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Home My WebLink About0108 CAP'N JAC'S ROAD - Health 1 og Gaff :'acs C enfe f ul 1/t m3 - a16 S M EAD KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORES MIN.RECYCLED INITIATIVE CONW10% CeNFled Fiber Sourcing POST-CONSLIMER wwwAproprSmorg SM1290 MADE W USA GET ORGANIZED AT SMFAD.GOBu L0CATI N 1 SEWAGE PERMIT NO. �.®T- 7 Ap� VILLAGE 2 INSTA LLER'S NA r & ADDRESS ` e U I L D E R OR OWNER C 5m ITJ+ DATE PERMIT iSSU E D DATE COMPLIANCE ISSUED 01 i - , �� NoP .:. ®.... YmB...r..............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF.......... C.J�.f.(1 S .. � ......................... .. Appliration for Uhiputi al Workii Tnnitri�rtinn ramit Application is hereby made for a Permi to Construct ( 9-y"o'r Repair ( ) an Individual Sewage Disposal System at: ..- . . .3c�L,.... .....! --------------------- --------- ........ ..------------------------------------......----............---- Location Address or.Lo No. - � _....... .......... ... r ...._...i�'----••-•-•------------------ ..................................................k:!!:=..................................... n ]_ Addrg`ss ......•... ......... .tij.=.1. ... .K, ............r........................ Installer Address as �..s l0`33 Type of Building Size Lo ..... ..................Sq. feet Dwelling—No. of Bedrooms.........�...............................Expansion Attic (09 Garbage Grinder 04 Other—Type T e of Building . No. of ersons____________-----_--__-_ Showers Pa YP g --••-----•----------••-•--- P --- ( ) — Cafeteria ( ) a' Other fixtures ------------------------------•• • - W Design Flow.................\�.fl-......._......_...gallons per person per day. Total daily flow___--__--___3 n---•.-----..-•--gallons. WSeptic Tank—Liquid capacit}'D o.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 ( ) Dosin tank Percolation Test Results Performed __._.._ �-aS-g� ------------- Date------.................................. 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........................ a ---------------- ------------• ............... ---•--------•---•- ---------------------------------------------------------------------- O Description of Soil------0-.-V)......... 1Qa!'�----------V......�4?.k?� � ................ ---------------------------------•-------------- w v ------------- •-------------- f c V-'�=\•.-•--- ----- �1�................................................ 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 TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate Ifol, as been.'�ssued by the board of health. W>- -kI- Application Approved By....... .•'................••-•••-•••••••--••-••••-•...................... Date Application Disapproved rreasons:................................................................................................................ ------------------------ •------------------ •---------------------- •---------------- --------------------------------------------------------------------------------------------------- -•--------•--- Date PermitNo..................................................._•--. Issued....................................................... Date t N�nPI/... ................... THE COMMONWEALTH OF MASSACHUSETTS �--.^� BOARD OF HEALTH ..._.. ,OQOA----------....OF........B... . .0,�..`:...a—�0_N.S�- ........ .............. . ppliration for Bispos ai Works Tonstratrtion 11amit Application is hereby made for a Permit to Construct ( &-j"'or Repair ( ) an Individual Sewage Disposal System at• GGr►1 wIj Locatio -Address o t No. .:.�.(1.1. : = ............................... . ...................................••------.... ............................................ caner Address Installer Address UType of Building ,, Size Lot •�.3�_._._..Sq. feet Dwelling—No. of Bedrooms_.........................................Expansion Attic 6 ) Garbage Grinder boo) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures .......... -------- •--------- W Design Flow................kLQ....................gallons per person per day. Total daily flow._-_. ............ ................. WSeptic Tank—Liquid capacit}j0.02..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_i a,_V.. ......_�n- m-.yc--_--.-_--.---_-- Date_-�:_ �._ - Test Pit No. I................minutes per inch Depth of Test Pit.._..._........_... Depth to ground water.___.................__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------•-• -- ----`•----......-•---•---------•-------••-------------- O Description of Soil...... .—.-�----... S Q �� - _ '.i_�_ W = 3C � "�------•••-- `t �' J - 1�'S............................................ x ---•---•-••---------------------•-----------------------...--••----------...-•--------•--------••------••-••--•-----•----------•------•--•--••----------------•••---••------------••------•....•-_•..... 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 TITIE 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. igned- -k.tri JQ_ •---` = y '`--... .............._.... �.„ ✓` e ApplicationApproved BY = .... _._................................................................. -----•-- Date Application Disapproved, t he following reasons----------------------------•-----------------------•---•-----------------------•-----------.....----......_..._ ---------------------------------•--•----•---.........---------•-•---------------•------.....-------•------------•--------------------•-----------.....---------------------------•------•-------------. Date PermitNo......................................................... Issued-...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......` .c?.t .n............OF........... c n.:a.. ... 1 ............................ Trrtifiratr of Tootphatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ,,Tor Repaired ( ) by..... ------------- ...........---------.....-------------- taller `at_ a �? --•--? ns------- has been installed in accordance with the provisions of TITZF 5�° e State Sanitary Code as described in the application for Disposal Works Construction Permit No.. .................. dated................................................ THE ISSUANCE OF HIS CERTIFICATE SHALT. NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL F CT N SATISFACTORY. PATE........-(- --�...---- ....................................... Inspector-. --•--•-------------•----------------.......--------....------------•------- f THE COMMONWEALTH OF MASSACHUSETTS Q BOARD OF HEALTH iR .......:7A..O.A.n..............OF..----..... n. . .1• - . ....................... No. FEE.. �i��ro��tl orko �.�tt�trttr�tioiT rrttti# Permission is hereby granted.......ut.p'n n ( = S_ ._.__.__ Z . . ---•---•--•-•---••--••--•------••--•-•-•---••---....-••......................•••- to Construct (_,�'"or�Repair ( ) an Individual Sewage Disposal System at No....... ........... V... _On .Y N U Street as shown on the application for Disposal Works Construction Permit NIV.I � a c Dated.......................................... ...................... ...-- --•-------•----••--------•-•------•-•---•---•-•....................._ Board of Health DATE------ FORM 1255 A. M. SULKIN, INC., BOSTON -` Sl u 4 t_�: �Aitrt!L� -� 3 �..00M �. •��, '• � • �, _ '� I . 3306-:P. D iSP_Y-nC_ TAWK.•• 330 x 15*67 49S u K l` 1000 ':ofSPoSAI.. 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