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Home My WebLink About0168 JAMES OTIS ROAD - Health (2) ll�� Jame ohsGerr►► 1- r No.....`/'°.......... ` FEs�( ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD CIF HEALTH Cfi'WYI............OF........................................ .... ........ .............................-- `6 AVp ira ion for Diuvu,ial Work.5 Tomilrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: cation-Address or Lot No. .......... �.............................. .......... � ...........------•---......... (A qcOwner Address a ....._..,��.�, ....`.... C .. ... !�-401/ty...................................................... Installer Address U Type of Building Size feet Dwelling—No. of Bedrooms.............._?'_.......................Expansion Attic ( */O Garbage Grinder (/V � Other—Type of Building No. of persons............................ Showers � YP g ---------------------------- p ( ) — Cafeteria ( ) dOther fixturS.%........................................................................................................................................................ W Design Flow.............. ...gallons per person per day. Total daily flow.._.........._. . . g ��—.�------------------ g P P P Y• Y - ...............gallons. WSeptic Tank—Liquid capacity/ltiprjgallons 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 tank ( ) - aPercolation Test Results Performed by....................................•------------•-----....--•••--•-•••••. Date........................................ 14 Test Pit No. 1................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........................ P4 -------------------- •--------------- •...................... -----.............................................................................................. 0 Description of Soil......................................................................................................................................................................... x U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- w ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. reement: 4era undersigned agre s to install the aforedescribed Individual Sewage Disposal System in accordance with or o i TT of the State Sanitary Code—The undersi ed further agrees not to place the system in n u i er ' to of Compliance has bee issuedby the boa of healSi -- -- . �..................................................... J - .... ion A roved B OPP Y ..... Date ion Disapproved for t f oll ing reasons:---------=------------------•--•-------....-----------------...-•---------•......---•-•--- --••------•-••-•--. --------••••---•-•••--•-•...•--•-••-•------••-•-•...----•••.........................•-•.........--••--•-••--._........•-•--•----------- ••-••---•-•-•-•---------•-•-•••......----••-••••--••---......••. Date PermitNo......................................................... Issued....................................................... Date No.t c ..... �� Fxs JD . ................... _ THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH OF......... ..........................................:-_: .............................. Appliration for Dhip ott1 Workri Tonstrurtion ".erutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .....JIAJ!f —••_-f- •l.f ....f!;Cf. 1 �.......1'.......... JG .........•••-•-•-•....-••....•--••-••-••••-•-------••................•••••••-•-•-••••••••........ I_ocation-Add ess f or Lot No. �+ / /yam ..... -'Sf. :, /i .:. ... ................................. ..................." :: - .!.C..r'`.•::� .C: ':.e�...N'.. .......................•••--•___ T f1 O Address y� /1 ---Owner � G% "...................................................... Address ress Type of Building Size Lot_.'r....r_._ r `=' Sq. feet Dwelling—No. of Bedrooms................. ........................Expansion Attic ( .rt),,rO Garbage Grinder (A)' Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixture* ------------------------------••- W Design Flow........ - ._______gallons per person per day. Total daily flow____________ _____ ___...............gallons. W. Septic Tank—Liquid capacity.//:r.ggallons 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 tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (� ----•--------------------------------------------------------------------••__••••••••-......••••-•••......................................................... 0 Description of Soil......................................................................................................................................................................... W U Nature of Repairs Ior! Alterations—Answer when applicable............................................................................................... .............................................................--•-...................................................................................................................................... A reement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with th pro on of iLTL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in erat on un 1,a,C�ery'• to of Compliance has been issued b the board of health. f 1 ..rt-rc� 4sr A li tion Approved By_...... - "_ . . �� ` Date pplication Disapproved for the�f olio 'ng reasons:...............•---.....----------------------------------------------------•---------- ...................... Date PermitNo......................................................... Issued-....................................................... , ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF IHEALTH ..........................................OF. Tnrtif iratr of Tnutplittnrr MR-f! IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( orRepairedby = .. ...... ..................... ------------------------------------ ------• ------.......--•--.... (/ L a has been installed in accordance witl t e�provisions of TITLE 5 o`,The State Sanitary Cod as 6e.ribed in the application for Disposal Works, nstru�`'�ion Permit No.--�a__ _w_d_ _ _____________ da.ted__,/` �.Y_._____..__..._________.. THE ISSIJ NC OF T Ij! .C•I?RTIFICATE SHALT. NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM I F N SATISFACTORY. DATE...L-,�__..... 4 .................................................... Inspector 1 f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.........................•____..._....._......_....___...______........._........._.. ..... FEE.... ........sk. .... �i ork� �unotrttrtion rrmit Permission is hereby granted....',-.-'"r_-.E'.-------------------------------------------- to Construct ( ;,for Re �-.:, ) an Individual�Sewag al S"-s" at No......................... ----�.. cl - '' Jl '��1�`` �.. .� Street as shown on the application for Disposal Works Construction Permi . 'T?....................... Dated.......................................... Board of Health DATE................................. FORM 1255 A. M. SULKIN, INC., BOSTON ►JGLL— FAMI��( - � t3G ORnoM u5 �'Ca�a.BAGE �,P.�NDE2 Sti , F►.0W .: Il'o x 3 = 33oG.PP o �. .5EPT1G TAQK = 'aaoxl5o% u5c- 1000 7 y ev / o%5Po5A�- PIT v5E 1000 COAL. o`�' / ; '�Z�'t k. 5%DG.WALL S.F t'5 0 5.t= X •5 r 3 5 G.P o S: vN BOTTON, AQEAr-, �o S.F.G o hP fou.,o�noN . 5 � o s.t= x ►. � 5 'T oT A>_. q E 51 t;N Q ..�}-2 5 G.P. D. .t•.�,.( ,. -IOTA%- -PA► FV-C>V( = 330 G.Po• c I "�� M PE2COLATIWsI RATE: lIN 2MIN o�►-ASS w ::, �,�" - ao e i x pew �� I ti • a 4.s m'q�r,•>1� • /o cF / o� OF OF ti0yC. �y ! RICHARD DAVID A. ';` C. It;1 BAXTER i CD7)IULIN LP No.21.11C a3 P No. 29976 'A � � ,o •P G/V/V O NQ/STGP�Q� �hv suR��'� ��/ONA 3�Z��g� ,, • TOP � ^�•7,y FWD PIT' = S 4. Imo' �JO.O y 7` 7AW l� 4- � Iooc� lN�• D►ST. lw Ong. 13 56PTIG Gc�.. 4� SA I� L � INV. 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