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Home My WebLink About0128 ANSEL HOWLAND ROAD - Health 128 Ansel Howland Road Centerville A= 171-261 i 5 M E A D No.2-153LOR UPC 12534 amead.com • Made In USA y rmumN1iMSiAODIaum SFI OFn*sFi " wwwSFPWGPAKOW r . u_ FEs..... . THE COMMONWEALTH OF MASSACHUSETTS BOARD HE I............OF.................. ... .................. la Appliration for Disp.aiittl Works Tomitrnrtiun 11amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at . .. . . ........................... ...... ----•-••--- tion-Address ..................... or Lot No. O tu e/� Address W -?, _*-------------------*-•-------.... v ........................................... rtr�rirJ... Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons.........................'.. Showers — Cafeteria a O her fixtu es -----•----------------------------- .44 W Design Flow.._... .. .....................gallons per person per day. Total daily flow............ .. ...:a___._---gallons. 9 Septic Tank—Liquid ca.pacityl. allons Length................ Width................ Diameter---------------- Depth................ 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 tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---_.................... L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------•---------•----•--------------------------------------••------------•-------...--................................................................ ODescription of Soil........................................................................................................................................................................ x U ---------------------•------------------------------------•-•----•-•---------•---••------•----------....----------------------------------------------------------..................................... 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'TTL: 5 of the State Sanitary Code— The undersignedrtl:er agrees not to place the system in operation until a Certificate of Compliance has been i s d the bywd opfiealth. Signed ---- ....... ,cam ate Application Approved By..... --------------- Date Application Disapproved for the following reasons:....................................................................... ........................................ ----•--•---------------------------•---•----•-----.._..-----------•-----------•--.....-------••------•--.---------------------------------------------------------------•------.....---•---------------- Date lPermit No...............................................•••....... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................I...............-OF..........................---..........----............................................... Appliration for Dhipaii al Workii Towi rnrtinn Vernfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ................_........-...................................................................... ....................................................----.......................................... Location-Address or Lot No. r' ......................».........................'--...------------.........................._.... .---....----•------•.............................................. ............................ Owner Address.w,. , a -•......................•--.....----••-----------------.....••--•------•........._................ ..........................----•----••-•---.....---•........................••--•--•--------------- Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.....................--..... Showers ( ) —.,;Cafeteria ( ) Q' Other fixtures -------------------------------- d - .......... .......... 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. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................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..--.--.............---. a -•----•---••-----•----------•--•....•-•••-•----•-----•............•-••--••-----•---•.............•-•......................................................... ODescription of Soil........................................................................................................................................................................ x M W •--•-•----------------------------------•---•----••••--•-•--------•--•-•--------....-•-•----•-•-•------••-------•----------------------•--------•---------••--•---•-------•--•-----•••-•................ UNature 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:TT1,;�. 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...............................................................................•... ----------------•-------•------- ,��-•�-- / ate Application Approved BY----- a .'. 1._ ' ............... ....6/ y'q Date Application Disapproved for the following reasons--------------------------------------------------------------------------•-------------••--•-••-•------------- ..............••-•--......------••---........•-•._...•---.......--•-•---...----•-•-----------------•---------•-••------------------••------•---•------•----•--••-•----•------------••----•------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtif iratr of Tnntplianrr THIS IS CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } -- .... <_ ..`-•---------------------------------------------------------------------------------------o--•---•---------------..........._......----...----- Installer has been installed in accordance with the provisions of TITLE; 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.------8. -.Y-d.,..--...... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUq AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------•-----------�fJ__-..-......--� -•-------.. Inspector......f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................O F..................................................................................... �.C✓ No....g.... �d�... FEE........................ Disposal Vorkg Tnniiri ion path Permission is hereby granted..----- ...... ::......................................................................................... to Construct ( L'p", -per ) an I vidual ewag D' osal Syst atNo. ..> . •- ...... -------------------................................................. as shown on the application for Disposal Works Construction Permit No...................... ated.......................................... v Board of Health DATE ................... • -- — .... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1-7 -Z& LO•CAT ION SEWAGE PERMIT NO. -1 at 3li ��s�/ ot.y �NJ 2a1 �07- •yG S VILLAGE c� IKSTA LLER'S NAME & ADDRESS �,UKRT B. OUR CO., IHC. ttORTH HARWICH, MASS. 02845 IBUILDEIt OR OWNER; DA T E PERMIT ISSU E' D DATE COINPLIANCE ISSUED 1 �s� �� z, ��q 1; slvNN LJ N o�.►LY FLow : 1IO x 3 = 33o G.PG, �+.I��EL �WL/�►1�D 6E,PTlG '1•AtJW- = Z30XI5C>% =�49/r" 6-P 0 usc— 100o GAL. Ili -33 �• 015Po5AL PIT u's 1a00 GAL.. � -�� 5%pr-WALL A26A = 1506.F I r71,2�i 50 5.F )c .2.5 0 37`! 6.P q I BOTTOM AREA r .. �. F.- I 1. 0 5 0 6.P.0_ 3, .} TIQ �7 -IOTA 1- 1'ESIGN * 425 CG.PD _ It .I�' � 'ToTA%- DA I LY F%-ov4 - 33o G.Po t/� PE2G0LATIOu RATE= I"IN 2MIN o�►-<=55 I? �' No N I r JP P-rq/ i �°; 132"1g � v RI AARO A N BAXTER a is a No.2 r" 4 NAL T>r'�T To P F►�A;c�Z Y/y' I NoLc- EL s-II-�I F6= Sa ��9 Inly.4$v I .� . 1000 INS. SUT3soIL� DIST. INS. G°►.. $ i r6PTIG 2• I o0o INY, 0uX L TANK �iJpl Ga1.. 41 I v LElaG11 INV. INV. E AVISL.. P IT WITIu , WASKGD 6TaNG T3o,IJ f 4= CEZTIFIG0 PLoT Pi-A-W PR.oFILG Lo�L1,•TION C�JT w/IL�� gL I"Z NO• SLALE _ . SGALE I1= `7 VATS Bf 11IB�L.'' 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