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HomeMy WebLinkAbout1056 SANTUIT-NEWTOWN ROAD - Health �'����►�1� CZ�- .� 54n7v(T,- LOC TION SEWAGE PERMIT NO. L-E i> YIILAGE , � ��� �s o -7 _ Cr -7 I N S T A LLER'S ,NAME i ADDRESS B U I L D E R OR OWN ER DATE PERMIT ISSUED ,_ �� 1 DATE COMPLIANCE ISSUED - i -��� `� � �2. � <_ -j� � � � 14 Not. .................. Fmc ......... THE COMMONWEALTH OF MASSACHUSETTS SOAR® OF HEALTH ............77�;WAJ.......OF................. ------------------------Appliration for 14sposal Works Tmi atrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ........... ..... ........................... ............................................... :cation-Address or Lot No. ......................................... ............ Owner Addr ............... ...... ..................V.,....11 ....!;Z��:....................................... . .. ....... ­ ------ --------------------------- Installer Address PQ Type of Building Size Lot---al;.:..) M Sq. feet Ui-------11------- Dwelling-No. of Bedrooms...........................................Expansion Attic Garbage Grinder Other-Type of,..Building ............................ No, of persons............................ Showers Cafeteria Otherfixtures ......................................;............................................................................................................... Design Flow....................15.1�57______.____.__gallons per person per da7. Total daily flow.._....._.__... � Q, .....gallons ......... - - i ...................... Z, 9 Septic Tank-Liquid capacityljQPP-gallons Length_ -.6.•'Width..4-1__10 Diameter-------...... Depthr__116_7 Disposal Trench-No. .................... Widths...... ..... Total Length.._.._............ Total leaching area....................sq. ft. Seepage Pit No............I...... Diameter.19-.-P..... Depth below inlet.L.1-6.....-, Total leaching area.. I..sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by---- ..... Date...... 0.4 72 V Test Pit No. I...... .-_-minutes per inch Depth of Test Pit..ZV=0..� Depth to ground water P..4..... lvkrle 1 4 - e�� Test Pit No. 2...__2.....minutes per inch Depth of Test Pit. ..-P Depth to ground water..__._.................. q..........V. V W-----------*--------­­-----------------**------------ Description of SoiLjO.....-..JA---- ------/5.74....... 0 W ........................................................................................................................................................................................................ ...............I——.................................................................................................................................................................................. U Nature off-ICe-pairs-or Alterations-Answer when applicable------------------_--------_----------------------------------- ............................ ............................................................................................................................. ......................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Disposal System in accordance with the provisions of TL I Ti U 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 r of health. ..... ............. ........ ........ ... ........ D ApplicationApproved By............... ................................................................................ ...... ...... ... .....---------- Date Z/ e of Compliance has een issued b r of health. D ............. . ......... ............................................................ ..... _-- --- ---- Date f Application Disapproved for e owing reasons:................................................................................................................ ............................................................................................................................................................................I.......................... Date PermitNo......---------------------------------------------- ............................................ Date -----------—----------------- No� .. j.._ ► FRs .............. . -�� THE COMMONWEALTH OF MASSACHUSETTS , BOAR® OF HEALTH ..iY) OF............... Ak-ti S-r g?_ .................... Applirtttiun for Dispu.sttl Works Tvautrurtivit ramit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: ......... :.: =- t ......... ... ! - ........ ._.......... .. ocatiio-^n-Address ,- l `'` or Lot No. �q ........................................... '` �1 ti�h�.]r,_ �... { 1i`1 ►.......:Y .:. ll � O Add s Instal] fi � ' Address Q Type of Building ,t.. , Size Lot._ T•la................ feet Dwelling—No. of Bedrooms_______________________________ Expansion Attic ( ) Garbage Grinder ALI Other—Type of Building ............................ No. of persons............._..........:__-. .Showers ( ) Cafeteria ( ' ) aI Other fix t> es WDesign Flow..................�' �.__.. gallons per person er day Total daily flow-__- ......•.._:dons. WSeptic Tank—Liquid capacit}�00 c> .gallons Length... ��_.._. Width . ���._ '°'"'"" p 1 Diameter..............._ De t _ _... x Disposal Trench—No ___________________ Width.................... Total Length....__ ._._....... Total.leaching area...._ ...... `...sq. ft. r Seepage Pit No..................... Diametei�_`�__.......... Depth below inlet'�^�._".�............. Total leaching areaV-- lx'.sq. ft. z Other Distribution box . ) Dosing tank '-' Percolation Test Results Performed by._ =' ! s� 1 f f/�._i:..----- D.�.. ate----�,f-�.'��(�.�- ...---- Test Pit No. I................minutes per inch Depth of Test_Pit 4. ._ Depth to ground watery.`1"_C-5-7Cf&14-kc.ew LL, Test Pit No. 2._.-.._._minutes per inch Depth of Test Pit :.... ...... Depth to ground water...'.................. W ... yY_. .................:. .............D......:...._.__...................._..__............. tion of Soil ... ...................... .._. 0 Description s ! x P s --•- --•---------------•-- 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 T ITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the'system in operation until a Certificate of Compliance ha Pen_issu and of health w l�y - -------------- ------ ........ Application Approved BY------------ --• ......--.---- --�� �` ......._ •-•-•••--..--_... Date Application Disapproved for a lowing reasons----------------------------------•---------------------------------------------------------Da.------------- ---------------••----•-----------•----•----------•--•------------------•---------•-...---------•---•---- Date PermitNo....................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................:........................OF..................................................................................... r fit1Prttfirtt� of �llYti�tlittYtrP S°7 0 CERTIFY, That the Individual Sexag isposal System constructed ( ) or Repaired ( ) by ..................................................... -- - ----- -- Lr t tiller at ! � ............-------------------------------------------------------------------------------------------------------- aller been installed in accordance with the provisions of TI 5 of Th State Sanitary Code as described in the application for Disposal Works Construction Permit No... ............. dated- ............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEMY—L f UNCTION SATISFACTORY. DATE......l!l --------------•--...---......-------------••--•--------- Inspector .... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - 7 No ' ',, ............................. C FEE........................ t o u dun rudiuri amif Permission is reby gran " ........................................................ to Construct ( .. or Re ) an I al Sew e Di o atNo..--•-- •--•- - •----- --•-- --. •... ---•-•--•-••••---------------•---••-••••-•-•------•••----•........... Stree as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .........................•----------------------------------------------------------------------------._ Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON l � .e.w . q1�z L.QT I$ q&7 taoxt t X'DL LeACAINC, Pit' j (oFr EFFecrivE Depro N Lli 4�ou • � 8 �;4, Sty .. �g�4.:'3`� � �-'� L'E'�9 �H Of WALTERP. 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DiS4• M3o� gAd,'t''S z J aeem .J d w q��8 g go0Nt OF WALTER s� P• ti OLDHAM v 4t23207 REGISTERED CIVIL ENGINEER OF WALTER }} 0384 SMITH JR. , #15128 9FGISTER�����``� �'��IONAL E��G