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Home My WebLink About0001 HENRY F LORING ROAD - Health (2) �- kwe�� \-oevy, 2d 4Z No......................... ` Fm$.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF' EALTH Appliratiun for Uhivwial Workii Tonstrnrtiun runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systm at: ....I........ r ..... ... . . ..f.n. ,.. u ft. ..._... f ............................................................... Locatio -Address or Lot No. O Address W Installer Address � Q Type of Building Size ...Sq. feet U Dwelling—No. of Bedrooms................... ..............._--.--Expansion Attic Garbage Grinder ( ) aOther—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures- -----------------•----.............---•-•------•-•----••••-•-----••......••• P ................................... g . Z ........_ _ ._gallons per person per day. Total daily flow.....�;.................................... gallons. Design Flow----•---•- ---------�--... -- WSeptic Tank—Liquid capacity _gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—Np: .................... 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........................................ aTest Pit No. 1................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........................ �+ --••------•--------------------•--••--------------.................-•----------..........------_.............................................................. 0 Description of Soil........................................................................................................................................................................ x U ._......_... x --- ------------ ................................................................................................................,...................................................................... 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'I I'I LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isss ed by the board of health. gned _-.'C. . ...�� 1 --------------•----.....-•--- / Application Approved By....._! _ l�f 1--4 ..Date ........ Application Disapproved fort a following reasons-----------------------•--------•----•---------=-•------•-----....-----------•----•-......_........_...••--....... .....................•-------•--.....----•-------....----.....--••-------......-•---.....--•---...-•-•---••-•-••-•----•••-•••-•-•--••-•---••----•-•••-•-•••-----•-•-•-•--------------------••••---•-•--- Date PermitNo......................................................... Issued-....................................................... Date to N6. ................... Finc.............................. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... ...................OF.......................................................................................... AppHitition for Uhipviial Worko ,(famitrurtion "rr' Application is hereby? m,ade for a Permit to Construct or Repair an Individual Sewage Disposal System at: . .. ................................... .................................................................................................. ;i ;tj�, — or Lot No. ............................. oca o re;; wo .. ...... ..................... ------------- Address ................. - -------- ..................... ................................................................................................. Address M Installer - !4 Type of BuildingS t.. U ................. Expansion A Size Lo ,eA�._Sq. feet Dwelling—No. of Bedrooms--- Attic Garbage Grinder Pk Other—Type of Building ................le*------ — Cafeteria No. of persons............................ Showers Other fixtures........... "AP11 ....................................................... ................................... A------1' Design Flow._...... ..... L,$..qall6ris per person per day. Total daijy,flow., O',,.,....................................gallons. .44:1�t.J� ..... apa All Septic Tank—Liquid t ....gallons Length................ Width... eter................ Depth................ Disposal Trench—N Width:...._._.._...._._.. Total Length.1.3 Total leaching area....................sq. f t. 7 Diameter..................... Depth be ow inl;�t.................... Total leachino,area..........> .............. .......sq. f t. Seepage Pit No w� 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.___._..............___. . ....................................................................................................................................................I........ 0 Description of Soil......................................................................................................................................................................... X ........................................................................................................................................................................................................ U ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable.............................................................0................................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions, of T I T LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ssW d by the board of health. gned_ ...... &4............................................................... ........ ... .... ... Da Ze ell Application Approved By...... .. ... ....... .. ................. ---------- -----------------------------................. __le Date .Application Disapproved fo Xtffollowi!ng reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............................................................................. (5rdifiratr of Tamptiaurr T, I IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired abty..-.-.- ............ ........ ....... ......... Iz........... .......z...................................Installer ... ..... r ------f---------------------------------- Ivi -"d has been installed in accordanc with the pro sio s TITLE 5 of The State Sanitary Code a's escribed in the ............. Z� application for Disposal Wor s Con truction Pe dated...... ................ _Sios__� ';e - I'THE ISSUAN E IS ERTIFICA E SHALL NOT BE CONZSTRUED —AA GUARANTEE THAT THE 'T OV SYSTEM WILL U TION TISFACTORY. DATE... .......... ............................................... Inspector---. ............... ............................................................ THE COMMONWEALTH �F MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... No. .............. FEE.... ................. Ropwiat Permission is hereby granted........... .......................................................................................... -ifiv I to Construct ,4a'?-Re air aff fn i idual Sewage Di osal System 's y 'T v ..... ............ z. .................................................... ...... at No..... .......5... ct4, pp treet ---------- as shown on/the/lica 'on for Disposal Works Constru Lan ermit No:— Dated.,eV. z/ .................. ----------------------------------- ..................Board of Health DATE.../L .. ............................................................... FORM 1255 A. M. SULKIN, INC.. BOSTON I -51QGLr' FAMIL.Y - :6 BCOROO/A Wo�GAcz�AGE. (�LZ.INDE2 VL G3 t9�-o I DAILY FLOW z 110 A 3 = 330G•PD• SEPTIC, TASK = 33ox150% 4956.P. q oe I USti= l000 GAL. � � �� ' �oo•oo 2-Z / 015Po5AL PIT y6E 10o0 GAL. I 'S I DGkdAIL A26/a - 1 jo S,F, � 150 5 F 2.5 - 37 5 G•PD �q. 50TTOM AREA= �A ( � 50 S.F• x 1• o .. ' So G o p l� Hof 'T oT A I_ DES►G N = ,�}2 5 (�,P. D. TOTAL pA I LN( PL-OV4 - 330 G•Po Is j PE2coLATIpN RATE : 1''IN 2MIN — ,I �o /8t tN OF W } .'. rdli HARD 9c�G Ord ALAN G -� A. W. I Oo•00 2v. <' BAXTER v, J ES H No.240480 Nos 4Nv suaNF� 'I TE`5T 7&ie, + Gv Top FWD I' HOLD ,-V,- - yr„ I 58•o � LaAM �cJ850�(- 1000 INV. DIST. GAL. lI 2. wX INS. !SEPTIC- GAL., 5�8 II GoA�E 100 I1JV• $7, TANIG Sn� 570 LG.A.0 li ¢ PIT INV. INV. WITW 57z 57 ¢ II MED WASN6D 6TvNE I SAS a II GESZTIFICD PL07 P1.