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Home My WebLink About0062 SEABURY LANE - Health (2) �0�1 � �5a � , . Biqa AWPN C) 3Nng MMLW —19'_NNISYIS kF l Von Ut OM 0 worp"m ME&Oan G V:3 1 I i , 0 ' No..... Fss.1S�. THE COMMONWEALTH OF MASSACHUSETTS BOARR®,, OF HEALTH , pplirFa#ion for 11ispno al Works Tons rnrtiun Vamit Application is hereby made for a Permit to Construct ( K or Repair ( ) an Individual Sewage Disposal System at: ,.f ��►arrr ...�� ............... .`�'........� .................................. ,iy�o dress or Lot No. O ner J Address. _ ............. ..... ..................•--•-•------- --•-�....�.°�.......... ...........-.......RT.Via....... � .v.--.. --- Installer - - Address Type of Building Size Lot...._._.__U I...:.............Sq. feet Dwelling—No. of Bedrooms..._.�..................... .Expansion Attic (a� Garbage Grinder (alb ........................... No. of ersons........................__.. Showers — Cafeteria Other—Type of Building p ( ) ( ) a' Other fixtures ........................................................ W Design Flow.........5..__.........................gallons per person per day. Total daily flow...... _......................gallon . WSeptic Tank—Liquid'capacity-10CZ�allons Length " ��._ Width..!7 W Width.. .'Diameter................ Depth..,. -.. . x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------- ----------- Diameter......a........ Depth below inlet... Total leaching area-_ ...sq. ft. Z Other-Distribution box Nils- Dosing-tank ( ) Ova 11 -- -- Percolation Test Results Performed by -- .•.. Ov_.. .-.--. _ a.._l� ............. Date.._ -x -BG.......... Test Pit No. ......minutes per inch Depth of Test Pit....U........... Depth to ground water. �. S�Sa►�� , ,�s0 fZ Test Pit No. 2_G 3n.._._minutes per inch Depth of Test Pit___-1.0......... Depth to ground water.,APT ae,Q a1k1mt,0D •---•----------------------------------------------•-----•-•---•----::::.....- O Description of Soil........... Q. -�' +-n-- _ �?_ 9�,......�' .t-�-------��7.....:..A -3.................... x W U Nature of Repairs or Alterations—Answer when applicable_---..•...............:.................................................I......._......._...... -•-------------------------------------••---•---------------------------•••••••.._.......---..._....••----•-•---•-•-••--•----•--•---•---•---•--•--•-••---•--------------------------•••---•------------- 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' sued�by the o d of e � at Application Approved BY �! ; ��c ._.....----••-•---------•--••---•--.....� -•--------------------- ................ Date Application Disapproved for the following reasons:............................. ...................•-----....--•-----------•----•-••----------•-•---•----------......------....-•--------•---------•--------•-•--••--•-•-•-•-----•--------•-••-•-•-----•---•--••-- -------•••••--- ° Date PermitNo.......................................................... Issued........................................................ Date No................_....... Fps............._............_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...`.c�.......!.....................oF.....�7 ��2 ............................... Appliration for Diipniial Works Tonstrnrtinn Frrutit Application is hereby made for a Permit to Construct ( Al or Repair ( ) an Individual Sewage Disposal System at: ' J SchvU+_�...9 t a\ �7c iZC_ r.�'t�Z�/,LL ........-c�, - ._.... ................ ...... ..... •-• .......... -•--• 2 r7 Location-Address or Lot No. -•-•---•-----•-•--............................Ow�'-�1..........................J...... A t f Address (sa .... ................................._ , r Installer Address Z0 1 Type of Building Size Lot...........I________________S feet Dwelling—No. of Bedrooms___...�................................Expansion Attic (O)C� Garbage Grinder �a Other—Type e of Building No. of persons............................ Showers yP g -•----•-•-----------•------• P ( ) — Cafeteria ( ) dOther fixtures .............•---•--•--•--••-•--•------•----••-•..._...••-••••-••••-•..........----------•-.....--••--•- W Design Flow.......... ...........................gallons per person per day. Total daily flow....... .......................gallons. W Septic Tank—Liquid capacity._►C_. allons Length.g_:.".. Width__`!'-.(0'.Diameter_______________ Depth_.. .'_. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-__-.---•-•._-------sq.'ft. Seepage Pit No.....__.._ Diameter....... p .........:. Total leaching area..7_�O..sq. ft. � pag �.._....__. �.__..... Depth below inlet.... .. Z Other Distribution box (��S Dos' nk ( ) '-' Percolation Test Results Performed by�k`tEZ �`�G..I?J -............. Date..... " .... - ••-----••-*•------ --- Test Pit No. L.4.? minutes per inch Depth of Test Pit----I.?.......*... ,Depth to ground water-_- � r=, Test Pit No. 2..G. c.....minutes per inch Depth of Test Pit....1.Q......... Depth to ground water. q�: `..Svu�:�2tJ —•---Z------- ---------•----.....-•-s---------...-------•--•-••----.......--•-•-----.........._.....--••--...-•---•--...-- .O Description of Soil-•-•-•..----.. _.... v3 t ...............................Z........ ....___ . . � � ...-- 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 TIT11 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. �J Signed ..... ; _---- �'A_1 �! ,. j i i. ...r ..`✓' •=--- Date Application Approved By ---------•----•--------------------` �.. Date Application Disapproved for the following reasons:-------•-------•----•---------------------------............................................................. ......•••-••---••••••--•---••-•--•--•--••---•••-•-••----•-----••----•---•---•-.................................................................................. ..................................... Date PermitNo......................................................... Issued_...................................... ............... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 17 ...................` ....................OF....... .............:...�...................................................... vorrtif iratr of Tontpliatta THIS IS TO CERTIFY.,, That the Individual Sewage Disposal System constructed (><I or Repaired ( ) ,\-),, VC Installer at.................(2 :1-............. .L.n.....•..=; .g�°(? -------�n!v . + #L,044 rN`tr'r)� C•�.- -V1 r has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code s 4escribed in the application for Disposal Works Construction Permit No.......... ..J59/6...... dated----------:5. ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................. ! 1 ...................... Inspector.................................................................----................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I ............1..... w�...........OF.........?..... ..-,/� ``....�........................................... is�J'V 4? No........... FEE........................ Disposal Works Tonstrudion ranfit Permission is hereby granted....----------------------•- w� -------------------------...-----...-----............------.... to Construct ( )0 or Repair ( ) an Individual Sewage Disposal System at No.........6.a..............CA....:A 1A...•---tea w f" .....t=-- t........................... Street as shown on the application for Disposal Works Construction Permit No...... Dated.._.__.__.S_. .._..� 8 6....-----•-- Board of ealth DATE - ----------------•--�••........�. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - a S%NIG(_.E FAMILY - 3 6CD12ool�I. No GA►ZBA G� ,►.1�C� m� DAI U,( FLovJ r- l I O x 3 = 33 o Cr. P. D. SEPT•I c- TANK = 330 X I5o 4q5 ya ' G.P.D. USC D IS Po!SAL P lT QSE I OCO G-AL. I f 51 OEWAL i�REA ISo s, r. I `152 v3 G Iso s.F x 2 . s 3-7s a-. P. o. ya-� Zz. � -� goTT•o M A?-E A = So S•F. I ... raj: . TOTAL -DCSICGK) = 4ZS" GnF. D. 3'f S?•3 -Fo—rA L IAA I Ly FLOQ = 33o 27 PER ;r RATE I i►1 2 MAN, oQ LESS (16.. Ze, 3/.3. . P::T R €� SULLIVANN3 7 'N it �• 733 No 2cij�) CAI Lrl N/.40 /9 �_. , =Ve- 1 Oisr. 2_G .vi /von BoX � / • ��_� • GA L ' o• P.T 3� 70��• •� � - `G',E,QT/F/EO :PGOT ,oL:4it/ v : WR4HG 0 ex 12 ,yE•�Ec.v GaMP�•Y�S lt�/TX�Th'�'.S/OE,G,/ivE :.. . : B.4XT�,e€�VI�E, /.uG. Aiv1�.SETI�/�G` .e�4lJ/eE�1ENrS O.� Tiy� .eE6isT�'ec'IJ,CQ.tio.S!/,eti<<yo�S aAl,4,4/11Y.ST,e- : : SDK/Nh'E,eo�i✓.5.4/ovGl>.s/aTI�E IJSE''