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Home My WebLink About0123 ANSEL HOWLAND ROAD - Health l nSo/ fqawl o%aj C��fi�e Cvt r w 171 — 232 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLEFORWRY MIN.RECYCLEDm INITIATIVE CONTENT10% CerdBed Fiber Sourcing POST-CONSUMER www.sfiipmgram.org S"12W MADE IN USA GET ORGANIZED AT SMEAD.COM t r LOCATION SIWAGE PERMIT NO- _ 0 VILLAGE f 7-7 INSTALLER'S NAME ADDRESSnoe UIL0ER OR OWNER f-r GuYl ✓vim Ci DA T E PERMIT ISSUED DATE COMII'LIANCE ISSUED 21_9 ✓:� a4 d �.q 30 J a Nof.�..':.l- Fizz.... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OJ5 HEAr�� Aptiration for Uhipoii aiWorks Toustrurtion ramit Application is hereby made for a Permit to Con truct ( ) or Repair ( } an Individual Sewage Disposal system 1 - - f r---------- Lo ion-Address/ -- -j,'Lpf No. Owne Address --. .. n.� -------------------------- = Installer Address ��-''"' Type of Building p Size Lot.Z��l �..Sq. feet Dwelling—No. of Bedrooms..........`� ...........................Expansion Attic ( ) Garbage Grinder (l�J '4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures ................ ....... . W Design Flow_...__� .?..�______________ gllons per person per day. Total daily flow................... _................gallons. W Septic Tank—Liquid capacity ......gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. ............... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../.N'V Diameter.._..may. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1_____________•__minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' ----•--••-••----•---------•----------•----_..•-•••-'---•--------------•-----•---'----••...........--......................................................... 0 Description of Soil------•----.....--••--•'•------------•--....:•..-•.....................•---••------------------------------------------.......----------------'•......-••............_.. x V ...•------••-•-------•------••-------•--•------•------------••-•.....-'-•---'--•---.......--••-•----•---------•••--•-•-••----•---------•----•••-.....-• ................................................. 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 T IT..-:. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianc as been issged by the board %health. ��6� �'�� l ..3 tgne •--..---- '--.... .. ...................................... .----- . Application Approved B - --------------------- PP PP y-------. . _....----•-•-------------------•---.._..-•-•-----------•--------- -- -----j Date Application Disapprove or a following reasons-------------------------------------•----••------•---------------•------------•---------------•----------'----- .....................................................-.................................................................................................................................................. Date PermitNo......................................................... Issued-.................................................... Date r� No.I:%°. %_.... '..... FEs.... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....---.._........ .. ................OF.......................................--•-............................................. Appliration for Kiap.aaal Workii Tnnitrnrtiun 11trutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .............................................................................••-•--.......--...... .........................................................-........................................ Location-Address or Lot No. ---••--•------•..................................•-•--•-------------•--•.......................... .............................................•---••...........•-••-•.................._........... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria p' Other fixtures .................................. ...... 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. I................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---___--_-_._-__-_-_--_- •--•----•-----------------------------------------------------------••------------------•---•------------------ ------.-------------------- -....... .---------- ODescription of Soil------•------------------------------------------------••----------------•-----------..••••••••----•••••------•-•-••-•-••--•-••-••--•---•-•••......--•-••-••••-••----... x 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:T'IE 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. e .. F/ Date Application Approved By....... 'r`= `'-- --- �:_f' :.c%F' ........... v Ar /f„, / Date Application Disapprove.f or the following reasons-----------------------------------------------------------------•-------....................................... ......-----•----------------------------•.......•..---...-------------.............-------------------•--------------------------------- Date PermitNo.......................................................- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................I.....OF.................................................................................... ,rTrrfifartttr of TompliFanr.� THIS, 0 CER*TIF'Y, That the InRividual'�Sewage,'Disposal System constructed ( ) or Repaired ( ) . �, by.. =_%:.✓' lf' f� L..:f ._Ir Xt ..E cry c Installer at.................................................................................................................................................................... +'' _,.., has been installed in accordance with the provisions of T i Ty; 5 of,The State Sanitary Cod as ascribed in the ' t.<� dated.. . application for Disposal Works Construction Permit N o. �,.__. /.;_�'?,�Az",._' .................... THE ISS A E OF THIS CERTIFICATE SHALL NOT BE CONSY AS A GUARANTEE THAT THE SYSTEM L /UNCTION SATISFACTORY. DATE._...7�1v d�-------------•-•---------------------------------------- Inspector..... If------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ,,BOARD OF HEALTH ' 7 ...........................................OF..........-----...................................................................... No....::::................. t�c ` FEE.. �ia�aaatl nrka �.an��riir�i.an r�ani� Permission is,krereby granted. r'" r' ---to Construct o for Repair ( )-an�,/Indivtdi,41 Sewag Disp sal System " at Now ... , /` <_ �'4 ... %'"'�'" ,* -- -------------------- ----- �` -.........._ r" ..._.. r.. Street �,.� ry �r as shown on the application for Disposal Works Construction Permit No--- Dated,:.';-...E'�';;; ............. ...................•- -------=---..... ............. J'DATE.............................. Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS s1►Js�E FAMILY - '� B.F-CORQpM II �IC�G,A�t8A6E GWtJDE2 �� DA1l.�( F1.oW : Ito x 3 •_ ?,3o G.P.R SEPTIC, TAwK =. a3ox15a% ---4956.P. Q. I y5E logo GAL. D14P05AL PIT V4E IV00 GAL. ` Is c � � S 1 pSWALL AR.FA• 1560 5.� ao 50TTOM AQEAz .. 1 S�F• ` v cj o $.F x 1• o A .p G.P o,_ zcl.6.r-. 0. cr ®k i 'TOTAL- DESIGN * -+Z 5 G.P a• 1 T pouHDAn oN. "TOTAL. pA I► '`( FLOW = 33o G•PO, � PE2GOLAT1oN RATE��`1� a�'1=E�5��- � I R1CHAD r AL.AN R �'- a�S BAXI ER -: 11 J0 Es Na 21,048 No. `'/STf��{d5� 40 SUit , HSV� �G.S To P FWD=54, O SI S� 8hz181C 11.Iv. So,7 -+' 7 t . loco 1NV. Su(3SOIL DIST INS. C"L. O.S ScvTlc. Z lOvo INV. BaX to'Z' TANK 49.S LP IT INV.. INY. toQ4 VetL M/ITu 41.8 wAsuco 6ToN6 .. Ca ZTIFIGD 'PLo•T PLAN PR.0F1Lr= Lo�4'r1oN CL�(—rL=2V► Lt_L -2- 31,5 No 5CA-LL- SCALE VATS ! 0 11Ja- (Z. REF EIZEN GE ! 1 cERT1FY -THAT TN� FvuNDAT1.url 5>{ovYN ►I.E•i2E�o1J GOMPU?!S WITN'THE SIDELINE L 07 11 ' Aug S1ATL�AGK R.6Qu1R.EMEN'f� oF'CNE 'TOWN OF•BARI4STA%LCAN'D IS 90T CEr>,TETLv11,- IGI-I LAMDS ! LOCATED •WITr,j,r N E6, F OOD PLAIN SECTIUiV DATE ..�L".g3 Q I� gAxTEcze LIVE INC. a.E�1 s��-��.v'►�.0 o 5 u ev EYoe�s 'Tull NorT 5t%$Wn, oa AN os-rEczvlLLJr • MASS• IN5T'R.UMEN'I' SV12VG-Y -rNE oF�-'SE'TS 6uou�.D _ � APPLIe-" � Ll�� ! NOT DC- V�C'.C)TO �GT(":.t'1�I►�C l.�"�� .1NG�� P, �. -