The URL can be used to link to this page

Home My WebLink About0126 RALYN ROAD - Health �aa -ash — ca-hua- pnh SME ,AD . vcrn,ar. vigil QR(:n^1"... No. 9 033A 2-,53L MADE IN USA � T nRrANiZED AT SMEQn.CI LOCATION SEWAGE PERMIT NO. (44 VILLAG�E INSTALLER'S NAME & ADDRESS * LcJ e U I L D E R OR OWNER n DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 5 � 173 - (ZS � . cc �rt�h�C b7 ovS"e.. w- NO..� ...: � � Fss............QyU THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................... Appliratilan for Di-gniiFaf Works Tome atiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ................r..P ...........�.. x.i............................................. ................................Gp.}................................................................ Location•Address or Lot No. . . Pie- �--------------------- ... - .. ...... Address�. Own r a .................... >°.... a ... :---- ..........---- r � ..................----..... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.-.a................................Ex Expansion Attic�•+ g— p ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons................---......... Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------•----------------•------------.-•------•••--•--•-•---•---•-----------••-••-••-••••------••-•....-•--••-•.........-•----....... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.-lZED.gallons Length................ Width................ Diameter.............--- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.1..G k Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (��S Dosing tank ( ) Percolation Test Results l Performed by.......................................................................... Date........................................ 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---..................... 9 .•••-•-•-••----•-•-•••••-•••••-••••-•......•---•--••-••......-- ODescription of Soil.....Ut'1........../ ..... .........................................................-................................................ W 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 iITIL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ssued by the board of health. .P ig nn `` Date Application 4Approved BY ... ... '?e v_1'�L. -41-- _- Dae Application Disapproved for the following reasons-------------------------•---•---------------------------------------------------•---........................... ....................................................... -----...••-•-------•--•--•--------•----------•-----••-•--....•••-••••••---•---•-•--•••-••-•••--•-•-•---•-------•-••-•-•••-••••-•--•••......_.... r_ Permit No........ - - --•..............•----.._ Issued....------ ` .....-Date e------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...•.......................................OF................ Appliration for Uispoott1 Works Tonstrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ............... . ,.--... ............................................. ......................... ......--..•..---------.........---•-------•-••--••--....._......-- Location-Address or Lot No. . C^ ::. _.._ei1 �.� ._......... Ow r Add................................................... 11 ........ g Installer Address d Type of Building Size Lot............................Sq. feet4, Dwelling—No. of Bedrooms...'.'..................................Expansion Attic ( ) Garbage Grinder `4 Other—Type of Building a yp g ............................ No. of persons............................ Showers ( ) Cafeteria ;( ) Other fixtures -----------------••-----•......--- d ...............................................................i............ W Design Flow............................................gallons per person per day. ,Total daily flow__._...•..._.._.......................... gallons. WSeptic Tank—Liquid capacity./..gallons Length................ Width................ Diameter................ Depth4............__. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Pit� See a e No..p g ,. �___ Diameter.................... Depth below inlet.................... Total leaching area................... ft. ZOther 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --••---•----•-••-•---•-•------•----•-----••----•-•----•................................•--•-.....---......................................................... 0 Description of Soil.... __r-p__......(t ___.. .� ------------------------------------------------------------------------------------------------------------ -•----•------•---------•-----•------•---•-•------•-------------•--.----•------------•-------------•-•--•-------•--•-------•-----•---------------------------•-----.---.. ........... 0 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 TITLE 5-of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bNorgissued by the board of health. Sine g 0- 5......-� ' .J ,J - .tee. ... -'�• ri V Date Application Approved BY ---- .•. r:+ .:.. J 1` �--------••-•--------------- --•---. 1 f ' �� Date Application Disapproved for the following reasons:-----•------------------------------•--•-----------------------••---------------•---•--------•--•-------•.----- k. Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............................................. ........ . . C�rr�if irtt�.e of f�om�rlie THIS IS TO g��RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) " - w .. Installer has been installed in accordance i4h 1Wprovisions of TITIF-., `5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...` _• =_. :j. ....... dated_.--------I---7--Ln-1__�--—---•--. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUE® AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--•-•--•--S-.!S_--_.5...................................... Inspector------..... ....... --------------....._.....--••-•---••....•. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF...................................................................................... No......................... Dispoal Works TaInstration Upanfit Permissionis hereby granted......••=�......�;'-- 2.L.tL•----•---•----•--•--•--•-••--......--•....-•••••----...••-••-••-••-•-••.......-•--•--••-••---- to Construct (114 orRep ' ( ) an Individual Sevtrage;D'sposal System at No. �,i �... I�• ------------�. u Street / as shown on the application for isposal Works Construction Permit No..?..-•�.__=_k 7? Dated........ �!_.��:fi........... f�� I '_. --•-----•-•-•---------------------------------•--------------•----------------•--_ DATE. Board of Health >/`3--.ram_......•-------- r FORM 1255 A. M. SULKIN, INC., BOSTON OA/LY FLOW - //D X 3 = 330 G.P.O. e SEPT/c T,4NlC = 330X/S�o Z-51 /f'o s X Z.s = ,37frG.00. 77 1 A. 7-oT,4L. �,4/LY�Lot�ri= ,330 G.•�v. '�;/:�.,� OEs/G�t/ �.E.2COL4T/GAS/.2�JT�:'/"/.t/2�/�t/. O•G�LE.�� 9y'G / t '� t -r � `�' Igo.?•�0�3 1 , •iY i.`�,J\ i �y��Kf4�.[� �_� �� F6. =/��• Z ;, ', TG.��.t�0,_ /ate o LoaM�' /AI'OOOV- �vo0 /rv✓. z ' 6a�. ,�, Box mac U sir 977 SEPr�G �/�� .• .fTGNE ,� �7'•3 %7S G'E,2T/F/E.� �G oT �GAN "° i Li Z z / GE2r/may Tf//1T Tye ,�/E�Eo v GOiy1�GY.S W1711 TiS/E S/1�E,4, A, F /.tiG. A1/9 o,-- T,L&Z �2EG/,ST�2cjJ�Art/O.SU.2j/E)/�.�5 /.S No7- AAWZ L Oc.QrE.O �i✓/Th�iil� 7'.�/E �L aa�PL4/iV. ,r . /Z � c �/ �1 C P r mot/ T///S Pl�,f� /.S �YoT 64SE0 G�✓ A Al/iYST,e- Syo�.�/yE,e�oi✓s.�ov�-��S/aT!� vsEo Ta E��l�L/S.y LGT G/NHS