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Home My WebLink About0075 JAMES OTIS ROAD - Health sAmn-es o7ts �a 171 t6B S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR OREAI LE MIN.RECYCLED INITIATIVE CONTENT 10° CorofwaFborScurcino POST.CONSUMER wwwAmommzg sampo MADE IN USA GET ORGANI7.FA AT SMF MMA I I '•. ti ter. ',6 No........ = - Z ' �a{�� FEE ......'v- THE COMMONWEALTH OF MASSACHUSETTS ,_-... BOAR® OF HEALTH d .----......OF....... .......... ... . .. __- ------- ------------- �. Appliratiun for Disposal Works Tonstrnrtiun Vamit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal S � ....- �r .............. � �' � --- ........-- -•-•-- p o-n t .—----- __ _---- Locat "lddre Lo ---•- --•----- . ........ .......... . .. ...................................... O ress Installer Address r Type of Building Size LotZ:?,iJ-.21"'v...Sq. feet ►� Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other-T e of Building No. of ersons____________________________ Showers a YP g -----•-•-•-----------•------ P ( ) — Cafeteria ( ) P4 Other fixtur --•-_... W Design Flow____._�_Z ___________________gallons per person per day. Total daily flow_._______�`�__ �_____.____gallons. ---- WSeptic Tank—Liquid capacitA_r allons Length................ Width................ Diameter________________ Depth................ 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 ( ) ~' Percolation Test Results Performed by................................................................_......... Date........................................ W 4 Test Pit No. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 0-4 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W -•••------••----••---•----•--•-•-•--••••...................•-......._....._.._.........._•----_...•.......................................................... 0 Description of Soil........................................................................................................................................................................ x V ._..._.....-•••--•-•---------•------•--------------••._._...---...--•--------•------•--•-•-•---•------...---•---------••._...-•------••--------•...-•-••.....----------••------....-----•••-•--••-•-•••- W U Nature of Repairs or Alterations—Answer when applicable. -------------•-•-----------------------•---------------------------------------------------------•-•-----•------..._..__......•-- A Bement: The undersigned agrees to install the aforedescribed Individual Sewa e Disposal System in accordance with th pro iot o 1 TI.I of the State Sanitary Code—The undersigne urtller agrees not to a e the system in r n t er to of Compliance has been i e by the lard o ealth. 7 Signed tcation Approved By ....... 1/�.... � a-•_�--- te Application Disapproved for the llowing reasons_______________________________________________________________________________________________________•---.._._ ---------------------•----------------------•----...----------.....-------•---------------...--------•--•---•---•----••---•---•-•----------••------•••---------•-•-•-•-•••-------•••-••---••-•-•-------- Date Permit No.......S5----61b - -- ----••--_--- Issued-..........................................Date -----------------=------------- --.•--- ....... Date Date w w No.......! Gt. 3 Fick -........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH k. % '' r, r OF - �.. f,ar Uhloosal Works Tons#rnr#iun Fermi# Application is hereby made for a Permit to Construct ( `) or Repair ( ) an Individual Sewage Disposal System at: ............ ............................................. t'o ...---- L .......Loon Ajddress� r �" or Lo Noy ................ Owner Address Address ,W_I fir........... -......-..= •- "f r"•-•----•----------------•-------- .............. _''' -¢L- ................................................. Installer Address Type of Building Size Lot....._...`___...........Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (i'�)c`? Garbage Grinder (l 1 P aOther Other—Type of Building ____________________________ No. of persons___._._.__.________________. Showers ( ) — Cafeteria fixtures`. ---------•------------------------------------------------------•--------------- W Design Flow.........................:....______________gallons per person per day. Total daily flow................ .___.___.___gallons. WSeptic Tank—Liquid capacity.............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 tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•----------------------------------... --.......... --........ --............. -... --------------••---•------------- ••••--------- ••--•------- •----------- • ' 0 Description of Soil........................................................................................................................................................................ X U •--••---••---------•---••---•-••._.._--•--•-•--••----•--•--------•--•••--•----....••---.......•-----•-••---•----•-••-•-----•--••----•--••-•-•--•--•-•--••--------•-•-•-•••---••-•----•--•-•-----•-••-- W ----------------------------------------------------•----------------------------------------------------------------------------------- •.................... U Nature of Repairs or Alterations—Answer when applicable............................................................................._.................. ---;••-•--•-------•-••••---••--••-•••-••••-----------•-•-•--•••---•-••••-••----•-•---•......................•-•---------------------•-•-------•---••------••--•-••-•--•---•-•-•----•-••....-•-•-----•-- A eement: The undersigned agrees to install the aforedescribed Individual Sewy�e Disposal System �Ia accordance with th prosio o T� TIE 5 of the State Sanitary Code— The undersigned�further agrees not toce the system in er on t r to of Compliance has been i�ssud by the board of''health. Si nei x rr jr�� g .............. ...................................................... �1• ��--- ........ nation Approved BY ..... --- --• ..... .. . .---•..................... ---•----. --r� --- --- te Application Disapproved for the f 1lowing reasons-----------------------------------------------------------------------------------------------------•--•------ -- ------------•-----.......--•_-••- --•• - ----•-•---•--••--- Date Permit No...... ............. Issued. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................... ................................................................. kurrfffiratr of 5 ft unt�rli nre TI TO CERTIF That 'he Individual Sewage Disposal System constructer Repaired ( ), by.........-- -% .------'�''_"--- "- ---------•----------- ---- -•------------•-----•-----•••--•----•._....-•-----•-------._._....---- taller at............ ---- -- ----- - f--••----------• ---- ----'- has been instalee in accordance with the ovisions of TITLE r of The State Sanitary Co> y C e as d cribed m the application for Disposal Works Construction Permit No------- �-_�a_4��3______________ dated_-_.._ _ a __ ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUIRAN E THAT THE SYSTEM WILL qUNf.TION SATISFACTORY. DATE.. .. .................................... Inspector---_--- *, THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF HEALTH C �r. ...........................`;..............OF...........-_._._...._.._.___..._.-......._._.---..____.....__........___._....._._.. No.- +. FEE........................ Mops I or Q1.0stairtion rrnti# Permission i hereby granted...... ..... to Constru o e air I ivldual Sewage Di os Sys �� ✓, at No......... - --••-•- Street as shown on the application for Disposal Works Construction Permit No_______ ____________ Dated........ _� _-.0........... .............................. - - - - -- ---•-----••--•--•---•--_-•--- �_O - Boar o Health DATE----------------�----------------•------ FORM 1255 A. M. SULKIN, INC., BOSTON LET z6 Z, 1So,00 _ 0AIt _ �' Y;..FI.oW: : lCa; x 33'o G. P. D. s"6.9i SEPTI c:._Ta(vK -..330 X. t5oyo ' 495' G.P.o 8t zo Ts Is Pr�SaL P iT. V SE' 1066 6-AL .. 3 0'L p gip• �"• Ya 151 DewAU " AREA' - I5o S. F• -' L 3 g'± 74 .1-OT 21-1 �n $o. _ S. F._:x' I.;co So G. P• �• ; yb� 5,"0O T 1110 �ZZA U Q. 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BUILD ER OR OWNER Q DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � S �S �� 3�' 27' 3�� 0