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Home My WebLink About0025 PASTURE LANE - Health fare- r/ z lz W r. IL 1. M W d N W at d W N d N W 09 W r Z W W Q 2 N � ~ J C d S W � ac a • v O J S aG"tl d CJ 1 Q -4- _ W J > .� ce O 0 �: g` ..a�, �� --�-- � r v � �,� V � e�,�. ti �� J `/ !. _ _ No..... N FEs.......7.Q.._ t�THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA_LTHz / .......OF......... .................. Appliration for Riipniitti Works Tontitriartinn "rani# Application is hereby made r a Perrmt�to-Construct ( or Repair ( ) an Individual Sewage Disposal Syst at: �..� .... Lot N .- •�.. .............................o_.....:..Locdo rss G --- Own Ad es Installer Address d Type of Building Size Lot.._/�.O C.r7-----Sq. feet U Dwelling—No. of Bedrooms...................... Expansion At c (�� Garbage Grinder (17)9 Other—Type of Building ....... .. No. of persons............. ( — Cafeteria ( ).._.__.._._. Showers Q' Other fixtures .......... �c .......................................................... d ..................••--------........-•-....._----••--......... w Design Flow............... .............. .gallons per person per day. Total daily flow.._......3�3:).....................gallons.- WSeptic Tank—Liquid capacity./i gallons Length-__ ..... Width....... _... Diameter................ Depth.``_._&..... x Disposal Trench—No. ..._1Cr12 Width.................... Total Length.................... Total leaching ---sq. ft. Seepage Pit No---------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Result Performed by..-.a .. l�h . ..L ....... Date................. �c�rl � ,a] Test Pit No. 1................minutes per inch Depth of Test Pit....9k_......__ Depth to ground water....na.2*7..� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x •••----- --- - -----------•----W ----------------------•-................................................................. Descriptionof Soil.......... ----. - ------------------------------•--•------------•------------•--•........................ ds=� - .�--- --------------------------•••-. 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of health. Signed --- ----------9 ate ApplicationApproved By---•-•----•-------..................................................----------..........---•-------- Date Application Disapproved for the following reasons-------------•--•-•-----•---••---••--......-•--•----•--••--------------------•--•---------- •----------------••. •...............••••-•-•------•------•----------•------•-----•--•••----•--•-----•-...........---------..........................•••-•----••--•-•....-•--•-----•-----------••••----••••• •............... Date PermitNo......................................................... Issued........................................................ Date No......................... Fmc.............................. r THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH /0-�,( "f .>........0 F.........`. ........ Aplifiraition for Uiupuuttl 111orkii Tomilrurtioit Funtit Application is hereby made fora Permit to Construct ( or Repair ( ) an Individual Sewage Disposal SystF at ........ _: ' .-..........................•----.........../ ........................................... Locatio Address i / �=ftil t N ...-•- �i........:...........................`.....; ._:.:_.._..._..._._-•-•--•----... ._....._.._..---'•--== ...........................�./t •--•----- ........................... Owner Addres a ...................................... ........................... Addre..... Installer s - d Type of Building 'y Size Lot..., e�4�j_ �..Sq. feet 0-4 Dwelling—No. of Bedrooms........... .................... A14ic (r/d Garbage Grinder '4 Other—T e of Building _ No. of ersons_____________ ___________ Showers — Cafeteria YP ng .....••�. . ---- P ( ( ) d Other fixtures .......... ........................................................ Design Flow...............�5--- ----_-__-•---gallons per person per day. Total daily flow.........,�,�Ga.......:.............gallons.- WSeptic Tank—Liquid capacity_/��gallons Length...111._._... Width__.....__.. Diameter................ Depth../.____.__. x Disposal Trench—No. _-..P..�12_��_Width.................... Total Length.._..............._. Total leaching area... ..SQ...sq. ft. Seepage Pit No----------- ------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (t,,K Dosing tank ( ) - Percolation Test Results Performed by.... ___ ? /1ti- ....... Date............._---et*' 4A Test Pit No. 1._ _minutes per inch Depth of Test Pit.... .... . .... Depth to ground water..__n. .at .. rs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil..__......Q::�a)_....�_ '!1??'?_f____' -. -------------•-----••------.....------------...----•-•---••......------ U ---••--•-•--•-•--•......••-•-• « •--j........................................................................................ W ------------------------------------------ •--•-•---•-------------------------------•--...-----•-•------••-------..._..-•-•---------•-•-•-----•--•••--•------•••----•---•-••-•-••-•-•--•.........__-•-•- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•---------------------------------------------------•---•--•------•-••------•-•---•-----------------------------.....------•-----------------------...........------. -•-• Agreement: A . 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 bee issued by the.board of Health. Signed .. 't•- ........ •--------!� Application Approved BY•-••----•--•----•-•-----•-•----•-•----•--••..................... ---........._. ........................................�ate ".. Date Application Disapproved for the following reasons:---•----•--------•-•----•-•-•-••-•--•----•---------•--••---•--------------------------•••. ._............... -•-•--...-•---••---•----------•-•-------•-•---•-•---••-•-•--------------•--•------------•--••-------.................----•-----•-----------•----------•---•--•----•----- --•••----.....-••••-...... Date PermitNo......................................................... Issued..........--------••------•-......--•------------...... Date THE COMMONWEALTH OF MASSACHUSETTS _.--� BOARD OF f EALTH .. ".`�-:.......O F................./ � '�............... �.. (9rdif iratr of Toutpliaurr THIS IS TO EITIFY) That the I �ividual Sewa Disposal System constructed ( or Repaired ( ) by �.'•-•-- .' ---------------- ------•----......... ........ --------.---- - �r r taller has been installed in accordance with the provisions of TITLE 5 of Th State Sanitary Code as described in the application for Disposal Works Construction Permit No........0-"__7. .........,'..-'d-ated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF CTORY. r DATE.............................................X�•..- ........... Inspector... .....--------• THE COMMONWEALTH OF MASSACHUSETTS F —� BOARD OF HEALTH / ..................... No......................... FEE........................ r boat itruan rrntit Permission is reby granted............ ... < ----•----------------------------•------.----•------------------ to Constr ct (14 r'Re air, i n ual ewa a Disposal ystem Q Street �✓F. t as shown on the ap catio or Disposal Works Construction Permit. o..Gt_________________ Dated.......................................... ...................................... .... rd of Health DATE-----L. .-- -••--------•--------•---•-••--------- FORM 1255 A. M. SULKIN. INC.. BOSTON UOA3Avns aNV1 '031:! 31 a "r'-JOiT133H6 ' .-�`,�• __ �8 fi/-;! �, S S d W S I N N VA N 133alS N IvW Z14-' SVA ' 31AWILL 9 ,Jl®`!!O a a3 IdION3 SMVI ONINOZ 3H1 Ol S14UOINOD ._ .. ®NV'1 '11Aia 4 NV Id SIH1 NO NMONS ON10'11no . 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