The URL can be used to link to this page

Home My WebLink About0112 CAP'N JAC'S ROAD - Health (2) �'Ol/aZ- capc ' tj `s �d 4 t e �--V r L L. >�41 — 4 i a r i i k 'll A Al L' 817ee ,- VILL.. e. � No.---. ...'...y.. Fus........../.._.............. '.,rHE COMMONWEALTH OF MASSACHUSETTS �,,,.0 . /�� ✓ _1 BOAR® OF HEALTH (9140,� �� N ?-W.-ll� .......OF....... '�d (ll'� Via'..` �_! ---------------------------- ioAppliration for,Ro m al Works Tonstrur#inn thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys at .....: . .-..... .. .. ... :.... .i �i .................... 1�A: .--------................. 1^ cat!., ddress or It No. ...... .. .. .. ..Pa'� �1 ...... fk .................................. /� ey Ow p� ^ Address ........V.6_x .TL. .>:..�� ..__ .lS s� = 3 �.c=...t. ............................ Installer Address U Type of Building Size Lot....11rN.3---Sq. feet Dwelling—No. of Bedrooms.................�................_.......Expansion Attic OW Garbage Grinder ((�9 Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ---------------------------------------------•---- ss ------------------- W Design Flow............t�o........................gallons per person per day. Total daily flow............_____._..._.-....._gallons. ,W x Septic Tank—Liquid ca acit lb;49 allons Length__.._._.•...._.. Width................ Diameter___ -______-_ Depth................ Disposal Trench-No........_. Width................ . Total Length_.__...--........... Total,leaching area ...........s . ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area."..:............sq. ft. Z Other Distribution box ( ) Dosingjank ( ) a ----Percolation Test Results Performed by._... ,, ..... A ..e.................. Date........ ...... .� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to:ground water-------_................ Description of Soil....�"' 1 1 . 1 �>-----�JA.Aj..b-....................... v ---........••-•-•-•-------------•--••--------•-------1.1..�- -113...- ------ -I .- L4 _ .....-------------- W x •-•-------••--------------------•-•--•••--------•---•----•-------••------•---•-•--•----...--------------------------------------------•----•---------•••-•-•-----••-••-•••--------------•----.........-- 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 provisions of iIT?L- 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 health. ��( Signed--------- �"i'sA �l---- . ..... �A,.�7-T. ....---- --�. q D o Application Approved By............................. -•--••. ° . . -----------------•---•-- ....... C-...—tfie ,y........ Date Application Disapproved for the following reasons:..............................................................••.----------------------.._.......-----..._..--- ---••--•--------------••--•...----------..........-----------............--------•-•---•---------------•.--------------••-•-----....------•-----••-------------•-------------------------------••-----•. Date PermitNo.......................................................- Issued....................................................... ............... Date Na... �-= •----- FEz.............................. THE COMMONWEALTH OF MASSACHUSETTS "r BOARD OF HEALTH . O.W..iJ................OF...... - Appliration for Disposal Works Tonntrur#ion rrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy em at: ] .... R��I.j- ,:t..s ... Q:... 4.4J�. u1C;lt%...---...-- -----� - ......... . .�.. ....................................... ------ ----- Locatio Address or Lot No. - �_. s...- ......_ ✓n z ..._ ow -------------- ----------•--_ F1 .... �...................................ress a .....-- L �`''Q= ��US.-........................... ................ ( a4 ,r....------.........-------------- Installer Address U Type of Building 2 Size Lot....-•�.$................. .3....Sq. feet �-, Dwelling—No. of Bedrooms...............`.................•..........Expansion Attic (�0) Garbage Grinder Other—Type e� yp of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOthe fixtures .----••-•-•-•-----•-•-•-..._•---- • •----••----.-••---....•--•-•-•--••----••-----------•......••-•-•- W Design Flow._........