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Home My WebLink About0113 FURLONG WAY - Health WL oj No.. c5/ l rV u FEB.............v.`........... THE® h' COMMONWEALTH OF MASSACH U SETTS-7^it, d f,j t--a n _T � � fA0 a ®OAR® OF HEALTH 4,�- ? ..........................................0 F.......................................................................................... Appliration for liupuuFal Works Tontitrurtiurt rnmit Application is hereby made for a Permit to Construct (7or Repair ( ) an Individual Sewage Disposal System at: .... __......_. .. ----- - ocation- ds _ or Lot No. . .1 �1L... .� .�..11�..... = r �llL�1 :X : Vie/ !-ra+d `i � c1 ./ �4..:.......... ow er n dress ` .... --•.. .. C. __ ........ZZ...... Installer/ Address Type of Building / Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........ ............... _..._.....Expansion Attic Garbage Grinder '4 Other—T e of Building .... No. of persons....._3................... Showers 1 — Cafeteria Ga Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/e ---gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I.............. Diameter.__f_..)(?..._ Depth below inlet_.'6_._F7 ..... Total leaching area.lpo_°.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. i................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-___--____-_----_---. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------•------------------------•-----------------------•--•--------------............-------•--......................................................... 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(iVued by th b rd health. rA �Da Application Approved By.._... ---.------...................... .::_ _.._ _::: � Date Application Disapproved f th ollowing reasons:----•-------------•----••---•------•--------------------------•-------------•---------------------------•-.•-- --------------------------------------•-----•------•-----�......---------••-----------•---•-------.........--------------------------------•--.....-------------------•----......-------------------•-.. Permit No.__�........................0..................... Issued. -- •7 0-.................. Date ____- __ -- ---__--_- - - No............ Fps..... .. ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................ .............OF............... .............._........ Appliratiun for Disposal Works Tongtrurtiun frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual.Sewage Disposal System at: ................_.._...._.......................... ....-------------------••---------------- ----- --•--------..-_------------------------------------- - .... - -... Location-Address or Lot No. ......................_.......................................................................... _...•---_...........•---------•_..•-•••-•-•••-.......•----•-•••---•----.........•................ Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U a Dwelling—No. of Bedrooms................................_____.__.-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------•••••--•---••-•----••••••••••-----•-••--••••--•--------•----•-••-•...----..........------..... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter--------------.. Depth............._.. x Disposal Trench—No.........._.......... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ,..- '-, Percolation Test Results Performed bY--•-------------------------------------- Date...................•.................... W Test Pit No. 1................minutes per inch Depth''of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ..............................................................•....•--•----............-••••-•--•-•.......................................................... D Description of Soil.......' ............... U ........................................ --------••• ••••. -----•-------•------•-----------•----•-----•-------•------------------•-----------.......................................•........ W UNature of Repairs r Alt- t"ons—Answer when applicable---------------------------------------------------------------------------------------•-••__-- Ag ee pr entr F n ,t;I?he-"'Qersigned agrees,to install the aforedescribed Individual Sewage Disposal System in accordance with T the provisions of TITLE 5vofahe 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. igned•••••--••••-••--•--•----•••---•----------•.........................•-•............... D - ApplicationApproved BY-- ............................................................................................... ate Application Disapprove f or a following reasons:---•-----•----•---•----------------•----------•---••---•---•-----•-•-•----------•----••••-•--••-•--••----•••••.. ............................-...................................................................................................................................................................-......-- Date PermitNo......................................................... Issued...............................................•....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... ��- (9rdifirate of Tomplianrr TIS, RTIFY, That the Individual Sewage Disposal System constructed ( - or Repaired ( ) 1 F ZA e"e by _. ..-•_... ..... ..... ....... ............ ------------------------------------------------------------------•--------•------- Ins tailgf,.��has been installed in accordance with the provisil'sf TIT �of ,T� tate Sanitary Code s d scribed in the application for Disposal Works Construction Permit No..............__._.__........(.__....._ dated...... '�._. .__._._._..._. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CO STRIDE® AS A CwA, A TEE THAT THE SYSTEM WILL FUYCTIOIJ SATISFACTORY. DATE............... ... I_ ........................... Inspector_... -- ------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f�f L L ...........................................OF..................................................................................... 'll 1�T0 ......................... FEl. .................. Permission i, hereby ranted........................ • .........................................................---------•--•--•-.......... to Construct ( air ) angen 1�Sewagsa1 System Street as shown on the application for Disposal Wor Construction ermit No .:..: .... .... Dated.......................................... ------- ------------•.............................................Board of Health DATE-------- / a ........................................ FORM 1255 A. M. SULKIN, INC., BOSON � Y 1 L O CATION 4�71/3 SEWAGE PERMIT NO VILLAGE .r I N S T A LL,fIt'S -�ilA'ME a ADDRESS B UILDER OR OWN[It Sr e 0,DATE PERMIT ISSUED DATE COMPLIANCE ISSUED -a t ��s RIG a�� i� pti K�y • V r �a 10, 2� 0-1 44 f t w If C) lit l / v� WALTER Gs ��7to w y x. :•„ P. �+ o OLDHAM cn No. 23207 �,,� <4�y0 S v 1 r t '�` ,st tT�'• s�a �'� r�,� '. .y , '.,, pv.�,, REGISTERED CIVIL ENGINEER AN OFZ�� I�c 6AmN1 i � WALTER vr*1 C.�16-�r4?. Ax/w, Q o fi4K E. 1 �.� f�tv•D.��. j` f . SMITH, JR. #15128 FSS/ONAL ua i s W��,%,[.L{��L `va-tuL l6` �9�r: `e�i� }.a,� �,�i 'fi��.w �" ��;�.� r+��•- I� ' K.` ��#��xt >�v"+�i t jay. rTt f�•' s., ... �� }'. 4 7 P $ WZ - i q4 4 �4 �„ • 110?4V C plST• y(_B� µ Ao® CcF�• Di�M. b:0lJ r i. . 4' , Q Ad consc• LEAci f-14 P,T� SepftC. Tan k- d o aaA A eo 8 8•�Y e A BoT. PST ELP-v 7117-7, � Q; uot� C,2ov�avO ,� .. p E S !G-%N D A`rA t,1/µ� Y D S u b_°=' ,, R Co l..A T"t o N RA-rr= .. 2��A J R o P � TES � r- T R -oRM Ev ' 'O. 13,19 fir^ pRoomS x 110 dtPD = 330 C Pp LEACNruC, i & t U► . CAPAcITy PFzoV1pED : S. 8a TTa>� %/ . i, Q gig- G p D Sc ®ems iT-/a x �% •� 4-7C S{ CC c)4-u r l) I OTP.i• C.A FPt( !T j T�0 VJ PS.,� 54 q, -CG P D Acc®R,c>^NCE wiT+4 ��o�rsloNS o� p4 SOIL rA'