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Home My WebLink About0054 HAWSER BEND - Health (2) 54 Hawser Bend Road Centerville A= 192—092 0 in O R� A OPendaffaC *Esss/te t. 42101/3 ORA 10°lo P4 a V r) �e u• i a o r � r _ •1v �� cq -a, No.... F� .. .a THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..................0 F `?� Applira#ilan for Dispaiial Worko Tonstrnrtion ramit Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal Sy tern at: Location-Address or Lot No: •-•--- frl� �� Cl�. Owner __••......................Address ---- taller Address Type of Building Size Lot_15 _OC 0_._Sq. f t Dwelling—No. of Bedrooms--- ....... ........................... Attic �d() Garbage Grinder 5 `4 Other—Type of Building No. of ersons_________________________ Showers P4 YP g --------•-----------•------- P ( ) — Cafeteria ( ) p' Other fixtures .---- do/---•-•••----•--------------- -- - ----••---------•--------------•------ W Design Flow....J`��...T_.—:5; ..........gallons per person per day. Total daily flow.....' _ ......................gallons. WSeptic Tank—Liquid capacity_) Q allons Lengthi� 'k?__. Width__!.:: __________.._ Diameter___ ___ Depth__"...__. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter._._...k!-_______ Depth below inlet...... _........ Total leaching area:._1.F.1......sq. ft. Z Other Distribution box (Viles Dosin ank '-' Percolation Test Results Performed by. � � -- _ - :__�- ........ Date___ .o__---- E ° �J � Test Pit No. 1__�._Zo.._._minutes per inch Depth of Test Pit......I Z.__._____ Depth to ground water_______o_T_____M1_co_c�r_f- 44 Test Pit No. 2__�.2-------minutesper inch Depth of Test Pit.....1_.Z....... Depth to ground water..___)..____._.___`..` -------------------------------------•-•----••--------.........__...------------------------.....---------.....--•--......----------•••--•-•••---•_•----- O Description of Soil_____ll— ------Q--' --- -b! w�tl��? 1 ......?'-1•S -sow► ......!VZ.5_77':_!_7 __�MV 2. miE (xj -----------------•- '� �------••---------•---------------------••----•--------•--••-----------•-----•------•---------------------•-------•--•- •-•-•----------- - - ---- - -- W -----�'--Z--------L2-2- 'Ar° -Sti? 1� �.. ----- -.:5A14__�1-jG_. UNature 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 TITHE 5 of the State Sanitary Codohnde ed further agrees not to place the system in v operati u it a Certificat f Compliance has been isf h th. C Signed------- -- .... ---------_•- '"r /,. .Date Ap ation Approved BY .--- __•• _-_ -------------•. -....IGLU Day Application Disapproved for the f oll ing reasons-------------------------------------------------------------------------------- --•-•-•-•---•---••------------ .............................................. ----•------------•.-----...-----•---.....-----•-•---•------------._._....••--•-----------------••--•••--------------•-•-----•------•-••-•-----••------- Date PermitNo.......... ....................... Issued....................................................... Date - L,OCL.TIO 5EW&C-4E PERMIT QO. I S7 LL R 5 1J E ADDRESS BUILD R S ISVAF— ADDRESS DATE PERNA T ISSUED D ATE COMPLI WdCE ISSUED : "' S _ _ _ __- 'l� �� 0 �� sOyG SEWAGE PEii i0. ASSESSORS MAP NO: P v _ MC—FI i N' 5 i A E E R'S NAME A D 0 R� a U1i, DER 0R 0wNE r P, A E P € 0 DATE ; 0MPLIP, HC" E IS511ED )1-7 w P A k. , .f 3 S No................_....... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH 2�JS r t, •� ------- - ............................_OF.....-....-:................. Appliration for Disposal Workii Tonstrnrtinn 1hrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: �� t�c�r�D��J�Z`:��lr cc i. C i '3 .......... _................................ ......... -............ =- --------.... Location-Addd-ress or Lot No. --------- (�+�y----••----..'........................... .............'__.-_.-----......._.._.......-Address....._^-......-----'--._................_. .