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Home My WebLink About0131 CAP'N LIJAH'S ROAD - Health (2) l3 l c61PT L l j n4 lqz - l6 � /// a M EA® No.2-153LY UPC 12934 smead.com • Made in USA a0CYC(� 2 SUSTAINABLE FORESTRY INITIATIVE Certified Fiber Sourcing wwwAi;rogramorg LOCATION /ram/ (/.SEWAGE PERMIT NO. s VI IjAGE INSTA LLER'S NAME & ADDRESS po`so-Z 7, o u z CD tlU c, B U I L D E R OR OWNER DATE PERMIT. ISSUED _ � 74 0ATE COMPLIANCE ISSUED �.- 16 � 76 E� !DO TUT c f 43 � bb�o� a r E _ p No. ............... .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --- ---------OF.........Z9��v... � .6- ................... Apphratinn -for 43i,ipuiitt1 Workii Tomitrurtion 13rrniit Application is hereby made for a Permit to Construct ( )) or Repair ( `) an Individual Sewage Disposal System at, ` `� --( �'w xrt'2 �`� / Location-Addr G > or Lot No. Ow r Address .W1 ............••/C- ...-�727`...---.....D ------••--•-----•--•----------•-•--------•-- ( .................................. __....__.....------------------............ i Installer Address UType of Building Size Lot----------------------------Sq. feet a Dwelling—No. of Bedrooms--------- ---------Expansion Attic (,cr& Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons......(--_________--__-.__ Showers ( ) — Cafeteria ( ) Other fixtures .. -------------------------------------------------------- W Design Flow------------17753......................gallons per person per day. Total daily flow..... .......................gallons. WSeptic Tank—Liquid capacity Q9tP_.gallons Len . _- ----------- Width................ Diameter................ Depth------------_-- Disposal Trench—No- ------I------------- Width Length-------------------- Total leaching area....................sq. ft. Seepage Pit No--------_----------- Diameter.....--------------- Depth below inlet____...._....._..__. Total area..----._.---------sq. ft. Z Other Distribution box ( �' Dosing tank ( ) D /�� `�- t' 7;- aPercolation Test Results Performed by-----------------------------------------------------------••-•-••...... Date---------------------------------------- Test Pit No. 11----------------minutes per inch Depth of Test Pit.................... Depth to ground water----.__.--.-_---.-.---- f4 Test Pit No. 2...............minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.------_-_-_---_-_-_- W ......----. --- - - -------------•-- ---- � p J O �f Description pf Soil-.-Lv � . -P..�'`:---•--•---•• ----- � � �"` \L.K� Q ---------------- Ud�` t'z ....._S'......•....---••--•--•------•---•---------•--- W U Nature of Repairs q Alterations—Answer when applicable------------------------------------------------------------------------------------------------ -----------------------------------[. --------------- ---------------------------------•-----------------------------------...--••-•---------------------•----------------------------- .-.----------- Agreement: j The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The under ig d furt er agrees not to place the system in operation until a Certificate of Compliance has been u b t e b r o he h. } ned-.. . ,.� df Date ApplicationApproved By--------------- -- ----------•-•-•-•••-- --•-•••--• •-•-•- -:................ Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------- ----------------••••------•-•••-•••-•-•••-•-••-•---•----•----------•-•-•--•---------------•-•---------- ----------------------------------- Date PermitNo.......................................................... Issued------. -------............. Date 7G No......................... Fus... ..rr .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF............... 7 .............. / l............................ Appliratiun -fur Diipngttl Works Cnunitrurtiun Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ---------•-•-- - Location- ror Lot No. --- "�^--- ..................... - .`.......... -•------------------------•---•---.........----- �i � Owner /-/'1,7 f !` Address W /............ . •-•- ---------------------------------- -----------------•----------• Address � Instakler d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............. .............................Expansion Attic Garbage Grinder Other—Type of Building :.............-) -------- No. of persons....... �?cShowers ( ) — Cafeteria ( ) Otherfixtures -----------------------------------------------------------*-------.----------------...........---------..-.-...._....------------------------------- Design Flow............... ..... .. gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.__......_.gallons Length---------------- Width................ DizunQH 5-�........ Depth......_........ x Disposal Trench—No. ...................f(Wi4th------.---------_.�tal Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- diameter--------------------- `IIepth�below inlet-------------------- Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) d j - -7 - �-- 7z . aPercolation Test Results performed by.......................................................................... Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.........._-.-._-.-.___. t� ------------------------ --------- A -------- ..............................................--.- O Descri tion of Soil f0 "� ` �... . --------------- �`t......--- :1�_•-C=G.u`-�`-� --`-`-""=-4f -------- ------------------------------------------------ ......... 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 Article NI 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. gned- '/------------- /I ------------ -- .............Date A lication A roved B —�'r - X......:�:.. �-- - :--- PP PP Y---------------- - -----•f'- yy',/ /q!%----•-•---.... --------••--•- Date yr Application Disapproved for the following rg sons:..............................................................................i _-- ----------------------------------------------------------------------------------................................................... ------------------...............�.......------------------------. Jaate Permit No.--••••---------------•-••. 2`'- CL/c9 -------------•-------••-•---- Issued.'::--q------------------------------------•------ _ - - Date �`` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .....................OF................-"�-57.............................................................. "Vi _r 'law rtifi u ratr fdAsmpe THIWS -S TO CERTIFY, That the Individual Sewage Disposal System constructed 4r-or�Repaired by ---------------- ✓---------------- ---- —-------------------------------- ...................................................... - --- -- ---------:.............................................. --------- le---- --- Ce has been installed in accoremee with e provisions of *6cle XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.---.-.-.--_�Aj ............... dated----------------------I ------------------------- THE ISSUANCE OF THIS CERTIFICATE SHAI BE CONSTRUED AS A R N EOHAT THE SYSTEM WILL FUNCTION SATISFACTORY. ;-------------------------------------------- /01-------------------- 2 DATE-----q. ........ .. Inspector----------- ........................................ THE COMMONWEALTH OF MASSACHUSETTS 1-70 BOARD....0.F HEALTH ....................................0 F ......... ...................*........—------------........ ---------- Z . ................ Di-tipatialMorkii Tomitrirtion Vamit Permission is hereby granted --------------------------------------------------------------------------- or Systems; to Constru f Re � �an�, -Li J6 Sewa�! i oal 'r—u", atNo.... r......OILZ:7c......zW...4/X::7.....Vk -- ---- ---------------------------------------------------------------- as shown on the application for Disposal Xks Construction Pjerit No .......-------- Dated---.----....----.-- .............. 0 ......... DATE....................... ..................................................... FORM 1255 HOBBS & WARREN. INC.. 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