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No.2453LY
UPC 12934
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LO,C AT INN S A E PERMIT NO.
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VILLAGLh,
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INST LLAR;o NAME & ADDRES
B U1'LDE OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED J, 23'2-
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... Town...............OF.......B..arn.s.table...................................................
App iratiun -for Dispniiat Narks Tatuilrnrtinn Prruid
Application is hereby'made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at:
1'j-•Crocker Road `" - O °• t -..- G
Location-Address or Lot No.
William Baldwin Centerville
........................ .•--•......-------••------•--•----••-•--•..___...................------ ..........................................-------------------•----------•-----............_..•---
Owner Address
------•----Joseph--p.---Macomber---&--ion' ? ........0ente-r 7l--e••-••-•-••--••--------------------•-......---••••---....
Installer Address
Q Type 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 ---------------------------------
W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons.
;4 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter.....--......... Depth................
Disposal Trench—No..................... Width..................--_- Total Eength.................... Total leaching area......--------------sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet-------------------- Total leaching area----..-.--..--__--sq. tt.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test.Results Performed by-•------------------------`"-•----...._......I......--•----------_..... Date----•-•-----•----------•---------------
,� Test Pit No.° 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water.-----.-----.--.-------
r3� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.- _--.-----------
a, '
O Description of Soil___.._....Sa6nd.._$�___caravel-----------------------
x C- -XV-
U
W
V Nature of Repairs or Alterations—Answer when applicable...-1-1U4.Q---gallon.-overf low...(pit.).-.-------..
-------------- ---------------------- ----------------------------------------------------------------------------------------------------------------------------------- -----•-----.--. ----------...
Agreement:
The undersigned agrees to install the aforedescribed I.xtdividual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b ed b the board f ealth.
igned /�-- 5/z3/??-
Date
Application Approved By............ �---- .....
Application Disapproved for the following reasons:...........................
•--•-•...........................•------......------...........Date ...•--_.....
-----•---•-----------------------•--•---------•------------------....••-----•----•-•----•--------------•-----------•-. ---------------------------------------------------------------------------------
Date
Permit No.........................................................
._..... Issued---------------------------------.......-"7-•-------
Date
No......A.ya .._.:.. � ................
Imo• THE COMMONWEALTH OF MAS,SACHUSETTS
BOARD 'OF HEALTH
...... _ .Town................OF......B,arnsta�};�t?....................................................
Apph.ra#ion -fur ]!ipwia1 Worko,.0 0Yt rr�ti#
Application is hereby'made'or a Permit to-Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
17 Croc ......................................61
-- ----- :...
Location-Address ___________...................
William Baldwin - Centervil,le°r Lot N
----------------------------------•-•----- ----••----------------------------------•--,--- ----------------•----------------r-----------------•--------------------------------------------
Owner Address
w J:-_senh P.___Macomber & Scan 7 rr zQ�nter�ry.71P
----•- •--•------------- ------. - ---- -f ---- ---- ----------------------------------------
Installer + Ad-Tess
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-_-_ -1________________ _______-__-Expansion`Attic ( ) F"
��+ Garbage Grinder ( )
`-4 Other—Type of Building ` No. of persons----------_________________ Showers Cafeteria
04
Other tfixtures ----------------------) °> --------------- ----- ------------- sY -•-----------
W Design f7r_________________________gallons per person per day. Total daily flow._.__: ....................................gallons.
WSeptic 1 ank=Liquid capacity. -_____ -gallons LeLngth ___. ___ Width . Dri4�ter_-__: ___ Depth-_ -.
x Disposal Trench No Width__ __..___ _:Total Length Total�J�aching trca_-__-__:____- _. sq. ft
Seepage Pit'No ___. _`"Diameter------------------!--Depth below inlet.................... Total leaching area-___--___-:_____sq. 1t.
°pis=, a-
Z Other Distributio'.ti box ( ):' i Dosing tank ( )
`-' Percolation Test Results VeI rformed by------ --- ---------- '-_____.:__---__------------_------____------ Date-------------- -------------------------
Test Pit'N16. 1................minutes per,inch Depth of Test Pit____________________ Depth to ground water--------------.
r.
f=, Test Pit No. 'I.................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_-_-________-____-:-:
9 Description tion of Sdt__._....5911 -----------------------t f
U •-•------------------------•-----------------------•-•--------•---------•------------------------------------------------------------------------------------------------------------------------------
W
------------------------------------------
----------------------------
V Nature of Repairs or Alterations—Answer when applicable_J—.19 Q-9 n_._ol,,-.rf 9w- (Ra -)
--------------------------------------------------------------------------
----;--.:6uer�kr�i''p6ktl,ram'-:Z,ttrlii:.fY�b,-•t
Agreement
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 undersigned furtl er`agrees not to place the system in
operation until a'Certificate of Compliance has been,issued by the board of health.r'
•�Xn y"r
'
5/23/77• Date
Application Approved Bf4�� .
_ .
t3� Date
Application Disapproved for the following reasons:----------•----•--••-•-=`---------•-----------= •-------------------•------- •-------------------
E -
l r ,Permit No._-•- ----- .............................. Issued- -----------•--- -•----__-._-•-- -•---..._...-- -
Date
` THE COMMONWEALTH OF.MASSACHUSETTS r
y
i 18,0ARD OF HEALTH
Tc..rr� urns table
OF:::...........................
,ppr#ifira#le of 101rrntlifiatta
THIS IS TO, CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X)
:a
bY------dosex- P°---a a;�c..mbfix--�--�:•::_- nee.. -----------------------.........
Crocker R ad Cen Installer
at --I ................ .. ' --to vz lle --- Ba --win
-- ------ ------- •- --------------------------
has been installed in accordance with the provisions of ! r•' tXI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No^--- - YA'_/,tw ----- dated-__�---� ---7.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST� E® A GU ANTEE THAT THE
SYSTEM WILL
DATL- r jt"'tj!K ,K
z. ,. , :w Inspectoz x e
k+, f . l,y;�.. v s•z rr... ♦.i ...a w .r: Jk�*M,1. Ts'+.rJpj a't"3t'3^`�4y.'�' >Y
_ ., t:..L.•s r�ro^^wy.'K•Y'w'W'Y'+i'§}°!'8'^YY9 "grua�.Tr1k..t.a�'.:':'. ...- -:�"-';:1C a.s�»..r+�+�+ 3 ..� .. • - �!_ai i s�k�'.`�^� tiY 6f#`�d
THE CO WEALTH OF $ AC"SETTS
` BOARD LTH,
.. S'J � ..... . oF...- � rnstfi's P
a, ...--- --.-. ....... .........................
FEE ' -'
r -
K. a� . Joseph P. I,laoonber z Sor, lnc , t
Permission is hereby granted
-- -•---••------------- ----------------------------- - --------•- ---•-- --•-•-•--
to Construct°( ) or Repair ( ) an Individual Sewage Disposal System a
r � t a - _.
at No ( rocker Road � xterville...- .._..-- : Ba,Idvin
Street77-
r
as shown on the application for Disposal Works ConstructiVnPe,,, No �tDated.....r _V;
a `m r �� -------------------
w` �t� • 4 Board mE Health r t'
DATE ..............................................................'s ._.___ . -
x Y
FORM 1255 HOBBS &;WARREN. INC.. PUBLISHERS �-