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HomeMy WebLinkAbout1057 SANTUIT-NEWTOWN ROAD - Health ios� �J"-hw,� _ h'�arS7orLS MILLS D��/UQ� °C' 7 \ - LOCATION 2 �,v � SEWAGE PERM�T N0. VILLAGE vo?7-ov$ INS TA LUER'S NAME i ADDRESS ,<',- 46fcf e U I L D E R OR OWNER DATE PERMIT ISSUED S2/ II DATE C OMPLIANCE ISSUED T � � l t® I Fns... fOTHE COMMONWEALTH OF MASSACHUSETTS d BOAR® OF HEALTH ............. .........................OF..........--........---•----...........-- Appliratiun for Disposal Works Tonstrurtiun Prrutit Application is hereby de or a Perm' o Co str ( ) or Repair ( �anIndividual Sewage Disposal System at:: _ In�, Au X S= ✓.. .`-�.........: ."_....© S..� ..:..l.vC1-�` n..riL4A t. ""'' ---...... ---- ------------ cc�� Ltion-Address or Lot No. ............................ ...................................... ...._ r W ---- ..............•-•......-----•----- ... .�.... � r . Installer Address Type of Building Size Lot_2� 0-6-----Sq. feet U Dwellin �No. of Bedrooms.............................. .....Ex anion Attic� g --------- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ frq Test Pit No. 2................minutes per inch Depth of Test Pit............_....... Depth to ground water........................ a' O Description of Soil.... . `1< ................. x U ...............••---•._.._....--••••••---•---••-••-••-••••••••••--••••...•--•-•---••----•••-•--•••••••-••-•-•-••-••••-•---•-•••--•---••--•--•-••-•• -••---......•--•-••.--•-- ••---•--••-...---------- ------------------------ ---------------------------------------------------------------•••............. / �, U Natur Repairs or Alte "tion —A suv hen 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 issued by jhe board of lth. o ,[ ......................... Application Approved BY G\Ta Date Application Disapproved for the following reasons-----------------------------••------•-----------------••--------•---........................................... --......--•-•-----------•--------------------------•---•-------•---•-----....----•----------------•--•---••••-•••....-•••-•-•-•--•--•-••----•--•-•••-----•••••-••••----•-•-•---•-----•----••-------•.... Date Permit No......................................................... Issued-.... - `0 — 8�,� ----•---•-••.............•---------- Date No5';ZE_::AC1S ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ....................._OF.............................. Aplifiration for Disposal Works Tonstrurtion Prrutit Application is hereby to de for a Permit to Construct or Repair ( 44�anIndividual Sewage Disposal System at: b"-ito . .................................................................................................. L tion-Address or Lot No. . . . ......................................... ....................................... --------------­ *......................r.......ess ................................... -'i Installer Address Type of Building Size Lot.s� -------Sq. feet U Dwelling,*No. of Bedrooms............................................Expansion Attic Garbage Grinder Other Type of Building ............................ No. of persons_....__.__._...._........_.. Showers Cafeteria Other fixtures Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 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 It. 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_..__.__..........__.__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......___...........___. .. Description of Soil . ..............................................................................................................I.................................... 0 ...........................................................................................................I............................... W U ........................................................................................................................................................................................................... W ........... ............................................................................................................I.......... ............ --------- ----------- �rs or Alte�Iion nS� U Nature-Df ReDairs or Alte ti_ n A hen applicable,14.t-444A -----0417- .0 .................... ------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITA LZ 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 by the board of Ith* ignedw. ........... § .6 ...... ............ ................ Date Application Approved By ----- A . .. .. V S.. Date Application Disapproved for the following reasons:................................................................................................................ ....................................................................................................................................................................................................... Date PermitNo....................................................... Issued....5......;_.w ...... .. .................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF Trrtffirate of Toutplitturr THIS IS TO GERTIFY,Th at,(the Individual Sewage Disposal System constructed or Repaired by-------------------- ...... 'Valf ............................................................................................................................. at..............1_4>?�=_:].....1.OS Installeflk��14;::t .............. ........ ............................................................................... has been installed in accordance with the provisions of T TIE 1 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ... ated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE HAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. ........ ..... Insp6ctor......................... 6/1VZ.. ............. ............... -------------------------------- THE COMMONWEALTH OF MASSACHUSET BOARD OF HEALTH 7 F............................................... N A&t.�515 .........................................0 ....... FEE........................ J Workv Tons urtwit Vamit Permission is hereby granted .. ...................................................................................... :ed L_'la:. to Construct or Repair an,Indiv �ilual Sewage Doposal System at No......... . ........ t4;1. _# Street tr G"_)__ 7P NoqZ�'S-Y as shown on the application for Disposal Works Construction I Permit 95 Dated.... /Zq ... ............... . ............ ---------------------------- .................. Board of Health DATE.__.... .............................................. .... FORM 1255 A. M. SULKIN, INC_ BOSTON