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Home My WebLink About0259 LONG POND ROAD - Health Lono, Ik LOCATION L-o-c SEWAGE PERMIT NO. 9 Is �.rn..C, CYAA VILLAGE m��- ..1� I Its INSTA LLER'S NAME A ADDRESS CAI l �- B U I L D E R OR OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED e• - i i o No. .py.....�9yL/ Fps............................ THE COMMONWEALTH OF MASSACHUSETTS or�� BOA RQL OF HEALTH ...................OF.... ............................... Appliration for Uispaaal Workii Tonstrurtion runfit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: x2sC ... . .....%00-L.... ..... ....................................... V or Lo Loca��ddies,,j,.. .....W'.AI" . 0. . .............................. ......%.kb2ac., 0 r Address... ..... .......... ..................... .................. .............. Installer Address Type of Building Size Lotl'-(0500.........Sq. feet —No. of Bedroq s.......qGarbage Grinder Dwelling *. .. ................................Expansion Attic Other—Type of Building Utbselw'��._ No. of persons------ ........... .0................ Showers Cafeteria 9therfixtures ..................................................................................................................................................... Design Flow..(C)O..................................gallons per person per day. Total dall flow..._...Z60.....................gallons. Septic Tank—Liquid capacityi.Z-S'O.gallons Length_12, OFf Width-- ,... Diameter__.__-_--____- Depth.& ....3;--- Disposal Trench—No. .................... Width............._._.... Total Length...__.............._ Total leaching area....................sq. ft. Seepage Pit No.___ ---------- Diameter..L.a........ Depth below inlet.........IR.... Total leaching areaS.Yl.........sq. f t. Z Other Distribution box Dos' tank Percolation Test Results Performed by'_ X&��'h...O\Qtl.�..................... Date ...\CA&L Test Pit No. I................minutes per inch Depth of Test Pit._______............ Depth to grou�n water.-1JG&...'3.!:� Test Pit No. 2................minutes per inch Depth of Test Pit.__.............._.. Depth to ground water...................____. ............................................................................................................................................................. 0 Description of Soil......()Cmajpo _Aeo...V-,A..P......<4. .................................................................................... W ......................................................................................................................................................................................................... ........................................................................................................................................................................................................ _4JU Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ............................. ---- -- ---------------- ------------------------------------------------------------------------------------------*--------- Agreement: a e a t Sanitary The undersigned agrees 'f e aforedescribed Individual Sewage Disposal System in accordance with o q a t the provisions of TL I Ix U 5 of the fate Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been r* sued by the board of heal,th C. L Signed./)V. Application Approved By..........................................Id< q..... .L .- I ...................................... ............. � Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................................... ........... ............................... 1 ,, Date C_? q Permit No______ ............................................. Issued......... .... ................... 4Date ---------------------------------- ---------- ----- No: ..:....-----.-••----- FE$............._............... THE COMMONWEALTH OF MASSACHU-SETTS BOARD OF HEALTH 1 H Appliratiaan for Disposal Works Cn> notrur#iaau Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage`Disposal System at: f DL oc ' n- dres Lot No. r ` 1 Ow er i Addre .............................. ---•....................... ................ _ ........ ........................... Inst ller Address Type of Building Size Lot-_�40.'5QQ--------Sq. feet Dwelling—No. of Bedroo s___......�.............................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building —Type g . ._ S�1__►. No. of persons....................... Showers (Z) — Cafeteria ( ) 04 d Ot er fixtures -------------------------------------------------- ----------------------------------•---------•----•_--•-----------_-...........