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Home My WebLink About0095 KEARSARGE AVENUE - Health 9 Kearsarge Avenue Centerville A=225-017 i 1 Q BAR%STABLE a o� _ ZI4 SEP t 5 PIS' 37 55 r inn. I IS Street ettwo A icce � � /•" � QJ� - '\ - i o CD 41 NNW. /• ''•' 1 trf N � w� / o �. r� '�� 8*i q•Q �� y / y 45, 4,441 ce 46 Ao a lq THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .................................OF...............-..........------...... Appliratiun for Uhgpviittl Works Cnunutrnr#inn amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: VV A-IN N IS rT -� �-r � 5 .....N .�'......_... .................................._..- ..._..... - ........................... .. Location-Address or Lot No. .....-. 1Q .Q_��r 5----••----•-......-•.................... .•---................ E ..................................................... ,Qwner _ Address Installer Address dType of Building Size Lot.................... .....Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------•---------------------•----......-----...-------------------------------------••----•--•-----------------.._....--•...----•---•--•...... fuel. Design Flow.......... .........................gallons per person per day. Total daily flow.........1B_Z-_P.....................gallons. WSeptic Tank—Liquid capacity WQQ.gallons Length....==—...... Width...... ...... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length................ Total leaching area....................sq. ft. Seepage Pit No..... ......... Diameter-__-- ..y...... Depth below inlet_.....y.......... 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........................ ---------- -------- •------------------------------ .-•-------. --• .....--•-------- •---- ------------ •-•••----------------------------------------- 0 Description of Soil--------------C. :44 a-�-•-------.S-tq�'-t•.n.....................---------..................................................................... U ...............•---••--•-•••-•••--••--••------•-•----•-•-•••--•---•------••--•-••----------------•-•----•--•-•-•------•----••••....-•--•--••-•-••-•-•.....-------•••••••--••--••--•--•--......•-----•... W UNature of Repairs or Alterations—Answer when applic4ble_-----�-_4� ..__ f_. .14_l�l. .._.._...p.e. C...� _. ----------------Q-------.. ...... �+s........ . ............................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of iITI.i� 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliare leas ued by the board P S) . .....5 ....... • . ••••- Date Application Approved BY —i /-d......---- - ..............•---•------•-•-•--- ........................--............... Date Application Disapproved for the following reasons:---•-•------•-•••-•-•-•................••-•-•-••••--•---•-•--••-••-••-••----...--•--._..._....-•••......_..... -•.................•-•----------------••..._.._....-----•--...---...........-•-•--••--••---._......•----•-•-----•----•--•-•-•---•-•-••••-•-••-•--•---••-•----------•••••-•-----••--••-•--•----•------•-- Date .Permit No.--••-•...---•-------------- •---•----....------•---_. Issued -- Date Fps....:::'.....'.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................... .. ................OF...................................... Appliration for Rupuutti Works Tonxitrnr#inn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:..... ... �f / /. N15a5 � �rT�..................... � c--••� -e ...............................................- s---......................... .......................... G aO S dress _S �11N__or_Lot No. ............................._.._.......... ..----..................................... . .................................................................................................. Owner '' 4 Address W (I T r /� ( '� 2 J-� vim-w, r-"5 oq i tj a .......�.�..... .............•----•--•----------......-----•---•-•------•----•. --------------.........--•--_..... ..----••--......_....•----...p.....-•--•--___....--.... Installer Address Type of Building 6 Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type a of Buildin g ____________________________ No. of persons............................ Showers ( ) Cafeteria ( ) 04 Other fixtures ........................... W Design Flow.._......_�_5.......................gallons per person per day. Total daily flow........._..................................gallons. ...... Width................ Diameter................ Depth................ W Septic Tank—Liquid capacity��.gallons Length___..__- -' x Disposal Trench—?�jo. .................... Width........ Total Length_._._.._y__;---- 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........................................ a 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 ----------j� ............... ------ -------- ------------------------------------- D Description of Soil............ . ........................................`ramw '(� x ..............•-•-----------•••••-----------•-------....----••••------.......-------•-------•----......_....... U --•-•--•-•-••--------------•-------•---•----•••...-----•----•-....-------•--•----•-•......----•----••------•••-------•-•--------.....-------•-•-•---- .................................................. W x -------------•---------------------•--••-------••-••--•--------- •--••-•--------••••------••-----------------••-•-•-•--------•------•-----•--------._....---•-••-•••--•----......----••.... •..... V Nature of Repairs or Alterations—Answer when applica le___--..�©.CO _S ,:T `4 I\1 V, Q.i ETT S_G;� -- ..._.. L� x 'Pam-= � }_�.... -u' �--.---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLT: 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance-w-bEen-issued by the board ofh-health—..._.__ Signed------ _ ......................................`` Date Application Approved BY r— -•--•-------••..............•-------.............----.....-•--•--•.........------•••--.......... ---------•..... --•--•----•-.....--•-- Date Application Disapproved for the following reasons:-------•-------------------•-•--•-----------•----•-----•------•----------------•--------•--•-•---............-- C •..............................•---•--.....----`----•.....----•-....---•----••-----.........-•-•-..._._.....------.........------••......---------•-------•---------•••---------• •----••--•---- Dam PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....:!...U....... !'v..........OF.......3 Gv r.�s �. ., e.................... ......... (Intifutt#r of fjontplittnrr THIS IS TO-C:ETIFY` That the Ind�ual�Sewa Disposal System constructed ( ) or Repaired ( ) Installer at. �-`�-�' -` C`......`�-`- �, - v ----.... V\/..... w-�`t o .............. has been installed in accordance with the provisions of TI T LF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___._._..__r-..._:�'...__!.1.` ... dated.-_..__...�_...._..!____.>`--C,>..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCT ON SATISFACTORY. Inspector ! DATE... �31 ........ •••--•-•............................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD�OF HEALTH .........�...O..VV..N..........OF........1`.:.-.i 1 1 1 V�b.�_e....... � �1' No................... FEE........................ t'oposttl�Work (gun rumon Orrntit Permission is hereby granted....._.__ -a4(:`F__y....... _ '_ ...................................... ........................•-... to Construct ( ) or Repair (11-an Individual Sewage Disposal System at No-------------•-....•----..._r"'�._J .............(c�� A-V C Vl/I w w►S �' ...... ....... --.._.._... ---.-•••-----• -------... •-•.. ..... Street as shown on the application for Disposal Works Construction Permit No........._......` Dated.._..�.%�...._.. _ ---------------------------------------------------------------------------------------------------•--•- DATE_ L Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON j r ,{� C �`Q� T 110 CAT ION N S b [i A G E F E R M I f NO. VILLAGE . MSTA LLER'S NAME Z ADDRESS ._.. 5 U i L D E R OR OWN ER T so clelc+`'VjooD iPD l WEST NF- wYOoll�-less 02I6s D A T is P E R AM I ;r ISSUED I a n-lj- PAT E COMPLIANCE , ISSUED 1�.1�wi n1C, V -Z % 17 20006Ai--5-zvs« Tvwe O \ 17' DVS�RtgvTCON �oK 1.60} 1 �%b PQ�sGAST P�'f Fi-2ti w/4'ef i�vsu+E t +fNly PP-E°CAS PiT H-10 of 1$1'6'i014e 3 L 0 CATION S E ly A G E PE RMIT N0. _�1 ��11a '.Si1RC�C d\VE, �a- 1�U ; N5TA i_ LER•S NA ME Z ADDAE3S 8 UILDE R 0 0wriEA 0 A T E PERMIT ISS E0 PATE C0MiPLIAP.. CE ISSUED t,,� 2coo6ai--6w7it Tgwr I _ pis' O �J jf� \ �7� D'SiRltjuT(CPJ box . JCS Y �i axy PW-,CA'4 r PIT H-24 w�N'af I��sorag PP_E°GAyj PIT 1-1-10 : :1.`- �+4a`... ac'`�ti..°a.: - yT � i h.� t :. �� a tvi�v '.!t ' •..:F �1 S.+" �i��-�� t 1. - s r S t♦, ..,<. w• '«..�"�� Y+ y 1�'�e� � - - to- D � � S ... i iZ s .: TWO 14 k 6 P1 r. STO 000 , q+ DwELL N SEPTIC 7rAN/. - i Soy. a, T61R e. r. RAM®ve CUSS 001.