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Home My WebLink About0095 JAMES OTIS ROAD - Health R S uoaAt is 07 170 /// S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR ORE SW MIN.RECYCLEO INITIATIVE CONTENT 10. Cer68edFbersourcinp POST-CONSUMER wwwopmramorp WIN MADE W USA GET ORGANM AT SMEAp COM J No....... FRic.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ............OF......... ? J'. . Appliratiun for Uiivu,ial Warkii (Somaunrtinn Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: lQ.T`r - ................................. ................... ..... ----...... •-----------------..---- ---........ Locaty�n- duress qy Iyt�DTo. �j� fJ .....:I��-�- .......'S-M.-�`•K'....... ................................... ....... ........... ............ Owner%�� Address a (e-zr �s s d Installer Type of Building Size rLo/, ,..4.r6-......Sq. feet U Dwelling—No. of Bedrooms.............................. .. .....Expansion Attic ( Garbage Grinder (A,�) Other—Type e of Building ............................ No. of ersons...._....................... Showers —rry��p ag p ( ) Cafeteria a .q ......................gallons per person per day. Total daily flow....... _Q...................gallons. Other fix res ...... W Design Flow_._. WSeptic Tank—Liquid capacity/ allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....rA'.&'O--- 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........................ G� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p; ....----•--------------•--•...-•--•••-•••-.........--•------•---•--•-•---•--••--•-----------.._..---......................................................... 0 Description of Soil........................................................................................................................................................................ x U ••-•--•-------•--•-•----------•-------•••-•-------------•---•-•-•.....-•--•-------....----------------•-•-----------------------•------•-------•-•-•-•--•----.....-•------.........----•-•--•-----••-... W --- •--------------------------•---•---•-------------••----•--------------------......------•••--•---•••-------•--•-----------------••-----•-•--•--•---------•---....---.....----•-•--••--•-----•-•-•-- UNature 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 LIT Li, 5 of the State Sanitary Code— The undersi ed further agrees not to place the system in operation until a Certificate of Compliance has been the�o of liealt . _ g � Signed.. -- . D/ate i Application Approved BY =_r...._�_ ......---- -----------.�-;//�-r �.... Date Application Disapproved for the following re¢so s________________________________•------------------------------•---.-------•-•------------ -•------•---------------•----•-----•-••--•---•-.....----•----•------•----....--•---.............----..................-•------•------•--•-•-----•---------------....--••-••---------- .................. Date Permit No--------------------------------------------------------- Issued....................................... _•-------------- Date n No......................... t. �� Fps..-.... .).. .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF.........3C fti. r_r ?-.0=-G':. ................................ Appliration for Bh5paii al Vorkri Tomitrnr#ion unfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .....k'� -----------------------------•---- , :�--------------------------....._..._..-----.....................-- --- Locati n- dress or Lot �10. r�1 .I.:.) ./ �� _...-----•............... ......t"� � 7�. . 'L�'lC�........•---•--• :;� ............... -- Owner Address Installer Address Type of Building Size LotZS_f.r.......Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (/, a`4 Other—Type of Building ............................ No. of ersons._..__.__._.__-___-.__...... Showers g p ( ) — Cafeteria dOther fixtures -----------------.----------...------•-------------------•-•---•----------••--•-----------•••••••-----•---------•------•-..._._-................_..... Design Flow... F ----------•---- g P P P Y Y '2 ? �-------••----•-----l�lons. wgallons per person per day. Total daily flow...-__.._. a__ �._ WSeptic Tank—Liquid capacity/e w°`gallons Length`________________ Width................ Diameter................ Depth................ x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..... ` 0---- Diameter.........tv...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. i................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------...---•-••••••-••••••-••••--------------•-•••-..........-------=----....--............................,........................... 0 Description of Soil........................................................................................................................................................................ w UNature 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 TITLE 5 of the State Sanitary Code—The undersi ed further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the hoa/0 of healt'- Signed-- =- ...............:...............•--------•-....--------..._-••--- ---_•-•- Application Approved By..-..--...r _;....................................... -•----�-.4�in---- Date Application Disapproved for the following reas ________________________________________________________________________•____.__.____._ons .................•--•----••---•-------•---•---•-•---....----••--•-•---•-----•--------•-•-•-•-------------.-------••-------------•------•-------•-------•-----•---...--•-----•----..:..._._..:------_...._ Date PermitNo......................................................... issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..............................................................I...................... (9rdifiratr of Tontplialarr THIS IS TO C Y, at,the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--------------------- _.....`... �;; .G,t .............. . -�--••--•-----------._..........----•---------................---- ------..-.__..... at...................... r- ----------- � % ------- .��--�---- --C---�, _________________----- has been installed in accordance with the provisions o TIC 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.---.-.-9Y_-_.v�._.__. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................h °j �• ------•-----...---•---•---- Inspector........A_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................OF_..---............................................................................. Rspiial Wourip (tono#rnr#ion rrtnit Permission is hereby granted.......... / to Construct ( ) r epa ( ) an Individ 1 Se�rage Disposal System Street as shown on the application for Disposal Works Construction Permit N ............_....... Dated......._.................................. Board of Health DATE..................................... U- FORM 1255 A. M. SULKIN, INC., BOSTON t �,Y. - It l :�, -DIQGLC- FAMtI_Y - i3G�RooM '1 I..Jo GAQBAGE F L O W c I 10 A 3 3 o G.P �± SEPTIG TAtJK = 330x15c>'/• d cp +43 s� S7+I D15Po5�1_ PIT v5E IvoO 64t_. 0 Ex/' R; pj !! S I DCWALL yo S.F x I. o 5 a G.P D. -TOTAL- DESIGN q2�J (�.RD. Q F -TbTA%_ r-)A I L_Y Iovti/D47-/oaf �s} PER.CoLATIC)q 2ATEt J"IN 2MIN oP-LG55 OF Mq,r� too DAVID RICHARD C. a r A. THiJLIN �AMEjeJ ;a tiNCTTA v u No. 29976 y Na 24D49 <d4,t) St!St 6� _/O}AL EN P 21go F T $7 To P FNU = SST T 6 �T 4 NOLt= lizhs/a3S G = 57 LvA�I a � loov tNV• 5✓a5oll_ _ DIST. INS. one. 8 Z (000 INJ SSf�G TANK G D.L.. ��, • PIT INV. INS. Az \4AsurD 670 II SAS k GF-- R.TIFIGD PLOT PLAN _ P42.UFILr=. l.ocA"T ►oN C��1-�/1 s 13 ►.Jo SCALE 'SCAL,E. ( 11 C." pATrc rj-�•� 00 1�t/ATt7L p>_P.t•l R E F S�E N GE 1 GE R.TIG•Y -THAT TNr- 5NoY,fN 11ER =o W C_OMPLY5 WITH -t NE S 1 oELlt-I 1= q Ld•T A�1D •56TlaACK 26QvIR.[;MEN�"� oF -CUE- z� 1 7 >WN or- T3Afz►J'ST'Al3L3 ,e,ri� IS I�aT L_OCtNTED •WITNIQ T51 G\-OOD PL.b IW DA'T E BAXTEQ.e til`(E I1�1C. REGIS'T6.26,D,�.AuDSuevEY67_5 + -Fu15 PL_aN IS N0' anSr_r� o►d Ati as-rG2.viL.LE- - MASS. �� lu•STRUMENT Su2.vc-Y �_ `rNE DI=r5ET5 6WOULD Noy' C3� vSEDTo DE-TEFL/^I►J� L.o-r �_ INE�j ,4PPLICA►�T � J" C� . � � I., .- LOCATION S SEWAGE PERMIT NO. 4vT a5� J,i1n is OT;A t 67W VILLAG-E I N S T A LLER'S NAME L ADDRESS . t3 vv2 CD. Ie U I L D E R OR OWNER DA T E P ERMIT ISSN E D le � DAT E COMPLIANCE ISSUED ��cIC 55� ;�• g �' 1`� � '