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Home My WebLink About0081 MELBOURNE ROAD - Health �� rn�1 b��-e �Z � , ��.� � �� . �� _ . _ _.� LOCATION EWAGE PERMIT NO. VILLAGE IN A LLE 'S NAME A ADDRESS `1 � t U1LDI R OR (`OWNER Is fi DATE PERMIT ISSUED 0 DATE C0M ►LIANCE ISSUED CB ��, � — � �=- �, c_, q1 � — � � " G 0 I`. — -� FEs.....L:: ...�............. THE COMMONWEALTH OF MASSACHUSETTS • BOARD F HEALTH .4........OF....... �� ................................... Apphrativii for Diipniitti Workii Tnnitrnrtinn Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at, U ---• ........D � :.[... l /� �— c� Lo.c o -Addr or ........... ..../..1..? i�g/.�x`�,t.`.... %�_ ��........ `��/1� � -• �c��Ga Owner Addre ---�Az......1�� '................................f�.�.1�!. ��......_... 0.16 ! �s....l'�A .............. .3�...:. . Installer Address Type of Building Size Lot_-__-L feet Dwelling ZNo. of Bedrooms............................................Expansion Attic V-4.) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ... W Design Flow.... ................... -ilons per person ppr day. Total dai17 flew........ _...._......... �nsa. WSeptic Tank—Liquid capacity./& allons Length��..�`.`.. Width... ....... .. Diameter--------- Depth... x Disposal Trench—No.................... Width.................... Total Length........ Total leaching area-._.-_-•------------sq. ft. s, Seepage Pit No..._._../-..,_-____-- Diameter.....1.�..._ Depth below inlet_.__ ._..._. Total leaching area....;.............sq. ft. Z Other Distribution box (1,< Dosing-tank ~' / Date__.__ a Percolation Test Resul s 'Z� Performed by.. 1 ..N ..._..._.-.!?r ______________ �.p�.ya. ..l 0-. Test Pit No. I�_._......minutes per inch Depth of Test _..../ to ground water...��-ems___/�/ L%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... •-------------------------------•-------------------------------•--•---•-----..............------•--------............-----------......._..__.. ............. 0 Description of Soil......................................................................................................................................................................... x U W ---•----------- ------------•---••-•••-----•-•--••-•-•--.......----...••---•-•-----------••._._....---•--------------•--•••-•-•--------------••-•-------••-----............--•--------•--•---•--_...-- x Nature of Repairs or Alterations—Answer when applicable............................................................................................... U ._...----•..........................................•------•---------------------------.....--_.....------------••-----•---....------------------•----••-•------•-•----•••-••----------.......•---..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b721, ed th oar f health. Z � Signed - ..... .................................................... ... •----•...........---- ?Date�Y Application Approved BY------------- ._...�.. - - ----•---------..............._..._..-- -----� Date Application Disapproved for the following reasons:................................................................................................................. -•-----------------------•-----------........-----......-----•--••------------...--•-•-•--......---.....----...--•-----•---------•-----------------••••-••---------------------•-.. ------•-•-•--- Date PermitNo......................................................... Issued...................-----................................. Date - - - ------ ---------------------- 'f No.__, :'_l?..>r 2 `r FEB......$.q...��............. THE,COMMONWEALTH OF MASSACHUSETTS BOARD_ QF•� )HEALTH 1 _.......0 F.......!✓. �t .✓. _G ------------------------------------- w Appliration for Disposal Works Tonstrnrtion Permit Application is hereby made for a Permit to (fonstruct or Repair ( ) an Individual Sewage Disposal System at: _ 1N.�rl / et/r> G4� - 'Y v .. ... ... -.-.-.-- .................... �• Locatio -Add r or Lot No. ......��v- '!/. TZ�--. I......1121*/:.!1_t_1...---•----- .S?"7L41_ ____ ✓!.9 ...... a Owne Address e, Installer Address Q Type of Buildin�� Size Lot.....��. J...Sq. feet U Dwelling ZlI o. of Bedrooms____-__-3..............................Expansion Attic V-4) Garbage Grinder (/> aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures _..--•�-----------------------------------------•--................................................................................................ W Design Flow............................55..___gallons per person pi r day. Total dail7 flow...._...� ?_�.............. 1Pns., Septic Tank—Liquid capacityj�A. allons Length Width..61-.-$_. Diameter........._ Depth... -.. W Disposal Trench—No. .................... Width.................... Total Length..... Total leaching area....................sq. ft. �rllSee a e Pit No._______�...,._______ Diameter_______ _________ De th below inlet__._._. __._ .___. Total leaching area..................sq. ft. P g �� P - a z Other Distribution box Dosin tank ) Percolation Test Results Performed by. .... Date____ Test Pit No. 1-G�_.Zminutes per inch Depti of Test _____ ... Depth to ground water...C1fJ-p1�__.�o�/ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•-----------------------------------•----------••---.._..._..._..----•--..........--••--•----•-•-.......................................................... 0 Description of Soil.................................................................................................... " V ..................................... ••-•••-•--•--...__.:_:_._..---•----•-----•-•-•._.........•----••---.....•--•--•-•-••-•--•--•---•-••-----....-•-------------------••--......•-•••-••._..._......._._ W . x ----------------------------------------------------------------------•----------------.-..---------...----------------------•-------------------------•-------........................................ U Nature 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 TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been Xed IW theobdiealth.Si ned_ l�►_. h - p- _ � ��/ GDate Application Approved BY �-" � /1 - ____-_-•-- --•- -. _'.�.. .......... Date Application Disapproved for the following reasons:..........................................................-.................................................... .....................................................--•-•-••----••-••--•-•••.....................••••••.._...._............••••....--•••••••---...••----••----•---•----:..•••-•-------•-•-•--••---••--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......................................1-........................................... (Inrtifiratr of Tompliatur THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ___ ____________•-•-•-•••---------•------•-- Installer has been installed in accordance with the provisions of TITLE 5 of The'State Sanitary Code as described in the application for Disposal Works Construction Permit No.------ ________ dated................................................ THE ISSUANCE OF T141S CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL FUN(/ ION SATISFACTORY. DATE.. __.Z_ ..d1�. ,... Inspector.....r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3r ............................................OF...................................................................................... Disposal Vorks Tono#rnrtion."permit Permission is hereby granted............. . ..........�gi . .... ... to Construct ( �or Repair ( an I i�ailewposal System atNo. ..: ................................................ Street as shown on the application for Disposal Works Construction Permit No..............�..... Dated........................................... --� - ---------------------------------------------------- Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON I DA t�`f �..�� t t'o 4JDErL !',3�.C� P R •-- • --• --------- - -------- - _-... . `, .---- G. T Aw 6c • C�LS 1 , v15PoSAL PIT 0�� s MALL A &A- BOTTOM i ToTa t_ Est��.�= 4�U GP� •. � �(L I PEZC.lr_)L_ T 1 o►..i QATt= ...• C'-��) , ` � .-�' �• to C `Its I .. OF ^ WILLIANb �,.. �� .�r'�'` .� :n •�. 1 l:�� () �`I `� ("V /�"j-�,% '. o' N Y E.. v r No. 193,34 rm STf.ti.� ,j-r;'. 1-'�/�• /'fir' � ---- —. .. v tL Box. (,5. 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