The URL can be used to link to this page

Home My WebLink About0008 FERNBROOK LANE - Health 8 Fernbrook Lane A=208—085-008 Centerville S M E A D Na Z4UWR UPC IUU �nwdoom • Yaa.w ud► MM" . V THE COMMONWEALTH OF MASSACHUSETTS Ock, BOARD OF HEALTH .OF......... /g.�lv�_!. , ppliration for Uhipaiittl Works Tonstrnrtinn Vamit Application is hereby made for a Permit to Construct (1/11"or Repair ( ) an Individual Sewage Disposal System at: Ce- 1` ��.lf ... .................................. Lo on• ess r Lot No. ' �.�-P�...... �� r n ld.... .c........ -•..........................0 ................................................................. n ` Wan D Address - /l�.i-C - .... ......................•.... --....-•--^•---•.............................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms._..... Expansion Attic (NlJ) Garbage Grinder (�c/d/ ------------- aOther—Type of Building ..&VO& v--- No. of persons......,Ste............... Showers (2) — Cafeteria (N0) Otherfixtures .......V_!�•N 17 -------•-•-----•--.....-----••••---.....---•----••-••--------------•••-•-----•-•-•--•-------••-•-•....:---•--....----------- WDesign Flow............Y,,5.........................gallons per person per day. Total daily flow...........V3..(.]....................gallons. x Septic Tank—Liquid cap city 4 .0.gallons Length.__l.O....... Width....4......... Diameter..-__1�.__.... Depth....e........ Disposal Trench—No. _ ..._..... ....... Width.................... Total Length.................... Total leaching area......1-&4....sq. ft. . Seepage Pit No..................... Diameter.................... Depth below inlet....._.............. Total leaching area..................sq. ft. Z Other Distribution box ( Pr Dosing r,.,A Percolation Test Resul Performed b , , ......... C------------------------------- Date........ ........ Test Pit No. 1 �..d1_minutes per inch Depth of Test Ftt.................... Depth to ground water.._ � � Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ...............I............-�........... ...........,......-•r.................... - --"............_... -------- O Description of Soil....h4s ... S v �C91_ --•-.-..L...3..............M Y -- x W ----------------------------•--------------------.........------...--------------------...•-----....---•-----------....:-----------------•-----------------------------------------------•---•-•••...... VNature 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 iIHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Cqrtificate of Co lance has been issued by the board of iealth. �....••. ..... _.. .. ...a•1`--- //�� c ate A lication Approved BY •--•--�"�. --------- y ..:vlr- ...---•--, •-�........... .....-•••-••••-•.•-•--- Date Application Disapproved for the following reasons:--------••-----•------••--•-----.....-••...-------•-•-•••-•--••---------•-•...................---..........--•- ..............•---•--•--•.........---•---••-••-----•....--...:2.........---.....--•--••----•--•---.._.....-••---•--•-•-••••--•--••-•-•-----...-•-•---- .......... Date PermitNo......................................................... Issued........... ........._....: y + No.......................... Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ ..............OF...........:......................................-... Appliration for Di_npasal Workii Tontitrnrtion Permit Application is hereby made for a Permit to Construct ( , ) or Repair ( ) an Individual Sewage Disposal System at: ..........................•-•---•-•----..................--••-----•--------•----•••......._....... ............................................................................................... Location-Address or Lot No. .............................................................•_----..__..........I......._........ .....................-••...........................................__......._..............•...... Owner Address a ............................................•................................................... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther 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.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G� Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water._._-__.-_--____-_-----. c� ._..--•••------------------------•---...........•-----•--••-•-•••••-----•-•--••--•••.....----•---••-......................................................