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Home My WebLink About0086 HELMSMAN DRIVE - Health 86 HELMSMAN DR Centerville A = 193 - 236 i 5 M EAD KEEPING YOU ORGANIZED No. 12534 2-153LOR FORESTRRYY MIN.RECYCLED �•(J FORESTRY 'f INITIATIVE CONTENT 10, Certified Fiber Sourcing POST-CONSUMER www.cfiprogrem.org $"go MADE IN USA GET ORGANIZED AT SMEAD.COM L0 C AT 10H 5 (VPA E PE RMIT Ito. L Q ff �si �L � �v H d L L A'If Ir I N S T A LLER'S NAME I ADDRESS � 8_UILoER OR 0w eR 6-Al IF If OATS PER91IT ISSaJEA 3 — /0 OAS' E COMPLIANCE ISSUED � r - 1 �. ��y,; � � �� r � �` ® 37�� r �3 Flcs ............. No ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH- ...........0 F.., - -------------------------------- .............................. Appliration for Disposal Worko Tonstrurtion Prrutit Application is her, d f t"� � y made or 4 Permit to Construct or Repair an Individual Sewage Disposal S t t WiVY6 PY' ... . .........7. ..... ......... .... ..... .......0-1--------- ......... . .. .. .................................................................... Loc * n-Addre or t 0. 9 ........ . . . .. ........................................ .........i . ... .. ........................................... Qm%er 2 d ess . .................. . . ........62*.. ...... .............................. ......... ............ . .................................................... Installer Address Size Lot_ . . ZZ.-Sq. feet Type of Building U Dwelling—No. of Bedrooms............ty................. ........ -------Expansion Attic VA Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Othfi tures ....................................................................................................... ........ Design Flow_______ ----------_________________________gallons per person per day. Total daily flow----- S...........................gallons. 04 Septic Tank—Liquid capacity............gallons Length________________ Width_.__...._.__.__. Diameter_.._.__...___.__ Depth_._._______..._. W Disposal Trench—No_ ____________________ Width___._.._.__.____.__. Total Length.___.______..______. Total,leaching area....................sq. ft. Seepage Pit No_____________________ Diameter__._.__..___.______. Depth below inlet_______._.___.__.__. Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing, Percolation Test Results Performed by.. .................. .... ....... ....................... Test Pit No. I................minutes per inch Dept of Test Pit.____. ............ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit__.__.__.._.__..___. Depth to ground water_______.....__.__._.___. Ix ........... --- ------ ---- ----------------*--------------- -----�_____............ 0 __2 :� - .. Description of Soil....... . .....V... .......................................%=� U -------------- ..................................................................................... .. .......... ... .................... ............................ -------------------------- U Nature of Repairs or Alterations—Answer when applicable................................................................ .............................. ...........I................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE IL LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operatio til Certj)•icate of Compliance has been issued by the board of he;#-h. .. . ....... ... Signed.. .. .... ...... ....6..J14. ate Alication Approved By .................. ................................ ...................................... Date Application Disapproved for the following reasons:.....................................................................................I............................ ........................................................................................................................................................................................................ Date Permit No.--------- E;69=11:�C� Issued...................................................... Date ----------- ---------------------------------- Fxs,•�-.... ..� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2L.. OF. G ` ._K-r`.......................... ... Appliratiun for Disposal Works Toustrurtion 1hruat Application is hereby made for a Permit to Construct or. Repair ( ) an Individual Sewage Disposal S s at . ../.,<. 1::��t .., �.'............. �. ------------------------------------------------------------- ----------------------------.-.----.------------ f Loc on-Ad r y .�- -a....r....e�rt................................ ....... o .e w.Cr -: a ....... ... Installer Address r Type of Building Size Loo ,._...7 Z._..Sq. feet F-I - Dwelling—No. of Bedrooms........... ...........................Expansion Attic ) Garbage Grinder+C''"✓l aa Other—T e of Building YP g -•----•--------------------- No. of persons----------.....------------- Showers ( ) — Cafeteria ( ) O7/' r fixtures --------------------------------• . ----------------•-•---•------.......-•---- W Design Flow..... ..r�.............................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 nk aPercolation Test Results Performed by. __- .I.. " .__V:----. . _ ______ Date,, "' ....__. 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........................ RI' D Description of Soil...... -�--... -- - - - -.................... v '. --------------- Uw ........••................=-------------•-----•------------------------------ ------------------_------------------------.--------------------------•------------- ---- 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 further agrees not to place the system in operati till Cer 'ficate of Compliance has been issued by the bo rd of health. Signed--( d-:. dT ._._.. zusL.,�- _ r .. Dat plica.tion Approved BY----. .- �'rr' _--•-•--•-•--- ------------•--•-•............... ...............J'""_ _col..... Date Application Disapproved for the following reasons--------------------------------------------------------....................................................... ...............................................................................................................................................................................•----------...-----••-•--- r Date Permit No............. �Jp ._1. -. Issued.............. Date THE COMMONWEALTH OF MASSACHUSETTS a: �G.�.�._:•.............OF....��F HEALTH.. BOARD ........ ..... s.1.' ....:.. ,-......................... fardifiratr of Toutpliaurr Tyla'i STO CERTIFY at the Individual S -age Disposal S stem onstructed r Repairedby... �-.. . 1..... � ,..... , x'a' .. ... --------------------------••--......•--••- Installer ` r 11 r' has been installed.in accordance with the provisions of T TLF 5 of The State Sanitar . Colic a described in the application for-Disposal Works Construction Permit No..... _ r1-........(.•5.-?.... dated ------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARANTEE THAT THE SYSTEM WILL' UNC�ION SATISFACTORY. 1.� DATE................. ....................................... Inspector` f. THE COMMONWEALTH OF MASSACHUSETTS . BOARD F HEALTH e'............O F.S: 1`rwCKs. ,,,.„,�J................. N .. a FEE iu I Vorkii 0116u#ri$rfiutt permit Permission is ereby granted.. a"i c2....-•.......................... to ` Con tru rkRepair ( ) an Individual Sewage isposal �ystem at No.--- U�!. ......... } Street as shown on the application for.Disposal Works Construction Permit Igo`'-.G �►_ DatedZ8 .v ja�.....:......... Board of Health DATE..... �...� _ FORM 1255 A. M. SULKIN, INC.. BOSTON - • v r4 t� DES IG-N D/aTf i I w M/ NE B n.a►� ��, 1,S,IKG-LE FAM►t_1� 3 BCOIZnoI`'� Na : f�AtZUACsE . Gt2tN DCtZ. i ,_ { .AP1tLY FLow: �1 t0 K ' 3 330 - GP t�• � 4� �sz SEPTI C TANK. 3 3 c� Iso7o �..¢�5 USE 1 o00 GAL. TAK%jV� \ Lor S ups o k D►SPoSAt_ PST" QGc (i t 000 GAL.. � _ T t stOC-WALL.. A9-EA s �S'o . S., F. 3 7S Cc-.P. O BnTT-o1K A?-EA $o• S.G. '��' .�i.� `° �'� ,� Pluo : :ToTN 1. OEStG�J z 42S Cr. P,:.p. 48.3 F-,,SS l pL icN3 RATS : 1"i;V Z pi Ili 02LESS •O,V`. "?As F .,.•.k AAA eat ; A . 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