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Home My WebLink About1758 FALMOUTH ROAD/RTE 28 - Health (3) Pro iu*�� S M EAD C KEEPING YOU ORGANIZED d No. 10334 2-153L MADE IN USA '4 GET RRGAMVEQ AT SMEAD;COM �0V No. ... ....... F>t$............ ...... THE COMMONWEALTH OF MASSACHUSETTS `� BOARD F HE T C ....O F... .... ... Apphration -for Uiopoottl Works Tonftrjtrtion Pumit Application is hereb made for a Permit to Construct or Repair a�dual Sewage Disposal PP Y ( ) P ( ) a P System ocarion d ess �� or Lot No �l Q d C3 , -•-- ------ a = .. �-a - -e ---------------- ............................................... wne Address e •. .............. ................•---•---•------- -- Inl Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___________________________________ ________Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers — Cafeteria P4 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........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-..-------.__.._--_.--.- �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.-...-_____-.---.---.- g --•--------•-----------------------------------•-•---•••--------------•---------•-•-------------............................................................ ODescription of Soil..................................................................------------------------------------------------------------..-------------------------------------- x tW ----------••---------------------'-------...--•----•----------- --•-----....--h---••- - •--•-••---- ...... V Na re of P.epairs or Iterations—Answer when ------------------ -- �J4r4....-��^"�di reement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitar Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h b n iss d by the61. a d ealth. Sign r V Date Application Approved B A�� Date Application Disapproved for the following reasons:................................................................................................................ .........................................................................................................I----------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued...................... ................................. Date IJ &X6 .� 0 sy , No............ ............ Fas...M�. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD �)F HE T Apphratiun -fur 4%gpouttl Norks Tunutrurtiun Vrrmit Application is hereby made for`a Permit to Construct ( ) or Repair ( ") a�dividual Sewage Disposal System / �i G f.L_--_------ 22��-................................ ocat,on^Address or Lot No. O aVQZ11n/!A -� � n Address Ins) ler Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building 0.1 YP g ............................ No. of persons.---------------:-------.--- Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------•------••---------------------------------------....-........----------------------------------.-.._.-..------ W Design Flow---------------------------------------------gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity------------gallons Length---------------- Width.---..--_-_--- Diameter_..............- Depth.........-----_ xDisposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below,Linlet.................... 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 "Pest Pit..............--.--- Depth to ground water........................ ( Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water......-..-_-----------.. R; - -------------------- -----------------------------------•-----------........._---------•----•--••......................................................... 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ �4 '" j f U Na re of Repairs r 1 r t .1 I � l �---------------•--- t --- - ---- ----- - - U -._ rep -�--�. to at•o s—Answer when �p�li ble.-� -->------------------•-----�--�-------- --f'^ ,----`-+--------------- - A reement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitar Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h be n issued by the oard of ;ealth. . ';-- 7-4... Stgn �,�1�,� Date Application Approved B .---- =:Z_4- ..; �/f-f 1 �.t-!1-/f_/.u�d f �. ` .. � /� F Date Application Disapproved for the following reasons----------------•--------- -------•-----------------------.--------------------------- ----------•--- ..............•----------------------------------------------.....--------•-------------------------------------------------------•-------------------------------------------•---•-------------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT , ...... 1�-1.��Y............OF.....IX ...rsr >r ......, ............: ......�............. Trrtifirutr of 01.untpliatta THIS IS TO CE 1IF hat the I dividuad'`Sewage Disposal System constructed ( ) or Repaired / Lb hat bY..... .` ------------------ r---- �J` Installer /I at..-.. r ! - n � ..-..:/ •�'' C - --= - �'`c.I_ Z� a�/// 1 r. 4- = , �- has been installed in accordance with the provisions of 'Art ��X� of The State Sanitary Cfide as described in ie application for Disposal Works Construction Permit No( . ._... ..�. ........ dated..- ZS".-- .- ........ THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_.../j�------------- � Inspector.....� - -- ---------- .tom.� ................ THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALTH 1-19 5 1.:L...........OF. .......,. ................... " No......................... FEE... ----------........ Bi-putittl uri �u trnrtiunYr utit �� z Permissl n is hereby granted v 'ff - ------------•-----------------------........................ -� to Constr ( ) or pair a IndiviLI�Se,age Disposa System r �- Street / as shown on the application for Disposal Works Construction Per _ ''- ed....�. ------------- - ----- •�;---.. :-- - -- --mac -------------------- Board _ ----------------------- of ealth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �.