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Home My WebLink About0149 HILLSIDE DRIVE - Health I �q Ni I I sijt d r C�fi�rv;I l� �q3 - n ►8 /// SMEADI KEEPING YOU ORGANIZED No. 12534 2-153LOR FOREMY MIN.RECYCLED INITIATIVE CONTENTIA + CerdedFiherSaurcinp POST.CONSUMER W-laproOramarp sr�0=0 MADEWUSA GUORGA MOATSmEAD.M i No-- THE COMMONWEALTH OF MASSACHUSETTS BOAR® 9F HEALTH � .................OF....... AV#ftratilan for Disposal Workii Tnn,strnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( -k) an Individual Sewage Disposal System at: U ......d6w..;e oc ion-Addre or Lot No. 1r1 - ✓ -�- .... -------------- .... wn ................... Address .......----••----------------•- Installer Address UType of Buildings 1 Size Lot............................Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `A Other—Type T e of Building __•_---____--- No. of persons............................ Showers W YP g -------------- P ( ) — Cafeteria ( ) a Other fixtures .......................................................•- WDesign 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 ( ) a Percolation Test Results Performed by..... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - ------------------- -------•----•-- Descriptionof Soil -----�.... ------------------------------------------------------------------------•-•-••--•-•-••... x V -----------------------------------------------------------------------------------•---.....------......------•------•--...----.....-------------------•-----------------••••-......---•-•-------••••-. ----4 ili -------- U Nature of Repairs or Alterations—Answer when applicable---------44---'' - - •--...-•-•---------------------------------------------------------••-•••••••.....•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'L U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued by �_�bod.of.heal th.Signe .. !� ..- 1l . /7 Date ApplicationApproved By.............................,..... ........................................................ Date Application Disapproved for the following reasons--------------------------------•----••-----------------•..................................................... ........--•----------------•---------------------------------•-----------.....---------•---•-------......--------•------------------------------------------------•------------------------------------- Date PermitNo...................................................-.... Issued------------....------------------•-------------------- ---- -- --- ----- - s_ -- --_------------— -------------- 7 No................. ...........,:: .... -- THE COMMONWEALTH OF MASSACHUSETTS BOARD P F• HEALTH Appliratiun for 11i.spoiial Works Towitrurtion 11amit Application is hereby,made:for a-._Permit to Construct ( ) or Repair ( `)xan Individual Sewage Disposal Systein g at , , f ) } 4d v f .. t .c ..•r ..S_. t .. t. ............................. ............................................................. /1 +/A Loc lion-Addres� �� , or Lot No. ............. am: ............� y� .. - ......_. t --- a'0wger e Address ..... t Installer Address ;Type of Building,/ Size Lot............................Sq. feet t-, Dwelling o. of Bedrooms.............................:..............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p' Other fixtures ---------------••-•-••--•••.•. --•-••--•- •-•-=- •--•-gallons er--erson per da-- Total daily flow.................•-••-•......-•-•--•---•••------------- Designio s. WSeptic Tank—Liquid capacity_....:____..gallons P Length___......_...... Width................ Diameter________________ Depth_..._k�s W .. xDisposal 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..................................... 0.4 Test Pit No. 1________________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.........._-__-.--____ Descriptionof Soil -------------------•---------------•--------------------------------•------------------ V ...................••-•...-••••--------•---•-=-••---•---------------------......-•--=----....----------...---------------••---•----•---•--•------•-----....-•------......-------•---...........--•••••- W •••- ------------------------------------------------------------•••••••---- -----•---•••............-------•-• •--- U Nature of Repairs or Alterations Answer when applicable_.._...__ f .------------------------------------ A/ ---------------•-----------•-------•-----•-----------------------------------......•-•----------••------------------------------------ ............................................................ 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 bo.ard of health. Signed 'r� � P ' s';o-f �r , :t � .--- ..... Date Application Approved BY............................ ..........•-•......--_-••-- Date Application Disapproved for the following reasons----------------•-----------------------------------------------•---------------•------------------......_-•---- --------------------------------------------•---------------------------....----------•-.....---------------------------------•--------------------------------------------.•.......................... Date PermitNo......................................................... Issued--•-----------........................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ...........OF.......:. oj#'. ! �. d?�f.:��.:............................ Trrtif iratr of Totxtphaurr THIS IS1,,CIO CERTIFY, That the Individual ,Sewage D> pgsal System constructed ( ) or Repaired (10-y { 77 Insrau ,f ----- ---- --------------------------------------------- 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......................................... dated-.------------------------ ..................... THE ISSUANCE F THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS.-A GUARANTEE THAT THE SYSTEM L U ION SATISFACTORY. ,. DATE... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' �, . No......................... FEE. ,,z..,"?--- --- Disposal �urko Tonuirurtion rrutit Permission is hereby granted...... A:..f........ to Construct or,Rehr n Individual Sewagg,Disposal System { ) P O` s,sf Viz' - ,`�' .+ J� / J . .;3 as shown on the application for Disposal Works Construction Permit No..................... Dated......................................... ......-•-------•-----•-----•------•-•-------------------------------------------------------••-••--...... Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN,.INC., BOSTON LO CAT IQN SEWAGE PERMIT NO. IA , I , q 76 VILLAGE 1 1 I N S T A LLER'S NAME A ADDRESS B U I L D E R OR OWNER pe a DATE PERMIT ISSUED DATE COMPLIANCE ISSUED -� a i I i