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Home My WebLink About0170 OAKMONT ROAD - Health (3��- oc�l) ��ns-Fab -e. No... ....... � '`'- .. .�. .. �$ ... .... THE COMMONWEALTH OF MASSACHUSETTS =T: t,/ BOAR® OF HEALTH ` ...------ -- . ..._...............OF................................_....... Aliptiration for Diipnsa1 Workii Tong rnr#iun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an. Individual Sewage Disposal System at: Location-Aodres5 or Lot No. ................. ,, /.KV,tf''/� --.......... Owner Address .............................................. •----•...----------...--•--........ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms----------- -------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers � YP g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------•--------------•-•-----------------•--•------------------------------------------....----------•-........------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/_fi��..gallons Length................ Width................ Diameter................ Depth................ f x Disposal Trench—No..................... Width......:............. Total Length.......... j----- Total leaching area....................sq. ft. Seepage Pit No.f---------------- Diameter...f.L'....... Depth below inlet...... ............ Total leaching area..................sq. ft. 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........................ LT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ..--------•---------------------•-•----------------•------....---------•---•--------•---••-•-•---•--..................................... ------------- 0 Description of Soil---------------------•-----------------------•--...................----------••------------------------------------•-----------------------------.....- ............. x w VNature 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 iITL% 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. l - Signed...................................................................................... ................................ Date ApplicationApproved BY.................................................................................................. ........................................ Date Application Disapproved for the following reasons:............................................................................................................. - ..............•---•-•------------•----...-------------•------...-•-•-------------•--------•--------------•-----------•---------------------------------------•-----------•-----•-•---•------•----------- Date PermitNo.................................. Issued...................................................... t Date LOCATION SEWAGE PERMIT N0. VILLAGE INSTA LLER'S NAIVE i ADDRESS l 0 UILDE R OR OWNER i� DATE PERMIT ISSUED x DAT E COMPLIANCE ISSUED ��,� - �`�� p]'i J / �T. i � �' y�'� � �d� F �� Y ti�� 1 �.�' �� , A ,�/ c �lrk;ge/�L� � � �N�- _, •�; � r Rp��1� ti✓ � � ca,� No.. C/rI�..� •- t ..s '�s....... ............ THE COMMONWEALTH OF MASSACHUSETTS �t• BOARD OF HEALTH ........ ...............................OF........................................------ Appliration for Disposal Works Toes rnrtinn Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - .... -== ��' e ..f ° '. `' /. "% 4 . ............:.................. Location-Add? or Lot No. <_ ��79/2 ......................�.4 •-••-•---••'----• .e!..-...�. ' ` ----•--.............................................. Owner �� Address .�C_/.t-----•------------•---•--••----•............ ........------------.......--------.----------------------------.--------------------- Installer t Address Type of Building . ` Size Lot............................Sq. feet Dwelling—No. of Bedrooms......... ............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria 0.1 Other fixtures -•---------------------------•-- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/11T...gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.. ... Total leaching area....................sq. ft. Seepage Pit No./'_9_'_-l-:_____- Diameter.../1 ....... Depth below inlet..... __.. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---•------------------------------•-•--••.............................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ --.----• - ---------------------------••------........--------•--..........................•-•-'-•......................................................... ODescription of Soil........................................................................................................................................................................ V .....-•--•••-•••---•----•-•--------•--•--•••••-•••--••.-••••-•••--•...........-•••-•------....•----•-----•-••--------•-•----•--------••-••-•••---•--•----•-•--•-•-•----------------•--•••---......_...._. W x .................... ................................................................................................................................................................................... ,V-._ 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 TITIE 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 ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons----------------------------------------------------------....................................................... --------------------------•------...-----....---•----•-•-------..............------...----•----------•------------------------------------------•---................................................... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... fiff Tntifiratr of TompliFanre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.. = ......45r-:.......!.�--'-•-----•-•--••••-•-••--•--••-••••••. •.............................................••• -•--••••••--......-•-••-......--•-••--••-- .... Installer at........................ ......................... i --- T--•---------------------- i---IL=-----------------------------------------------•-.--------------- has been installed in accordance with the provisions of TITTE5 of A Th State Sanitary Code as described in the application for Disposal Works Construction Permit No... _l __� ...... dated....:........................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................. .. O. .:h.......•--...-----•-•--• Inspector....................00(`�� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �!'i.•1 r, ...........O F................................. .0................................ Cam_ No......................... FEE.. .................... Disposal Works Tons n Opumit Permission is hereby granted.......................................e.,4 ' f to Construct ( ) orRepair ( ) an Individual Sewage Disposal System at No. " �d Street as shown on the application for Disposal Works Construction Permit No..................... Dated ---------------------- -.............. ... ......-="`== ' -------------------------------------- B of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON Ad'r' �'; D (=�?O -- - •- _ u L 44 3 - - -- --- . y 41 40.7� 4 • -30 a { G _ E,<TEti.'D 43L [_ F� PPL/�- fy BL_E � T � IJ ------ — V F_ �2T- Sc:: ,9LE- / " _ / O' /`�o43AJ<--r'OLE. GOVE,QS 7-0 —o — o—o—o -- Proposed c�rovnd Prof'; le s c HE 40 P v c o,e ------- -----/c L o w ---- T EG',-.'fjL 7ZD SEPT;c X4" P&r W'a5 eC:7/ rne� 7ANK-,- _- —1AJ _ 0 < . M tl o o jj; �79 / D/ST BOX a dra ° i j J �' T,� '` ..,_ /.., DO GAS- .SE PTi._ Tfjti K t /4 � • 0 I o E- T,q / S [g �D,ecC, M !�G�'SE DAT-e y I c-S l - j f 60V / THE i 4 2 42 .= z 7 p �C t Lo4J C J � _E .• LOL\/ �c f� .`E �C7 e• ` 1'T- ! , � -�cJrJP. J. jF+ c�t�; - GHLs,JFIY Lfj 7"(JM - � c T�n./Ac'- � �:d � / _ �� TE s 7' # T E S T H'o L E- #Z HOLE / USE : � �u� GAL. TF?A J.� - -� F � ` -- jc�. ,., s14:. r � c � � �✓B�'`- � 3,. 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