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Home My WebLink About0025 MATTHIAS LANE - Health �._ - - - - - -- -_ ______ _ -.�a�8 --�a�t ._ -__ �_ r� _ _--- _.. -' � � :_ -- ..�� .� . . , . , LOCATION S E tlY A ' P R M I T I�O. l� VILlAG� IMaa �CV�Lli t IHSTtAL E!P Sf/ NAISE AD , ESS 0 U 11 D E OR , OWNER r s s�!�G1% DATE PERMIT ISSUED -3 DATE C 0 M P L I A N C E ISSUED �a 0 No........r Fms.... dYJ THE COMMON±VEALTH OF MASSACHUSETTS o BOARD OF HEALTH I'f�1/'2--......OF......- � d..... Appliraatiun for Eiupuii al Works Tumuur#iun Vamit Application is hereby made for a Permit to Construct (/") or Repair ( ) an Individual Sewage Disposal System at: .. �...?y� ------------------ ------ �® -....... 1 L do - d ss_., or Lot No. ....--... _ ..... l�. `s ---•------------------------------- ................ ✓ Ay dress Installer Address Type of Building Size Lot............................Sq. feet V Dwelling, No. of Bedrooms................... --------Expansion Attic (✓) Garbage Grinder Other—T e of Building No. of persons-_-----X------------------ Showers — Cafeteria Otherfixtures ------------------------------------------------=------------------------------•---------•-----••... ............................................ Design Flow.........__..................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid ca acit /0- gallons . Length................ Width................ Diameter---------------- Depth.......-.-.-.- x __._..�-. �� . . Disposal Trench—No..................... Width..._..:._...._..-.. Total Length.................... Totalleaching area...... sq ft Seepage Pit NO..J_.�-----. Diameter....... Depth below inlet....... of ��n .... sq ft.. z Other Distribution box ( /) Dosing tank 0t Fe '—' Percolation Test Results Performed by._.: 7 _.__ _._ Date...._hf.-.l SP_`. ..--. aTest Pit No. I-e—S..-----minutes per inch Depth of Test P ---•-•--•-- Depth to ground water........................ (i Test Pit No. 2................. per inch Depth of Test Pit.................... Depth to ground water........................ / // D Description of Sbi�_....._Q_.:1.. - ..... b — ... x W -----•----•••-----......••---•----•-----------------•--•------•••-----------------------------------------------------------------------------------.-----------------------.----••.. --•- UNature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------- ------------------------ ------------------------------------------------------••---•----••••---•••-•------- ------.._.....---------------•-------------------•----------•------•----••------------••---•------------.._....... Agreement: -The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ;t 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 -----------------------•----•---•--•-•---•------ ................................ t Date Application Approved BY-------- -`7 ---•--------------- D e Application Disapproved for the f ollowi r ---------- ............................................ Iw......-- ----...----------------------------------------------------------------------.........-- r Date PermitNo-------------------------------------------------------- Issued-....................----................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....OF............. . .. .... [. .................................... C�rr�ifirtt� of �um�r�i�anr.� _ &SS CE I Y, atthe Individ 4age ispos System constructed ( or Repaired__ oby_...- -- - .. ` nrtall has been installed in accordance with the provisions of TIT of The State Sa ry_Code as described in the application for Disposal Works Construction Permit No.'_------- .----/&e2 ..... dated__..: -- -/�--_-,�-�...-...._... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ... Inspector-------•----•-----------•-----------•----------------------------------------------- NN ....................... THE;COMMONWEALTH OF MASSACHUSETTS -BOARD _QF HEALTH ............ akl)l.........OF...... ......................................................... Appliration for Dispatial ]Uorkg Tonutrurtion Permit Application is hereby made for a Permit to Construct (k/) or Repair an Individual Sewage Disposal System at: ... ..... . ....... ............ ....... ....... ................. ................................................................................ Jd L do r ss or Lot No. ............ ................................................................................................. dross .... ... ......................... . ............................... Installer' Address feet Type of Bu'ildinWl Size Lot............................S4. U ,M, I . Dwelling- 'No.,,of Bedrooms...................a....................Expansion Attic ✓($/) Garbage Grinder Other�:Type of Building ............................ No. of persons.....;y.................. Showers 0, Cafeteria aOther fixtures ............................................................................................................................................ Design Flow............................................gallons per person per'day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity/W..grallons Length................. Width................ Diameter-_-__-_--__----- Depth................ Disposal Trench—No..................... Width.__ ...... Total Length..................._ Total leaching area---- ft. Seepage Pit No...4t..A-------- Diameter....... Depth below injet..... of eacl(n area...--.?0 ft. Z Other Distribution box (V Dosing tank A 0-4 Performed ........................ Date..... y— /3�-- 7f Percolation Test Results r- Aw ............................... Test Pit No. L _2�1 Depth of Test Pit____________________/ . Depth to ground water_.___.________.__..____. ... .........minutes per inch Test,Pit No. 2................minutes per inch Depth of Test Pit._......_.......... Depth to ground water._...._.___............. P4 . ........ ........... ...... 4k U0 D....e..s.c..r..i.p..t.i.o.n...of go* AQ -------- --------------.-4----4------ —------.---..--.--.-------------- . -------/-- 4----- ----- --- .....................-------- ----------------------- ............................................................................................................................................................................ 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 TITS.; 5 of the State Sanitary Code—The undersigned further-'agrees not to plac e the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ............................................................................... •................................ Pate r............ .. ....Application Approved By......___ 7...1. Z. ...... •�_.._. Date Application Disapproved for the following reas-ons:...................................................................................*............................. ...................................................................�..................................................................................................... ------------------------------ Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF "NEALTH ........... . ......OF............. ............. C E/RI�Y, t the Individual Sewage Disposal System constructed /1�1or Repaired a b ............7----J/ .X/ /ins:ta, I at.. Al... .... .....Z.....-............ �e) ...................................... has been installed in accordance with provisions of r I P of The State 'Sa y Code as described in thi! .1� I ," 1�� r application for Disposal Works Construction Permit No_ ..../,t�....... dated.....3....... -f------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS-A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH 7?) . ' ........ .....OF ............................................... No......... .._ FEE... rkii on ion Permit V PermissionV* h b granted.... .. ........... leuz. .. ........... .................................................................. Permission n eDy to Con or ReDair an I i a e age Disp at,No.. ...�&4t4or- V...................................... . ...... Street • as shown on the application for Disposal Works Construction77-19 11 /ew a gt SPV----------- Wer at/_...L L ------J-r----------- ............ .......... ........................ .............................................................................. DATE.' FORM 1255 HOBBS & WARREN.-INC.. PUBLISHERS i ;.t 8f/7.0 44~ LAIC& vrt/ic0 W17yIN IZ k'',I _ C) - 1 - _ I /von G,a� - - - -• - - - , cc �. 5L,X '•t,/t Z•� i Hsu•• - 3Y-. r .. _ - - - - - - - Gxrst , 9 giro r�'e/ prof, !e �.J & if 7- / / �© - -o—o -o-o-- p opoSCo! 9i-ouriol Pro�r /� (/ E ,E' T. t /1 — SGHE1�. 4D GV. 0 oe '9 T T EquA� To SEPrI/C _ ---� N K t _ 3 fi c 3 1 2 .. o-•- o " 1 3�O - -- washed stone . 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