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Home My WebLink About0113 HEADWATERS ROAD - Health (�3 Heads OtA 1-erV f IIt 2.z8 - 1$3 S M EAD KEEPING YOU ORGANIZED No. 12534 2-153LOR 0SUSTAINABLE (dIN.RECYC D WITKAVE CONTENTIO°/o Certified Fiber Sourcing POST-CONSUMER wwwsfipmgmmorp Sfl-0r29p MADE LN USA a No....F3-".>sjo Fxs.. ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .......... �....... �� , .--------- Appliration for Uhipoii al Morks Toustrnrtion .erntit Application is hereby made for a Permit to Construct (Repair ( ) an Individual Sewage Disposal System at: ..........Tj S .i .S..-----....PCQ.L.---•---------------- ... -----•--•.............................................•-----•------•- I�/��-- -Location-Address /,q � ,• or Lot No. pe.iV.'.JP L A.&............................ ..... .. .rK.�r.= ---..... :±.........----•-- Owner Address a = °� '!•' v......................................................... > � .--------•-------------------------- Installer Address d Type of Building Size LoL:3Z-42e.?G2.Sq. feet Dwelling 4--Ko. of Bedrooms...... ..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ 14o. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures =_--------•---•--•-•------------------•-----------•--------••..._....--•--•-•-•---•-•••. W Design Flow......_ ........................gallons per person per day. Total daily flow_. .........................gallons. WSeptic Tank squid capacity&P llons Length................ Width................ Diameter________-____.__ Depth................ x Disposal Trench—/No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.__-1_____--------- Diameter___..__..... Depth below inlet...t _.`..... Total leaching area_�alG'.sq. ft. Z Other Distribution box (4,4— Dosing tank ( ) Percolation Test Results Performed b .......................... Date-, Test Pit No. 1.... minutes per inch Depth of Test Pit___ ---- Depth to ground waterA�_4 5_.. ____________n 44 Test Pit No. 2.... iinutes per inch Depth of Test Pit._I-`Z-r..... Depth to ground water,�l��.y Description of Soil ._..�.._.... --fit ?.� '- C..�,� .........�1— -- .... 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 iITL2 5 of the State Sanitary Code—The undersigned further agrees not to place the system in o eration until a Certificate of Compliance has been i ue by the oard of igned.---- ..... . ----------------•---. A-044ate Application Approved By-•••-......••--••...• •......•..... .. . . .... -•-••-•..._.... ---••-•�. Date APPlieation Disapproved for the f ollo i g reasons---------------••---------------•-----------------------•------------------------•--------------------........... .............................•----•--....---•-----....------....---------.....-----------....--------•-----••-•-••-•--•-••----=-•---•---•-•-•---•--••••-•------•--••-••----------------•---••......----- Permit No........ ��.` /s `3S ,�..�-Qi.----••------•-------. Issued_--•-----�---�----------- -------Date.............. Date .LOCATION COA SEWAGE PERMIT NO. 1 `'� -1:vs 0 VILLAGE INST A LLER'S NAME i ADDRESS S U I L D E R OR OWNER ram�� rv DATE PERMIT ISSUED DATE COMPLIANCE ISSUED '7'- , cq _�j i d.� ............... THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH pfirattilu for Uiipugal Vorkfi Towitrnr#ivit Prrmit Application is hereby made for a Permit to Construct (�-__) Repair ( ) an Individual Sewage Disposal System at: .................. Location-Address / J or Lot No. 7 ......................__........................................................................ -•--._....-------=--• •-- ' '' �'`� .............ice....---..._..._. .... Owner Address r a .....................................:...............•-•----......_•---......_•-••--•------------- -!' - /M/ ( :_// _.... Installer, Address d Type of Building Size Lot. r-r%':� .Sq. feet Dwelling L-<o. of Bedrooms........... _________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building _ No. of ersons____________________________ Showers � YP g --------------------------- P ( ) — Cafeteria ( ) Otherfixtures ----=-------------------------------------------•-----•----------••----------•-- ------------------------....----•-----•-•--•--------•--.._......-••- W Design Flow...........5_-� .................._......gallons per person per day. Total daily flow--. r_=?.........................gallons. WSeptic Tank=Tiquid capacity: ':,gallons Length---------------- Width................ Diameter---------------- Depth................ x Disposal Trench No_____________________Width_:_e............... Total Length..............._.... Total leaching area____________________sq. ft. Seepage Pit No_____________________ Diameter. .-__--_--- Depth•below inlet--- '_.......... Total leaching area__Ze'2,,�Z_sq. ft. Z Other Distribution box (f, �)� Dosing tank aPercolation Test Results Performed by __~}`' -- _.....'��__________................... a Test Pit No. 1...;>---minutes per inch Depth of Test Pit_____�_�_-__.......... Depth to ground waterz!�'_*!-"_ = f=, Test Pit No. 2................minutes per inch Depth of Test Pit__,/�Z__.-____. Depth to ground water�!>_!..(-_=. ................................................................... D Description of Soil_..___�>.__":. .7— ��'' 'F --��-'/ ---��'�� / (-- /? x -------------------------- x ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---••-.....-•-- V. 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!Ti f•" p 5 of the State Sanitary Code—The undersigned further agrees.riot to place the system in o eration until a Certificate of Compliance has been issued by the board of igned--•-------...•••....................... - ....-- - �:: Application Approved By-•--------------- •- --------•---•-- --•- *"- Date Application Disapproved for the f ollo i g reasons---------------••---------------=== .............................................. ---•---------------------------•--•-----------------------•---------------••-----•••--••------•------------•••----•-------•----------•-----••------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,Or�F HEALTH .^en.................OF......................................................_.._........_._._.............. ulertif iratr of f�aant r�i�tnrr THLY.JS T CERTIFY, That the Individual Sewage Disposal System constructed (�r Repaired ( ) by---•---•-• . - !kl.tt !.9...---•---------•-----....•--------------••-•----------------------------------•-----•---------------------•...._.....---.._......._......._._.._...._ gyp., Installer has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposai Works Construction Permit No----- _____:`.a ........ dated-............................................... THE ISSUANCE,OF THIS CERTIFICATE SMALL NOT BE CONS"UE® AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................`5 � -.� ... Inspector ---• -••---•-------------------------------•----------- v , THE COMMONWEALTH OF MASSACHU ETTS BOARD OF HEALTH No._. .... � .....L.:.N.n..................OF...."3ti,t� �-- y > ......... ........................... 0 FEE.................0 wispasa1 Workii Tnni#rndinn anti Permissionis hereby granted.............------------------------------------------------------------------------------------------------------------•---------•---•--•-- to Constrqft ( pr Repj ( ) n Indiv ual Sea a e Disposal System at No.----- ?'�"'_._'Sa-------.J__l 'Iy nec' �_..... -- Street as shown on the application for Disposal Works Construction Permit No _J. ated.._.�.:___'�-J_.__g ------------------------------ -- •-- ---•-------------------•------------- BOarealth DATE.......................... $ ' FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 1>G 7 I L.7 n.i _y r-%1 /-k 51► t!z i� uo GARBAGE- GaaNI->EQ. D N%L.. F u o w .: 110 X 3 = !� .rjEPT1G TP►JK = 33ox15�'/. =�497l�,P. � �� 0151Po5AL PI-r v51= Ivoo GaL. II 51 Dcv�lA� AeCA. 1� S. . �I 150 5.F x z•5 - 375 �.Pa . 50TTOM AZ;-:Az.. 5O S,F, >.:�� 5� S.F. x 1• o � . 5•o G.P o' .. I� -ToTAI- DE516N = .4.2rj G.PD• . ;) 1'oTAL. DA 1 L%( F%-D. W .M 330 G,PD• �1 PE2GOLATIOIJ RATE: VAIN 2MIN oQ-LESs �j1{ OF /y PETER ' o SULLIVAN \ �" No. 2y;.33 -i I TOP FwuZRAo loots lN�. D t ST. 1}J./. G 4 t.. 7, 3 Z � (00O BvX EpTIG i�r�P,C INY, �7/ TANK I LS A AA PIT INV. INV. I �96�. I'�3/q•I%L f,'ra N E Lj • Cti=R.TIFIGD PLOT PLAID �,..- tilo ..SGa.LE 1 G6R.TI�Y THAT 'TNT Pt '� 1=rJ�? SNowN pL-AN REPE26►� GE• 1.{EctEotil GOMPL.`�5 Y�lITN-C H6 S 1 oELIN� ��7"" � E- ToWN of x� - AMD L0 J-=D W IT"I/IJp 'r �G.Lo a Cl P L t.� D AT lhJ Cs '1 �:.✓ I • ;- � t3AXTEczt N`(E INC. R.SG I VT 6Q6r'D'L A►S D S u IZV EYbZ! 'Tlli•j PL�NI 15 NOT E3n5c T� o�i AN d3TEQ-VILLE• - P•5S. I i►�5T'R.uMEt,IT 5�2v�Y �-rNE ��5E-r5 6uou1,D Tl5 Wt L.c'r A P P L 1 r o vi T 7-- ' V r 68 .7 91, l 7— tea, 9 u x, %rota Cr fry tc ►,�>R�_4q�t �j / �/ PETER SULLIVAN a� No. 29733 UNAL r