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Home My WebLink About0000 EBEN SMITH ROAD - Health C e IN I� ► - ( 5� i LlC AST 10 ;_/jklt, AGE PERMIT NO. 'VILLAGE INSTArtjL 'S NAME i ADDRESS t U I L D E R OR OWNER .DATE PERMIT ISSUED i DATE COMPLIANCE ISSUED it �� . Z, �, �.� �- �-- �� .w -_� . - �., 3 � �d No................ .. Fps............._.. ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH ._./ ..._.......OF.... .. ............................................. 01#*App iration for Disposal Works Tonstrnrtiun runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal systt. ..... - .............................. --_-_ •__7._0 ...... .... -• - _ - Lo tion-Address t No. .... - .._...._-•--•-------•----•--............ Owner Address Installer AddressPq Type of Bui ing Size Lot.../,7��''''��''.4A•/t ,_G_! Sq. feet �., Dwelling—No. of Bedrooms...... ..................................Expansion Attic ( ) Garbage Grinder VL�Ld aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Ot e W Design Flow______ ________ _gallons per person per day. Total daily flow............................................gallons. WSeptic Tank/—Liquid ca.p/acity.l . _ allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.,/ .... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..... ------------ Diameter......... ...... Depth below inlet./....6_. Total leaching area..2 -l.1...sq. ft. Z Other Distribution box (� Dosing ink �C Percolation Test Result Performed by_._-' � � % _.__-.__ .. _____..._... Date...7:4....r.4.__......... a Test Pit No. I..... _..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........................ O Description of Soil----- '...dC�F�S..... G0 V -------------- ------- •------- -------- •------ -------- __----------------------- ___---------------- ._..... ------------------------------ _-------- •----------- _------- --------------- ----------------- W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------•---------------------------•----------------------------------------•--------•---•-----------------•--------------------------•---------------•------------•-------------------••••••-....•.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage isposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned fu ler agrees not to place the system in operation until a Certificate of Compliance has bee u by the b of li lth. Signe .......................r..... ..................... DapApplication Approved By........ f- ..... :.... . . . 41--------•-•-•--------- --- /.A...._....Da-te.............. Application Disapproved for the following reasons__________________________________________________ ........................................ Da..............-- ..------•------------------------------------------------•--..------------------_._.....•--•--------...•-------------------------------------------•--------------------•--------•-----................ Date Permit No......................................................... Issued_.�i.._°2_ � . Date No......................... Fes$.. ............... THE COMMONWEALTH OF MASSACHUSETTS { - BOARD OF HEALTH r.•. ..............OF....,R'` a �. ^ .r, , GyE` Apliration for %Vaa al Works Tonstru rtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systeni'at: .....:...: l i f tt• ! .............................. ..................� .....-•----... -......................._..... " T - Location-Address / '_ or Lot No. Owner Address W ° '"e�""- r e a ......................................................r e "t .. — -�;:--- Installer Address d 0• Type of Bu Ilding Size Lot...'`_J A---------------Sq. feet Dwelling—No. of Bedrooms...... '_^_...............................Expansion Attic ( ) Garbage Grinder (k-5-0 P4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other,fixtures ,.,,,,.,,.,,.,� e WDesign- Flows. """`____2i gallons per person per day. Total daily flow.............................................____.__.__-_gallons. G4 Septic Tanq—Liquid capacity gallons Length................ Width................ Diameter................ Depth.. Disposal Trench—No. ``:-# ___. Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No._,!t_ _____________ Diameter.__..__......... Depth below inl t___. ......_.._. Total leaching area.!_�.f_....sq. ft. Z Other Distribution box (r') Dosing tank ( ) Q/ aPercolation Test Res It Performed b;;, � k;� �__ ..._ Date7`_+'__`:�:�.'_..._..__-. -•-Test Pit No. 1___ _�-__..minutes per inch eptTest Pit____________________ Depth to ground water........................ ft, Test Pit No. 2________________minutes per inch .Depth of Test Pit.............. ...... Depth to ground water:='..................... t --- Description of Soil --7_::`�---4 •• ....................... �/ j U W 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 TITLE 5 of the State.,Sanitary Code— The undersigned fur tl:er agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed••• • ` ``........... r'3 ..... ._. Application Approved By. 0 ---------•-------------- �-�:............... ............... -- Date Application Disapproved for e f ollowing reasons:.................... ---•---•----•------•-------•-----•--•-----•--•--------•--------•-•---•••••--•............. .....-•-•-•-•-•----------•-------------------•--------•----•---------•----•---------•-•----•--•-•-...--- Date PermitNo......................................................... Issued............................ ............ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Pf HEALTH ":• ,;.: CIrrtifiratr of f amplianrr THIS 1 TO C TI Y,-That thevi a Sewage Disposal S stem'conatructed ( or Repaired ( ) by........ q_ T._. c�-'3-•----- .... Install at..__------•-• -•-�•�---•-•. --- »;.-•----•.2_:7D------ .. ... .......... ......... ------ •-•••-•- has�ee n'st{.11Te i accordance with the provisions of T 5- Tt�e�State Sanitary pdee;�iele i�atl in the application for Disposal Works Construction Permit No... ......_......_..................... dated_................................_............ THE ISSUANCE. OF THIS CERTIFICATE SHALL NOT,BE CONSTRtD AS A GUARANTEE THAT THE s SYSTEM WILL FUNCTIO SATISFACTORY. : DATE._....:�.^----f�--•--•-•-•--...�.................................... In;Pec tor:...--- - -•--- - ----- ---=----.._.. --G......... '------- - c�� s THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH N � '/• ..................OF. . .....'----.._._.-...-----•------------•----... FEE........................ ioroottl on utit Permission ijs�.5eeyeby granted.._ ________ __ ___ +__ i [�"'to Construct (- r Repai , ) Individual e gage Driposal st /� at No.. :.. - oZ..?�_ f ---.-/--'----•-•------._ ..-•-------- -----I+� y •;4 Street l .� as shown on the application for Disposal Works Construction' Perm o =C..' ted_____r __._.__ - - ... DATE Board of Health _-.._:_. let. -"'t-�3•' r;:k^�. + -. FORM 1255 HOBBS & WARREN, INC P,U.B,LISHERS , ��t�tr�t_r: c=cinn►l_:�! - 3 �tw-�evo M -- ---...... r��1�� F Lv�ci t IO •c 1 = 330 G.p•D. lD 5 D -Se�v—t-Ic_ 330.. ISO % - 4-9S u Sc.- t ooC3 6AL. UIT - vsL l oCOo Go•L.- rlu:u/ALL- AV:-EA - l �,o ,YrN 9&' iC� SF 2.S = 3'7S G-P.D. 9P.a EXP U os . ,� t .o So S-Pv. F''' I - e44164 t=. TOTAL -r_>ESl6,Q = d25 �- A TOTA L l:;>,&t L'-( i=LDW PV-rfc_oLeT100 GATE : „�0 sMI1J,orz LF-SS. 9 9q,, ' ... -- - ° 21 �rjlY �+/ p,lr~ y`° •.TT��``''--1'"'�-Ya ,��' N «� ``D iV�a. ?;!;�� n � � �� Y r�' /oo•O �CJ7j•OU � JaD. • •`?y'� n, ��b"i fit' � F6't 99 To 1''«ID t 100.0 lild Goar�'I PPS IQV• 97 s�B�eL 4T -f- peps vlsr I►JJ. G,� ��,g Z 'sox *,4 sepnc Io • T47 T'AWVC 54i10y loOoGAL l` un, INV 9d4 LeAc N 'A PIT ' '7 W 1 Tt•3 i' � �'�D _ sroNF 9a a A Le Cr 0-TIPiED pLo'1- Prz� -t t_ 46 1 C_UIZT1l=-r T$4AT- T14c-. T--OUQ-t ArofJ 5&A0%u .J PtA Rr--Pm _a►,Ic a WIr'.t,i=61,1 A►.l b `;�:T L'yA C lC �'r C�1 cJ 10 E AA c 1-1'T y U F -t'H C-- OT �-�0 -To w►iiTAPAX �- 14_ t4L.,� �!Ds 1, t j �CGIS iZ;�i�D 1.Jt.l•.1C'j St:r`�:GYctr�S Tla lS h LA.1�! (!, 1-�O'r GT-D (?L•,► �1 r,.! U:?E Q,�/1l_t.G o �,(A;�i•' ` IW y('L:J:✓t�:l.l i /�IJC•:�lt_ti' ;� -Y1a(:. C1�=�'•�G�'�'�� •� !. �iJLD A.1�lal_t GA.I...CT � �•�- /� a•:r e•,.r ,, ,t<r-tom lyr La*C l 11•IW,'s