HomeMy WebLinkAbout0061 RAILROAD AVENUE - Health R&t.Roacy
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THE COMMONWEALTH OF MASSACHUSETTS
P
ARD PF HEALTH
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Application -fur 43hi laiittl lVerbi C omitrurtion Pumit
Application is hereby'made for a Permit to Construct ( ) r Repair ) an Individual Sewage Disposal
S tem at
--- ------------------------------------------------•-----------
L cation-Address or Lot No.
Gle ..�?5.PZ ..................•......... � �.�� �.` �...._............
2.4 Owner Address
Installer Address
d Type of Building Size Lot•---------------------------Sq. feet
U Dwell�—Type
No. of Bedrooms---___-_._ Expansion Attic ( ) Garbage Grinder ( )
------------------
aer of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' 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/A010-40-- Diameter____________________ Depth below inlet.................... Total leaching area.---___.._--._-_-_sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by------- ------------------------------•---...........---.........-------- Date--------------------------------------
a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.__.___._--....__.._._-
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-------------------
------------------------------------------------- ._-_
0 Description of Soil----- iL�---_-------_----_- -------�_ . . ,��a.
x --------•--------------------------------------
V ------------
V Nature of Repairs r ritrations—Answer when applicable..._.__... ..............................................................................
.............•--••----•---••----•-•-•-•--------•-----------•----------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en ' ued by t oard of health.
Sign -------------------------------------- - ----- --K
' Dat§�
Application Approved By------ G - ------7 7
Da e
Application Disapproved'for the following reasons-------------------------------------------------------------------------------------------- -------------------
-•-------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued...................... -------------•---••----••-------•
Date
No. 'fit? Fas............""""".........................
THE COMMONWEALTH OF MASSACHUSETTS
E ARD PF HEALTH
Appliriation for 13i�poiittl Works T #rratrtton rrnai
Application is hereby'made for a Permit to Construct ( ) (Re�pair ) an Individual Sewage Disposal
S em at
► ._ _.:1 �
canon-Add �//� y�[if or of No
Owner Addres
a Installer Address
Type of wilding Size Lot............................Sq. feet
U Dwellin No. of Bedrooms__.__._. Expansion Attic ( ) Garbage Grinder ( )
-•--••--_---•----- - S —
aier Type of Building ---------------------------- No. of persons----.-••---.__....-_--•-•.-. hovers ( ) Cafeteria ( )
Q' Other fixtures _._. -------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity------------gallons Length................ Width---------------. Diameter---------------- Depth.--.__-_-._----
xDisposal Trench—No- ____________________ Width--------------------- Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No. '-_,40. -40_- Diameter____________________ Depth below inlet_..._..__........... Total leaching area..._--------------sq. ft.
z Other Distribution box ( ) Dosing tank`(_ )
aPercolation Test Results Performed bY-------------------------------------------------------------------------- Date------- ---------------------
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth,to ground water...__-_.-___.--_._.:.:-
Gz, Test Pit No. 2..........:.....minutes per inch Depth of Test Pit-------------------- Depth to ground water--------------------
---- -------------- ----
D Description of Soil " `' ' t ------------------------------
V ••--• -' •• ----•---•----------•---------------•-- ----•------•-------------- ------ - --- -----
UNature of Repairs 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 been ued by t oard of health.
Sign D1O._
,« at_
Application Approved BY------ - ----• J ' ��'1- ► `
Da e
Application Disapproved for the following reasons-------------------------------------------------- •-------------------
--------------------------------------------------------------------------------------------------------•------------=---------------------------------------------------------------------
Date
PermitNo.•-••----•••-•--•---•----'•-----------------•-=-------.... Issued.........................................................
Date
THE COMMONW,€ALTH OF MASSACHUSETTS
A
BOARD O HEALTH
-
3 .....j '1'4.. ........,OF............. 444
........... .
T.rdif iratr of Q.,omplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal-System constructed ( or Repaired ( )
I alter j
has been installed in accordance with the provisions ofe XI of The State Sanitary Code as described in the
dated _ ..application for Disposal Works Construction Permit N ... .__..�.__� _ 7` it?. ,
THE 15SUAIdCE ,OF THIS.CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
DATEX,
d/1'1 ...�f.. 3 f I ector r 1' '+�' --------------
-
THE COMMONWEALTH OF MASSACHUSETTS
r
.�~� f BOARD HEALTH
{
' ' ?.. ..:...OF.... .. . , + !. .... ........ ......................... 'J-_
.. . . .
NO.•-----. -_ "- FEES
el
NPermissio
n •� eby granted---- -- -•-- --------
to Constf or R an Individual Sewage Dis
ato. l . �.. __._.__..�..�..r+
i*y r�-tAoe..m.l4t e_rNn-t-it------. ..........................
.. k... --_1 "
S t re,
as shown on the application for Disposal Works Construction,P mit No......... .v D _-__ __(__ �'�._._..
----- --
Board of Hea th
/� ✓ r ....._....._
774
DATE _.-. ------ -----
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - -