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Home My WebLink About0027 MAY LANE - Health 27 May Lane Centerville A= 147 110 S M E A D No.2-153LOR UPC 12534 smead.com - Made in USA 2 S THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF.... r.� i/� 14 H .. _....... - Appliration for Uhipatittl Works (�nntrnrtinn rrmit Application is hereby-made for a Permit to Construct (L,� or Repair ( ) an Individual Sewage Disposal System at: .C®1` Cgs— ........................................................✓� L im ..�"ii✓T��"eio C.(� v�............................................ ............- Location-Address _ or Lot No. BZ1/e_ f( w l........................... ��w4Ll.............................................................. Owner Address W �� 1 'f �,y. ,4.......... Installer Address QType of Building Size Lot.._�.6.z.-y'..............Sq. feet Dwelling—No. of Bedrooms...7.� n-.e. ....................Expansion Attic ( } Garbage Grinder (z'o p`4 Other—Type of Building e,P<;�e........ No. of persons...�................... Showers (-Q — Cafeteria Wq a' Other fixtures .............. ................. . Design Flow..`/...........................:.'__..gallons per person per day. Total daily flow...................:��.�..._.__.__.gallons. W , WSeptic Tank—Liquid capacity.:`.........gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No.........: ........ Width.............._..... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No.................. Diameter............._...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box.(; ) Dosing tank ( `" Percolation Test Resulis Performed by.....67.�.`��...._....� '` .''�!�. Date �:: - Test Pit No. 1.......a----minutes per inch Depth of Test Pit.. .f'... Depth to ground water..... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ •--•----•-------------------------------••------•-•--.............-•----......................-----..........-•--••--•-----••--............•-•-•••••--..•---- 0 Description of Soil..........a '� �C?��G �&✓��`p/4 •----•-----------------------------------------------•--.....------------.....-•--•---............._.. sa7............'S - ---..... � '.` -...._i ts.. .....`� �`...... U --........ W ---------------------------•-----•----••-----•••-------------------•--••-•-••-•----•--...----•---•--•-•---•--••------•-•------•-...•••--•---•--•--•-•---•-----•••--•-----•----••-•-••--•............... VNature 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 iITILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as tleQ issued by the board of health. igned :.................................. .r--C� _ D �j ApplicationApproved BY ........................•-•--•----•--•-•--•----•-................----.......... ..... ..... . i•5... ..... Date Application Disapproved or a following reasons:------••--------------•--------•-------•--------....--••--------------------•---------------•---....._•--•.... ------------ ----------- ---------------------------- ------------------- ------------------------------------------------------------ •-------------------------- •------------- Date Permit No......................................................... Issued-------•-•••-----•---- Date................................. t L 0 C A-T ION SEWAGE PERMIT NO. VILLAGE Ce-A)I� INSTALLER'S NAME ' i ADDRESS --T�p 01C.R Aj 5- �A&t+ Ra r- 6�- Q d <-(?4 r� BUILDER OR OWNER le o DATE PERMIT ISSUED 7 DATE COMPLIANCE ISSUED y� ��E�J� �.� � �� -S/ �� G�2�� .3� - a� �- - 4L � ��. �— �. ( .c f`��' • X 1 No. ................. Fxs...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF...... �. .�.; - ------ Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at � .......l ................ �/%, £ xsr ---•- r -1 ...---....----••-----•--------•------• Location-Address of Lot No. •------•••.....-••................. W Owner Address Installer----------------------------------------------- .. �j�.n1,.��.Y,�t��-Addressp.................................. Q Type of Building Size Lot.._._... Sq. feet U .� Dwelling—No. of Bedrooms...... .---___-__-Expansion Attic ( ) Garbage Grinder Other—Type of Building ___ persons--------- .............. howers ) — Cafeteria p., ___ .___ .. . No. of P4 Other fixtures, �'`Jr� Q ---------------------- ............................................. -------------... ....... ------ 'Design Flow........Z�h�........4.....................gallons per person per day. Total daily flow...................... . ........gallons. W .Septic Tank l iq�iid capacity............gallons Length i-.,......__..... 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,( ) aPercolation Test Results Performed by..: f r:.a?..eAt.......... + �?' '� {�. Date.... "d" ............ a Test Pit No. l.......A....minutes per inch Depth of Test Pit- g�._G..._ Depth to,ground water___-c8...-47 10--_ 124 Test Pit No. 2................minutes per inch Depth of Test Fit.................... Depth to ground water......................... ... ............ ..:-•...............:.•-:........•••-•------ D Description of Soil.........C3.~.-?. ..'__.._._.- .eio •$'u o�C W ---------------------------•---------•••--------•-•-----•--•--------••--•---•--••••••--•---••-•-••---••------•••-----•----•---•-•--•----••------...•------•-•-•-•-•...--•-•---•-••---•••-•--•---••-•---- V 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 TIT11 5 of the State Sanitary. Code— The undersigned further agrees not to place the system in operation until a Certificate of Complia ce - s issued by the board of health. ,,r''. igned_ ApplicationApproved By----•------- ---------------------------------------------------------------------------------- Date Application Disapproved f t following reasons:-•-•--•-••-•---•-•--•---•--••---•--•------•------•-•--••----------•.....................................••--•-•- ---•-••-•-•.......................•-•-_._....•••---.....-•-••---•-•-.-•---••--•-•-----•--••-••------•---••----............••--•--•-----•••--•--.•----•------•--••-•-•.....---•-••---------•-••-•-......_ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �rrtif aratr of Trrt phatTre TINS 0 CERTIFY, That the Individual Sewage Disposal System constructed 1�- ) or-Repaired ( ) by......... ••• . • --------------------r.... _.. .------. ...•---------••-----•-••--•-----...-•-•-•...._----••......- °, 'lr./'� Installer at....... ........ .....•-•-••-----•••••--• -------- -•.................................................... ........................•-- has been installed in accordance ' the provisions of TITS r tate SanitaryC e e in the application for Disposal Work onstruction Permit No•----•......••• -•--- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE SYSTEM WILL U �j TION SATISFACTORY. DATE.......? .. . t Inspector.•../ ._.' ----------------------------- _ ...---------••----•--.........--••-----•-----•--•-••............. THE COMMONWEALTH OF MASSACHUSETTS w• BOARD OF HEALTH ...................OF......r•. �s^-. r9 a'4v No t+f,rr�j .. ..A• . FEE........................ Permission is her ranted........... ..........•..• ... ..:�,!...- to Construct ( pair ) an - > Sew a posal System atNo............. • -----------• ---------------------------•------------------------------ Street as shown Ztion fo Disposal r� Construction Permit No.:..:....... ....... ated...... __.. ...... ..... ....................•-------- ••--• ------------IV.............................................. 7oard of Health DATE.._ .................................................... FORM 1255 A. M. SULKIN, INC., BOSTON 'p65 L6.ki -DA-TA t o 6AQSA.CPr.- Qzi uoEQ AV 6 17t+-1 L.�-( FLo%,V ■ 3 >< I I O ■ 330 !..pr-> SE�'I"tC TA.1J1C Q a30 >< ISO o/o • Agr7 (p III �o' 1 Misr — _ - VS (000 /ooILo tr,v.c+1 F t�L� • u S E.:2- �.vw �I t=Fv55oQ5 : : : : P 'StCEv/&L.L, b.¢EA r_7A+d8Xl.o8)(_2.r7) - 194 6-PD. .. . - . .. .T: :� :► .T_i L. Z'. � ' BoT-roM" Ac7rp=A . .. .. �l2'�cZd:��•l.o� = . 288 G•RD. , .: �p�'� q_ : ': �. '�• ' �1 � ` � ' _. � :.: ; . TOTAL 'D��St 6N s d82 G.RD. . i : f, �, ;. • i _.._. ... r( _..._ .f_ r I FLotU 1--c j - 1 . . - ....... .. .. :.. _. � Odt• I. ` 1 C Zn F`( T"AT 'Tt-I F'O 5140VJQ WEZg6OR GOMPLY5 `IJ►Ttil_ .TNE.__ ,i1DEu►..tE. AND StEt 4C-C- tZeQUl2EAdi:�."TS q' .... :., •-. -rt-I E -row u El a . tA1ln cuQt,"oV. raGbt� : /:•. yo �7AT�: ;G.�To , �3_A.IC-fEr 4- uyE= IuG• Pl eI �&SPP_5-•-•,>--__: T�sT 4; t000 11h.. ItIJ MKT 11!✓ ✓�BSd/c _ ��\N�` .fyR gci 7 3e a y RlCNARD4 ,i A. a+• No 24C1 .. Z. 4{8 FLOW DIFW�SG(Z�, WITO A:OF 314 TO I/s' WA%4W j � • . `' ',„:m GToUP- ALL A0.00WD. 1V OF : : ( kh WA4llEr> Pr.ASTO►IG. ON TO W&T>a 2 r;L P2�OF1 L� oF- PPoPOSED _ � � � tN f 1-4,�. - .. _... 02 'AN \�\ rs