- y►-' jy�cj - W I�Ts 11 Address ;- Q Type of Building / Size Lot............................Sq. f t U Dwelling No. of Bedrooms..........'3.............................Ex anion Attic Garbage Grinder " per, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other_fixtures .....:..................... ,. ---------•-•--------------------- T. Design Flow..... ...............................'�' __.gallons per person per day. Total daily flow...... .........................gallons. WSeptic Tank—Liquid capacity..... allons Length....... ...... Width...'?--.. Diameter------ '_------ Depth....`.?.. x Disposal Trench—No. .................... Width. ....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diamete ._._..... Deptl} below inlet......-........ Total leaching area.I.L�.....sq. ft. Z Other Distribution box (� t��"7 Dosing nk Percolation Test Results Performed by..................ti ...A'._.._... C'_..._..................... Date........................................-� Test Pit No. I.... -_-_....minutes per inch Depth of Test Pit...... ��........ Depth to ground water___N'` T.':."."t._`:`'� Gt, Test Pit No. 2---_._Z�_....minutes per inch Depth of Test Pit.._.._t..Z....... Depth to ground water__....r............... t� --------•••-- ----------- ,------ ------ ..................-................................................ O Description of Soil-.-- �..__I------ _ O -� `�bti�l� SQ�vit t <wV �? i L-✓i�:v% `" U!t.. ----------------------------------------••--- ----------------------------•-------------------------- �.�.1 C �- `•�-...... -� 4'��a1yt ✓kIFiS'Jtt, � ' u! f�il� 9r-.. 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 TI'111 5 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'b�'a f hea xh. �, - f Signed--- -- -- - -•- - -- - -...-----.=� -------------- -- -�--•s-----?._? J o i r Application Approved B ........................... -----' ............................... ..-----,..r ....... ..........� Date Application Disapproved for the f of ing reasons:................................................................................................................ .................................................... .....•••••................................................................................................................................ '--:--e6 75 Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntifiratr of Tontliftatta TH,II j.�_T.,Q, �F�RTIFY, mat the Indiv g Se age Disposal System constructed ( ) or Repaired ( ) by------------------------------------------------- .................. •-•-----•-------------------------..........--------------....-•-••-------.........------------------. l� 11 ,,?tea L_ 4 Installer { 1 at .......................•--• '•------••----......•--•'-. •-----......--•---•---•--•-••------•--------•----•-••----•--••••----------•-•...••-•-•------•••....•---------•--•------- has been installed in accordance with the provisions of TIT 5 of� e State Sanitary Code a ' d�scribed in the application for Disposal Works Construction Permit No-------______?......................... dated_._.______/""�7---`�..'._.........._... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WIL�L��i�T1ON SATISFACTORY. �---r—.--- DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 5?6 ...••............................••••••................. In No......................... FEE.......5.......... Permission is hereby granted.....__.: .......' to Construct ( ) or Repair ( ) an Individual Sewage-D.iap sal System atNo........... � .. ----•- ----- •--•.• ----------------- � [�/ +v l�Slreet as shown on the application for Disposal Works Construction Permit No �` ..... Dated.......... 7 �I� ............................................ /• .....•-----.... - Bo of th DATE-------------------------------- ---t......................................... FORM IZ55 HOBBS & WARREN, INC., PUBLISHERS a E f ' 71 Ti 4 _p4t L 1 0 r"SE�TtG j'1'P+-IiG �� - i VSE 1s00 Ga.t. `tom[1 l L:.c�T 3 r777, PST v � _ j��L Q' �._ tA 30 ' . :f�tT.��1R/,�.1 ' S S'TUt.1�. QtzEA ?.G. F J. .. 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