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Home My WebLink About0005 SACHEM DRIVE - Health 5 Sachem Drive Centerville [ A= 209-007 0)),,Pford, NO. 1521/3 ORA 10% a ASSESSOR'S MAP NO. 9 PARCEL 0 0 '7 IYOCATION 5 5 E W A G E PERMIT NU.- I�IS� VILLAGE INSTA LLER'S NAME ADDRESS oi OWN ER � DATE PERMIT ISSUED ' DATE COMPLIANCE ISSUED � .� } lk i d E q0 V, ASSESSORS MAP NO: No...Q...........--.----- PARCEL NO.: ®b F�s......I. ` ... THE COMMONWEALTH OF MWgSACHUSETTS 'BOARD OF HEALTH .. ,41 '?— -----------OF........ :..... ....... ......................... ........................... Appliratinn for Uiipniittl Workii Tonaxurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair �andividual Sewage Disposal System at: ................... - ------------------------------------------ Location-Addre or Lot No. i , ..............: .................. �'��... . ..........................."�.�:: ,T.........--•---.................................... O r Address staller Addk ss UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........_�...........................Expansion Attic (A,� Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------•-- W Design Flow............................................gallons per person per day. Total daily flow........ ........................gallons. WSeptic Tank—Liquid capacity/,.�lgallons Length__..__''.. Width__---j-C-..._.._. Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length................ Total leaching area....................sq. ft. Seepage Pit No---------1-------- Diameter.....149....._._ 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........................ a .....-•_.... ............------ .----------- --- ---------- --------- ••----------------- ._... Description of Soil..------ . -•-•-•......-`�`--I------------------------•-•--............................................. V .------------------•---•---•-•-••--•••••--------•••......-•-----•-------•-••-•-•---••-----••••••••••-----...--•--•-••-••-----•••------•-•---•----•------•......•--••••...-••••-•----•-•................•. W -----------------------------------------------------------------------------------`---.....-•••-•-------•-•--•--•---• ---------------•----•-•••-•-••••••-•--•---••••-•-•--••----•-----••---•-••--•---- U Nature of Repairs or Alterations—Answer when applicable........... ....... ____________________________ ................ -------�.;ra-,-�..... ----------------------------------------------•--------------•--------------------------------......---------- 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. ate Application Approved By••-••.... :.....: ................................... ....... •-- 7 .`d ._.....---- Date Application Disapproved for the following reasons:................................................................... ---•-•-•-----•-•-•---•••------•-----......•-••-••-------••••••---••••-•--•-••-•-•-------•-•---•••••••.................................................................................................. Date Permit No..... ® --------------- Issued......................................................... Date ------------ LIJ�.�1JeJ.Lall..l l.... ............... ----------- No.T6 .q0..! Fizs......� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- ..........OF........ .. .---- r Appliration for Disnniitt1 Works Tonstrurtion rami# Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: •-.... 1A ..Y................. ----- -' .- .--- ------------------- Location-Addres /J or Lot No. -• ... - �Fi'L`.e�.el'e�s�...art ... . ............................. ..........................-................ _ �1�• Or Addre a ............... . ,1. .. Ate. ..:...... ...---- staller Addr4fss Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............ ...........................Expansion Attic Q01 Garbage Grinder ( ) Other—Type of Building .....--.... No. of persons............................ Showers a YP g ---------------•- P ( ) — Cafeteria ( ) dOther fixtures .-•-•-•---••--•-------•-••----•-----•--•--...------•-•.....-•--•-•--•--.......--••----•------•----•---•-•----•..............................••---_.... W Design Flow............................................gallons per person per day. Total daily flow----..... ........................gallons. i W Septic Tank—Liquid_ capacityA2 gallons Length....... ...._ Width.... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length............... Total leaching area...................sq. ft. Seepage Pit No........./........ Diameter.--..Id-----... 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........................ (s., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ..................................................................................... � ..........--•-••.--- UD Description of Soil......--•-•= -- ------------------------------- ------------------------------------------------------ ---------- •-•---------------- •------------•---------------------------.----------..--------------- W UNature of Repairs qr Alterations—Answer when applicable..........�.4? . - -t?........ . �. -------•---•---• ..... .... . -.t''- -�-?.`---------------------------------•. ,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. ...................... .. . ... -- .. ------ ate Application Approved BY 4�-r :...... .............•---•-•- � • �...... Date Application Disapproved for the following reasons:...............................-.............................................................................. _ Lf --•-------------------------------------------------•------•-•-----•------••----------•----.----------•-•-----....------------. 11 Date Permit No....... . t ------••-•-•--• Issued...........:........•------.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7...........OF.... ................................. Trr#if irate of Tuntpliaurr THIS IS TO CERTIFY, T at the Individual Sewage Disposal System constructed ( ) or Repaired (4-y7— by ---------•--•----••-----.. .::..........................•---•-•--....------..............-----.....•. Instal at........./W....-.:. --•-,,..y!Lr.;....------L�•c2--k - has been installed in accordance with the provisions of T 5 o��jj�The tate Sanitary Code as described in the application for Disposal Works Construction Permit No.- `� `Z. ._.... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL TION SATISFACTORY. DATE. --�= �s...... _--....----- Inspector.... Kt ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ v�_� OF...... ....................................... FEE No....-%C.o._.......7..._.. ........................ Uisp'osa1 Workii Tunstrurtiun Permit Permission is hereby granted................ 1.s .! .. -------------::. ............................................................... to Construct ( ) or Repair t,.4.►an Individual Sewage Disposal System at No........ . i C ... ----- - ....... ............................. r Street as shown on the application for Disposal Works ConstructionPermit No .'.y® ated...... � L?.............. a = .� _ +...� s ........._•...--••••.......... / )C ( Board of Health DATE (/ ,� ...... ---------- FORM 1255 A. M. SULKIN, INC., BOSTON ASSESSOR'S MAP NO. o'Z 09 PARCEL O D '7 L 0 CAT 10 N 1-Is �-- � � ,5 SEWAGE PERMIT NO. Z,22 22 5 2 VILLAGE j INSTA LLER'S NAME a ADDRESS l U 1 k ot OWNER ' DATE PERMIT ISSUED DATE COMPLIANCE ISSUED l ZZ- 4 4