The URL can be used to link to this page

Home My WebLink About0063 VICTORIA STREET - Health 63 vtc' CIN St Cet'Urvace. - 148 - ohs i S M E A D No.2-153LY UPC 12934 smead.com • Made In USA FORESSIUSTaN�ABIE WITIATIVE WMUAOPWNLM � CatlBrdF�r8oureinY i i � ,. ��' '1 `,� n i' i 1 I No.. ........ ....... Fss... ...................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH f IN..............OF.........:45a(�4— .� .. Applira#iun for Biuvu,a ai Works Tome rurtian j1prmit Application is hereby made for a Permit to Construct (pQ or Repair ( ) an Individual Sewage Disposal System at: ........Vl ._. .. . .,t- -�. "'..r------------------------•---- -•-------•----•----•---------....... ?-T..•....t.1-•--•-••-------•-'-•....------......--- Location-Address or Lot No. ............4Buing ............. ••••••••••--••--'-...._................•......- ................ Owner Address W Installer Address Type of Size Lot..-F/...Q_�� .Sq. feet Dwelling—No. of Bedrooms...............e...�._............._......Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building __ a Other—Type g ________ __________________ No, of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------- ------------------•.... . ---------......----------------------------- W Design Flow................$6......................gallons per person per day. Total daily flow........... _=ff.�_.................gallons. WSeptic Tank—Liquid capacity/000gallons Length...... ...... Width....... Diameter................ Depih..4_. x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No----------I........ Diameter...eTk.5.'. Depth below inlet................. Total leaching area.�564.�.fsq-.f Z Other Distribution box Dosing tank ( ) Percolation Test Restilts Performed by.......L- '& ___._ .: Lc3 El.� �� //�=�Zate... --------------------- Test a - Pit No. 1_-- 4.?._minutes per inch Depth of est Pit..... !� Depth to ground water/UVZ-_�-" 14via•t.)7�E� GZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---____..._......_.._ 9 .---------••----•--•--•-------•-----------------------------------------••'-----.........•--•-....••......................................................... O Description of Soil--------------�efg.......&.7..T 6..<;HjEP.....pxr:J-A.j--------------------------------------------------------•-'---------•--- x 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 system in operation until a Certificate of Compliance ha een issued by the board of health. ned --------------•••-'-----•••••--------------••••------.._...---•----------••--.. .. Application Approved By ----_... l�.�l..v.. ..--•---.....•'---•-•-•-------------------------•--........----------- ---.......-- Date Application Disapprov or t e following reasons-------------------------------------------------------------------------....................................... --.......-•.......................••••-----------.....--......--------------------•-•---.....------...••.---•----•---------------------------------.................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .... G+ N.. OF............. .. .x Applirta#ion for Uhipaas al Warkii 041witrnrtiaan ranfit Application is hereby made for a Permit to Construct (>Q or Repair ( ) an Individual Sewage Disposal System at ......... --- — ,,ww 1..r. — " ''.A............................. ........................ "'. s - ��y ._.... Location-Address or Lot No. a Owner -------•--------•-------------•-Address .�C,�/'»• ------------ .........................•-^......-•-^ Installer Address Q Type of Bu' ing Size Lot__ I...Owl&.Sq. feet Dwelling—No. of Bedrooms............... ......................Expansion Attic ( ) GarlIage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures -----•......-•--•-•--•••--•-•••. . . --. -- w Design Flow...............ee ............................ per person per day. Total daily flow..............5.0-,.................gallon. WSeptic Tank—Liquid capacity/A49t9gallons Length...... Width.....#.__.... Diameter---------------- Depth..! ......_. x Disposal Trench—No. .................... Width....._....�__._._._ Total Length.....................Total leaching area•__--___•-_.......sq. ft. --_«�•-Seepage Pit No........../-------- Diameter-__Z9•_ .•• Depth below inlet........ ..... Total leaching area �e �isa +C-a►,,+1 . �� Z Other Distribution box 10<) Dosing tank ( ) '_'' Percolation Test Results Performed by__...._�Ow.. �esit.