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Home My WebLink About0065 SANTUIT ROAD - Health 61021 ntuit Road C A - 088 r 7 sue„ -7V; r rd. � � LOCATION SEWAGE ' PERIII*T NO• VILLAGE INSTA LLER'S '+ NAME D ADDRESS BUILDER OR L OWNER DATE PERMIT ISSUED � DAT E COMPLIANCE ISSUED 5-l5-Sy !L�� _ , � � � � �^� % �� t P�.� .J leto.». ......7f7 F$a_� THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE T ..... ............_..................O F....... . ...............:.... ®� ` to ,� lirtt#iun for Disposal u "orRepair #rnr#uan rrmi# Application is hereby ma a for a Permit to Construct ( ( ) an Individual Sewage Disposal System at: / .� � . ............... G ........... ......---.......... ....j.,.�..�....... ...................... ...........�... dress ....••------................................. ... ........ »»_......_... ' l anon' .. i!`/I'..[.."" .. . /E. :.-:.Y! a . ............. ..............................................••............... ......t........':...................................--•--...........................».... Installer Address Type of Building Size Lot... ..Sq. feet Dwelling—No. of Bedrooms....... ..............................Expansion Attic ( ) . Garbage Grinder ( ) '4 Other—T e of Building .... No. of persons.... Showers — Cafeteria 44 Other r d -----------------------••----.....-.......--.-..----.----•-----••----.... •---•------.._........:_... ..... W Design Flow.._......__ .......gallons per person pe day. Total�ily flow.......��& ...................gallons. WSeptic Tank—Liquid capacity =. gallons Length..... Width-_ . ........ Diameter................ Depth................ x Disposal Trench—No. .................... Widt ................... Total Length.................... Total leaching area..................sq. ft. Seepage Pit No....... .......... Diameter..{t.............. Depth below inlet.............. Total leaching area...' ,�:�sq. ft. Z Other Distribution box ( ) Dosing tank '" Percolation Test Result Performed b .... . .. ............... ..... .� Date.......-.. --��/Or-.3 a y �� Test Pit No. 1................minutes per inch Depth of Test Pit...R..d.__._.. Depth to ground water........................ 44 Test Pit No. 2....Z_..minutes per inch Depth of Test Pit......4'tj�........... Depth to ground water........................ a -- ................--..... Description of Soil........( ....... - ....... �' r� 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 TITI.i; 5 of the State Sanitary Code he and sign further agreesA to place the sys em in operation until a Certificate of Compliance has been s e y and iea i ...... ............................ •. • .......... .---- �y ........».... ApplicationApproved By........:. . _...� . ... - �.. _ ___ L' .... _....-•-•-•--•---.....----•--•--•.........................» Date ...--•------ Application Disapproved for he lowing reasons:...........................................................................................................»-» ......_......................................•----.....-•----...........-•-•-•-----••---............................----.. . ............ Date » PermitNo...............•-.............------•......----•-... Issued..................................................... / Date THE COMMONWEALTH OF MASSACHUSETTS t BOA R D /Q F H E,A I{T ` ,mot Appliratinn for Disposal arks ( ,nstrtutinn Errant Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at .......r ,f, »...... po�a-tion�A dress .................».----•--•-- .................................. or Lo*�PIo- --- »--__.....»...»............».... W .....Z..C. ... / �� ... n'..:!:...................................... ..Y.Y.3................................... ----- Address a .........................................»»..».... Installer Address Type of Building Size Lot....7-�. a�_F=..Sq. feet Dwelling—No. of Bedrooms........-3...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------•--.... No. of persons....L.................. Showers ( ) — Cafeteria ( ) p' Other W Design Flow...........r.:.................gallons per person per day. Total daily flow_.__.? j.�_-.....................gallons. WSeptic Tank—Liquid capacit/ gallons Length................ Width_-/.......... Diameter................ Depth................ x Disposal Trench—No. .................... Wid h______-._._.._...... Total Length......._.__......... Total leaching area..._...............sq. ft. Seepage Pit No....__1-..._..