The URL can be used to link to this page

Home My WebLink About0100 EMERSON WAY - Health (2) (O o EA&O rA n �d SMEAD No.2453LY UPC 12934 smead.com • Made in USA Susraw,BLF FORESTRY w IATIVE wm-d Fiber soumWo LOCATION „ SEWAGE PERMIT NO. V'r C A I -� O VrG 1O-lj INSTA LLER'S NAME & ADDRESS B U I L D E R OR OWNER I DATE PERMIT ISSUED ► � _ X4 - 25 DAT E COMPLIANCE ISSUED �zZury - f I(i c Psi Scene -g tj i 61—A ccr c Prr, A5; 16w v �� a t r �� No..... .5._...l Fps.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF_....................................................................................... Appliration for Uiipnaal Works Tnntrurtiun "rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...._...._llz_ ............ ..... ...............................1..a.w....................................................... Location-Address or Lot No. ......................... z .>.—. ---...�.7..........................------ nner Address Installer Address Type of Building Size Lot.................... .....Sq. feet U ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .................................. W Design Flow............O.S --------------------gallons per person erday. Total daily rflow........... ..` ..............gallons. WSeptic Tank—Liquid capacity.I.&Pgallons Length.. ............ Width-Al.."'.. Diameter...-............ Depth........_....... x Disposal Trench—No. .................... Width.......o ......... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...1-------------- Diameter..../.Q._...... Depth below inlet---�.. ......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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 ••••-•---•-----•-••••--------••--•••--------•-•------•---------•--••.........-••...............................................•............•-•---------..... 0 Description of Soil..........................................................-........................................................................-..................................... W U ....-••---•------•••••••-•••--•-----------•---•-•-------...•-•--------------------•-------•--•-------.....---•---------••-•-•-•--...--••-•------•---•••--••------------....---------..........---...--••- W x •--•-•--•--•---- --- --------------•••• -•----•---•--•••-•--•-•--••--•--•••-•-•-----------•-••-••-----•-•••••---------•••-••-••-••-•-••••-••----•---•---•-•••-•-•••----•••••......--•--------...------ U Nature of,Repairs or Alterations—Answer when applicable...../_Q_-G.Q--_...5�_T N. --------- _. ' t :...�p�t- ' ..-----=-- c1Y�:�.o.................. ti�`'-....Nr J5.................................................. 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 Complian the boa of h asp Signed •-- -•- - -•------- - ---------------- •----1•----•--.........._.... Date Application Approved BY ---•-•.....�_.�. _-•2-q--g Date Application Disapproved for th I 911owing reasons:.............................................................................................................. -•------•-••---•----••---•..............••-•-••-•-•-••....-•-•----•---------------------•--•-•.........---•-----•-------...----------------------•-•-•••••-----------••--•--•••-••---•---•--•-••-------- �( Date Permit No.............g .� 1_ •-- ...... Issued.............. ........... Date ..+.+► �J No.. ._....._ ..l off, FEs.......J . :. ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....-• ......:........................_OF.-.......-.....--........-.-..-........------•-••-------..-..._......_......_...._..._.__. Appliratiun for Diupuual Worko Tunutrur#iun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Locati n-Address_ or Lot No ........-•............... :i -- •---•__....._ Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ____________________________ No. of ersons__.____._._____________.___. Showers —yp g p ( ) Cafeteria ( ) a Other fixtures ___________________________________ W Design Flow.....___._..'.S.. ....................gallons per person per ray. Total daily qow______.__._- '_` ..............gallons. WSeptic Tank—Liquid capacity_1.41-?gallons Length.5�____..... Width... Diameter________________ Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area__..................sq. ft. Seepage Pit No.._/-------------- Diameter.___./ ._ ___ Depth below inlet....4/1.._......... 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........................ GPI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•------------------------------------------•-- -------------------------- ••-------------- •--......................................................... 0 Description of Soil-•--------------------•-----•--•--------------••---------I-------------•---....-•---•--•---••-•-••-•-••---•--••-------•••----••-•••-••---•-•..._._.._...._-----------••- U ----•-•-••••----•----- -•-••••---••-••----•-•---•---------••------••--------------••----------.._.__.._...•--•-••-•-•-•......--•--•----------•••••--•--_...-----•---._.......---------....-------------- W VNature of Repairs or Alterations—Answer when applicable �?Q d_____ _."'?"i4lR! ._._ 0 4 - ?_ -: F ._.._ -..._._._',,,3` ��5!� '�`� .:--•-----�.._._i�i_5�:.....��'e}Y ................................................. i Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLij 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliancs5u the boaO of h Signed .. rt r„= _ �E�2! ....... Date Application Approved By.......... a I* 25 Date Application Disapproved for th f llowing reasons:......................................................A......................................................- ......................................................................................................................................................................................................... Date PermitNo....................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALtH ....... hf'`: "."...........OF......... -'r't..✓..!? ............ .......... (Ier#ifiratr of Tunmplittnre. THIS ISCT�a.CERTI•' Y, That the I 1 ewage Disposal System constructed ( ) or Repaired ( ) d( Installer at...................................lO_ 1f' r' .Q._4'�►- . .....................................................•-------...--------••----- has been installed in accordance with the provisions of TITLY. 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_.---_____-__, _,_._.__.-_..__.___._..._.._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............... ..-.¢_' ........................................ Inspector.................. - � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....I.�l.i. FEE........................ Diupu Worko TungU ion Permit Permission is hereby granted....------- - .'" .T.rr ......... L .................................................. to Construct ( ) or Repal-r 1 ) an Individual Sewage Disposal System -- ------- --- - Street --- Dated--- l .� . as shown on the application for Disposal Works Construction Permit o. RF°w ` ••-----------------•---- -- _--._........_......- Boa of Hea t DATE.--•• t r 4 FORM t.12.55 A..M-SULKIN• INC.. BOSTON t �i T d � , SD, ov �0+ IT\ 1 'EAAF- ZSa ;V WAY' M 3 3Fo Qaow� y� d