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Home My WebLink About0136 STERLING ROAD - Health I3ti 34erlut Rd.) LOCATION SEWAGE PERMIT NO. 1I& :& - VILLAGE 16 - .�� INSTA LER'S N & ADDRESS L T 2y - 414 - OR 0 . N ER DATE PERMIT S ED DATE COMPLIANCE ISSUED �.� " � it Ll No... q::_.1_? Fxa.......... _ .......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ___-----.... -----------------OF.......................................................................................... Appliration for Disposal Works Tnnstrurtion rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, t 4 - e .... .3 .. ' --------------- ............ .......... Address or Lot No. Installer Address dType of Building ^� Size Lot_*VA_1 _.......Sq. feet U Dwelling Z-1-��o. of Bedrooms.___.1J...................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. ofpersons_------------------------- Showers — Cafeteria a' Other fixtures ------------•------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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--------------------------------------- aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---- -------- �'' ---. 0 Description of Soil-------- -� `�` ---------------- - ---- •------ - -•-•----•- --- x V •----------------------------------------------------------------- -_•----------......... __.................................................................._........................................... W ••--------•-----•---------------••--•---•--•-•--•-•---•---._..._..•-•-•-••••-----••-•---------_...__...•-••- p............ j V Nature off pa�.or Al e ations—Ans r w en applicable.._...• C° �_ _ ?_':/�®_ __._.______ ' --- � � 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 issu d b/y the ebboar o health. C/ Signed ` `•`L---•---- ................................l Y ....•-•-••-------•----•----•---- Date LApplication plication Approved By.................................................................................................. Date Disapproved for the following reasons--------------------------------------------------------------------------------------....................-.... ..............................................••-----•--.._......._......-•---------•-----------••--------------•----•••----•-•-------•............................................................ Date PermitNo......................................................... Issued-....................................................... Date � THE COMMONWEALTH OF MASSACHUSE17S ' BOARD OF HEALTH H ............ ..............................OF-_____________ Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Lot No. Installer Address Type of Building Size Lo4000'o.........Sq. feet ..e^ __ ^yx` of Building ............................ No. of Showers \ / -- Cafeteria � ) � Other fixtures .-------__------.------------_---'_---.--.-------------_-'-------'--. Design Flow'--------------------'�ul000 per person per day. Total da�v8ovr-----------------.'--' . � Septic Tank—Liquid capacity------------guD000 Length................ Width................ Diameter........ Depth................ � Disposal Trench -No. .--------' Width.................... Total Length.................... Total leaching 8. Seepage Pit No..................... Diameter.................... Depth below inlct--'------- Total leaching area.--------ag. b. � Z Other Distribution box ( ) Dosing tank '- Percolation Test Results Performed by.----'--.-----__------------______ _________________ � Test Pit No. ]----------- ....minutes per inch Depth of Teat Pit.................... Depth to ground water........................ 44 Test Pit No. 3................minutes per inch Depth of Test Pit.................... Depth toground water........................ o4 ................................................ ` �] ----'--,------'--'-'-'------- D�ocr��000f �� ------_'-------------_._-..-____�.__--_______________ ' ~ � Nature . Agreement: . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in with � the provisions ofTITIZ 5 of the State Sanitary Code-- The undersigned further agrees' not to pla& the system in � operation until u Certificate of Compliance has | - - Signed -'_'�'-'---------' ' -_"-'-'�_' -~ ' r ' ' Date ApplicationApproved Dy.................................................................................................. _________-__________ ` Date Application Disapproved for the following reasons:............................................................................................................. \ ...................... "=" No � Permit� `. �� _-__--__ Issued_ _____-- � ~.e ^~ ^ THE oomMowvvEAcr* OF MAssAo*ussrrs - BOARD OF HEALTH ------_............. TyWrtifiratr of Toutpfiatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bc'--'-'------'-_-'---'----__________________________________________________________________________ Instaler ot-----------------'----'-_--_________._____________________________________________________________ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED THE COMMONWEALTH orwmsSxoHusErrs BOARD OF HEALTH � ---_--'------��F--�_____ ______ | m �� Disposal Permissionis hereby ---'.--��.��t........................................................................................................... __- to Construct ( \ S Z) at No.------_-.-u�~��-'--__ __*��__ ______.___________________. ^' ^ Street /�~.�_~ �� -'----' uo shown oo the uppl�utioofor Disposal Works Construction Permit I�o---------- Dated-�2-...--'�-.�__-_-- . -��=e---------------.__________________ y=� � e�� C��T}I--__--.------------------.-----------_ ~ / pon� /ums A. M. su�mw INC., osrum � ' � ' ' | '