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Home My WebLink About0011 DEEPWOOD CIRCLE - Health 1 1 Dee pwood Ci rC le 16 9-013.010 Centerville No. 4210 1/3 ORA O ESSELTE 10% o 0 0 p No. ,:!S THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l(o ?0 Appliratinn for Dhip iial 10orkri Tonstrnrtinn Vamit Applicatn is hereby made for a Permit to onstruct (LJJ or Repair ( ) an Individual Sewage Disposal system at: ' ...........4.G r �c>......1 .� CuA .........�-/.z ....c /..-sR T..'. ........ Location-Address or Lot No. Dvs'C din.Yq T/vs . il,rP✓ci,G .......- .................................................... -----------•----_.-.. Owner Address Gs Installer Address Type of Building Size Lot.!?i.Z 't;5 .....Sq. feet Dwelling—No. of Bedrooms............. ..............................Expansion Attic 4/j Garbage Grinder (1vj �90�.............. No. of ersons......_.�____-__-______- Showers — Cafeteria pa., Other—Type of Building _ _ _ p ( ) We) Q' Other fixtures ------------------------------- -- W .Design Flow............ ....... ...,.._.._gallons per person per day. Total daily flow.......................3-7:3...........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 (+-I Dosing.tank ( ) 4 Percolation Test Results Performed by...... « �i4.h�z................................. Date........ -6� —k ?. _.. Test Pit No. I........A---minutes per inch Depth of Test Pit........Z`R-._Z.. Depth to ground water.ti'2.............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ W •-••-•----•..................••----------••..........__...--•-------------------•--••-------.................................................................. 0 Description of Soil-------------0-`� --------••-------•--------------------------------------------------------------------------------------------------------•---------------- U ---------•--.......---•-••--•-•-••-••-•�.'_ .. W 7— U x. 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 L ITLE 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. 4 .......................................... ..--5-- ate Application Approved BY------. ±-�.... _-_:C"" ``............................................ Date Application Disapproved for the following reasons-------------------------------------•-------------------------•----------------•---------------••---------•----- ....•-•................ ...• ---------------------------------- •--------.... ----------- Date Permio--------------------------------------------------------- Issued..................................................... Date a_ No..� Fes$...........:..............: . ^3�l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ru. . ..............oF.. .--may A � ApplirFation for Uhipogal Works Tonitrurtion amit Application is hereby made for a Permit to Construct (" or Repair ( ) an Individual Sewage Disposal System at: ......-••• ...... ............................. .......................................... Location-Address or Lot No. i r7 �(�.11�'ii.t� T/—s,-- (fP•t�7-R- .< & ----••...... --...................... --•---•---•---.............----••--...... ----••----••............------�-•...... ...•-•---------•---------•-•--•-.........•`--- Owner Address ai r �/ C`CJ ✓„7�u rT/G�t. c✓.7 7'PiYiiC •••.. ........ ........... ..----------------------------------- ---•----------• ---•••--------•---.�..ddre•-••-------•-----•---..............._..-•---- PQ Installer Address �11 Type of Building Size .....Sq. feet U Dwelling—No. of Bedrooms........................... _Expansion Attic '(✓ Garbage Grinder (N9 114 Other—Type of Building ? .............. No. of persons-------- --------------- Showers ( ) — Cafeteria we) Q, Other fixtures --------_-------------------- - W Design Flow............ ,<G........ ..........gallons per person per day. Total daily flow_.__.......--_••----_--� .