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HomeMy WebLinkAbout0111 HARVEY AVENUE - Health �> > � a� � � 1'No.� J .... 2 f Fsa....... .© .. 31 � - � � THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH .........../.6�1-fr1�/.............OF..... ....... ...... .. ....-. :.._...._......-.-.... ................. Appliration -for Rfipoqlttt Workii Tontitrurtion Prrniit Application is hereby made for a Permit to Construct (r/) or Repair ( ) an Individual Sewage Disposal System at: (1�` ( GL --_...._ ?(11 - _t �CJC1 S. .Y�� -- Lo ation.Address 7 dr Lot N thu�r � yes � :..(�e�_�xl `�.rr►�s__ 45s //�(J� S 7-1 --.............•......... l�1J/-Q/�/ T �' ... a ....b'• 1 t_ /?�v-•-----".Y'..`^�e-'-'.----•-.../�.-1.. :.---------•------ --------�M-!!_[S.-.!V�l- �..r=---r-----•-•------•------I--•--••----•-----•---•-- Installer Address QType of Building Size Lot............................Sq. feet U Dwelling�No. of Bedrooms.____, '----------------------------Expansion Attic ( ) Garbage Grinder. ( ) aOther—Type of Building _____________________---- No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) Other fixtures _.__._... Design Flow..................................... ... tllons per person per day. Total daily flow__________..__... . gallons. w SCE l) WSeptic Tank—Liquid capa city +, allons Length---------------- Width-------......... Diameter.......... Depth................ x Disposal Trench—No. .....__./.......... Width---- ........ Total Length-__ 0....__.. Total leaching area-___�f_0sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area------------------sq. ft. y z Other Distribution box. ( ) Dosing tank a Percolation Test Resuts Performed by------- ----------------------------------------------------------------- Date----•----------------------------------- Test Pit No. 1................minutes per inch Depth of "hest Pit..------------------ Depth to ground water._.___.._________-__:-- (, Test Pit No. 2................minutes per inch Depth of Test Pit-_________--___-__- Depth to ground water------------------------ ------------------------ --- ----------•-••......-----•----•. Description it - " --- -- U e fla. --• ••--•- ---t-- - -- - W -- - VNature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------___-------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------Agreement: I , 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 f ier agrees not to place the system in operation until a Certificate of Compliance has been ' y t e ar o Signd__•..•. ..........D. .- Application Approved By______ _._ . ...................... ... ... Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- --.....---•---•--•--------••-•----••----------------------------•--------•-•-••--------------•---•----------•--•-•-••--•-••-•----•-•-•---•------••----------------._.....---------------------......... Date PermitNo................ Issued........................................................ Date M No------------------------- t� Figs.............................. .THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _... . .... ..............:..................................... Apphratiott -fur 4%ipoiitt1 W. rko C outitrudtntt Vaulit Application is hereby made for a Permit to Construct (-. .) or Repair ( ) an Individual Sewage Disposal System at: 1 i Location_Address or Lot No. L �e / a ............................................... - - ----e f/b &ir..�---------- I c �} -} �^ y�-¢ ^--- W �`- /7(`tom)�/1Tf-/L-/�ddress._....._ ._ ____-__-^-•---J____---•---•-••--•---_._....-•----•_______________________••••...._..-••._..._..._ Installer ' 't--'t 4 'Address- 17 U Type of Building r'-i; 1 `( S Size v Lot-. .................Sq'. feet Dwelling o. of Bedrooms--------___ _____________________________-Expansion Attic ( ) °G rbage`Gr-order�(�-) aOther—Type of Building ____________________________ No. of persons---_____-_-__-_..__--------- Showers ( ) — Cafeteria ( ) Q' Other fixtures .------------------------------ -- d W Design Flow______________________?__r> .__.__.-------gallons per person per day. Total daily flow..._._.._.__._._.75�.'0�___-.--.-.--.-gallons. C4 Septic Tank—Liquid capacitVZ llons .��Length________________ Width-............... Diameter................ De��tl .-.._-_-__..--. Disposal Trench—No________ __________ Width___ _./�_.__....... Total Length---� -______.. Total leaching area.-- ___�...... 1. ft. Seepage Pit No..................... Diameter______-___-__-----_ Depth below inlet.................... Total leaching area----.-- ---------sq. ft. .,z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by-------------------------------------------------------------------------- Date------------------------------------._.. Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..--_-_.-.---.---._..-- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-_.-.--.--------_----. -------•--•--- • --- ----• -------•------- ` ..................................• - O Description of Soil _... 1 ' -- x P t~. tI a, -•- \ [s '; r r1 ._•.{..... U / + ! f >L F �cp t ----•------ ----- - - - 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 NI of the State Sanitary Code— The undersigned fu tither agrees not to place the system in operation until a Certificate of Compliance has been issued by the jard-of h�e�Ith. i � Signed........ ' Date Application Approved B - ............ _ ,_.- " "p ;(" f f--f r�. -- PP PP Y Dater' Application Disapproved for the following reasons:........................................i....-----------------------------------------------------..._--------- -----•------------------------------------------------------------•.•.•..-----------------------------------•-•••---•----------•-••...---------•••-•------------,--------•--........._ ------------------ Date PermitNo..............--••=•-•--••:........................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... OF............... ... ��.::_�? •_:-: :�: ................................. mwrrtifirtt#r of Tomplitturr TI I SrZ Q� IFtR�IFY, /h �hg tidividua� w�atige Disposal System, o`� cYe�d ( 4)�Dr Repaired bY--••••••-•-••..-•--•---•••-•--•---•---•---•••--•-••••- /7 ,/`.�� Installer at : > •-`--+' f '�. _r = ---------- --------------•----------•--•------- ---•--- has been installeffin.accordance with the provisions of Article XI f he State Sanitary C de s descd in the application for Disposal Works Construction Permit No...... -------------- dated.--. __ , _.3......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® SAbGUAR4AN EE THAT THE SYSTEM WILL UPI TION SATISFACTORY.DATE----- L/ 1� -------------------------------•-• Inspector----• ' --- ---- !�� THE COMMONWEALTH OF MASSACHUSETTS f f- BOARD OR HE 641 ... ..O F....................................................-----.........--•-....--- ............. ... .... . ......... .... No......................... FEE........................ n Permission is hereby granted------ ,. _ !�,='= •: ,». = ' '< " to Construct or Repair ( ) an Individual Sewage Disposal System at No. � �-,..K.n`�✓ yt��'"ta. �-.',;,:�;,.�.»�'._''�[-•iF✓ Street n f as shown on the applicar for Disposal Works Construction P No. :.___ l �` y� •-••••••----•••••••••••- �J Board of Health / DATE... E% "?-- ---- ----------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS / ' l