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Home My WebLink About0164 KATHERINE ROAD - Health ►6NA'��6t"i Ale r� Cen ter'vUlt - i Fim THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA�LH - Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal ,Location-Address r Lot No. ' ��. « T. Address Dwelling—No. of Bedrooms..... Expansion Attic /4�j Garbage 04 Other—Type of Building-T4% _�_IF _.__N___o-------of----p-e-rsons............................ Showers Cafeteria�5) Septic Tank--Liq" d `^p^` y' L=ysu^--'---' Width................ Diameter................ Depth................ � Disposal Trench--No .................... Width.................... Total Total area 8- � > Seepage Pit No----_-- Diuoz�ec—.---.-. I�cnt6b�mm Total �. 0H`crI}�t�bodoo' Dosing( ) � �� tuo� ( ) �� ` ' ��~ ^ ^ � Percolation Test Results Performed b� Date' ----.------'-___. t_.--_-'_ -'__-___- �� F� N� l- ' per inch Depth of Test Depth to ground Test Pit No. 3................minutes per inch Depth of Test Pit--------- Depth. to ground water......................... ` | 0 c� Soil --```---'--`` ------'--__--_-'-----'-_--'-----__`._-''-_--'—.--'--------'-_-----------____-' U Nature of Repairs or Alterations--Answer when -._---__.-'_--_.---'_--.--_-________.. ---__._''''--_-'-_. ---------_-.--_-'--_'_._'-.-.--___-'____-. Agreement: ` � The undersigned agrees to install the aforedescribed. Individual Sewage System in accordance with the provisions ofZ[TIU 5of the State Sanitary Code The further agrees not to place U� in operation until a Certificate of Compliance has beegissnb4 by the bo health. 'y rVDate � --------.-_--.---_----'--'---------------_--''---_------------'-..-------------_-_..--.--..------- n°te Date -'-'-''-'''-_'--_--------''---- -' ' LO A ION SEWAGE PERMIT NO. 3 3v fli V I L L GE 1 ST LERS N ME & ADDRESS . Y I YJA, -R-- on OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED _.. 6 � / � � l� t l� �,�.� f THE COMMONWEALTH OF MASSACHUSETTS -.�. BOARD OF HE I-1 Appliration for Diipnii al Workii Tonotrnrlion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...X0.7.. .d.. ... ' .!f:?!:: .:i.1 .......Rd..................... -------------------------------------------- ...... .-----...-•--••---•--......... ocation.Address _' r Lot No. ilJ,• , Owner i•-- f Addr s 1 /f�J�q � //� ta,.�__x•F:�.k.....1..Ist,l-� S. ySk.,,,C_...................................... .... t_�_........__?.. .....__... s4:1<1� .c�...`:"Ja....._................ /' Installer Address d Type of Building Size Lot............................S q. fleet U Dwelling—No. of Bedrooms._.._. ...........................Expansion Attic ( j Garbage Grinders rj�,% aOther—Type of Building >�'scf ... _- No. of persons............................ Showers (2)-- Cafeteria � Otherfixtures ..-_.... ---w.................................................................................................................................... W Design Flow.............. __ P .:gallons per person per day. Total daily flow.._....._. ,�_?.0.................. W Septic Tank—Liquid capacity./®IIQ.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./ a�!a..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..................................................... ._ Date....................... ......... Test Pit No. I......._.minutes per inch Depth of Test Pit....../.�....... Depth to ground water.........Vet_. 114 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a t ------------------------------------- --------•--.-..--...... ....._......----------......... O Description of Soil_........,.._ A4....-..__. .0 > rr_s.-......_.. xa U ......