�.Q....................•••..gallons per person per day. Total daily flow........._ gallons. WSeptic Tank—Liquid capacity.1.00P.gallons Length................ Width.........._..... Diameter................ Depth................ xDisposal 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 _"�T��.Qr__`3,.....��.'��.................. Date.......�_-.I`�._ 6'4 ,-a ------••-•-•. Test Pit No. 1:---_---_.___-minutes per inch Depth of Test Pit.................... Depth to ground water................... LZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .------•--- ......-- ----- --------------------•-----.....-----...•---•-----...------............................................................. D Description of Soil _ ..... . b_� .....��..�3_- = y ` P (xj ....................................................... •-t.3...---rn�t -=----S•\_2.- -•---•-� "...I.......... a� ��t'.�-�.................... 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 provisions of TITIF, 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 health. Signed.... " ..rI---•. - ' a"r ------••-- J i L Application Approved By•....--•-•-•-•............: : ... .. --------------------- Date Application Disapproved for the following reasons---------------/01- ........................................................................................... ......................................................--•••--•---•----••---•-•-•....-••-•...--•-•...------•--•-•-••---------•--•-••----•-••---•-•-------••-•-•......-•--•-------. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........F0...V...±................OF.......Q). �..W. T. Lrs .......................... Tntifirate of TontpliFanre THI�SVyI�S TO CERTIFY, That the Individual Sewage Disposal System constructed (�or Repaired ( ) by..--------.V. .� !�' ' ''� °•--•-....t P= §=....--••----•-•--------- i � 1 { Inall at.•....�T.ir -&----..... A_�'_. .._.._ !f �=�- -st �� lv V l'C has been installed in accordance with the provisions of TITW,, 5 T 1 State Sanitary Code as described in the application for Disposal Works Construction Permit No______ ______________________________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRIG A . GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ..........................�5...-----•------------- Inspector.......-- •. .--- -------- ......................................... cn THE COMMONWEALTH OF MASSAC SETTS BOARD OF HEALTH _ L ..................OF............ ................._._................................_........... ... . No.... '. FEE........................ Disposal Workii Tongtrudion rrntit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or-.Repair ( ) an Individual Sewage Disposal System at No. Street as shown on the application for Disposal `'forks Construction Permit No..................... Dated.......................................... �. DATE Board of Health ------------------•------••---...------------ FORM 1255 A. M. SULKIN, INC., BOSTON •',�Q&LL— FA.M��_�! - :3 BGUR�oM • �tJA1as 1Ca ►,10 GACtBAGE G�NDF2 ,, ,� c�A�L�( FLOW : 110 X 3 p30G.Po �22� 5EPT%G TAtJK = 330x 5o / -- A 9 rG.P o �n,`a -•F;.r E.rP us - ►000 GAL. 3/ofi dJ2.SA usE 1000 6AL . l„' o15P05AL PIT S Dr-WALL TANyc. I BOTTOM AREAS .. "ToTA1- ol<S►(.N = 425 G.PD. ` �, II�a 'TOTAL- DA%%..-( f E2C.0LATION RATE 1''IN 7-MIN or,.LEOF S PITEP U. r; RdCHAR� A. PAXTER u Na 1: 24 Irk A �1 FG TOP FWD= +�4L•o •T E1�1T I IS 40A-M fd- loov lNV• SvdSOlL D I ST. I N-/. G 9aA /27, . SevT�� 3 OCO INV TANK M�SaNp GAS. /Z=• L�AGtI INV. INV. 5 PI'f z /LZ.� WITLI /It iGI�. VJA�,,N�D .liwu►�, 6Tv N 6 Ile, Sowed �1.(� la �1•� PRUFIL� 1.oG4?1o1J C�->v�UIc-L�ls NO SCALE QZ 3 Mo WA — P L A N REF 62EN GE CE Q.T1FY -C LOT A NE.2SOW GOMPl.�f S 1nlIT1.1"TNE SIC�LINE &.wr,> Sr=-re4&GK R-6Qv1QEMENT'> oF 'CN� TOWN C)r- rt'A1�,(-� AND 11, �07- pLAW F2 2. A2r-gLL WILUAMJ LOCp►TED WITNI►J THE F%..00D PLAIN DATE C� fZ gAxTE�d NYE INC. d iZEG 1 S•t f-QV-rw J1W D S v e v EYoeS Tu15 Pl.�ti i 5 Nam' E3nSc n o►d AM os•rE2vILLFs • MASS• ItvSTR�M�NT ,�2vL`( `iNEnt=t'SETS Suou1,D �,f•t,lt!'� �� ►tor f'�F u5EDTo DE-rEFQtlWl� t oT k. INE�j APPLICA►JT Gi�l�rr