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Home My WebLink About0480 OLD MILL ROAD - Health 48�jO1d'=Mill'Road le-- A=`1661'667 1 I ° i II 0 ASSESSOR'S MAP"NO. Y PARCEL l� L O CAT ION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME A ADDRESS �I aoq--t �c) & a?-S A vl 0-4 S U1LDE R OR OWgE DATE PERMIT ISSUED Pq DATE COMPLIANCE ISSUED //�� TwN aV Rw 12-4 S BAC-I< Leo �5 �w No Fimic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF..�ckr-6oUL....................................................... Appliration for 11ispasal Works Tomitrurtion Prrmit Application is hereby made for a Permit to Construct or Repair ( Y an Individual Sewage Disposal System at: ............. .................................................................................................. Location-Address A . Lot . 0. ............................................... . ! . ........................ Owner Add A &...amw ... . . .... au A...........Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...................:Z....................Expansion Attic Garbage Grinder '_l P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4Other fixtures ...................................................................................................................................................... Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width..____.......... Diameter_............._. Depth................ Disposal Trench—No. .................... Width.._......._..__..... Total Length.............._..... Total leaching area....................sq. f t. Seepage Pit No..................... Diameter.._..._..__......... Depth below inlet.......__........... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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 ..........................................................................................................................................*------------------ 0 Description of Soil....................................................................................................................................................................... W U ........................................................................................................................................................................................................ ................................................................................................................... ........................ A"ZL---- .................... t lf"� U Nature of Repairs or Alterations—Answer when applicable-4. , - _100.o..3V---M ......... ...b_Qa_,qh..�4...WVD o.,&..4.._Arcmw...ma ................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'LlTLU 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued by the board of health. --------------------- ------------.... ...... ...$ (V....... V gLe,, Application Approved By....... e�2_6v'hd Appl ............................................................. .......................... ,/.ID to -- ate Application Disapproved for the following reasons:................ I...................................................................................... ......................................................................................................................................................................................................... Date Permit No......iST-.0---------- IssuedL....................................................... Date ----------- �l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...Uw?1 ......................OF...�... .T.». .:s1. ......................................................... Allp irativit for Disposal Marks Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (_( ) an Individual Sewage Disposal System at: :.. ........ .. .rl .......a ............. ...... .�..-----------..... Location-Address or Lot No _ -�� -• .................... n�:7:r.:!�a.................. ......_......-•----.. ..��4...11�c3r.��.;� :��z�... ��.r..n.�5........--......_1 Owner �*Address ..............•........................-----•-•-•-•......_........ . SG Fin J. r cQ :....U.....61 r r,r� ........... pq Installer Address VType of Building Size Lot............................Sq. feet ,.. Dwelling—No. of Bedrooms.................:..:............._......Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ..........................:. -•--•---......P ( ) — Cafeteria ( ) dOther fixtures .................................. .........-------•--•-•...........-•----...•••.....-•-----••............ •--•----•--•----•_.... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity. ._._.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.. S..r 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------------------------------- ••...... ............. .... -------- -.... •••... --------- ------------- ----- •••.... •--------- •... ............ •--------..... 0 Description of Soil........................-.............................................................................................................................................. -----------------------------------------... .........-........•.............. ........................•--.------ --.------------- --.----------------------.----- x ..................-...................................................................................................................•----••--•.................. U Nature of Repairs or Alterations—4nswer when applicable m s*, l...t o_sap�'i� rt��_-.�0 0 0-�� -------. .............•------...-- y ...........•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITLE 5 of th? State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bqgvajssued by the board of health. Signed) .. ................................ ?....--.... ate Application Approved ...G ..................------ ate Application Disapproved-for the following reasons:..........................................................................................................--- .......................................•-.....----•--•---•--...._.............-••-•--•-......•-----••----...---•-•-----•-••---•••--•--•---....-•-•--•......•---..._........•----•-••-•.......__...------ �• �//�� Date Permit No.. �_�..._...�Ll� ........ Issued............... ------......--•-•................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH i r 1:c?U....... ................O F ...1.. C.rn a c.a4�.<R................................................ (Ur#if irate of Toutp anrr T IS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired.) by.... "17.--... -• ........ 'I taller .........................•----------^----........... ..... -•--•--- at.......... .... .......--------------•------•-----•-------•............•.....-•..•--•- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code`.,::: escribed in the application for Disposal Works Construction Permit ....1 "' 47 o........ dated----- . THE ISSUA CE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ` TEE THAT THE SYSTEM UNC ION SATISFACTORY. DATE .......•. ... g .................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No '... ...... . ..................... -...... 19ispnsttrks 01uns#r�trtiun rrrmd Permissionis hereby granted.........--..:.... .t>.w---.....-------------------------------•----.............................-----....................._.. to Construct or Repair ( ) n Individ Sewage Dispo S Ste atNo........... ...-- -.... - •........... A..... .............. - as shown on the ap l Street // ication for Disposal Works Construction Permit No.._........(` Dated.._...... . _�f�.W-------------- '7/9 kTo Board of Health DATE................... .............................-••-•--............ - A FOPM 1255 A. M- SULKIN. INC.. BOSTON e