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Home My WebLink About0187 OLD STAGE ROAD - Health (2) Nq Oid Naf—ad" J I • No:....:. �?. —� �i `� Fizz...................._..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF�.`HEALTH TO.Xm..................OF .S .......................................................... Apphration for DaopooFai Workii Tonotrur#ton ramit ,i Application is hereby made for a Permit to Construct ( ) or Repair ( .) an Individual Sewage Disposal System at: -------------- ------•-----------------.................---- •----------------....................---- e Location-Address Lot No. r �`�I .._------k� t- ,7 .�......................................................... �. .2__a_l�__ ��.: �... ._�........------ Owner Address ..�' ---------- 3b a ?ain.. �c + ..1 a ._ �rrma - ,.a ---- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..............J..........................Expansion Attic ( ) Garbage Grinder ( ) pa Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a'' Other 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil........................................................................................................................................................................ U Nature of Repair or Alterations—Answer when applicable__-1Y!e:.. (DQA..ClfiQ._ fGh:. ?tl '._..../�.52t ...._. r ►� -----------------------------------------------•-------••----------------------------------------•-- me . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAIHE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. SignedIs: -- -----------------------------------•••------ .._Y"-1.4.J66....--.... d Date Application Approved By................................... 'D s 1-7 r.................Date Application Disapproved for the following re. ............................................................................................Dat Date............ .....................•--...-•----....-------•---.....------------•---•--•--•----------.........----------•----•--•--•--•--------•----••-----•.......................................................... Date PermitNo.......................................................... Issued....................................................... Date ��.v��__- ---------------------------------- -- al No...................... Ficii....... THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH -7run ..OF...............I............................. Apphration for Disposal Works Tonstrurtion rrrutd Application is hereby made for a Permit to Construct or Repair (V-) an Individual Sewage Disposal System at: .............. ..Location--Address ................ .........................................—or.Lot-Now ................. o. ................. (I CA VVI • 183 1 0 1 C. .5 1 1 Itev- V11 1L. ............................................ . ......................... qQ_ eoocr *3_1 .................. Owner Address A4 P 0c, n (L)es qorrneJA .............................nc............................................................... . ............................... . ............**'\ ...., Installer.er— Address i ........... Type-of Building Size Lot............................Sq. feet of-Bedrooms.................................Dwellingi—No. ...........Expansion Attic Garbage Grinder Other—�Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ......o............................................................................................................................................... Design Flow.....:......................................gallons per person per day. Total daily flow.........0..................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width m................ Diameter.._............. D "M epth................ Disposal Trench—No..................... Width.................... Total Length........._.......... Total leaching area....................sq. ft. jva: Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.... ....sq. ft. Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No; L.'..............minutes per inch Depth of Test Pit........._......_... Depth to ground watei.,......I............... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa.t8r. .......... iW ............................................................................................................................................................. Descriptionof Soil........................................................................................................................ ................................................ ............ ...................0............................................................................................................. ......................................................... .......................................................................................0.................... ................................1�...... ....... ........ - --------- j, -in., Nature of Repair or Alterations�Answer when applicable.._. ...........r................... 17,1_1�7.11 . I 11> r .. C ........... ....... (7 1 ?-Po U I re C .....................................................................................................................w............................................................................. Agreemet, The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with e provisions of TIT 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 issued b the board of health. y e oar A; Sig .. n e d.I-.- (& �__�4_1�_�........... ------------ ................. ........... ............. Application pplication Approved By.................................... ------------------------------------------------- ....................................... Date `A- e j �Jj6ijon Disapproved for the following r S:........................................................................................... ..............--- ......................................................................................................................................................................... Date........... Permit No..................................................... Issuedl...................................................... Date V THE COMMONWEALTH• OF MASSACHUSETTS BOARD OF HEALTH r) ryl stc,6 ............................OF..........�)......................................................................... Tntifiratr of Toutpliaurr - IS.TO CERTIFY, That the InIjivid)Zal SewWe Disposal System constructed or Repaired (-Y-) ell ............ n.Clj.. 'b........................---------I---- .......... ....... ................... installer helowc. .............t, A --a A.........................Z.3........9!%>.....aly•... ................................................................................................. ha been installed in accordance.with the provisions of TITLE. 5 of The State Sanitary Code! 7 describ d kp the ............1.7 Qk, tion for Disposal Works Construction Permit No............................ .4w--- dated ........................... HE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE 1 FU TION SATJ.A�A EK 15 IC "§��RY .. ..... Inspector............................................... e I .................... ........................ ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF...... jj�...............4.................................... No.... rk?.-43 (-V Fay.... ........'........ Disposal fork Tottstrudion, purAft Permission is hereby granted........ -4=..................................................................---- to Construct or Repair an Individual Sewage Disposal System ln��......jr�,_..................................... ...................... 0 '7 .............at No................................. .......L.o... ...... P, ;is,,Ishown on the application for Disposal Works Construction PermitStreet No...V..§.......3...3.4. Dated...........5L /-7 .............................................. B rd of He.I .DATE................... ... ..................................... . > FORM 1255 A. M. SULKIN, INC., BOSTOIN