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Home My WebLink About0046 TOMAHAWK DRIVE - Health 46 Tomahawk Drive Centerville A= 190—022 o , *Pendafle)C 4210113 ORA 10°/® P4, 9 r ASSESSOR'S MAP NO. g� PARCEL LOCATION SEWAGE PERMIT NO. Ami VILLAGE IIlf* INSTA LLER'S NAME A ADDRESS : /- G., P' a UILDE R R � OWN ER DATE PERMIT ISSUED 7_ DATE COMPLIANCE ISSUED 1 �,gr r i _ . _ . _ r �� . ' /j �. ' l lfi 1 / I � f ' O J ,� . , � �1 i�� / __ ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----I OW-A....................OF... 3 et ..--------......_.................................. App iration for R-4paaal Works Tonotrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (*) an Individual Sewage Disposal System at: �� •- arnah` `-'' -•- C�.r�_ !-�l �.............. Location-Address r Lot No. I Owner Address a At 3 Cain5o I'VlG gin.S 'rem� �ra . ................ Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms........................._..___...__.___Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length.............•.. Width................ Diameter__._____--___- Depth................ 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •--••-•--_--••-•--•.....................••-••-•--••--•-•--•--•---••...........-----------•.............................--••--..................-------•----•. 0 Description of Soil............................................................---.....----...-------•-•---••---•--••••••-•--•-•--••--•.............••-•••-•--........I...........-••....... W V ................•--•---•....--••••-•••-•-•-••••••-•-••--••-•••----••••••-•••-_..............._•••-•••--••-•-•............._.....•-••••••-•--•-----•.......••••••••-••••••--•-•••••-•--...-•••••-••••-.... W - --------------------------------------•--- ....... VNature of Repairs or Alt ratdons—Answer when applicable._A�»- ---[mop- •i�pn (pap---_---_-- Agreement: d The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITAM 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 t e oard o health. Si !. ••-• .... •..................................... •.... � �.._.... Application Approved By-.........• :... :......_ . !'�.�..r.------•--••---• // ......Ng.Dale ate ....._.. Application Disapproved for the following reasons:.............................................................................................................. _ ..........................•--•-••--•••••-•.__....._..•-•---•---•-•••-••••--•-••-••-•••-•------••••-•-•••---.........._..-••-••••••••--•...........•---•-•.............................................. Date Permit No..... -------•-. Issued-....................................................... Date No .. g� Fxs.. ._.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF . HEALTH ?.....................OF...... rY►.�t�?.�?t'a... ApOiration fur Disposal Works Tonstrurtiun rrrmit Application is hereby made for a Permit to Construct ( ) or Repair *) an Individual Sewage Disposal System at: tt .. .. ............. j� Location_Addresszz �� (� or Lot No. r EC K(N S- Sri ............. . .. ...w....... Ce t. �w c,t .....---......._._..._. Owner Address a A •_� �`................•- -�,So ....Givy SDI-4�� I.c�es €r UCH. I................ .............. ....-*................ C p� Installer Address V 6 Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......................q...................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers 0a4 YP g -------------•-•---•-------• P ( ) — Cafeteria ( ) QOther 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. 3 Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0, Percolation Test Results Performed bY.......................................................................... Date........................................ ►4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W+ -•-•---------------------------------------••-•--•-....--•--•-•--••------•--•-•.......------._............................................................... 0 Description of Soil........................................................................................................................................................................ V .. W .;----------....•-•-•----------------------.............. ---• ......................... U Nature of Repairs or Alterations—Answer when applicable-.»s �-�...�4`?�a.��0 Sr:��.�,t�_--•/wA_____•••--, &cic�-• s�. i`'/.�+rorrcz cis I t /w irr . 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 theboard f health. Si ne �....�_ 7' 67-84, l�t�.� atitnr I to Application Approved BY ............. ..... ..l tDa ate Application Disapproved for the following reasons:..........................................................................................................--- .......................•--•-•••-•-••--'•-•••••----•-•----......--•----•-•-•---•••----•--......_..---••••------.... ----...------ Date PermitNo.. ........ ......------ Issued...........................•-•--•--.._...........--•---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........�.h..?......'!...............OF..-- rv�s* t�1e:............................................... Tntifiratr of Toutplittnrr THIS S 0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by............ V !fit ti?. 1.............................. .. •• -... ••••• -----------------------••-•----.....__-----------_------- ...................... ........... Installer at..... - . .... : -------•-----••------•--•-----•---------•------------------------•---•---•--.-_ _••----- ary C •----------- has been installed in accordance with the provisions of TILE 5 of The State Sanitode as described in the application for Disposal Works Construction Permit Noel ......... dated..`. 1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA TEE THAT THE SYSTEM WILL FUNCT ISFA TORY. �A DATE.................................... -•- ...�5 c.�.......... Inspector--•--- ........................................................ THE COMMONWEALTH OF MASSACHUSETTS Per' 5 BOARDv OF HEALTH : O .. S cs.. �ri.................. . , ...------........--•--............................No <P....CQ.. Fn........................ Disposal Works Tunstrudiun Frrmit Permission is hereby granted...._CAIM0100 -� .....:..............__.... to Construct ( or Repair ( an Individu Se age Disposal System at N -....... �. ........3k �•-••---•--•--•-• -------•----•-•............................... ..........---... Street �/ as shown on the application for Disposal Works Construction Permit N_� &�'l_....... D ted.. __I bl�*................... PP P .-- , -- ---•------------ -- '= ................................. Board of Health DATE:........AA.. M. .......�.E ----------..................... FORM 125 ULKIN, INC., BOSTC' ' k