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Home My WebLink About0071 PEACH TREE ROAD - Health (2) paetil Act h'i G S 7—o n c,�r - 095_ c ? � L 0 C A T ION S E W A G E PERMIT NO• VILLAGE I N S T A LLER'S NAME & ADDRESS - G� I U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� r•� Y /S , :w THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH Inw.[A............OF...... 1 .f� ..................................... -- Appl ration for Disposal Works Tonstrurtiun Frrmit Application is hereby made for a Permit to Construct ( .<Or Repair ( ) an Individual Sewage Disposal System at: � - -_ ...............»_»..»...�..5 I.....T0 .......Q� ._»`. ................... -��---»------_--........»».... ................»..»_»»» 21 atiorn-Addres .. .. .....................................................or Lot No........_............._»._ ... a ...J.:YS�dner Address 4aSJ�1R .1. ..... ............................................ .....................................»...... A... ..... Installer Address Type of Building Size Lot.....Z-1-1 �.Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (KO p•, Other—Type of Building ............................ No. of persons..................--.--..--. Showers ( ) — Cafeteria ) a' Other fixtures d ............ ......................................................... W Design Flow........................ ...---._--gallons per person per day. Total daily flow.............-._..........31<2.....gallons. WSeptic Tank—Liquid capacity- -gallons Length................... Width................ Diameter..-............. Depth................ x Disposal Trench—No..................... Width...._..t...--..... Total Length............. Total leaching area...................sq. ft. 3 Seepage Pit No...........I....... iameter.........A9----- Depth below inlet......4�......... Total leaching area-..ZC?-.®.sq. ft. z Other Distribution box ( Dosing tank ( ) , 'r Percolation Test Result Performed by. )CUB... .t..W -.e.. 'r. rF`� ate.......... ? I �2 aTest Pit ND. 1................minutes per inch Depth of Test Pit.-...... ...... Depth to ground water.....-------_-_-........ Li, Test Pit No. 2................minutes per inch Depth of Test Pit...-................ Depth to ground water........................ F 4 .................••.•••....... -.......... -........ •-••••..................-••...---......._......... -•••-•-------- •....... -......... _........... -....... ••••- 0 Description of Soil............... .. ...... W •-tom............. i 1D•..............•----......---.....--•------...-------••-•-------•-••-------- W ................••-------------•-----------------------•---•-•...-....-......._....----...-•--••---•-••-------...--•••••---.....-----•-----•----•-.....-.-......--••--.................................. 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 pro sio of'" :'I.% 5 to Sanitary Co — The undersigned further agrees not to place the system in opton nce has een iss y the o i h. !} 3'd / Signed. ... .0 .............. 1. ..>...... Da Application Approved By... c.,, . .............. ..................... ......__ .... - ---------• Date Application Disapproved for the following reasons:..........................................................................•-•-•-------...-•••---•••-...-----•-- . .....-•.........................•-------......-......-..-.--.-...---•--••---------.....-•--•---.-.........-.......-----•---.............-..--•-••-•----------.....................- - •------_... Date » PermitNo...................................................»»» Issued............................................-.-........ Date rr.� _4-0 THE COMMONWEALTH OF MASSACHUSETTS . BOAR OF HEALTH ............G.t I..J.............OF...... n.2t �I!Q! ...................................... Appl ration for Disposal Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct ( VI"or Repair ( ) an Individual Sewage Disposal System at: a Location-Address or Lot No. ....................»»»»: .1! lea .......i- ct 4 ....T(2....... .............-•--------..............---... .._........................»... ... Owner Address ........................................1 ... ......... ............................................ .....--•-•-........................-----••. . . a Installer Address Type of Building Size Lot....f.1`4&_TSq. feet V Dwelling—No. of Bedrooms......................... .....Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ...........................•••.............-••••.....- W Design Flow...................... ..............gallons per person per day. Total daily flow.........................Z 0.....gallons. WSeptic Tank—Liquid capacity� gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width........I........... Total Length._...........a...... Total leaching area...................sq. ft. 3 Seepage Pit No.........../........ Diameter............... Depth below inlet..... .......... Total leaching area..ZO.Q..sq. ft. Z Other Distribution box ( ✓' Dosing tank ( ) �}-- a Percolation Test Results Performed b �Z-..�... .lM..._._.. .: �, ��. `Date.......... � Y r I Y ,.a Test Pit No. 1................minutes per inch Depth of Test Pit........(.2...... Depth to ground water.....' -- ........ f 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ pG .....-••••..................•--••••......• .... ....... ......... ............. .... ................... •............ ......................... 0 Description of Soil................. x .. .....�,A_Jk; tA.......�' !.�?�4!�.---.......... .1.,f-�....V ............................ --......-•------•----•------------.........•••••.....•- UW ........................................................................................................................................................................................................ Nature of Repairs or Alterations—Answer when applicable............................................................................................... ....-----•---•--------------•---•----...----.....................................---••-•--•--------•---•--••-------------------------•-------•----........---...........--..--•-•....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the prow' ioi f i T1Z 5 t e Sanitary Code.—The undersigned further agrees not to place the system in ope nce has een iss e" by th!�board-of-health. Signed.._. `- ... ...�....... '",, ',� � .. Date Application Approved By.- .r �f`• : ................................ --- -- p. �J te- o. Application Disapproved for the following reasons:---•....................•--•---........................................................................•....»» ............................•-••----................................------•-•-----••---^-•-^-•------»........•................-•----••-•-•--••--......•........................-- ••••....... Date » f PermitNo................•-•-••••••-•---••-.................. Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH * i C� .1. ...............oF.........................:..�.... i .�3..... ............................ Trrtif irate of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..................... .............. .......-:•-•..............••••--•....--••-••.................... .................................................................. Installer at....... ............. ........,�' .... ' ....•..........----.....----•---•-•-...........................•••- 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.8:,.cr./Pi' ................. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR AS A GUARANTEE THAT THE SYSTEM CTION SATISFACTORY. DATE....... ...................................................... Inspector... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NoA3,1>e ........TOWJ-.........OF.....�.ssv a..? :A ` ....................... l �-' Disposal Works f�onstrttrtUan �rruti# Permissionis hereby granted............4:;/� ..-•..............----.•..........---•-••--•---,.........................-•----..........................____ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System ,r at No................ L '2 !1 ............ ` Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... q v Y f................................................. oardo Health ' DATE.......... ..... ................. FORM C-1255 CITY& TOWN FORMS, INC.369-9708 SINGu� FAMILY - �� BEpRQoM uo GActBAGG �j21NDER. DAI�.Y F%.ow ,A 110x 3 = • SEPTIG TA►JK =. 33ox15�%•=�95G:�`� Tr- .F-Az .uSc- l000 GAL.o15Po5AL PIT VASE 1000 GAL. �•ta \'S DG WAIL . . ( a-D r 150 5.1: X .'Z 5 3?5 G.P1igOTTO/4t A �o 5,F _ - I So S.P x I• o A o'O G•P c. M N •TOTA 1- Cl S451 GN * 4Z 5 r;.P cx N 'TciTA DA I uY F�-C>W = 330 G Po, P1"V COLATION RATE+ 1''IN 2MIN ov-LE55• - � � 4� bA&. N° A T�N. N F ( 1 • / 1• OF Alq•, ALAN 4P�,H OF.hrA� �'� �L _ T•H• •p RiCHARD cy.�' A.( BAXTER JONCs 1 qq.p0 1 i 2(0•00 N CA N.24049 5I 1 26 S 20A'C:, su T aST Top FNDckG"'I 'lam La Am ►000 lw1j. G� SvBJwu. 5016T.0-Ar61-4 INS. SePTlt. '$ 3• IGOO �w�( •TANK PIT INV.. INY. W I T Ia !0/•2 Gi LC.EA�I 1'1 314.1 Yi WASNGD r�,4rJD 670 H 6 - LJ� CER.TIFIG0 PI-oT PLAID 1 � PROFII_t" LoCAT low Mk2x.ToQe, IL er 5/ l3 Wo SGAL.E 5CALE I JAI o hI�TE� po 6 sD P L.A t l R E F S ZE W C'E 1 CEciT�FY I VA AT •THE 004,G SNoWN -- i NE.R.EoW C•oMPL%?!S WITN'THE SIpV--UWE �� Z� Auer 56T &ACX R.6QUIR.6M1✓NT'� oF'TµE- -fowN o� FAf-Oirk P.:A: ANDI S 90r r pLAid fipfL JSLA�1 �NALU ;I IJG LOGp.T 0 •WIT I►J ,1• X,: o; I. IJ A- . I Jys 1we. • REG 5'c 1cQ6�'I.q►'t D s u�'Y�cYoe"S 1 Tu15 PI.e.N I<� NoT 4nS�c ca AN o3-rEc�vlt-�E • MASS. I�J�j-I-R,uMEN1' Sv2vG-�( -rHE OFK'SET� 6VOU0 NoT I3G- V�C'•hTb pcTc:.c',/�INC LM'V 1.ING!J APPIII_At�•T' �oa�m's � �.