-'-_
� � ��� ��
�����������K «�� ��������l ��ork� T�ns4rurtioKK rantKt
Application is hereby for a Permit to Construct
System at-
.................99.. ...... ............. .......... ..................................................................................
Loca ion-Address or Lot No.
Owne& Address
...... 3;/e........... ..................................................................................................
Address
oc
�14 TyprofBn8d' Size Lot---.----------'Sq. feet
DvrelG —No. of Bedrooms... --_---------- Attic ( ) - Garbage Grinder ( )
Other—Typeof Building ................. ......... No. of persons............................ Showers ( ) -- Cafeteria ( )
P-4 Other fixtures -----------------------------------_-_--'--_-.-'-'-_-_'-----__---_-----'_____. �
�
Design per person per day. Total daily flow.
Septic Tank—Liquid ............guDooy Length................ Width................ Diameter................ Depth................
Disposal Trench--2Jo .................... Width.................... Total .................... Total leaching area....................sq. 8'
Seepage Pit No..................... Diamctrr------.. Depth below inlet----'----- Totu area..................sq. ft.
Z [t6cc Distribution box ( ) ]�oo��o tuo� / ) |
~~ ` ' ~ ` ' |
Percolation Test Results Perfocoedbv-.--------_---------------------- Date..........................*
Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water.................-- �
Test Pit'No. 2................minutes per inch Depth of Test PiL--------- Depth to ground water---------------
'- ------------------------------------------
-...
'------------------------
'-'---'----'___-------------'-----'-----
� `^ Dmcr�ti000fSo�------------------'----------------------------------------------------_---------- �
No.....1..,, ....... FEE,..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® QJF HEALTH
.-----------•---OF...... "-`......................................
Appli ation for ighip ,oal lVorko Cnnnitnutgnn jJrrufit
Application is hereby made for a Permit to Construct ( ) or Repair) an Individual Sewage Disposal
System atr' � '. r':..: ,
-•••-••••...... k-''3. .... ..... .........
Lowfion-Address ________________________________________•-or Lot No.
p:�.:..... .:. .�........................ ............... ----........................................_.----
Owner Address
W ...... .� 4......... -- ----
�,
In ler Address
QType of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms.........:..:..................::...........Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ............................ No.'of-persons................................ Showers ( ) — Cafeteria ( )
Pa 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.................:............. `'
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............:..........
.
_ .,..
0 Description of Soil...............................................--._...._....................•----------------------------------------------.....----------------------------...........
-----------------------**--------------------- ------------------
W -•-----------•----------•----•--•..----- .................................................................................................................---....- ..... ....... --------------........................................ r
.....
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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a-Certificate of Compliance has be I ued by he boar f
Slglled..(..._,:. e".. Y .... -- ----•---•---Date --•----.....-
Application Approved B ..................
Date
Application Disapproved for the f of wing reason ..............
........................... ....... ................................._............................................._._......__........................... .............._..._..............
,.» Date
Permit No.--•-41'i�P ....... Issued............................. < •
Date
THE,COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH z
•. y t
.. ...... ...OF..................... ,!'7/ :,� l r....� :•._...
Trr#i$ilrttte of Toutphanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by•-•----•-•...... Ail :.. .. --•------------ ------- -------- -----------------•---------------•--•--. ... <
at . ...... /�G�� � ._t��..`.-- ----•-�`�. �`� ��L�� _.-•-----------------------••--.. •-•-- .................
-
has been installed in accordance with.,the provisions of Article XI of The State Sanitary Code as described in ttie
dated--------
application for Disposal Works Construction Permit No..........
r -. '"
u. * ---•---•.........
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......... . ----...... Inspector......------•-•--•.................. .•-••-...--•--•----.....................•••.
-�:e`•.s - :..:bra>..,..o-.J'v�.: '�d'!.�. J:-•:,�.Ei+rui.��y�ik.�e' � ��
THE COMMONWEALTH OF fAASSACHUSETTS
BOARD OFx +IEi4LTH
No........' FEE......... .!i
Disposal Works Tnnstrurtion frrmft
Permission is hereby granted....../ . /, °:... L '. ..------•-----------------------•---------•---•-••-•-•-•----....-••..to Co'n—strRc t ( ) or Repair (�`/�) an Individual Sewage Disposal System
atNo..... !........ . -•--...-•--•... ... ...........................•--......---------•••--••...--•--•......--
street �+
as shown on the application for Disposal Works Construcfiori�Permi't No i...4'�f ...... Dated........a�.� ... ,.......
.................. ---• -•---• ..
:.
DATE ....'1 ..•-� ................... Board xealth
F.
ffORM 1255 HOBBS & WARREN. ITYQ.. PUBLISHERS