-__.. Diameter.. Depth below inlet... - Total leachin area ,!" : ft. P� ....... P �--......... g sq. Z Other Distribution box ( ) Dosinggnk aPercolation Test Result Performed by.__... _ � ?.r.. !' Date...... lJ... ............ Test Pit No. I................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........................ a0Soil ..._..1 ............................................................f... .�.---........ -- J .. ... .......... ,� . .... Description of Soil....._nr ................= �!''�!lr to+..:`..... :z -i':�c�=� ..............................� `"� r 1 . �.... W `�,• P 771.. ........................ ------------.. ---------•--------____-------- ....____---•--------- ---•..........•••...•...••-••••••-•-•.......................................•---••.....----------••--•••---•-.........••••••••-•-••-•-••-•-......_...__...._.........._............-------•--------..._. 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 TITLE 5 of the State Sanitary Code 7-The un rsigned further a rees of to place the system in operation until a Certificate of Compliance has been)issGe by tth/e ,oar �'hea yip ` Cr Si ! f ........... ....................... ....:!. - A lication Approved B .. `_ ._ -F.. ............. Date Application Disapproved for he llowing reasons:.......................................................................................................... »»» ...........................................F.......................................................................................................................................................... » Date PermitNo.................•-----...._...._•-----........._... Issued...................................................... Date j THE COMMONWEALTH OF MASSACHUSETTS BOARD,, F HE I . Tnrtifiratr of Tnutplinurr THIS IS TO CERT,, ;'T)iat the I ividudl S w ge Disposal System constructed ( or Repaired ( ) by.............. .................. ....... �-:1 .........�� • .---...........•-----•-----...................-•---•••-••-......-----..............»....»... zz `- at...................... ....../ - ........................................................ has been installed in accordance with the provisions of T of The State Sanitary Cod�'"as ribed in the application for Disposal Works Construction Permit No.Y__._"'__d�,;. .............. dated. !! ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................... _.......... Inspector.................................................................................... jl� COMMONWEALTH OF MASSACHUSETTS loop BOARDz�bF HEA TH �.- w No. ' 71,7 .........j ..............OF........-...1'� ........ -• •......... FsE _./.,a.......». his n l nrk faun tritrtinn prnA t Permission �isereby granted._.... CI ...._..,e' .s" s_.. ::..... .........•------.....__....-----.......................................---- to Construct ( r ) an%Individual ewag ,Dis'po tem at No................. .;,1[..._ . ��.... .... L!'C .. Street as shown on the application for Disposal Works Construction Permit N ._. __ �'. .:. ... ---...--•--- Dated.. . .............. -•........................•--..._•-_..» �`• Board of Health DATE........ ............................................ FORM C-1255 CITY& TOWN FORMS, INC. 369-9708 '5 ►L FAM►I_Y - 3 BC.UR DM ,i tiJ0 G,d,R.OAG� (�21IJDE2 L. Ftow -: I10A 3 = �3oG.PQ Ci = �� ^�, oP 5EPT1G TAQP-, = 330x 15c>% = 9 r G•P. n 100o D15Po5AL PIT v5� Ivoo (SAL . lj I DCY�IALL A'26A = ►>o s,r i, 150 5.F X 2.5 = 375 G.P� 'I BOTTOM AREA= . 5O 5.r--• _ 5O S:I= x I. 0 50 G.Po. II "ToTA 1- DESIGN = .425 G.P. D. I� -TOTAL DA I LY FL-ov! = 33o G Po PE2�oL.ATIoN GzATE � I'�IN ZMIN o�►-E55 OF MASs9 H Of WILLIAM ALANC. �N W. f� Io N Y E -" JONES i v P No. 19334 �N) SURl -_�- i —q TO p FNu = 1ci •b ��• �� y,,. 7,YlY INV. loon S��Sa�L p15T �j . INV GAL. Q CJ (U U U IN.(. C�oX W t'O TaN�K Gay I e b LCAClA j I PIT GINV. INV. 'I WITW 14,-L 9 4- WASN6D 5 6TvNr_- (J � aP.TIF-ICD Pt-07 pt_A►J PRoFIL� 8Z No SCALE ScALG EeEN GE 1 1 cE c�TIFY T"AT -TNr-- 5uowN q&QSON COMPL`(5 WITH THE I ' A► P SET5AGK R-F Qu1,�.EMENT� OF "CND z 7c>wN S �i trOGPTED WIT I•IJ T GLOOD Pt,� N L �C Z'� I PG z. D AT E ww REG Igo>(T ��L�aN 5 u Izv RY�eS TuIS PLL\,ti IS NC)rT f3�`>t=D otd A osTEZ\�44,j L.L..E - MASS• IM,5- 'R-uMENT Svevey rr -THE n1-FSETS 5uc)ULD NOTUSEOTO CJETEtZ��I ►�� L.o-I' I_ IHE-'j APPLICP.NT IDS so, U co S t= 1.�Ls UaclJ D� �c I000 f c TAwK a 31 op � 3 I •+ DWl3t-L�►JC. F . Ar S,4 iJTv IT lr 'AAA 5S. Fo a� RICHARD yG �� J L��Z• I� f A. M BAXTER No. 2-1048 O �•STl~RVI�.�.$ lu�iSl . R