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Home My WebLink About0020 HAYES ROAD - Health 10,Hayes Road Centerville A=210 - 102 t No. 42101/3 ORA ESSELTE 0 0 0 0 ti J -- i is �s No A/ �?�,1..... Fps ................... t THE COMMONWEALTH OF MASSACHUSETTS '; BOAR® OF HEALTH n� .....................................O F..........................._....... Appliration for WspviiFai arks Tnnitrnrttun .rrmi P � <I —2- Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:,,-, C72C?............. t Y. -5--:----.. .�1-- --- ----....-........ ------------------�=°=-?'`........ ......................................... ---Location Address r Lot No. 0 ......---/�-.lf 1'.--/V--4---------- _.a._6--� ---L=a �r.... ".E /rx...1 - ' Address Installer ¢r— Address ., Type of Building L�"� Size Lot_.Za,,,.A.Q'_a....Sq. feet a Dwelling•`—`"-No. of Bedrooms............ Attic ( ) Garbage Grinder `•-4 Other— e of Building p-, gyp � g No. of persons____________________________ Showers ( ) — Cafeteria ( ) 04 . 'Other fixtures ...................................................... ,. w Design Flow..............l- _________________gallons per person er day. Total daily flow..... __.3__ ......................gallons. W _ Septic Tank—Liquid capacity.t.0(Jgallons Length___ ______ Width___._____.._ Diameter________________ Depth____ x Disposal Trench— _____________________ Width.................... Total Length.................... Total leaching area............... ..___sq. ft. Seepage Pit No_______ ___________ Diameter______!�_..._ Depth below inlet___.b__......_..__ 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........................ 9 -•-•--••-••-••----------------•----•------••-•---•--••---•--•••--•---._...-•---------------.._............................................................... 0 Description of Soil.............................................................................----------------------------............................................................. x 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 iIT1 if- 5 of the State Sanitary de— The undersigned further agrees not to place the system in operation until a Certificate of Complianc as b n issued by th board of health. 2 �PPlication APPr Y -----------------------------•-••------------._.......--•-------••. Date Application Disapprove or e f oll ing reasons:--------•-----••--------------••-------------------------------------------------............................. ----------•-••---------------------•--.._._._..--•--•---------------------------•---------•-----------------••-•-••--•--- ----•--------- Date PermitNo.......................................................- Issued....................................................... Date V N `.� .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..------. -- ....-------•----------OF......................... Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: p2.CJ.......--- . ...... ..... ..... d Location-Address --- :- -- ---- -------•----------------•----........••. or Lot No. Owner „„ Address ---- f-. .......--- -^..__ =_ .. ... � :..R t! ........................•---••-------•----•--. ....._.........-••--...-•---•...........-----••... Installer Address Type of Building Size Lot ,el_A,:.4`____Sq. feet a Dwelling—No. of Bedrooms...........ter............................Expansion AtticGarbage Grinder �) aOther—Type of Building No.No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow............. .....................gallons per person per day. Total daily flow.._..?-•_�?•••0._........... ......gallons. id W Septic Tank—Liqu capacity/<: f).gallons Length.•_ . Width...... ........ Diameter__-_-_-_____.. Depth.�....__-- x Disposal Trench—No. .................... Width.................... Total Length................. --- ft. Seepage Pit No------/----------- Diameter......ZZ...... Depth below inlet...4.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed by-•-••-------••-•-•-•---••••-••......................•--•--••----•-•--•... Date........................................ Test Pit No. 1--_-____---_-_-minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. 