--_._.._...gallons. � Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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----- ..r�.._.Q'`?k?�:'................................. Date.__.•...C9..............................�`"� ..,`�a Test Pit No. I_.._.... ___minutes per inch Depth of Test Pit......... Depth to ground water._ti............... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.-.._---_--___--__-__-. a •-•--•••--•-•.............•-•••-••••---••--•-•---•---•----•--•--•-••--.....................-•-•--•--........................................................ Descriptionof Soil -�•••--••-•---•-•----••••••-•••......--••-...•-----•-•--••-•-•----•-------••••-••--•-•--•----•-•-•-•••-••......----•-......•--•••................ - —2 - t. 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 provi ns •iTTI_E 5 of Vie=.:State Sanitary Code—The undersigned further agrees not to place the system in eration I a Certificate of Compliance has been issued by the board of health. j -------•----•-- Application Approved B = C� G .... /-J- .1:.. Date Application Disapproved for the following reasons----------------•------------------------- -------------•--------------------------------------------------•-••-- ---------------------------•-•------------••-------•-----•--...------------------•----------•---------------...--•...-•-•-••••-••---•••••••-•--••---------•---••--•-•-•--•---•-•••----•---••-•---•------ ` Date PermitNo......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Qwrtifirttt� of TompliFanrr THIS IS CERTIFY, That the Individual Sewage Disposal System constructed (y.) or Repaired ( ) . by........... ..... f...........__._._...._..._.....t............... Installer J at••--••......•-.." -`•- ......•.T_. .._ s((� .__..........-.........L....------------- has been installed in accordance wgli the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposai Works Construction Permit No.-_ ._' �� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS UE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 0 DATE--•-•-----•---j--.1 .`.- ................................. Inspector............. ........ ....... ............................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t OF........................................................................---.......... .......................................... FEE.. ......... �i��o��aa+� "ork� C�on�#rion �erani$ Permission is hereby granted......1++ :��----•----------•--------•-•••••-••-•--•-•-•-•--••--•••••••--•------•-----•--•••-•--••••......---••-••-•............. to Construct`(. ) or Repair ( ) an Individual Sewage Dis osal ystem rr — Street ._-... as shown on the application for Disposal Works Construction Permit N�o�`- __".,�_.___ Dated-__�_t t��._. DATE.............. l -------------•-••-••--- .. Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS S 1 U FA NA 1 t_,y I.�o Di5 S Pry.. . Toe- _...U'�x�c._ t vacs �.A-c..r ._S�'P� T�►..i Y� v1 5 G AL- t_cflk-c tA Prr ' \N 13 1 U S T�tit T`0 Pr�ZGv � ��ivu 2�r�� L z µ►u.S��,,G�a �aLp- ,,�A- •fit; �� f:.-s .t� QF WILLIAM G. PETER 8 N SULLIVAN r�o. .9 3a No.29733 a `N i 0 AL E G, TEST ya!E / 4o/7 / A/1/. /,yv /.v✓. GAG.; BOX �00 v 3U�5� '�� ,S,EprrC z., ►,. i • Get, 7,v.vrc \0 • FT •✓ �� , 3G �E,2T/F/EO PG OT p1.441 Y SGdL6 =I QU QftTE 3. Zto .&S u lv.b T G, .4T' SA/aw.v97 �/E.�Eo v_.GOMPLY.S Wirx�TiyE'Sid�A✓iciE 464Y72F2 /tic. •4N�.ffT.-l/-1G� .2EQv/�EN!�NrS d� Th'� ieE6isr�.ec�l..�tivo sli,2ciEya,Ps G�S ,2li/LZZ a. �l•Qs.� 3 �2 G ► �� C /.S 'S/o/-- AV M-`r7,,e- - • •sh�K/�yE.e�GN S.4'000��/a7--lE US.E.p. ob Pao G 'r'rr Vl i7 y647 - D C) OF��Ii PETER �G SULLIVAN 1 •a�0 ��cIS4�4a�� . ONAL 400CATION SEWAGE PERMIT NO. VI LLAG E �+s '� 1-x � 16' l LLL INSTA LLER'S NAME i ADDRESS m g- BUILDER R OR OWNER 0 abQgn DATE PERMIT ISSUED .. d DATE, COMPLIANCE` FSSUE'D - w a Ely F TF ' o ♦� l . Y y •S