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Home My WebLink About0093 WHIDAH WAY - Health 93 Wh tc1a� Wo �n Q 30- R Q O A -;ill ,SMEAD No..2-153LY UPC 12034 smead.com • Made In USA ocrc� �� pia SUSTAINABLE FORESTRY INITIATIVE Cer ified Rher$mtmbW �.cfinroo�amam `i - Ids •'� �, - No.... -.--- Fima.....�..�..... THE COMMONWEALTH OF MASSACHUSETTS __._.. BOARD F H A TH /...............OF.... 4e4.- -/ ------........••-••................ AVVliration for DhiVwial Workii Corm rnr#iun Prrutit Application is hereby made for a Permit to Construct (C—l"or Repair ( ) an Individual Sewage Disposal systemT.. .. .... . . ...... Location-Addf<!P; Lot No t.:.................._ _ I.?-•-�•.---•--- Owner Address ............................ ................................. ............................................................ Installer AddressPq `` Type of Building Size Lot-S.CC.7}.�F0.Sq. feet Dwelling—No. of Bedrooms......... ...........:....................Expansion Attic (h(j Garbage Grinder (470) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures -----•-----.---_--•_-_-----•---_ . W Design Flow.......... _..`?......................gallons per person per day. Total daily flow........S.3 ................gallons. WSeptic Tank—Liquid*capacit�Qoagallons Length................ Width................ Diameter--_---__-___-_ Depth................ x 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 ta.1 �J ) Percolation Test Results Performed by----- ------ --- .. ._. n_ Pr7 �i'"it7g Date.... ._...lip•••-_�----.0-1 . �°. minutes per inch Depth of est Pit..._ ...._ Depth✓✓to ground water... ,-1 Test Pit No. 1 ._....-5`--_ G4 Test Pit No.�� .minutes per inch Depth of Test Pit". ........ Depth to ground water-��C..... . j - •• ........... .............................................................................. escrptonoo .... = ---...G71fle?7-- .. --- V .....•••••••••••--•••-••••••••••••• • •-� ••••.sc�4r _ fl_�_�... Q _ ..rJ."1�S ------------------------•-•••-•--•-•-......•-•------ W ..........•---------------------- - ,�'� ..•.•...c.rt( ----------•--------- --------------------- 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 TIME 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 d of health. r Si ned.._�- --......... .�..... ...... _.... t Application Approved By............... ......._._. . .(-;I— � ----- Dale Application Disapproved for the f ollowi reasons---------------------------------•-----------------------------------------------•-----------------••••-••..... ---------------------•----------------.....••••-•--••••-•._...---••••• •--••---•-•---•---••--•••--••.•-- Date \ Permit No................................................•----.. Issued-....................................................... Date No................-....... Fins............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F H TH + ..............OF... ...1..yY ' ✓5 . . ..... Allpfirattun for, Btopuiitt1 Works Tonotrur#tun rantit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System)aa Location'- iddyeA �r. - t_ f' Owner Ifu Ad L>a r . dress C* 't_ .... ft L: a:S. 7. ..----------••--------•..... -� •---•-•---- ' `-` �` -� • ! ------• •............................. Installer Address Type of Building Size Lot. _ _Sq. feet ►—I Dwelling—No. of Bedrooms.__..__�.:.________________________________Expansion Attic (�Zy Gar age Grinder ( _ aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures .----•-•-•----- -----•-------------------------------.-•--•--•-----•----------._.._.__._.._..---••-------; ...._.. Design Flow............ __*4________________________gallons per person per day. Total daily flow_._.__._ gal W ._�^: .------••---- ...--- lops. � WSeptic Tank—Liquid capacitv!kO gallons Length................ Width................ Diameter................ Depth__.._________... x 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 tilt ) , Percolation Test Results Performed by..._ '.. / �"' '.. _ f�: ��! 'Date____ __ ______ _.__. Test Pit No. 1 11-e5 _minutes per inch Depth of Test Pit_ Depth to ground water_._ a� P P r P 44 Test Pit No. � � _minutes per inch Depth of Test Pit__ ..: .__._._._ Depth to ground water_. `_.__ xDescription of Soil ca,r( r C ( x ``�' ." n --- ......•--...-- •-•--- •-••--- ---•••. --••-••-••-•--•••-._...---•---••----------•.............. 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 has been Issued by thejbmar,� of health. Application Approved By____________________`> Da Application Disapproved for the f ollowi g reasons-------------- .......................................................... ..................................... .----------••--__ ............ .............................................. ..................................... Date PermitNo—,..................................................... Issued....................................................... Date' THE COMMONWEALTH:OF MASSACHUSETTS BOARD SF HE/AT T f:4 !5�✓. ..................OF..... . .. ...:...t... :._................................ Trrtif iratr of TOM' luturr TI-US IS:TO G94TIFY, Th t .the Individual Sewage Disposal System constructed ( r Repaired ( ) !,� 7 by ,r ----------------------------------------- : " / Inst ' '7 has been installed in accordance with thei.pro'visi of:TITLE. 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_-.----------- ................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY, DATE............ Inspector............ ..t... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEA �2 G ✓ '"� .............OF....17:K'�,0 ._ - - ,:.' . NO.__ _.....I..... FEE..... .......... Dispo Vora Tonotr ion Prrntit Permission is hereby granted....... ..___:+! _ °: .._ .1 _ ______________ to Constru (t-<c Re air ( J) ag Indivld Sew a Dispo /System at No.... ! '_ ^,. _ �_ l ' Street ' as shown on the application for Disposal ` orks Construction Permit No.?�__J �Dated--- _. ."` �:v-................................. ........ : .... ••--•-•-••••------_._... B a of Hea DATE............... -- 114-: x•-------. ............... FORM 412r5�5'" A. M. SULKIN, INC., BOSTON ` LO}� TION �' �� W =CI-3 SEW. �E PERMIT NQa.O�Ld z5 W ayg j Z I � VILLAGE I N S T A LLER'S NAME i ADDRESS e U 1 L D E R OR OWNER DATE PERMIT ISSUED -L - p DATE COMPLIANCE ISSUED f_ T v 3 9 1