0 a ................... --•------••-•-••---••-••-••--•-••••••....•••--•-•••••....-•-•.............••----...__---.......-•---......•--..._••--__.____....._....... Description of Soil........................................................................................................................................................................ W U -----•----•-•--------••-------•••••--••-••--•--...•-•-•--•-...--•-••-....---•...-•--••-----•--•---•--••----••••••-••••----•---•----•---••---•---•-------••--•••-••---•••-...-•...............•-•-•-•--- W x --•-•-•-----••-----------•------••-------•-•---•--•----•---------•••-•-------••-•----•-...•-••--••-•---••••--•-•---------•------••-••-------•-------•--•••-••-•-•••-------•••-•---..-••-...---•--_--••-- U 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 `de— The undersigned further agrees not to place the system in operation until a Certificate of Compliant has b n issued by the board of health. f ---.... - .� �. ...�, --- ............. s _ e �f 7pplication App y 7 �l/ Date Application Disapprove or e foll ing reasons:-------•------••------------•------•-------------------------.................................................. Date PermitNo......................................................... Issued•---•--------•-----------------------•-•-----__._...._. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF C9rdif irtt#r of Tumplianrr THIS. /IS TO CERTIFY, That the Individual Sewage Disposal System constructed (</ /or Repaired ( ) .................... --' �' Installe�/ � -_:�- �= -------------•----..................................................................... at ••-••.• -•••• --••• {= has been installed in accordance with the pro'visions of TI p �� 5 o��he State Sanitary Code as described in the application for Disposal Works Constructio ermit No____ ___ Ioo 1 Z dated------------7- •---•• 1 `-f THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FU CTI N SATISFACTORY. _ a DATE..................1 � .......w....................................... Inspector.. ..._ -••-----------.............................................. - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF... ............_..._.................. .-.............-...................-..... No........................ ` -,, FEE.5.U............. �io�ru,��ttl-� ur�� un�#riun �eruti� Permission is hereb granted•..- ':'.-._ ?% . •••.-•--•••--••••••-•-•••---•---•-••-•-•-••--•-••••.....................•-..........______---______ to Construct or epair ) a Individual Sewage Disposal System at No ' 62 ............................................--------------------•-----•---_-- Street as shown on the application for Disposal Works Construction Perm' ....................• Dated.......................................... --- --------- DATE.................................... - Board of Health-•------------=�--••----� - FORM 1255 A. M. SULKIN, INC., BOSTON rM i �,o1►JGtL FAMILY - � BEDRooM f q ►.J D G-,�:t`2BACsE (j t7J N D E R. \ IL U� L F%-oW 110 x 3 = 33oG.Po II SEPTIG TAtJK = 33ox 15D"/. = -49 f G.P ij u51c l000 GAL. ` e II o15Po5AL PIT u5E t o o o GAt_. P��-C'� C6 I _ � � 5%DGYdAI.L AcZ.GL+. ►�0 5.F ' 375 G.Po d 50TTOM p2EA= Imo S.F._ 1• 0 5 � .o G.P 'ToTAI-. C> 2- -TOTAL DAILY PG2CoL-ATI0K RATE : I''IN 2MIN C>Q-1_E55, ,_ 48 - / .J R Y EVo u.; fir• ': IVY{,�a, �� ,{ (�, 3� 1 10 LI =ct �► Top FWD = •�00•00 T6�T _� ,ZZ.�d, �G ,•y�r GaA/n ' 1000 t NVCJ SuIL_zs DIST. INS. GAL. C� •- - I BuX SEPTIG I c� 1 I o00 �N�it•-. r �L••� TANK R I o� U L6ACt1 \ PIT '10, IIL Z 4 , WITW WASI{GD KC D C C c litter Q 6TvµE day (J0n atT-kPJlE.: L4A .IVt.. n .0 GE2TIFlt=D P%-oT PLAt-J C P4ZUFIL� ' ►� L o c A7 10 N ! Cs=UTEY DAL a : I = �DV AT el1 CERTIFY -THAT 'TNtc SE 5Noww HV-V SOW GOMPL\(5 Its A Q P SE-t5AGK RF=Qv►a.EM6NY� -TowN Ot~ U�fZ-1-�5T7��=.ANo 1S �o �GI�- IrIQ�/�►J (+-,)\k)AC LOC, .TE D W IT W TN'6 1~LO0D PL,&.I W p� xTGV-r- Wye- INC. RLS6157 f:.Q1QD'I..AN C>5 u V V EYoi�S Tu15 PLC\PI 15 NET oIa A ` o3-rE�vlu.E - MASs• (� 1N5-1`R.uMENT 5u2.vE`( --THE 0I=F5E'T5 S"OUL.D ' No-T (3E uSEOTa �ETE.(z.1�!1J� L.o�' I_INE�j APPL.ICA►�T I��J�J'1- A