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Home My WebLink About0167 JAMES OTIS ROAD - Health (2) 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH lo� Applirttt-ion for Mipuual Workii Tonulrnr#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Locatio dress oP'Lot No ..................... ...................... a . w n. � Add"re'ss o�.. ... •-• . ................... l :�.. .... ...��.�I..................................... .-.`-... Installer Address /^ dType of Building Size Lot._. s..rSq. feet Dwelling—No. of Bedrooms...........�... ..........................Expansion Attic Garbage Grinder ( #)VO Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( 4-40 Q' Other,qxtures d W Design Flow........... ..... -..................._ allons per person per day. Total daily flow........................... ............gallons. WSeptic Tank—Liquid capacity.. allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.6..._�4'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........................ ------------------------------------•---.......-•------------------..............-•----......---•--.....-----•----....------...•---•--•--••-•••••......_----- ODescription of Soil.....................................................................................................................................----•--•-•----••••....._........__. x U W ---------------------I_.................................................................................................................................................................................. 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 TITLE 5 of the State Sanitary Code—The undersigne further agrees not to place the system in operation until a Certificate of Compliance has been is e by the board health. in -----•----------- .. .. Application Approve ... .. ................................. -•-•G.....�---•-•......---....... .................................................. Date Application Disapprove or a following reasons:................................................................................................................ •----•---------------•----------...------....----.....---•---------------••-----........---•---•----......--•-••--------••---------------------------------••----•--------------•••---••-••••-•-••-.-•--- Date PermitNo......................................................... Issued....................................................... Date w � M S.`................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F .................-.... AVVfiraatiun for Mipoiiaal Workii Ton.strurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at T ..... �...................................... Lacatio .•Address / oLot No a �t .................O...............FT;W wnez r� �Address ........................ ................ .._ !....... P ...... !!X f»a ..,� +.�.� ...................... � Installer Address Type of Building Size Lot........................... ._Sq. feet Dwelling—No. of Bedrooms...........n!"n...........................Expansion Attic Garbage Grinder a'4 Other—T e of Building No. of persons............................ Showers YP g ---•-----------------•------ P ( ) — Cafeteria ( �' dOther fixtures. ........................................................................................................ . W Design Flow........... .. .' .............___ allons per person per day. Total daily flow.............--'.._.-''_....._._..._gallons. W Septic Tank—Liquid capacity__1�: 4.gallons Length................ Width................ Diameter................ Depth.:.............. x Disposal Trench—No. _...�-%�i Width...................1 Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter....---------------- Depth below inlet.................... Total leaching area.. ................ 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•----•----•---•------------------------•----...------------......-----------•......----•---••-•......---••---...••--•....--•-..........._.....--•-.....-- ODescription of Soil........................................................................................................................................................................ x V --••-------•--------••-----------------•••••---......----•-•-----...-•----•-•----•-------........._........-•••-------------------------•---••---•-•----------------------•.....----•---•-••------------ 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 TITL i, 5 of the State Sanitary Code— The undersigne xurther agrees not to place the system in operation until a Certificate of Compliance has been issssueedd,by the board of health. Igned. 1.1 C' t .. ......I L: �XB ............. .. - de Application Approved .... ..... .................................................................................... 7`.l ........ Application Disapprove for following reasons:..................................................................---------...------------ Date............. -•------------------------------------ ---•-------------.......---------------•-••-•---------..............................------•--------------------------...-----------•---•••------------...---•-••-- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtif iraatr of Tompliatnric THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) Installer at....................... ............. .. f.1:.��.. t. .._........_.._...... _._......... ... has been installed in accordance with the provisions of TI 5� Thy-State Sanitary Cod . as . ,scr' ed in the application for Disposal Works Construction Permit No.......rZ .. ��............. dated_..1.__�>. ..../�------------..... THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRI! AS A GUARANTEE THAT THE SYSTEM WILL Y C TION SATISFACTORY. / a DATE.....��. ...._.... --••-•-•---------•-----••----------------------•---- Inspector.. ... .........-----------------------•--•-•--•-----•-•---•--...---••-•.....---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /'��- ...........................................OF..................................................................................... NO. ...................... FEE........................ Biupouatl Workii Tontrnrtion "permit ci7 Ypr- ) '...,.- --.... .................................................................. Permission is hereby ranted___..._ __-!:f:�'` to Construct or Re r_ - an_Indivldual wag Sys at No.........................-. .... .� %'� '.- � --------Zo ------------. . .= .... Street as shown on the application for Disposal Works Construction Permit . ...::..... Dated.......................................... .................... -----------------------------------...--------------...... Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON # h J I-!D °C�AR�AGE t'jPJNDE2 ' ';2°t:, vn.►�.�( F►-aw .. 11vx 3 �3oG.Pp SEPTIC TA►JK = 33c'>xl5c>% u5c— 1000 GAL. 309 " D15Po5AL PIT v6E 1000 GAL. i 5 ►DaWALL AR6la 15 0 BOTTOM I V-%-:A �0 5 F _ �- # �4�: 5o s.F x I O 50 �.P o. ^� 2 nwK 'TOTAL. �ESI(,N • .�2 5 &-P D. o ,a¢erA •TOTAL DA►LY35'} ;I..:{' PIE2ooLATIOW RATE : I"IN 2M1N o�L655r r ' ' p.., it IT- LP NOFh`'± 12 �• i� p DAVID v� RICHARD `,,, C.THULIN \C*lA. • �.. I� 4 BAXTER w v No. 29/ w ) 0< p o C/�T� i�+ �5 4` o �/,3 ��-. P NG 'U;l�t NAl �f I NOLC 10-14-83 F�}5� �� Y7 F rl` � INV. S-LaLoAA4rt toov�. , z . I '1. l4oP ttJV, Sl•L -rp�tK ` 5a L u 51 lilt A+/riL P IT INV. INV. II WASNGD i I 6TvN� • CE �TIFICD PLOT PLAI.! =M L o C A. T I i4Ei-= - - { 13 (.10 :SCAL1= SCALG ( 1150 DATE- G-Zo-$� ' a kI ATf� L N R E P E P 1,4 Gam. i ' NbA IOIJ o P P . .. C E Q•T►r-Y T H AT 'T N� rOtJ T 5N V+(N HEREON COMPLY(5 \rJITN HE S l D6LIN ( 3i Y, A U> 5'ET 5AGK R..6Q01 R-EMENT� -To w N O t= '$AQ/4'ST->d.'6La A N-D 14, ��u Fort ,d'-A LOCp.TED .WITNIIJ T 6 GLooD PLAIN S�ItGT A or- A D A E G pAT� iSiS T BAxTE2e tiYL- INC- --rids PLn.c.r lj NO"T C3n5r D o� AN osTEe.vILL� - MASS l I, lu5-rRQMENT 5veVey -TH& o1=F5E75 Suo�1� t 5 NoT DE USEDTCS DETER1�Itilt` l.oT - INE APPLICA►� r �(,/J, IN1 r AsBuilt Page 1 of 1 IG` LOCATION CE PERMIT NO. 'VILLAGE f..& 4L -1-P- — IN TA LLER'S NAME IL ADDRESS eAa. • I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED i .49 8 � L r http://issgl2/intranet/propdata/prebuilt.aspx?mappar=172235&seq=1 12/28/2018