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Home My WebLink About0217 FULLER ROAD - Health (2) Ql-q T-uVLZ-ed SMEAD vcco�Nr ynii npAani�-�., No_ 1033A MAnE IN USA 4 nRGANV,PAT SMI�AD_(�. 1 7 L0°CATION �7 SEWAGE PERMIT NO. 4-14 VILLAGE , IN TA LLER'S NAME & ADDRESS I UILDER OR OWNER DATE PERMIT. ISSUED �� 77 DATE COMPLIANCE ISSUED '7 -77 r ,, `� ,, t;, ., ' �� .� � s 7L _ F No.--- = 7X .. . THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA TH d' .!�..._ --- OF........ , ppliration -fix �i-4pasal parks Tonstrurtio'n rani$ VZ Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... ....... -------------- ---•---- _ � '� 1�-�-•�' ................................................. Location•tldd/yess_ or Lot No. W Owner A ress Installer Address UType o Build it}g� Size Lot............................Sq. feet Dwelling��No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ----------------_-_:---____ No. of persons_.._..)............... Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------•------•----------•-------•--------•--•----•- ------------------------------------- W Design Flow__________________________•-_-___________--gallons per person per day. Total daily flow_----_-------.____-_.----__-_-----.----_.---gallons. 04 Septic Tank Liquid capacity J)'W-gallons Length................ Width-----------.---- Diameter................ Depth................ xDisposal Trench—No. ---------- Width-------------------- Total Length.................... Total leaching area-.-.--.----_- _.--sq. ft. Seepage Pit No.1� ,00.&W&ameter.................... Depth below inlet.................... Total leacllitig areal........____--____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-.-_-_.------._._-.----- �, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------__-.-..____-._. ----------------------- ----------••--- ---•-•---•-----•---•-----------••-•------------•------------......................................................... 0 Description of Soil--------- ------------------------------------------------------•------------------------------------------------------------------------------------------------------ x U ------------ ----------------------- ---•------•----------------•----•••--•••-••--•--------••-----------•••••••••-••----•--------•-•-•--••---------------------••-------------------•.....----... xW ----------------------------------------------------------------------------------------------------------------------------------- ------------- ,..r ------------------------------------------ V Nature of Repairs or Alt Batt ns—Answer when ap hcble._ _ __ is ( � -�_._ ..:______ ---------------- r ---�-- �/ 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 •,place the system in operation until a Certificate of Compliance has been 'ssued by the board of ealth. If 77 9/4 ------------------------- ate - Application Approved By-------------- . -- • ••---- b. -• --........ -------)n ��-- -' Date Application Disapproved for the following reasons------------------------------------ •-•---•••••-•---•-•-------•-----...-----•---------.....--------------••--•. ---------------------------------------------------------------------------------------------------------------•----•--•-----------•-----•--------------•-••--------------•....------------------•---•-. .. Date------- Permit No......................................................... Issued........-7--� 12-- 7 7 Date \. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD F E T J... ---- . ----.-.OF........ .................. Appliratiuu -fair Btspasal ,ark Tutuitrurtiou ; amit Application is hereby made for a Permit to Construct ( ) of Repair ( ) an Individual Sewage..Disposal System at: ------ --- Location-t)d sg- or Lot No. ---------------- Owner A ress a ` .................................................. -_ • �-,d. . -.-------•---•....-----------........----...--- Installer Address d Type o Buildi>g Size Lot............................Sq. feet U Dwelling lL�No. of Bedrooms-------------------------- .Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ---------------------------- No. of persons--.-.- Showers ( ) — Cafeteria ( ) G4 Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tcutk / Liquid capacity_44 tt?-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—No 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.-----.----------------- LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............--.......... pd ------------------------........................................................................-............................................................ 0 Description of Soil......................................................................................................................................................................... x W ----------------------------------------------------------------------------------------------------------------------------- ............ Nature of Repairs or Alt t s—Answer when a li ble. ------- ----------- �_- U - .. , . 1 -� �-, -- .....*.......................................... 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 further agrees not la a the system in operation until a Certificate of Compliance has been 'ssued by the feed of ealth. I I� 7 7 signe t. - .�=x-• . ............................... v Application Approved B Date Date ' Application Disapproved for the following reasons:................................... ................................... --•••-•- ----------------------------------------------------------------------------------------•-----------------------------••-••-•-------•-------------•-----•---- .------------------..:...-----------•--- Date �1. PermitNo........................................................ Issued.............................. ...................... Date THE COMMONWEALTH OF MASS ACHUSETTS BOARD OF EALTH ..........O F............. ..... . ... Tntif irate of TDIri Haurr T I IS TO CERTIFY hat the Ind•vic�uaI Sewage Disposal System constructed ( ) or Repaired ( ) by_...__ • --•• - ----•-• -------- • -----•--•-•-••--•--- ;OV has een installed in accordance with the provisions of Article Y I of he State Sanitary Code as described in the application for Disposal Works Construction Permit No......... ?.40--------------- dated---..x..12_ -� _. `.-_.7.4 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A AJAR / E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. /� / f 77 DATE............................................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD. 41. OF HEALTH Q ..OF--........�� C...'- s4... ......... .... No.--•-_��._.1-- ._ FEE--- ............ %sVo lVor TJ1nistr ion ramit Permissio i er"eby granted-.. --- --• - •••---.. •- •6 - •-•................. .....• ................. to Constr t ( r Repair an v dual Se age al S Street as shown on the application for Disposal Works Construction Per ed____ __ ______ _____ i Board ^ DATE -----./...- .:!�:=--------. • .••••••------•-- :. _ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS --