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Home My WebLink About0135 JAMES OTIS ROAD - Health (2) � 3� �� 0�-is �d� ��- - � �� I�I No.......... t� � THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD . O HEALTH ..........OF....... ... ..................... .. ................................ ,� lirttti�ayt for Uiipu,ial Workii Tnnitrnrtiun Urrmit 3�Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst aki .....•..... .......... "� -c&' ' ..._...... / cation•Addre o Lot No. w�•-•--: ........ ... ................. /J Owner dress W ... ........(/ (i .................................•....... .. - -•---_.--.....-------...-----•-•-------.-.-._... a Installer - A ress Type of Building Size Lot.Z-4,_!� _Sq. feet U Dwelling—No. of Bedrooms......,, .............................Expansion Attic ( Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixture, -- Design Flow..... .. .-.Z!;_2.................gallons per person per day. Total daily flow.................._ gallons. W Septic Tank—Liquid*capacit �,}�allons Length................ Width................ Diameter---------------- Depth.-.--------.-.-- ---- - x Disposal Trench—No. .-..... Width.................... Total Length.................... Total leaching area...............___._sq. ft. Seepage Pit No--------- meter.................... Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--. 9 •----------------------------------------------------------'--...........................-•-•-•••---.......................................................... 0 Description of Soil........................................................................................................................................................................ x 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;1TLE 5 of the State Sanitary Code— The undersi ed further agrees not to place the system in operation until a Certificate of Compliance has been ' by t oar of heal Signed. ....... .. ................................... ...... ._ /� �I Date Application Approved By............................ ---- --r..,/_.! _ _ ................................. ........................................ Date Application Disapproved for the following reasons---------------------------•'•------•-----------....--••------••----------------•---------..........--.....----- .....................•---'-'•-----------•••-•-----------•-------•----------------•----...........-----"'...........-----'--------•-'•---------------------------•-•-•-•-•-----........------.......-•--- Date . q�. �� Permit No........... ....... ------•--------•--- Issued..---------------�---•- --....................... ' Date • --------- -- --�-��_�_�_--- ----------------------------� No..... ..........N ..... ....................... THE COMMONWEALTH OF MASSACHUSETTS ,0 � � BOARD OF HEALTH .......... r�`?:f...........0F.........Z�,!c!� h .: .<:. s................................ AVVfirttfion for Biipwial Workii Towitrurtion '"motif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys temlit: ------_.. ...................................................... .. r......-•••-...-•-••-......••--........----•-•-••---•••••--............ / Location Address or,Lot No. ............................. f Owner �/ Address a ..........r-�C- � j¢^f'- ._.. r :............. �` e —r`krn ... `G=: ✓E'.. ...... Installer Address d Type of Building Size Lot.*'' -.---�:-*�?.Sq. feet Dwelling— No. of Bedrooms------- ?...............................Expansion Attic ( ,�)��+ Garbage Grinder aOther—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 capacityl� _Agallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.........._R....... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------- ��i�meter.................... Depth below inlet.................... Total leaching area............_.._.sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----•-•---••----------------•------•----...........•------•--•--••...---••---•-•--•-..................................................................._...... 0 Description of Soil........................................................................................................................................................................ x U 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 been issued by the-boarfl of healt . Si fit! ., Date -Application Approved BY -----•----------- ....... -- .......... Date Application Disapproved for the following reasons-----------------------•----•--••----......--•----•-•---•-•----.......------------........_:.. -----•....-----. •-•-•----••----------••---•-••••---•------•-•--••--•-•---•----------•-••--•--•-----•-•--•--•-.......•-••...............••--••-------•----•-•--••-•-....-----•-•--•--•---••-----••-•----•-•••---•---••-•. Date PermitNo.-.....-_--------------------•---••-----••--•-------_.... IssuecL....................................................... - = Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHi ..........................................OF........................n_........................................................... (9rdif irtt#e of Tautphatt r THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...................... �`�'� ----••-----.....•-••••.....•-••-•----•-•••---•----•--......-•..........................••-----•-...._ .✓ Gw•'"%�. Installer at...................f:n---- .------... . ., ....... ...`=?....--.........---------••- has been installed m accor� nc rt ie pr ors erns o"I•TITLF �j of to Sanitary Code as described in the application for Disposal Works Construction Permit No..... _ ..____ � ............h.-,y dated...............................•................ THE ISSUANCE OF THIS CERTIFICATE SHALL NC BI CO TRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ P ............................................. Inspector.... ...1.. . ............................-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O F..... yr No lx.,.. FEE.... to �att1 orko Tono#rttrion rani# Permissionis hereby granted..................=` .._.... -.-----------=-••-•-------------------------------------------------------------------------------- to Construct ( ) or Repair ( ) atr ndT` ivi(ival'Sewage '*osal System atNo................. - -.: -•-•-- - ------ -------------- .. --._------------- .. ' ��--- J Street ...........:. ..... .� ..�.......... as shown on the application for Disposal Works Construction Permit NO.. ..._� '� Dated......(................................... ........................ « ......•--------`-.--•-•-•-----------------------•...........•.... Board of 1;hlth DATE..... ................................................ FORM 1255 A. M. SULKIN, INC., BOSTON pEsl<r� C�ATA. �a►►Jbu� FAMtLs( - •;SPBCOR�oM GAOL% AGE CjQJtJD62,, �'J$r' �r I` r �nrLY `F%.oW s I10x .SEPTIG .TP�K = 330xi5o'/• =�49%G.P. � �` SSE ►000 GAL. v►SPoSAL P►T v5E I Uo0 • ` :1go S.F X j �•5 a 3?5 G.Po o _ Fla' pp �i BOTTOM A2EA r �0 5•F• y. 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