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Home My WebLink About0473 MAIN STREET (CENT.) - Health (2) L208 reet 003 t i Owrford, NO. 1521/3 ORA -' 10% , .` -'::;TABLE CONSERVATI G'N No.--� -� ..--- COMMISSION Fxs...... .... THE COMMONWEALTH OF MASSACHUSETTS 1BOAR® F HEALTH ..............OF..... .. ��✓ �1�"... Appliratiou for Uhip a al Works Cnomitrurtion trmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal. Syst at- J, Ji 6e�„ rloo c...... . r�..v.... r 9 /----------------------•-----••I�t---rro. --- ----••- ...................... �%E sue.. Owner Ad e �?1r�9✓cgj... ----••--•-••••-�ci ` ...r ..------ -------------------- Installer Address Type of Building Size Lot___ . .---Sq. feet Dwelling—No. of Bedrooms.-_._ ______ _____________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers a ( ) — Cafeteria ( ) d Other fixtures w Design Flow................ ...................gallons per person er day. Total daily flow-------51/0.........................gallons. W Septic Tank—Liquid capacity./LNgallons Length. ..... Width.--g..... Diameter___ ------------- Depth-!/.7.%_'.--- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....___._�._....... iameter....X2__......___ Depth below inlet.....4............ Total leaching area...,: 1. ....sq. ft. Z Other Distribution box (✓� Dosing tank ( ) ~" Percolation Test Results Performed by................. Date...................... ,•------------- - a Test Pit No. 1.....0�.......minutes per inch Depth of Test Pit....42.......... Depth to ground water.!✓? (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..................... fx ........•.--. {-•------------------- J �^ Description of Soil......27:,Z- D-'��--5,Yke------------------------------------ ------------------------------- --------------------------- ?....ze li' ••4 WW -_--- 51-11 VW -••-••••••-•-----------•---•-•---•••-------•••----------------------------------------••-•-.---------------------------- ----------------------------------------------------- Nature of Repairs or Alterations—Answer when applicable..........?�V_*-__-..___•---------------------•-__-_______------------------------•--.--_. -----.....--••••••••••••--•-•••-•••-••••••••--•...•••-•-•••••-•••••----•••--•••----•••-•••••••-•••-•••------••••----------•••---••--••••-••-•-•••••--.................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITLL; 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 boarj,of health. � Signed..........J---/-`� ............................................................... -------I-/� -•g�••- ._.. Date Application Approved BY _ .: '�'� ' � •--••-•••-•-.....--•- /-. Date Application Disapproved for the following reasons----------------•------------•---•----------------•.....----------------------------------------------•-•..•---- ..•••-•----••••-••-••••--••-•••••-••-•••...•••••••...----•-•...•--••-•-••--•-••...•---.......•••••--•-•-•..•--••-••••---•-•••••--•-------•-•••---•-••••-=--•--••••---•-•-----••-••-----......••-•----- Date PermitNo......................................................... Issued-....................................................... Date No.. •-- ................... - THE COMMONWEALTH OF MASSACHUSETTS BOAR® F- HEALTH .............OF..... / 1 .................................... Appliration for Uigpoiittl Workii Tonitrur#ion firrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System�at• _ ., ............... .........................................•--. -•------•----------------_._.. - _' s - .......... Loc£f ess 'r r Lot No4 Owner d e /�`'......... ................................................................. ------ Installer Address Type of Building - Size Lot... 31_2 1....Sq. feet Dwelling—No. of Bedrooms___--.��1..�.......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ...................................................... W Design Flow.................. ...................gallons per person per day. Total daily flow.___.._V_9&_•--•----•---••.--_.-•_--gallons. WSeptic Tank—Liquid capacity.. ggallons Length._ '...... Width.)74.--.... Diameter................ Depth.4¢'-:e... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. _-__-- -iameter.....Z ..._..... Depth below inlet....L......._.... Total leaching area...... -_-•s ft. � Seepage Pit No............... p g q. Z Other Distribution box ( Dos�g tank ( ) Percolation Test Results Performed by----------- -- Date as Test Pit No. 1......?Z_..._._minutes per inch Depth of Test Pit.._.