•dc�►E .. /z .Date...-iZnZ0 -.lea........ ,tea Test Pit No. 1_."�_ '_.minutes per inch Depth of Pit..... Depth to ground water.? :"__ ri Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wateF=w `.40' P •---•------------------------------------------------------•---...........--------------------_.............................................................. 0 Description of Soil..............`-4�.......9.177'0.!rIQH .....A814 1..!�/ x w UNature 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasebeen issued by the board of health. � . -✓•"� ate Application Approved BY '� -�^ a: •. ' Date Application Disapprov for tine following reasons:............................................................................ ---•------------------------••----•------------------------....--•---------......--------.......-----------•--•--------------------------------------•-----------------................................ Date PermitNo--------------------------------------------------------- Issue(L....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............I.............................OF.................................................................................... �rriirttr of (�aa3nli�anrr T'HI IS CERTIFY, That the Individual Sewage Disposal System constructed (r--)-or Repaired ( ) by ' ....... °` �. ..----------------------•----------------- ------------------------------------------------------------- . � "` Inst-aver has been installed in accordance with the provisions of TITLE S of ..lae State Sanitary Code descr' in the application for Disposal Works Construction Permit No... _..._c5. .............. da.ted_s�... _ .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRI! A UAR TEE THAT THE SYSTEM W F NCTION SATISFACTORY. DATE....r .. ._ 3.. Inspector.-•.....: .... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Nov-`-25 i'" ...........................................OF..................................................................................... FEE.4,+._41)............. to as tt1 nn#ruction rrmit Permission is hereby granted---------•---- 4.... -- .--•-- ............................................................................................. to Constr 4. or Repai d'vidual S i�Posal System R _.. ! at No. r // 'If_._.L�' . ... .. .............. . ......... . Street �� ✓'- as shown on the application for Disposal Works Construction Permit I�'o.__-�____.___ ............... 1 J ......................................... ......--------......•---------•................---•- •�► Bo of Health DATE-- ...... -- ................................... FORM 1255 A. M. SULKIN, INC., BOSTON 3 yr LOCATION SEWAGE PERMIT NO. VILLAG—t" I N S T A LLER'S NAME 6 AD02ESS kl lf�P Qhie.Ys,� �sc 6 U I L D E N OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 2 (Y 3 q 3 r __ a- ► ar�.,c y ,� y� �� - �� 'J / /O —0 Q ol - /��011/g `x Ems.�,•� P:- f o4 - -4� _�, Y . ! D 2 10R.oo-/ _ /0-7, 6� 98 / oi. 25 91�2 94 __ EX7rE-ti/D F3L L f� PPLtCF� BL_� exisfir),/ ground 7- / MF+/I, HOLE GOVE25 TO %�/T•Hf/�l - - °- Pr-oPosed 9rovnd Profile H0�212 SC/9LE / - /p -- C / / 0A- V EA2T- SC /9LE / = / O' /2 OF r tils �,' Ecr E�A � E . S C A-+c D 4 0 PVC 0,42 - -- Eoull:�L TO SF_PT c Cry--, nirnurn 14" �r -1'oo-f-) washed sfone -TAivK-r - - - t D/sT BOX O 0 /000 GAL. SEPTi`C tTHN�'C C ' of 3/4 ° 00 , � 0 0 0 ll0 ° SCALE LE /9Ct � PtT 1 IDE- S / G /A�j -- - - T� �ST HOB LOG - / LOT --_._.--- �D2OOM HOUSC- DATE _�" "i _:�_ TE-S OG.J ✓� <- %E;c i/✓� _._ -- 1 ,lam A 7'E < M , %/ V C f / -- , -`-+ -_ + ------- - ----- -- 1J Sj' lF�=Y S C 7f �, KO � DHT(ini! 5T HOLE - , EST- HOLE Z I t _ P �. E�95E • EF�CH p/ T : Tc oq. z DE [,v Ai L L = � ._._.� $ .-'. (�, s ) = _4�7,8 G. P D.. co�2sc �' }, ' ��", ` �� f%' B o-r roM = _Be•� S F � : . o � _ _8�.ce .. . L o T V �� C�'S E -_1 L E C H O; 7- / 0 vo t1JAiE2 E�co`/ti/ rE,Z G / GE,27-/F Y T!-t!rgT 7 HE BU/L Dtti./G A-J P/2OPOSED oA./ THE GAE'OCJn/D /9S $H O &AJAJ OA/ 7f S t'L F of DOE S /'OA2 GONFO E'!`� i-O -rk4E-- B(1/L :)1AAS SET- V t G 7"O!0 / ST 2 S E T APE To%vn1 OF ✓ fH /✓{TH B<-8 OF r,jN 0,-MRS� S C fa l.._ E /,-4 S S f--1 0 tnJ N ' E / t5 k2O /'� LVEREI T GN o EVFrNE -- / HINCKLEY Nc 13230 A.'A, 5-t- ray e ,'evat on BLDG SETBF�c� 'J 000 Yro�oSea e , evct C)r� -- - - Ex .5 ny cor, four-S des,