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Home My WebLink About0043 JAMES OTIS ROAD - Health (2) 3 J�-rrc5 cc,)+s P�a� tlSfIN�iN MMI*M ® � Y ao�s�•a KV� *ON 03ZIWDHO f10A MIMI mod THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH ----- Jc .... 4....-...-.OF...... ... .................... Apphration for Diivnial Works Ti n iturtinn 1hrmit Application is hereby made for a Permit to Construct ,( ) or Repair ( ) an Individual Sewage Disposal Syst �?� fe, l �.. ............................. ..........., � ...__---___._..._ ---•• -.---•-•-•• n !rr� ,ion- dress or Lot o. .-- _.....••-•-•••......_.... .__...... .__..... •-wn •-•-• Address a ................ � . •------ ._.......i.......... ..................... ...... Installer Address V Type of Building p Size Lot.__ .� ___.Sq. feet Dwelling—No. of Bedrooms____....._V________________________________Expansion Attic Garbage Grinder (/•t,e_, Other—Type of Building No. of persons____________________________ Showers Cafeteria a' Other fixtures ____________________________ _ W Deessign Flow........ Lam,.................gallons per person per day. Total daily flow..........��_3d.............gallons. WSeptic Tank—Liquid capacityf. _gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. ____:............... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No:.._._..E. 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........................ -------------------------------------.........----.......-------......................................................................................... 0 Description of Soil....=.................................................................................................................................................................... x U ••------••-•-•-•---•---•-•--•-•••••••-••-•----•-•••--•---•••-----.....••-•---•-•-•-.......•-----••••--•-•--••••-•••-••-••-•••••--•--•-•-••--••-••-•----•••-•••---•-•••-•-•-•--•...••--•.....•----•------ W ------------------------------------------------------------ ------------------------------- ------------------------ -------------------------------------------------------- -........ ....._. VNature 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 undersig d further agrees not to place the sys em in operation until a Certificate of Compliance has been ' u d by the board of health. r/ Big ed. .a- i /D ............... `� ate Application Approved BY k 1_ ..l! --�.-� Date Application Disapproved for the following reasons------------------------------------------------------------------------------------------------------•---....... --••••-•-•-••• =---•----•••---•-----••••....•-••--••-••-••.......••••••••......................................-•----------••-••--•-•••••---•-----•••••--•-••••--•---•-• ...-------•-•••-••-••••-- - e i ----_Date Permit No........ 3 .......................... Issued_.......... �1(_- ,�•••. -••--- No "" FEs.. . THE COMMONWEALTH OF MASSACHUSETTS r BOARD ; - F HEALTH ApVtiration for Uiipniitti Vorko Tomitrur#inn Verntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at.: f �. �► .� Location Address •.f ,/r .�.'".._�.. or Lot No, C....t r,,.• f % Address W , "� o -- - -----------------.-------------.-- ' r Address dType of Building Size Lot.... _----_-Sq. feet Dwelling—No. of Bedrooms......... '.............................Expansion Attic (/i.}'' Garbage Grinder (j).- . Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( !.) Q' Other fixtures ............................... . . W Design Flow....... <'._. .__gallons per person per day. Total daily flow................:-._.. -.r.. .............gallons. WSeptic Tank—Liquid capacityj_ s'"-,-.,..'.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..-..-. ............. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------- `:`_f Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit-----_.............. Depth to ground water......................... rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GG O x Description of Soil........................................................................................................................................................................ 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 TITLL 5 of the State Sanitary Code—The undersigr,O further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board,bf health. / t / c � 1 r ,� ..' - at Application Approved By..----- �., d...: �. It f tom,........................ ----•-•-I�. �. .. c ;'........ Date Application Disapproved for the following reasons-------------•-••-.••-----•-....-••-•.......••-••-•••-•...--•------•--•-•-----••....••.•-•-. ••----------•.... ...._....-•----•-•••----...••-••••---•-••-•---•-•----•--••••••-•-•-•---••••-•................•----------•._..........._......•------------••-•-••--•---••--------------•--••-.............. -•---•••-••••- p ••-Date• Permit No.......2-_.-'9--.s_ .... Issued. l l -FS ---._..._•.... ...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............... ..................................................................... Tprtif iratr of Tontplittnrit THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--------------------------------------------------------------------------------------------------- ------------------------------ .............. ._.....------------ ------- Installer 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 S_Z;_._ .�.r)..._...... dated----- f_.. ..r.f.`._ ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRUED AS A GIJ ANJTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............._. gem Inspector f ------....... --•-• .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � - No....... °., .. FEE'-..— ................ �i��o�ttl nrk� �on��rttr�tinn rrmi� Permission is hereby granted...... ------------------•--•-----••-•------------•---------•-----------------------------•---.------.--•-..-.---------••----- to Construct ( ) or Repair (, ) �ividualjSewage Disposal System at No......�� .......---.. ..a r r�x.'S.. �I. .-•-- treet as shown on the application for Disposal Works Construction Permit No c4'5._P.... Dated.._..___ -1.i� �a.............. -----------------•--- - Board of Health DATE.-- - '... -----•---...•---•.............•....----•••••••. FORA 1255 A. M. SULKIN, INC., BOSTON S/N6L E F�tiy/L Y —• 3 BE0�2aoM EGG`� Zq� IVO GQ.2ByA 5E 6, &/OE.e OA/LY FLoL 1 - //D X..3 = 330 — SEPT/CX/So =5�91�G.P.O. I v o n o SSE /,000 GtJG. - xP• (SSE Ae6A s/OEW.aLG �1.2E.Q = /So S.F j �� poop. j S. X Z.s- - 3�f G.moo. 2�3 ° - —Prr. _ TOTAL_ I�.4/LrFLOW= ,33DG•PO. 17f �-^ i OES/G� �E.e.GOL4T/a�✓.P�4T�.' /"/.V 2�/N. G3[�LE� ,. 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