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Home My WebLink About0088 HAYES ROAD - Health 88 HAYES ROAD Centerville A = 210 — 098 5 M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR o�g LE MIN.RECYCLED INITIATIVE CONTENTIO% CertifiedFiherSourcing POST-CONSUMERI www.sriProgremorg S"1290 MADE IN USA GET ORGANIZED AT SMEAD.COM I LOCAZION f. ` SEWAGE PERMIT NO. VILLAGE I N S T A l AME i ADDRESS BUILDER OR OWNER , DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ( -) r ��T �cr � o � � �� ,�d 4 � � � _. �� ) \ D.,ev�w A� ��V No.....2.y7....... Fus --�--� THE COMMONWEALTH OF MASSACHUSETTS / BOAR® ®F ,HEA'LTH 1...... -- - -----_---------------_--_- Appliration for Digpnia1 Mirky Tomitrurfinrt thrmit Application is hereby made for a-Permit`to Construct ( ) or Repair ( "ran Individual Sewage Disposal System a ...-1. .. !:: :;�� ........................................................ t Locati -Address or Lot No. ..................................... .............•••••. •......._......... . • •-----------•-----............................ ner Address W ............... Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-- . ............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water................. G Test Pit No. 2................minutes per inch Depth of Test Pit.................•.. Depth to ground water........................ ..........................-------------...------------------------------------••-... .•---------•------------------- •---------------------------------------- O Description of Soil............................................................................... -------------------------------------------------...------..........----••-•••--..-•-•- x W •--••-• --- 3 U Na-ure of Re i s or AlteraXio —Answer hen ap licable_. !�_ ____ _________ __ __!>l1_ .____._1 �� .Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITH-;u. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha e issued by the b r o Health. Sign _. ^ .. ^� Date Application Approved BY-•--•-•--- r .............. /0..... dL Date Application Disapproved for the following reasons-------------------------------------•-------------------------•---------------------------......••---........... ------------------------------------•------------•--------------------------------------------------.......---------••-......•-•---------••--•••--..... -------•••-•----------------------•---••-•-•--- Date Permit No.._......... - Issued_... �` ..-.-----•-•--- Date THE COMMONWEALTH OF MASSACHUSETTS BOAR .OF HEA TH _ . .u� Appliration for Uiipniial Works Tomitrnrtion Errant Application is hereby made for a Permit to Construct ( ) or Repair (4"an Individual Sewage Disposal System ��_JU70 ...)�01".-A- .............._ or Locat Address ................. Lot No.......------------....................._. tEt3 ....... . n..................... .. ..........•. W ltan »___._.. r .................................................................. Addressller wy4 I 9} Address d Type of Building Size Lot.... ........................Sq. feet Dwelling No. of Bedrooms___............... Expansion Attic ' r Garbage Grinder ( ) a g— P ( ),�x,:, 44 Other—Type of Building ..___=...................... No. of persons_ ....... ______ Sho`.wers ( ) — Cafeteria ( ) dOther fixtures . == ----- -- - " x ---------------------=---------------- W Design Flow............................. Jv'=gallons ,per person per day. Total daily flow................... .._._. . fi ....._____.______.___._____gallons. WSeptic Tank—Liquid capacity..h . gallons Length �`" ___ Width__ Diameter ............ Depth___ .k ._..__.•. Total Length...__._. Totaf le'achrng area....................sq. ft. Disposal Trench—No. ..__...._._ Width__ `t u x , Seepage Pit No..................... Diameter ,_ `'.`..ODeptllp elow inlet_____.. .._.......'Total'leaching area.................. ft. z Other Distribution box ( ) Dos>ngftank ( ) Percolation Test Results Perform, ......................... ..: `'° ____.... ""'�"'" �`� Date........................................ a44e, ��. Test Pit No. I................minutes.per inch '='Depth of 'T. t Pit._.::a_______.__.__ Depth tb ga�ouad water........................ Test Pit No. 2................minutes per inchl, `Depth of Test.Pit..A................. Depth to grounq water........................ a J_•��' _ ................................ ....................•------_..... ; AF`4rMiM rtWW+^u•t .. 41 ...................._.._..._...._._..__.. } O Description of Soil......................................................................... V ------------------•-------------••--••---------•----------•------------------•--•-•-•---...... ; W --------------------------------------------------------------------------------------•------------ --- �ge; ure of Re s or Alteratio —Answer hen a livable a2.e _ ' � ...... `' . ,,: ' eement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL: p 5 of the State Sanitary.Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha e issued by the b r health. Sign f.! " '"� Date Application Approved BY w_ , ..; ..- ... -1. 'r....... 4" ✓ "`�r t Date C Application Disapproved for the f ollo"ving r`easons:.................................................. ..............::'_ . e u Date V n. Permit No. Issued------ v� ,'Date k- s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ./-----.+�'""��!�'""-••......OF... � .'.'T..:!.....................................::.... t (�rr#ifirtt#� of �rrnt�rli�nr�e �� y t T VT C TIFY, hat Individual Sewage Disposal System constructed ( ) or Repaired2�p4 taller — } .-• at_. ------------------------------------------- ---- l i ��i # �� has been installed i accordance with the provisions of j of The S ate Sanita d as described in the application for Disposal Works Construction Permit No k.117--_---------- dated: _., - U............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTI U.41,AS .� AR TEE THAT THE SYSTEM WIL FUNCTION S TISFACTORY. �. F DATE._ Inspecior . . f�n� � � „oaf• �. f � yt r �4•..t,�;.�Ld� i;-;'f; e 3'"i �t i r �t a t 1„�a.' .w "�4�ut.+ � �' } �^'�v fit � y a� r THE COMMONWEALTH OF MASSACHUSETTS ..- .�„r,,.., BOAR Of( F -HEALTH 4 \ EE ' Vk �N2_ Permission is hereby granted--•- ----....: a:............. to Construct j9r Repair ( I ivid Se Isposal ystem --- E" --------• . •-• -- t Street as shown the applicat on for Iiosal Works Construction it �F Dated___ .. .. .".. yx . ry Board of Health DATE----- �f r}✓¢ IV FORM 1255 HOBBS & WARREN. INC., PUBLISHERS