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Home My WebLink About0153 JAMES OTIS ROAD - Health c 153 James.-Otis Road Centerville F A= 170 - 154 S M E A D No.H1630R UPC 10259 smead.com • Made in USA z} r N®..... � � CIO - I's q Fmc....5 . . THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HE LTH .......... �' OF..... .... ................................................. .................... sE 53 Apptiratiou for Dispoii al Worka Tomitrur#ion ramit NApplication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal syst e:::>� - '6� Location- ddress Lot No. — ca/ner Address aG��.-------•-------------•-------•- ---------•---------------- y� I - ..................................... Installer Address G.r' Type of Building Size Lot_e�_t__?�'_`.!..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( Garbage Grinder ( 4la PL4 Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Othe xture d . - --------------- ....... ----••--•-•-----------••------- W Design Flow..... ..................gallons per person per day. Total daily flow___.._._......._.`-- :d__......_.._gallons. WSeptic Tank—Liquid'capacity..i1�4!' allons 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........................................ Test Pit No. I... ...........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........................ a •-••---••-••-------•-•------•._.._...-•••-........--••..................................•---•-----...--•------------------•-•-•----••----•-•-•-......------•. 0 Description of Soil.....................................................................................................-•----------------------------......------------------------•-•-•-. x U -•...-•------•-•-•--•••-------•---•--•-----------------------•--------------------......---.....•---...........•-•------------------------------•-------•-•----••--------------•-------------------.---- -------------------• --------------------------------------------------------.............._................................ ---------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----•--•---...•---------------------•-------------------•----------•---•--•.-••------------•---••---•-•••--•---------------------.....--•-----............•-•----••••-••---........--•--------••---... A eement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t e pr isio is 1 5 of the State Sanitary Code—The undersign further agrees not to pl e the system in er i licate of Compliance has been � u by the boar f health. Signed. ---••-. ----•- •-• -•----•--------------------••-----•...•--- .--•- / lam D e PPlication Approved BY ... ----•7 - • -g to Application Disapproved for the f ollor'ngreaso.s:-------------------------------•------------------------------•------------....................------•-•---•--- -•..............•----••--------------•-•...---••------------••-•---•-••---------•--•••--••------.....-•---•....._.........••--•--••-•--------•-••-•-------............................................. Date Permit No....15--- 6.f�5--- ........... Issued------------- - - -----••----------- Date `...�.�.. �...�e. 1 THE COMMONWEALTH OF MASSACHUSETTS A. BOARD ,OF HEALTH T fell --�� 1 fir tiaari'far Elispas tl Works Tungtrnrtion amit Application is hereby•�'made for''la Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System'at:;' 1 Location-Address / �r —or Lot.................................,t .. . ,� _� ..... ............. .........L.._...-. -..._.__....................................... .................. _.._.... _ ..__----------------- .............. ........... w f ,0- Address .................................................................................................. P...................................................... Installer Address r Type of Building r Size Lot_.../-----------------------Sq. feet UDwelling—No. of Bedrooms............................................Expansion Attic ( r) Garbage Grinder (� ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther,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........................................ �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........................ a .......... •------------------ •--•............................................................................................................................. 0 Description of Soil.................................................................................•-•---------------------------------------------------------------------........-•---- x U -------------•----•-•••---•---•-•--•--------••--••-------•----------------._......--•...•••••-----------•------•••------...••----....------•••----------------••••-•......--------......--•-••......---- w U Nature of Repairs or Alterations—Answer when,applicable............................................................................................... ------•-----------------------------••••-----•-•...---- eement:The undersigned agrees to install the aforedescribed_Individual Sewage Disposal System in accordance with t e prgvisio is TITt 5 of the State Sanitary Code—The undersigned further agrees not to place the system in perm fiCate of Compliance has been issued by the board of health. Signed----•----- < r ` f l I to plication Approved By.................... ..........._ t Application Disapproved for the foll ing reasons________________•_._------------•-----------------------._-----•---.------.._----• -- •................•--•------•-•----•-•--- --- -----••-•----•--•--------•-•-------- . ••.... ---•--------. •-•-----•------•--•---••. ��qq•.r /� Date Permit No... ,e+.."".. ._T1................. Issued....... _ . .....at ; . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................-.................................................................. �1 f�rr#ifirtt�e ,af �nnt�r�i�nrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed) or Repaired ( ) by-•-••.....................................•---•-••-•-••••..........---•--... ` Installer .. at---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The §pte Sanitary Cod . as escribed in the application for Disposal Works Construction Permit No--- '" _. __._____ dated. _-__`�_. _ ____ ---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUE® AS A GU RA EE THAT THE SYSTEM WILL IFUNJCTION SATISFACTORY. 1 DATE ...... C ��. „y Inspector._... --•• •-•-•--•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A........................... [� F ....................... G No -----..... �r. FEE.�j Disposal Workg (gunitr inn amit Permissionis hereby granted-.....................................................--------------------------------------------------------------------------------------- to Construct ( ) or Repair (' ) an,.Individual Sewage.Disposal System at No.................................... --------•...........:..::...................•----------------------------------------------------•----........------------•---•- -------- .............. Street as shown on the application for Disposal Works Construction Permit 1 ""`_: .. _____ Dated.......................................... ------------•---•---------------- ---- ----- - - --- ----___...------•--- ---- DATE.................. FORM 1255 A. M. SULKIN, INC., BOSTON 3v8 Fs i5A1C.1( FLoW:.. a ll� .x.3 z 55"0 G.P. 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G'E.2T/F/EO PGOT p1-441 WRSHC-D •• = srNE &z. 4.s LoG.GTio/s� CL.v 7-e"TLvi e-L6 �3! ao wATb"k �4�� No Sc. c.0 40 7 ZS / LE,eTjry Tf/,QT THE�-o v�1 Dq%.tI S.�/oW.v CC�.1T72..✓iG.l.l:. /��G�IG.y�v©5 /Ale. .4it/O,fETl/aG,� .2E4U/.eEHIENr.S D.o 77414 .Q v G-Z7-9 S- 8 7h*W it/oT 13.4SE0 lnAV.4 Al/11-/f7 2Z- •S�l��f�E.e�t�N S.�4UG�ii/aT l�t� USEp Ta E.S G4.51V LoT-G/NE,S LOC TION }foes t- is SEWAGE PERMIT NO. SS,4 VILLAGE INSTALLER'S NAME&ADDRESS A- a� & - BUILDER OR OWNER DATE PERMIT ISSUED 7/;) DATE COMPLIANCE ISSUED <§/,5 /,95 poi lit � i r'