•- ODescription of Soil........................................................................................................................................................................ x u ---------------•---•--------••-•--•-••----------------•-----•--•--•--•-••----•----•--••••---•---•---•••-•-•-•--•--------•-••••......-------•--------•--••--•--------------•----....................... 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 TITLE 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. Signed-----••------•----•-----------=•----------------------------••--•••............. •. ......-..........._.....•••-- Date Application Approved By----------------......... ••---------•-•---•------ Date Application Disapproved for the following reasons:......................--•••-•---••----••• .................................................................... ..............•--••-•--•-•---....----•-----...__...---------•----••-•------•-----------......------....----••-•---•---•-•-----•-•••••----••-------•-•--•---•-------•-......----•-----•----••-.......... Date .. Permit No.......................................................... Issued......... ----��------��•--------•--••------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtif irate of Tompliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( fi or Repaired ( ) by-••----•--•................•-...-•-...---••-•....--•-•--•---•---•--••-----•----......--•-----------•-•---•-•---•-•-•-----•--•--••••-------•-----.............--•------•-•......•....-----•------•-- Installer at---------------------------------------------------------------- •--•------------------------------------------------ ------•-------------------•-----------.._..-•--•--•-••-•-•-----•----•---------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.--------r`_.___f -------- dated-------.--------........:....................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS,, RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r DATE .............. ;................................ Inspector............ ------ ---...._..._.........-•---•--------- I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF....................................----••---.....................• . _----............ NO................•---..._. FEE........................ BiiiVoiiat Workii Tonitrtwtion permit Permissionis hereby granted------------ -------------•---•-•-•-•-•----...-----•---------....__.._..-------------•-------------..._....--••---•--._...................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated.......................................... ----••--•--•----•------•••-•--•--•---------•----------•---------------------------•---•--•------••--•-- DATE........................................................................ -• Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON �,t►.IG1t FAMtt_Y - 3 BGORooM I`��'�� ,��, ,� (� .• . 1.Jo GARBAGE 6Q'wOER. W I r ^� �v ��34•S c�/k,,tLy F�0W Ito . 3 = 73o6.Rs? 7 _ 1�eA�i1 !�EPT%C. TAOJIC = a3ox15o% =A976.R 0 E 11 '�SMT I '.'�3-, v U E- %000 GA%-. -A I d 1131 '4 TIA lip 0ISPD3AL P►"T u's Ivo0 GAL. + � I ,,1,1/ 2$• / ��'�`ti. eATZA StD4w/pt.� A2GIa = 1105.E t3sS�►ss i 1 dd/ 150 5.F 2.5 r 375 G.P� rl I .I.TM. BOTTOM AIZEAt .. �O S,F, 'I 3 / OR 50 $.F x I• o 5o G.PO t1' �� \ N� 31.�N -7OTAt- D .4.25 G.PD. Q3�G^��31 1 'TOTAL DA I LY F%-OV4 = 3 .Po a 3o GI I t / ot,AT1oN LZATE1 V'IfJ 2MIN C>V"G5J n� qet Fe op ri 72 f'fTEf" `': :, tp� �rz�.iE- �G.qLU ,2' MCHARD Na 241Y1t1 oeI 'cam 1 ae.3-MA I at•3-- ST'-- I TOP FNO=�Q••5 32 , Ar Iocu IN'J. S(1 0 1 L. a G DIST. INS• G41.. 56vt�G 3 1000 BuK 3S� -TANK to INS. GAL. IM LEALII P► INV.PIT32,2 met) wlTu 60a6& WASuSID 6TuN6 - , GE2.TI Pis D PL•o•T1 PL-A-w PR.UFILr.= LoGA-T1oN �E:W'ts12V1U4. 20 IZ� No SGALE SALE � It AO yATE II -(.-8� �f o WATU- ( I P�Sb'� p t,p,w REF r. M GE 1 GE AT 'f 1+E r GUSL S»cVYN NE.R6o►•1 GOMPI-Y5 Y�►TN 'T NE S I oE►-tN 1= LOT. ( I AWP S6TeAGK CL Qv1R.EMEn1T> F -t1•�� -To w N O F DS �3 br^LI�hT A v�v ►S N N I� G , C , (4q� 2. LOCATED ITN►Ve, TE.= �t 1 ,r_•. . .�._ BAXTEiZc IJYE INS• T4l►S PL&N 15 N� f3n�jC�D pId AN OSTE2VILLFs • ASS• I►J5•T-R.VMEWr SVeVC-Y �-TWE O1'FSE-T5 Suou� .DAG ( E o-T E_ V O TcC p e7 e?./'N l l4 s Lc'�' S I N E�j A P P�.I C A►J'r `p r�d�1 C L O CATION ✓ SEWAGE PERMIT NO. (—a+ 11 �--c1�,vgr,06 VILLAGE INSTALLER'S NAME i ADDRESS 5 co may ,,4005 w'Ls B U I L D UR OR OWNER DATE PERMIT ISSUED �1 DATE COMPLIANCE ISSUED 1� I s d a vim.