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Home My WebLink About0465 SHOOTFLYING HILL RD - Health 465 SHOOTFLYING HILL RD Centerville A= 213 - 004 KEEPING YOU ORGANIZED No. 12W 2-153M mma'a 0 EPM40NSUMM umaum CfTORMMIMATSWEADM a i No... Fxs..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ...........OF.......................................---------------........---------------------------- Zl3 - Doi( Applirafton for Uiipuutt1 Work,5 Tomittrurtiun Errant Application is hereby made for a Permit to Construct ( ) or Repair (,-ran Individual Sewage Disposal System at: // �c�_(.� e . _... ....T... .S. �! ---....._... .....................•----•........--•.---- •---•-•-----........---------...--•---••-• Location-Address or Lot No. N.t�/C% /„ /sr ............................................. ............•.................. Owner -.-_..-•---.-.••---••--•.Address ----------- --- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...._.�!...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Otherfixtures ----------------------------------------------------------------------------•-------------.........--•--.._....._............---............_•..•--•• W Design Flow..................... ............gallons per person per day. Total daily flow.............---------- a'_p.......gallons. WSeptic Tank—Liquid capacityA�0.tallons Length................ Width................ Diameter......_......... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..... Diameter....../,-2 --.. Depth below inlet---.'K."... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.-.-.-_-------__------ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R'+ --••-------••---------------------••--------------------------- .... ._-•--------------------------•-------------- -...... .--..---------..... -....... .---------- 0 Description of Soil............................................-----------------------------•--•------------------------------........----------•------------................---•-•--•-•- x U w x .................------••• --•••. U Nature of Repairs or Alterations—Answer when applicable_�r: o r o �C��S s> ....................... .a/ c , 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 theo o bf health , Sin ............ .•------•---•-- -------- -----------.......- Da*tl"**'*",--,,* Application Approved By............ �}• --• /....-•---•-------•---------•---•----•-- ........ Dat Application Disapproved for the llowing reasons:............................................................................................................... ---•-----••................•-----------...--•--------------------•--------------....-•-•----•-------•-----•-••---..._.......-----••-----•-•---•-•--------------•-------•-------------------•---••---•--- Date PermitNo....................................................... Issued..................... ................................. Date No........��.�`�'r F$s........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ......:::.... .... .....OF.......................................... ApVliration for Disposal Works Tons#.rur#ion Vprrmi# Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: ...L......»... ........................<.t�9LsdL .............................. ..........•••---...._» ........... _ -.... Location•Address or Lot No. Own, Address s�........................................................ . .................................................................................................. Installer Address Type of Building Size Lot...........................Sq. feet Dwelling—No. of Bedrooms...... .............:....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .......-•--•--------•-••--••--------------------------...------•-•-••--------.....------------...........----•---- W Design Flow......................l.__ 1.0...........gallons per person per day. Total daily flow........................-f... ?.......gallons. WSeptic Tank—Liquid capacity2�'_OlNlons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..... . Diameter...........r Depth below inlet-- - ..- Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by................ ....................................................... Date........................................ a 04 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.................••----.........................-•----..............---•--------......-•-----•--...---.................--•-•--•---•-•--...-----......................... W ---•--•--•-------------•---•----------•-------•----•-•--•---------.......----------•-------•-----------------------...---•---------••---------. ----••---•---•.....-----•---•-• -----------•-•-- x ---•------------------------------------------------------------------------------....................................................../ Natur of Repairs or Alterations—Answer when applicable.. i o 6.F o I �sr F'.?w •,�ST4/� icJe,�% G.0./__6a 0q.r P'�"..... 5-P°'" � --------- -------- -----........... --.---------•-.----- -----------------------------------------------------------•---------:............-•----•-•--••--••-------. 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 beep issued by the bo f health sign! ........ ............................. ................... � .._5"~ . Date Application Approved By............. ....... ... .. j y Date Application Disapproved for the llowing reasons:-------••-----•--•---------•-------•----------•----------------------------•--------....---... ------»__ ....................••----•-••----...--•-----•-•-------.......------•-•-•--•------------.....---------.».--;------------------•---------------••-•--......-------- -- Date Permit No................•••••••......._..._.._............ Issued...-___.•-•....._. _»»» Date..........-•-»••• •-•.._ t THE COMMONWEALTH OF MASSACHUSETTS .. BOARD OF HEALTH .......................................OF............... ................................................................. flrr#if iratr of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by...- ... ' --`"------ --- ------------------------•----•- -------•----•----------.--•-------------------------_-.- ••�......... ... ,J � •,/�nstall`� / / at .............................................................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... _..al.� .............. dated..........'?/ f�s� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. 4 r� )DATE_.. .... � •-••••----••......•-_____-•--•......... Inspector -•--•--•• »� ` u { .................. , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF No..... ...... FzE..... »�.r............. Disposal}},Works Tons#rurtion rrrmi# Permission is hereby granted..........ate 't ..�` .. :� T ...) ..............................................................., ...........».. to Construct ( ) or Repair ( fin I dl ideal Sewage Di sal S em/, at No.......�.i...�3:.. �i v6 ��i..�� k � `"��•�2 v/,/� ..----- ..... ........ .. . ................ .... ,,,,.street as shown on the application for Disposal Works Construction Permit No=< 5 "ated- .71- � --••.,•--- .............................. rd of Health DATE.....:.----f J - FORM 1255 A. - SUL IN, INC., BOSTON LOCATION/ SEWAGE PERMIT NO. VILLAGE • •,r ��/mac. U I N S T A LLER'S NAME i ADDRESS 3 o� .�Z BUILDER OR OWNER :cDATE,; PERMIT ISSUED 1A DATE :C0MPLI•ANCE ISSUED_ I r � Q 27