------------------. W Design Flow...... .............................gallons per person per day. Total daily flow----- ?.............................gallons. WSeptic Tank—Liquid capacity.1.VZ..gallons Length jZQ�..•.. Width.:6.15t..._ Diameter-_-_--__---._- Depth6r-i.. x Disposal Trench—No .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......... _._..._ Diameter.(a.- -------- Depth below inlet...7.jr:�...... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank `-' Percolation Test Results Performed by. S.En.q,'r.............. :.. _ Aq,-Date__ l 1.,.tq$ ........ Test Pit No. I................minutes per inch Depth of Test Pit.................... Dept to grown water_____`fQ�_t+!`,. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------•_--•----------•-_-•-.........---•------_---------------........_...------------------. O Description of Soil...�JOc�(I? x U .---------------•--------••-----....._..--••----------------•---..........------------......_..-------------------••-_-•....----.....------------------•-----.....------------------•...........-------- W ---------•-•----------------------------------•_---------------------•-----------•---••-••----------_-•-----------------------_-------------_------------------------•-------------------------•••-•---- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The unXersiggned4a*gg_r4fees*of;t0hettate t e aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 Sanitary Code--The undersigned further agrees not to place the system in operation until a Certificate of Compliance-has-been i sued by the board of health. Signed--4. dZ.....---_ -------------------------•-•-- Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons____________________________________________________________________________________________________________.::_ l Date Permit No...... _.'. r Issued ' Date THE,COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .( ..................O lE.......................................... Trrtif irate of Taautpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (>q or Repaired ( ) s'', 11 .!°a� f•--•---------•---------------•-----------------•-----------------------•----....--•---------.....-----•------.......-- Installer has been installed in accordance with the provisions of TITLE 5 f The State Sanitary Code as de cribed in the application for Disposal Works Construction Permit No-----&_(� _.......__........ dated........ .......(�._ ..4._.....___.___ THE ISSIDA E OF THIS CERTIFICATE SHALL NOT BE CEUSETTS AS A GUA ANT E THAT THE SYSTEM WILL F NCTIO SATISFACTORY. DATE............ - ................................ Inspector..... ----- ......................... ................... THE COMMONWEALTH OF MASSA BOARD OF HEALTH £ ? ?. ..................OF............. ......................... FEE.... <r.............. Disposal Works Tono#rudiaatt. rrutii Permission is hereby granted.........................A ......... '--�li�,�F'l E�r.,.-----•------•--•.............•---------..........-•---.... ._ to Construct 60 or Repair-J.-.) an I ividual Sewage DisposajI System at No.. ----- ••-- s` _ _s�c.� ...... --------m0 .. _ ----— ��\5-------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ............................................................. ... Board of Health DATE...... --.......................................................... FORM 1255 A. M. SULKIN, INC.. BOSTON G►�1 D I*1/30 0 LoTlZ `R3 . As s A �Q7X NM INS > � ► P� C0 4 giDP.cO 0 1° 9 fi 0 < y V JtaS � Q � 0 p 'U _o �o it rs �1 m t1 of A gs,9ctiG WALTER o E. -� " SMITH, JR: (p1 #15128 9FGI ST EM�� FPS/ANAL RE ED j CIVIL ENGINEER E � 1 �30 0, S a BAQWSTA LE M-A5S , DrsposA,- PLAN b �J& YKALL►#,M -cgoLS M4R LI I�"o M -S, l�Ss, s 1405 -EQ C-lR, ss6c, )Nc , Rh--/040*4 SCALE if 60 / .S EPT22, 196� P- 2959 � r" �• ievv 9s•s � qs,o log C O l ST..BC z:l t�8 �Z/Was�i�d S nr so 96 1250 Coal. Inc. q5.7 A 446 Co", lEAcu�uc� P,r SaP�r� T4� k `16•0 ,� 40 e AAn aoo a4a A 2 r o n ►A Ail %4-1 �z vinSA�c( s �C Bor. PST E�ti/ ToPsot�� Sv�5oi�� DES I CA N D A,Z-A : Ct-AY t =-P—CoL,ATI ON RATS: 2 M/N'INC 1-1 DRo P TEST PERa='ORMED AN. M jd364 +, ICGGDRooMS YC Ito GPD =` �440 C PD LEAC00'116, . �5 - �$" IV O C-ZAR�ACsE DtSPOSgI.. V SE rZ�O �A(..•SEP7"I��I CA PAC IT Pp,0VIDED : X t. - fig.SG P D L=7f?AVU- t Ctr 5 � � v -S = 47/; ZCi PP �� 7 S$ I OTa�- CA P!-�G lTyp YI PEP �� 9.7C p =lIODGi Cao. D 15 PO SA 5i c m De:s 1c�N E D 1 N A c Lo Gt D^"CS vv i T 44 PROVISIONS O.F SAND T'IT>_� S o� TF-��. l`<(ASS . �tJ Icz�l�lMEti� GODc . g50 NO r �IGf�AR P CF-L S7C NO C-tROVND WAT �-o��' /ua4/lerVA) 7-g59 0I L 5_rR ArA Su E T Z