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Home My WebLink About0094 HORSESHOE LANE - Health )4 Horseshoe Lane Centervillei A=207— 142 No. 42101/3 ORA 0 10% No...................... A ,............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........................................--------..........-----------...............---... Applira#ion for Uiopogal Works Cfonotrnr#ion runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: q 4 4.0 Y r-ts _ .. /Ps .................... ...........................'' ram......... -----..........----•1-..--••Y--`....---••-•'----...........-•-.................................. L" tin•Address �' or Lot No. .c�. e_x�1-----••�24.3"1..�.�e.��4...................... ............ -P_.�...�. e..y.�.J..� �'•--•----.....-----••--------.... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........................--.. Showers ( ) — Cafeteria ( ) P4 Other 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.---.................... ------------------------------------------------ •........... .'•..........................................................................---..---- ODescription of Soil........................................................................................................................................................................ x U ----•-••••-•..............•-----........-•--••--••---••••-•--•--•-••-•-'••--------.......--'-'-••••--'--•------...............••••-•-•-•---•-•-•--•--•........••••••--••...._.....-'•---•--------------- w x ....... -------------- U Nature of Repairs or Alterations—Ans*theforedescribed a li"le.-.....:- �d........ ..... .h..� ..............�11.0 ......P!_'- ..... •-••••--•-----•-•................................. Agreement: The undersigned agrees to install Individual Sewage Disposal System in accordance with the provisions of L ITi U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificemplianc has bee issued by he board of health. ne .... 1. -rc..1�.a.............. .... ....._.. 3 Application Approved B ...:. ... .. "✓........-•--- Date ApplicationDisapproved reasons:-------•••-•••---•-------------•-------------............•••-•.......-••••-----......_...-•...............-'--- ...................................••----...............---.........._.....---.......-------•--'....................-----.........._---...•--------------------.......--- ........------......__-•--- Date PermitNo......................................................... Issued_....................................................... f Date No.Q.,:.t.' Q.. f...-- FE.R... t............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................-............O F.............................--........... Appliration for Mipoiial Workii Tomitrurtiun thrutit Application is hereby.made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: L 1 e)T ('-e a 1, �. ................... :.............. .. ...__...._......... ....... ....._'-_.__._ ______-•----......._......__ ... ..._............_.............._.. +,,.R Location-Address or Lot No. ..................... ........... e,y c.• ................................ ..lm to el, Address W _ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P`k Other---Type of Building _______________ No. of persons Showers k ng ...•-•--••-- ----------------•--------...................... --•• .•: ( ) — Cafeteria ( ) d Other 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 ( ) aPercolation Test Results Performed by___________________________________________ _..__...____. Date......................................... 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........................ 0+ --------------------------------------------------•----•-------•---•--------....-•-•---•-------.._....-•---•--........----...__.......----••..*....---..•.... 0 Description of Soil............................................................................................................................................... ....................... x W U Nature of Repairs or Alterations—Answer when applicable.-----+] .._.__ -11•- 1.............. !-Id.0...... • -.-• r 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. ' ��, -ened ..... Application Approved Bned Y - ° ... ............. •:, Date Application Disapproved or t following reasons-------------•-••-•-------------•----•---...-•-----•---••------•-------------•--•----•-•--- ------•.........................•••--•-•-•••••----•-••••-•-•••-----•--•••-•--•••----•...•---•---....•-••---•--••-•----•--•---••-.._.---•-•-•••-•---•--•---••-•••••--•--••-••••••----•••••••-•--•-•-_.... +: Date Permit No. ------ Issued....................................................... Date �M THE COMMONWEALTH OF MASSACHUSETTS;;: _r BOARD OF HEALTH ..........................................OF..................................................................................... �rrfif irtt�e laf f�uut�littnr.� �g -•�� , T IS 0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (4.40 by..... ......•....._... .............. e................. _....._._................._......-----•---..._............................................. { In �^�f has been installed in accordance with the provisions of TIT ' - 5 of The State Sanitary Cod as d,��c•ribed in the application for Disposal Works Construction Permit No----- .� _ _________ dated--- '__�-7 _,�__,�___________________ THE ISSUYF OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® S A GUARANTEE THAT THE SYSTEM 1All CTION SATISFACTORY. DATE.... P -•-------....-•..................................................... Inspector..... __ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r .......................................... f(� .OF...-..--.-............_................_...-_..-..__.__.....__._..._................. .:........ . . .... FEE...: ................ �i��rrru�al rrn��rilan rrmit Permission is hereby granted •._._ .....-- --•-•-•• ............... to Construct ( ) or Repair an ndi iduaI, +age Dispos 7System at �` No.•-••••••••••---•••......--•.............• !"'.j .........-•. Street as shown on the applicatio for Disposal Works Construction Permit No..........:--" ted............................................ :oard of Health DATE. FORM 1255 A. M. SULKIN, INC., BOSTON- LOCATION �r i I-�O ,.e l d , SEWAGE NO. VILLAGE INSTA LLER' AME i ADDRESS R U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED fa �� r. 30 /a . iJ y�. � •--•---••....,a:•-...,_r,.�_a e-.ate �, DO Y� 4` • .. g Bb or MEL 70 � ro 6YYJS E! y? q1� All i q �� yfi9 �k d.-• /� �� ,Ir• 'b. •.u�• - - $ jz� �y +} n � .�Y� s yet a I 7v3it e.r' -< ?'�<I �.� ��f. 5•� N 7.fr• w'> T'ca'�-97 \14Ell ^,.;'� f" Ed aka�a •� '� -� A� ;gi VII ux �� I P' .z �;� u•4• 'Y• {.�Nt:� 'e'y� Y3}f,r Iy/�,� `J` 'fin ror� d /1r. '.!�"7y,ay.2: '�^"ly�� 45��!"'•�L�� GT4 ��y 1 . M Q ��+ � f.�r_/� � h,�L c�,�'r•.�k`��1•f�� G�',a�•H.'�� ' 'a r r� /"�,.r�' .��/�x O �+�.a�+KV V .!>�,`,v"i E'�4::9.� 4 . ,�#LST.1 fi:=.. rr.�.Y'rd ,.,,✓ 1 h tobg bpi I+ o� l cl I