-A. J I PROFILE a .. _ LoLA-TIo►J II'¢ /2 NO SCALE SCALE "_ Slj' .. "DA.T1= /ate � I V.l p�•-A r•..1 REF: E 2E N GE ` CE,czT1FY THAT THE Fo�IJDATIo+.1 5l1oµ/N NERE01•! GoMPL�(5 YJITN THE S 1 oEL1tJ � I' `I AuD 5675ACK Lor ZZ' -f o w N o 'E,�a. s1'a t'3c.� AND I S '(� r� / LOCp.TED WITNI►J HE F1.00D LAIN PC . �►C• �3 6l I� SATE 1-14-g3 , C1 BAxTEQ.e �.,1`(E INC. REG I SZ 6Q6•�'1.Au D S u¢.Y EYoeS 7VA15 PL&KI I Nei' f D 0Id AN vSTEiZVILLr-- (iv�jTRuM6NT 5u2VEY E- -THE oPF'SET5 5wouLD No-T [61~ 'u5E0T0 APPLICP.►JT ALA� � • S M�L� IEJc . No—......... 2"_--•5.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��- I►GI ............ 1 Appliration -for 4%ipoottl Works Tomitrurtiott Vanift Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: l Q' 0 I ` -- � ---- Loca'tion-Address No. : -- ........_ .�.....__. AFildi .......................................... W Ownerddress-Installer AddressJUType ofng Size Lot_/. _f_! ----Sq. feet �-, Dwelling—No. of Bedrooms. ______________________________Expansion Attic ( ) Garbage Grinder (*0 per-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.4 Other fixtur s __.__ W Design Flow---------------------- .............gallons per pet-son per day. Total daily flow.......______:Z Q---............-------gallons. WSeptic Tank—Liquid capacity/l_��_gallons Length________________ Width-------......... Diameter................ Depth,............... x Disposal Trench—No_ ____________________ Width..- ;____.-_-____ Total Length----------------- Total leaching area...............-----sq. ft. Seepage Pit No--------------------- Diameter/Q_.AT1.. Depth below i let.................... Total leaching area------------------sq. ft. z Other Distribution box ( ) DosingA k ( ,)e —(� = //'� a4- 77, Percolation Test Results' Performed by.__'_ ,-----F6A = _. __. Date____-��_`_ _2- 7�'"`---.. Test Pit No. 1__.___,��_fiinutes per inch Depth of al'-e"st Pit____________________ Depth to ground water-.____--__-___-__-_---. �14 Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water............-_--____- - W ------------------- •---- ------r f /f { Description of oil---- _0---- --� 1 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 Article XI of the State Sanitary Code—The undersigiled further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar of health. Si /gn -------------------------------- Date Application Approved By---- ��'..Z--'----:. Date Application Disapproved for the following reasons:..........................._•---__-_----•-----._._._._._______________.__.__._..____________:_____....__•_______ ._.._.._..•--•_-_-••---------------•--•---••__.._•---•-----------•--•--...-•---------•-•-•-•---•-•-------•-----------------•----•--•----=----------------••--•--•---------•------•------------------- Date PermitNo......................................................... _ Date No.........................l� THE, COMMONWEALTH OF MASSACHUSETTS -._ BOARD OF HEALTH Applirtttion -for lh�iporittf Marks C omitriirtion Prrutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: / Loc ion•Address /`} t No. •------------------- ----- i •• -----___--•-----••--•-----____-_-•---- f J ' Owner ddress -------r- - - � Z staller Address �, �•Type ofwilding Size Lot_ ; ....... -__________Sq. feet U Dwelling—No. of Bedrooms___. -------------------------------Expansion Attic ( ) Garbage Grinder Other—Type of Building _______________ No. of persons--________________-____--__ Shower Cafeteria Otherfirtt.tre$_.- -------------------------------------------------.........................................................-------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity€e"_-r_f�_gallons Length---------------- Width................ Diameter......---------- Depth...___-__-_---. x Disposal Trench—No_---------_---------- Width-------------------- Total Le h_______ Z..Totpl�aching area__---_.___--______sq. ft. Seepage Pit No---------------------_'Dlameterf_j_.'______. epth beTo e ......._ Total leaching Z Other Distribution box ( . ) __..___.....___....._...______.