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Home My WebLink About0063 LOOMIS LANE - Health 63 Loomis Lane Centerville A=230 - 108 UPC 12534 .2.153L LO•CATI N SE GE PERMIT NO. �d d -VILLAGE ( -P INSTA LLER'S NAME & ADDRESS. BUILDER OR OWNER 77-774 ( DATE PERMIT ISSUED j-7 ,.,Z DAT E COMPLIANCE J.SSUED 17` 2 Z , !1 z� � � 7 �6 THE COMMONWEALTH OF MASSACHUSETTS ABOARD OF HEA TH ............. I1....OF............ ........ _-.... Appliratiun for Nupusal Work unitrn.rtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at (O �4 �vl l � �-V��IZiOOLG� ,Loc'io - ss Lot No . 1.- -= . ................•.....--- . _._ _ ..- .-----.. ... .....----- � Owner Address Pq Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............:::......................._---Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) PL Other fixtures -----------•--- --------------• - W Design Flow.............�31Q...................gallons per person per day. Total daily flow.._......'L9-3........................gallons. WSeptic Tank—Liquid capacity./PA _.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width . __............ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........:...I..... Diameter... .�.�_______ Depth below�nlet ..._ _.._.._... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) O,(//JG _ '�'/S'_ 7 r. aPercolation Test Result Performed by..___,�# ...,....... ..r,/P_Y►�' ....�t��'_.__ Date__=2.��s'' ........___. Test Pit No. 1.. ......minutes per inch Depth of Test Pit.................... Depth to ground water........................ i4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W .....�._...__ . ............ Xe-/ u-„-�9t y�v 9' Description of Soil �� °Y Z - ------------- -------•... --•------------ice 1-------u1.. :z�r---------------------------------------------------------------- -.............................x •---••••-•-• ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the board of health. Signd_-•--- ............................................................. Date Application Approved By......" 4—el A � . /Dal 1 .. te Application Disapproved for the following reasons:... /f D to PermitNo......................................................... Issued- = D �= G' ...---...... L0. CA , N� �cs SEWAGE PERMIT NO. -,-V? VILLAGE 7'-e y INSTA LLER'S NAMES & ADDRESS 1 71) , . R U I L D E R. OR OWNER � o DATE PERMIT ISSUED DATE COMPLIANCE ISSUED t�1 i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF�EALTH ...... yL /.1".........OF...............: .G� ,,J.L.... ... ,.....-;. _�............ Trrtif iratr of Tont0aurr THIS IS TO C TIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by....... , '.Y f' st 64..; er at........ ;G'�3rit�-� id •..... f G, i v. has been installed in accordance with the provisions of TI/LF, j of The State Sanitary Code as described in the application for Disposal Works Construction Permit da.ted_..... _-..�_=_ .................... ------------ �' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH r �O .................. !c'l i,.1..F......O F...........s�`"?-/ )...a....�, f.fry '� FEE 1.? _ U? No._ ... ---......... Disposal Works Tonotrudion ramit Permission is hereby granted � - --- . . r :---- to Construct ( )yor Repair ( ) an In ividual Sewage Disposal System at G%/Gs j ....... .............. Street as shown on the application for Disposal Works Construction Permit No . Dated......�:17 f._-Z.......... it✓/ x 61'of -----------• Bo I alth ..._ DATE----------------- •---•---•-•-•-------•--------------•••............•....._..... �� FORM 1255 HOBBS & WARREN. INC., PUBLISHERS No.*...._........../. ................. THE COMMONWEALTH OF MASSACHUSETTS ' ��--••-- BOARD OF I-I E A MTH ................1 "`0.`.....OF.............!�?l2�1:L��.% .............---..._... Apptiration for Uiipusaal nrk Tomitrnrtinn Prrmit Application is hereby made fora Permitrto Construct (zor Repair ( ) an Individual Sewage Disposal ystelli at: .... ......................... .......................................... -• .._.. .---•- --- .. .------ --...... ------ Location- ddress iKress No a rOwner ` � Installer "Adress dType of Building Size Lot____________________________Sq. feet aDwelling—No. of Bedrooms--------------- ------•-•_._ -__--Expansion Attic ( ) Garbage Grinder ( ) p,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) # a Other fixtures ..•-•.........................•. . ". W Design Flow............. ...................gallons per person per day. Total daily flow.........�YS.......................gallons. 9 Septic Tank—Liquid capacity8dd__.gallons Length................ Width................ Diameter................ Depth................ W x Disposal Trench—No. -------------------- Wid h ............... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.............. ...... Diameter....... ___.._.,Depth below inlet-,_ _..._..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing,tank ( ) G/)" �� ." /�-- 7 F Percolation Test Result Performed by....�..? '::r`.r_.............�._..�.!'�_:=.___I�C...•. Date___ ................................... aTest Pit No. L.1�-------minutes per inch Depth of Test Pit.................... Depth to ground water.......-................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil-•-•- `� /„r ram._>_`!_.. = 7i'!%/..:(.r ' V ................................................--•---••-------------••--•------•••----••--•--••••-•••••---------------------•-••- ------------------------------------------------------------------------------------------------------------------------------------------------------------•------•---•--------------•--•-----•••-•---- 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 iITL- 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 board of health. Siged.........:.............................•-•--........-------•-------••----------------- .......................... 'e Y Date i Application Approved B f-----------•---•- -- �1% k). :........ f , -3 ...... PP PP Y 1 C : Date Application Disapproved for the following reasons----------------•----------------•----------------------•----------------------------------------••••------------ ..................................•----•--•--------•-----•--••------------------------......--•••••.................................................................................................... Date # Permit No......................................................... Issued_....................................................... Date LA fez Z)F TA4 LoruS /Itt"jt `7,5,0 7-, C 7-;,9/V/< a- �/ 'A`5? �) \ `��+ . "v '6 s /All -7,jr 7- 7-4- /t-�' 9 PE Al r» \ a a. D 7 4 z Iv 14 jt k I -� I 1� 1-1 . i4j 71� CF—R-TIFIE [D I A, ee VZ7 btiJ e. tA T e X T ER N r.I ST e-W_t V t> S\)*,j E At # -7 7-3