��__�..__ Depth to ground water.WT�,�!,gXv;UeZC� (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ .......... ..........c........................................................................................................................... DDescription of Soil...... -----= --•---------------------------------------------------•--•---•--------------------------........---.......---•---- U -------------------------------------- ---1. �..L`c ` e1/ ............................../Ui!7..... ` ®---•------•----------•---------------------.......-------------- -------•------------------------------------------------------------------------------------------------------------ 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 TiTL_ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issy_ed by tthhe' board ofhealth. Signed...........Z�.� P •-•-----•-------•---..... ......../. Ada Date Application Approved By.......... . .--. %,I +.. :.. -- - ---=------•-----•---__--•-•-•--- -•--..�'./ e Dat Date Application Disapproved for the f ollowi0g reasons:-•------------•-----------------•--------••--------•--•----•----•-•-------------------•-•---•---••-••------..._ w:� -----------------------------•---------••-•--••••••---••--•---=-=--------•---•-•----....•-•-•••---•--•-•-•-------•--....•-•----••-•-------•••-•--•------•-------------...----------••......------------ ,;: Date PermitNo...................---------------------------------------- Issued........................................................ Date .rf ni 7E COMMONWEALTH OF MASSACHUSETTS BARD F HEALTH /.. ...............................oF.....,,., / ..............................................................-----... (Infifiratr of Tompliatta THIS TO CAgTIFY, That the"Individual Sewage Disposal System constructed ( or Repaired ( )- 1 C� f1Ul�L Installer/ ✓/!��(//Le L` //1_ at.............F OF......./-------- (( `- r has been installed in accordance with the provisions of TITLE; 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._5 � " ___________________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHAH. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATJ,SFAC ORY. DATE........................................ f.....�. 1 ' ----- Inspector............ „. .............................................. THE COMMONWEALTH OF MASSACHUSETTS �.. BOARD OF HEALTH ...................f.... `. %,vN...............OF... ........................... NO,. '.. ..... FEE.. Disposal Workii C�Onstr ion rrmi# Permission i!,hereby granted....... --.-_. to Construct or Repair ( an Individu 1 Sewage Disposal,S stem atNo.--------- ...CJ_---__---. 4ta 1------------- '._`.L! -------------•-------•-------------------------------------------____---____._ Street as shown on the application for Disposal Works Construction mit No..................4 Dated.......................................... DATE..................................... --�-�--'---------- ------ �rd .flth FORM 1255 HOBBS & WARREN, INC., PUBLISHERS �i ,OCATION Lo4 FER�NBROOK, off Main Street , Centerville NO. y�o TILLAGE Centerville. _ �+ DATE 12/4/81 _ PPLICANT Alfred Cecere et al, Trustees FEE $25. 00 DDRESS c/o Delta -Homes , Inc. TELEPHONE NO. 771-7765 (Non-refundable 'NGINEER Peter Gavin _TELEPHONE NO. ATE SCHEDULED December 4, 1981 (Applicant' s signature) . . . . . . . . . . . . . . . . . . . . . SOIL LOG UB-DIVISION NAME FERNBROOK DATE ? ..12/4/81 TIME 2: 00 P.M. XPANSIONAREA: YES * NO Peter Gavin ENGINEER OWN WATER # PRIVATE WELL Ron Gifford BOARD OF HEALTE Dan Speakman EXCAVATOR KETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES : See Attached Plans ERCOLATION RATE. _ ,TEST HOLE NO: -- ELEVATION: -TEST HOLE NO.: _ ELEVATION: - 2 LOAD s S'vts y�� 2 3 3 4 4 { - - 6 6 7 7 - 8 8 • 9 9 10 10 11 11 AI -- 12 12 - 13 13 14 1 14 15 15 16 16 SUITABLE FOR. SUB-SURFACE SEWAGE: LEACHING FIELD# _LEACHING PITS # LEACHING TRENCHES # UNSUITABLE FOR SUB.-SURFACE SEWAGE. REASONS: NOTE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT i { I 3 \ 1 , 9 i i i i J _.....-. --- .s i i t _ �l 3 - t : x 4 E e 42j p r � z , - s oi T 'r}y ty .r y ,I'd .,»•- «,,,..:. a.,a 'i^^... 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