______._ Date---------------------------------------- Dosina't !'" aPercolation Test Results 4'erformed by___________________________•---___.s. Test Pit No. 1......... :_ Minutes per inch Depth of lest Pit __ Depth to ground water __-___-__--_ -_ - t14 Test Pit No. 2................minutes per inclo Depth of fe +NY f t th to �jjpuxi j ___-_____--. 0 ................................................................f' ` ............................. Description of ------------------------------=--------------------------------------------------------------- x � ------------- U W U Nature of Repairs or Alterations—Answer when applicable ...........-------- -'r__:- __________________•--•--••--•---•---•-----•-••--------•---------------__.__---•- 4. Agreement The undersigned agrees,•to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 'o'f'the State Sanitary Code—The undersig ied further agrees not to place the system in operation until a Certificate of Compliance has bee is-ued by the boar of health. 7' . Si lie -.. " �ls Date ApplicationApproved BY------------------------- ----------------------------------------- -------------------------- -•---•-------------- -•...........-•----..... Date . Application Disapproved for the following. reasons_________________________________________________________________________________________________________________ •-------------•--- -------------------------------------------------------------------------------•_---------------------------------------------------------------= =' ---•-•--•-•------------- c Date PermitNo......................................................... Issued...................... •---••---•---•---••-- Date `s THE CQMMONINEALTH OF MASSACHUSETTS 77 BOARD OF s. .;.. .... .. .................................................................. S �otiftrate of W.'aamlilitturr THIS.4 he I'idual Sewage Disposal Sy to ons cted ( ) or Irai ed---694, ) _--••-•---•----- --•- • - •- by- at---------------------- y t / - 4 74; �, has been installed,in accordance with*the provisions of Articl of TKetS1"ate Sanitary Code as`d scribed in the application for Disposal Works Construction Permit No............................................ dated.- _.________.. THE ISSUANCE"OF THIS CERTI'F:CATE..SHALL NOT BE CONSTRUED'AS A.GUARANTEO ,THAT THE SYSTEM WILL FUPlCTFON SATISFACT®RY Ins DATE__ 7 r 3 7 r ` . pector---•--•.. ..................................... .^' THE COMMONWEALTH OF MASSACHUSETTS r.: BOARD F EALTH ..........................................OF...........................................-........................................ No......................•. F FEE........................ ;.� - �i��tt,�tt� ark, �.�arc�tr�irtittai �rrutit at Permission erebgr to == _ to Cormtr � . . R s e��1� ° reet6 �.y 7dv / f�—• as shown on the application for Disposal Works Consiructio mit o D'aIteAd--- - •--- -----------•------•-----•--- i Board of ¢Ieath DATE........ FORM 1255, HOBBS & WARREN. INC.. PUBLISk ERS D��lGh�i UQ\TA � ., � • 5C-F-n C (r7 G % = t1-q c�6. +I 19 US� l oOC> 64,L.. , �ISPaAt. PIT - USr-- loco GAL-. �,E SME"AL- AzaA = (5o S.F. 15, D t 3 t i5o St= >< Z.S v37S G.P.p. Mf BO 1-O,VI - Sa 5j'. t .o _ SO (a..P D. TOThL -C>ESIGIJ = 425 _34_' -t-oTQ L v,d l t_�f r-L!�W = 330 IT± . PT_=f1CDLAT10Q IZQTE ILI 2-m1 , 012 LBSS. - t QJ lci MIµ ._Zv .. _ �EOL XV M a PST (:I TA*j;K. d) p�0� WILLIhM v�'L;'y i� � � � 1 _ /.S"o+•do Z pND. i`l3St . n 6 'TE-ST iG.99 Top Fwo =ioo.o 7 rPP� , 11JN 6i Sum fdo,6- 4 FIST: IW GAL. 9G.7 wv. /' `$ox 96,4 SEvrlc I oo0 9"� iwv, I►IV• , 96. Z LI=AcN A CL CA N FIT MEo WI rw , WASHED- STONE q, CEQTtI'IED pLb-r FCOF:71L 1.bGATlo" � ENYC.i��'tt_L ' e�,s` ►J o SG l�.t_.�- 5 C.nL.� �"�, �,a' t-AT� 3/1 U/7� No INh7TE�C'_' 1t�zZ/7y . i CM!ZTIP-f Tf-(AT" TNT b.b.l 1Zt=Fir2c►.iGE 1-I�.t;''��Ly►J GCaNIC�L�S �l/iTt•� TNT �jlD�.l✓l►-� IL o T 3 AWt:> SE,rV ACV_ V C-QUIQENtE+-4TS OP TI-N(-:� "TowQ Or- P��2NST- Cat.. ; CE NI-EeIVI w-LL H 14N f.-A AGS GATE 311017e " Ivg4rw BQXTCK. �`. WYE t2c-.GlSrctZ�a 'I.Al.tl;, 5v2v�YotzS "( WI5 FLAW I,S WOT BA-->GV C)" p.t►J 05TE2V1LLi-= o 11�C.�55. tfJSr"t?:Jt✓tC_t.!i 'fjL11��1�\{ � Tt�tC_. UFc=S�t'�irjtaOt!sJt� APPL.1 C_A,h..IT '1c) Mtw4& 11J"C' Ltwa — - / L� ni SM/'�LA