HomeMy WebLinkAbout0049 OAK STREET (CENT./W.BARN) - Health 49 Oak Street
Centervi ll e
A= 173-017-001
N SMEAD
No.53LOR
UPC 12543
smead.com • Made in USA
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Application Approved By.�!�___
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LOCATIOKI 5EW®C,E PERMIT UO,
CC- AJTEQ0Al) r-
IN15TNLLER 5 1 &MEOW A) ADDRESS
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DIaTE PER"I-T _I55UED�7
DATE COMPLI &&ICE ISSUED : ��
G'Iwq 1)6c,
DASD o
�000 �1
l000 PIT
tiEIAJ
No._J.19-#-----...... Fss. 7.. .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD&::
EALTH
.........._.OF...... ..........................................................
-XVp iration -for .4-Ji-wiml Warkii TatuArtt inn Vrrnfit
Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal
System at:
0,4 --_:)_ --------=--------------------------------------•-----------------•- J 17,1"----- ..................................
--ea- oyoidot No. ............
owner
Installer Address
U, Type of Building t_. Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms............. .'°-:____-_---____-__.__-..__-Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ....................... No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther 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.104.0... Diameter.................... Depth below inlet.................... Total leachingarea-------_.._----__sq. ft.
z i Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by----------- --------- ------------•------------------•-------------------• Date------------------------------ ---------
Test Pit No. 1----------------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--------------.---------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
O Description of Soil------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------
x
w
x ----------- ----------- ----- -- ---------------- -----
U Nature of Repairs or Alterations—Answer w n a licable._ _-- ________---------------------------------------------------
t � .� '••-------------------------------------•-----------
Agreement:
The undersigned agrees to install the aforcdescrib34 Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code The undersigned further ees not to place the s tem i
operation until a Certificate of Compliance ha bee • ed b t}e ealth.
Si ne ..:. •
. ...
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Application Approved Bye L �"------------- --- -- --
Dat
Application Disapproved for the following reasons:----•--•---•---••------•-•-- ---•---------------•-•-•-••--------•-•----......--•----•-•.....----•---------•-----
...................................................
Date
PermitNo...........................--•-.......................... S Issued_---•------------•-------•--•._.........----••......---•
Date,
THE COMMONWEALTH OF MASSACHUSETTS
s
BOARD O HEALTH
...........O F....... ............4 .....:''"" ...........................
Trrfifirate of f�pi t;ihaurr
*THIS TO CERTIF q the Individual Sewage Disposal System constructed �) or Repaired ( _ )
------------
Inst ...
'Y...............
has been installed in accordan with the provisions of Article XI of he State Sanitary Code s descri ed in the
application for Disposal Works Construction Permit No----------I.�_9-___:_:•-__.--. - dated_.. � /'. .___7
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANT E THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
Ce
DATE i�'�> 3� In
w, 's : Spector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH r?
/ GG ..............OF......
.... FEE�_•�...-•-•---•--•--•--•
i-
�i��aa�tt _ rk� un �x�t;#iott �rriati#
Permission is hereby grant ( !) -�'t--
I ------------------------------------------------•-------------......----
to Constr ( ) or Re VA an Individ 1 Sewage Disposal System
" .
at Nd'? d1.. `p Q. .1%
Street
as shown on the application for Disposal�Olrks Constructio ermit .... .. Dated__ ?7_ ,�"".--•--
' Bo d �f�H a /' ktw..............
o ealth
' DATE_.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i