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Home My WebLink About0164 GREAT HILL DRIVE - Health m it I ®®� SMEAD No.2-153LY UPC 12934 mead.com 0 Made In US Sl1�AINA61,� PORP51R1f 6[VIIIATIVE Cer�edFawsoufft xwMw.�iprogra�n.Aro -6 LOCATION SEWAGE PERMIT NO. VILLAGE )7Y _ U3Y INSTA LLER'S NAME i ADDRESS �t �r ,so• u z San B U I L D E R OR OWNER DATE PERMIT ISSUED o DATE COMPLIANCE ISSUED 3a 3� `� a� ,� 5-�-�-�..�-- �, � '7 d, Log No...... .._....... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS � a0AJR®, OF HEALTH -.10�� IM ................................. Apphratinn for 11ispn.sal Workii Tonstrnr#inn ramit Application is hereby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal Olt 11 - - - - - ' ` 1_ocation-A ess �f— -•--- canerf. Address lc� Installer AddressPQ yy / Type of Building Size Lot..� ....Sq. feet U Dwelling—No. of Bedrooms........3...............................Expansion Attic (A o$ Garbage Grinder (no) Other—T e of BuildingNo. of persons............................ Showers — Cafeteria d Other fires.. ---------------------------•----------------- --....-----------------------.------------------------...(---:)......•----------•.........._). W Design Flow............. .... ....................gallons per person per day. Total daily flow.............S..1.0................gallons. WSeptic Tank—Liquid capacity.j10.0.0gallons Length................ Width................ Diameter................ Depth................ x Disposal 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 ta}}c� ) Percolation Test Resul s Performed by_...............r0) ..... A................ Date.......7. ---- --- Test ___�_ Test Pit No. 1 . 6.minutes per inch Depth of Tes Pit.... . ._ Depth to ground water.._._.. Ga Test Pit No. 2L. ..._. .minutes per inch Depth of Test Pit___..... _... Depth to ground water___ _ a .................... ......--••.... .......... Description of Soil.................. ... . .........._..... ___ _ x �., , o x ------------------------------------------------- ------ � 5 ---------.-------------•------------------------------••------------------...... .... 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not place the system in operation until a Certificate of Compliance has been issued by th oard of healt - G Signed........................ .. ---•----•••---- ............. •----- Date Application Approved BY s .................•---------• 11 ._1� -� ------. Date Application Disapproved for the following reasons-.......................................................................................--.................... - .................................•-------•--•---•--•-----------------•-----•••---------•-•-•--------...-----------------------------------------..----------------•----------------------------••-•-•--- Date PermitNo................................................... -_ Issued....................................................... Dae No Fizz ............... THE COMMONWEALTH OF MASSACHUSETTS `BOA`RD�+OF HEALTH ................OF....f- t.!" u /� ....... .._............ Appliro#iun for Miposal Vorkii Tonstrnrtion V rrmit Application is hereby made for a Permit to Construct (tr/ or Repair ( ) an Individual Sewage Disposal Sy s t em at ( � J Jf��ff / / J1 (. /•... tf!. .._=..:.. �?.......... (11�11�...... �.�L/`jr,,//r..................................................... .. .. .... .... .: / ,v J.ocation- ddress orpLot No. ......__ 4-. a,! G'~% J' .. f' ........... ... , ....... �'rC d�-'• i.. ........__.... J.. "'+ . caner, Address a ---•-••-•--.---•- ,�Cj:!n.�:;3..�.1..► = ems'?l .......................... ......................... ..t'�' -.�' ............................................. Installer Address ,t i Type of Building Size Lot_`` "5 �U�.......Sq. feet U Dwelling—No. of Bedrooms.......�.................. .. .....Expansion Attic �1 S) Garbage Grinder (1 b) Other—Type T e of Building No. of persons............................ Showers G4 YP g ---------------•----------•• P ( ) — Cafeteria ( ) Other fix,prc --r r • ---------•----•••••••-••--••--•-•-••••---••-••--••••••••-••-•••••••-•-•••••.............••-•-•--•-•••- WDesign Flow............ ..... .....................gallons per person per day. Total daily flow............... ta.�................gallons. WSeptic Tank—Liquid'capacity;... Q.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 to ( Percolation Test Results Performed b __-_--_----_---�� ....:�`�'�.....•........•.. � 4- � •_Y... Y ` � =�.. Date •�• ..,S........ �1 Test Pit No. j%.r,c s:a'___minutes per inch Depth of T�Pit......,j'-a%5�... Depth to ground water....................... P4 Test Pit No. 21 WI.A.minutes per inch Depth of Test Pit... ..... Depth to ground water._ . . P4 - -------- :- r - -- :3 ..O Description of Soil.................. . x (� r_...__.t..1. ------..-".............. ................•-•......--•---••-•----•---•----------------.............--•--.........---- il - UW --•--•----------------------------------------•.. ._.�`'.__d.__.........1_...........�c�r.. f....------------------------......---•---••---•---------••----•-..........................•... 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 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 the board of health. Signed....................................................................................... ................................ Date Application Approved By......... :. .... ✓- - b Date Application Disapproved for the following reasons.. --------------•------•------------•----•--------------------------•-----------------------------. --......•-•••-•••----•-••-...........•••....-•--•---•-•-•••••-•--•-••---•-••--•••--.....--•--......•-----•••••••-----••-•••••-•--•------•-•-••••----••--••-•--••••••---•-----••.............••---••--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1l 'Wrtifiratr of ToutpHanrr TFJ,�IS TO CERT,.�FY, That the Individual Sewage Disposal System constructed (/—)or Repaired ( ) bY---•-•....:.16-121 ...�%' `� ,/ ................................................. -•---.....-----.......------..............._........-- Installer at...._' !a " ' c t d'CC� � %/,� d � • �- �/"/`� --- ---•---- ---- ••..... ---- has been installed in accordance with the provisions of TIj.L. 5�of The State Sanitary Code as described,in the application for Disposal Works Construction Permit No.. .�'....�_4!f........_.. dated_____________________________________`:._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................... l•1 � - ------- Inspector............ THE COMMONWEALTH OF MASSACHUSETTS ... BOARDF HEATH rt � ...............e7i............. ..... ..........-•---................:.w_.................................... ...... No....:..•-••••--•........ FEE........................ Dispostt orks Tonstr ion amit Permission is hereby granted........ .................. ...... L_�:G.�-�............................................................................... to Construct ( �r Repair ( ) an Individ al Sewage Dispos*Syste> J� e i . l r J Street as shown on the application for Disposal Works Construction Permit No.____••.•--_--______- Dated.......................................... ........................4.....r%................................................................ Board of Health DATE.......................................................................;........ FORM 1255 A. M. SULKIN, INC., BOSTON V6A3Aw.ns allo .fl.� 3.1va 0 ?133HS . 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