----• ...... ' �.........LIZA...------/�tc��-��v .......................................................... w 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the syste in operation until a Certificate of Compliance has bee 71kss by the boo f)health. / Siged ,r. �' --- ..._.�� ' " 'c. ..�r i�---- .... ...e f ,e .... Application Approved BY �/=✓�l'`:................................................•--------•------.....--- �``_'c '; ......... Date ..... Application Disapproved r/he following reasons:---...•-•-•.....•---•----•----••----••-•••--•---•-•----•-••••------------------•----•-•-._...-••-•---....---••- .......••-•--•-------•---------------••-----•-----•..._..•----•-••--•••--•••-----•-•••--•----........-•••-•....--•-•-------------•••------•-•----••------•.•-•---•-----.-•-••-----....-•-----•••-••••- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................11 fps i6n-...OF...../„ .. .1 %. ...v...... ................................. Trrtiflratr of Tomilliafta THI• TO CE"IFY That e Individual Sewage Disposal System constructed ( .-'�or Repaired ( ) by........Xir'�!/ .. . .F ? install _..... at.... .�...� /...--- ...... tft f� _ j ...----•----------•------------• ---- ........ has been installed in accordance with the provisions of TITLE ofhe State Sanitary Cede s d bed in the application for Disposal Works Construction Permit No._` r _�._r___/a................. dated--. __.,»�✓._ ____ .._ •-•--••--------- THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A AR NTEE THAT THE SYSTEM WILL FU CTI SATISFACTORY. DATE.__..__..1�....... . ._ .......... ... Inspector-- ---- ---------------•-•---••-•.......•••---•••-•-•-•---••-••••............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r o�K ..........................................OF.................................._.........:.....-•-••-•--.......................... t�r� N �?.:_.J........... FEE...::................... Uiiipniial Voroii �ua� #rr#irrn rrmi# Permission is eby granted..... t. ✓?:? .- to Construct ( y, > o,Y''Repair Van�2` divldual Sevc�a�ge Disposal System . ' � , . j .-.------.--- ---- .. f ..................... Street �s as shown on the /plin for Disposal ��orks Construction Permit No..................... D-�Board fIealthDATE-----• •.......... ...••---•••--•-..:---............-------•_... �` t FORT 1255 A. M. SULKIN, INC., BOSTON I SINGLE- FAMILY - � BEOROoM �d�� N �' �� Qd�� I L!O GAR .G6 �jWNDE2. ?.S.o � 'Q 9S• � � I vA��.�( FLOW ' iz 110 Y. 3 - 33o G.Rp °� 5 E P I = 0% n, = �4 9 5 G.P. 0 PUP, ' � ,. I T G T A+u K 3 30 x l 5 \ u5c- %000 GAL. AAA o15Po5Al F'1'�' 5 �JSE t o 00 GAL. %PSWALL A2CA = 1 Jo S.F o ;t� o I c' _� a I t5o 50TTOM AREA- . 50 5.t= x I. o � 5•o G.P o~ w�� 'ToTA 425 G.P. D. Po � �1$� ISt9 14- 'TOTAL I{{• ' PE2COLAT1oN RATES l'�iN 2M1N o�L�55�• �.S - \\, .A = 11 l A NC t lo,�d �, +',-k of ra�� 2� " -4+ �ti�'� s` P`�N OF 9 RICHARO �� o��,� ALAN yG M �_� SP.T.3'vwb. I` BAXTER No.24048 JONES 44 I' . 251 _. . jAV FNP .;� pt;u t UZI i % � ;f' ►ooc� INS. ` . ; . � f '� SuR501(. FIST. S6PTiG c Z�i Poo INY+, . dux (l.•G -rAHK 3. . w TN f�,2 wed- .� '�:� ::• i'f- . � , SU- CtA�! IV►C WASNGD ERTIFIao • PR•OFIL� L 0 cA-t_lot-I M 140. SCALE SCALE ►- d.D. VAT1= S- I _a3 1 d �AT�s7Zr�os�t-r] I P 1--A I`I R E 6 CZE N GE , e.s wr -CHAT 'T VtE we,er 5llowP4 i A u P SET AC R.SR �MN�`f� -t�r�►E- -(c>W N o LOCINIMP -WIT IN T '6 GLodD PL bllI4 aA-r t✓ 5't1-� , � . . - � - - � s �.E�I s-��el�•v ►.Au o s�ev�Y�es 'TINS PL&KI 1 �P RIOT gt.,5r_v 40d AW cSTE2VILl� MA55. . j '1145TR•uMENT Sv2Vey �_'TNE oFF5ET5 SUOUL, __NOT C3E •USE•DTd �E'TER!'^I►Jrc L„cT 1-II-lE�j- APPLIGA►`I'T I F• �„1 • �V'.�.t�•tO8