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Home My WebLink About0073 OLD FARM ROAD - Health Ck-b �-,n RC) /// SMEADJ KEEPING YOU ORGANIZED No. 12534 2-153LOR OFORES RYA MURECYCLED INITIATIVE CONTENT707 CertifiedFiberSo-ins POST-CONSUMER wvwsfipropr&;wp IR 072p0 MADE W USA GET ORGANIZED AT SAD.COM ASSESSOR'S MAP NO. ;)Z _PARCEL LOCATION SEWAGE PERMIT NO. VILLAGE Q I N S T A L L E R'S NA A ADDRESS � w S U i 1. D E R OR OWNER DATE PERMIT ISSUED MAY �� (40 DAT E COM°P,L1ANCE ISSUED 1 S� Ito` �iV�wwy I t7d�GNL SEPftL�NK S�S-rQt�oov fox �-t Ni✓ 1RARWrHEALTH_gEP_ S r 02664 � �- Fps /� ............._............._ THE COMMONWEALTH OF MASSACHUSET VCj BOAR OF H BALT t J1CI - -0-�-U -......o F.. . K _ Ami iratiutt for Dtupuua1 Works Tonotrurtiuit trruttt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System (lam ^�^ .I. t*kp.Address �. .__... .... - ................. .2.IcL.L ..... - e• Lot No. —� .................... WOwner ............................»_.._.. . Address .._._ Installer .............Type ----- of Building Address U Dwelling—No. of Bedrooms..._..___._•••-- Size Lot............................Sq. feet -••-___---_-Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ..................•...-_..._ Nb. of persons.............._-----_-----.• Showers Oth s .._......_.. ( ) — Cafeteria ( ) ....................................................._.......-----•........_..._.. W Design Flow......... _ gallons per person par. day. Total daily flow___-._..._.c c tly gallons. W Septic Tank—Liquid capacity Ogallons Length----- --------- Width......_. ....... Diameter................ Depth................ 3 x Disposal Trench—¢No -- Width.................... Total Length...........- Total leaching area--------------------s ft. Seepage Pit No......!.............. Diameter...._ _ Depth below inlet_.._ q Other Distribution box p Total leaching area..................sq..ft. Z ( ) Dosing tank ( ) ' Percolation Test Results Performed by.......................... --------- Date....... Test Pit No. 1................minutes per inch Depth of Test Pit--_-----_-_.•----_-• Depth to ground water........................ fs+ Test Pit No. 2---•--_•--_.____minutes per inch Depth of Test Pit.................... Depth to ground water.................... . ... .............................. ............. p .... Description of Soil._..----••- 44 W ..................................................-•----•-----•-••••----•-......----• .......--•-••----••-----•-• ----- -- ---•• pp .✓ � x ---•-------------- .._.-•---• ------ . ---- •---------- ---------•--• - (� Nature of Repairs or Alterations—Answer.when applicable _ ,? '•- Agreement: = 1 �....... Y 7 The undersigned agrees to install the aforedeseribed Individual Sewage Disposal System in accordance with the provisions of'I�'114, 5 of the State Sanitary Code—The undersigned furtla rig ees not to place the system in operation until a Certificate of ComplianceFha's been issue rd ie th. Signed..._....__ --------- ------ - 6 Application Approved B .. i --------------------------------•---- �ate� � Appliea.tion Disapproved for the following reasons:................................................................. Date ---------------------•---•••--•-••------•--••-•-- /^ Permit No............ V Date • ---•-----•---------- ----------- Issued------_-------......................................... Date r • ur �� jam_, ,�. FEB............._..... ..... E COMMONWEALTH THBOARD�OF OF HEALTH Ts2-3� f.......OF........ v`�1�' NVVIlration for Disposal Works Tonuirurfion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 0 40 1 r� --.Locations Address or Lot No. .._..._ •t,v J o�: _�....................... ...................... Owner``. ^. Addr ------ .................................. (f Installer Address Type of Building „Z Size Lot...........................Sq. feet a Dwelling—No. of Bedrooms._..._mot.................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fi u>:es ......................... •---.....---•-•---=-=. W Design Flow.........:....._.-...._......_...........gallons per person per' day. 'Total daily flow_.......... . .............gallons. WSeptic Tank—Liquid capacityV.') eons Length.....Y....'.. Width....H....... Diameter................ Depth................ x Disposal Trench—ttNo. .................... Width.................... Total Length........_.._..... Total leaching area....................sq. ft. 3 Seepage Pit No------I.............. Diameter...._L.rr�_i... Depth below inlet....._......... Total leaching area..................sq. ft. tKw Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.........................•.......•••............................:...----_. Date........................................ 4 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ L: Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - ----- -----------••••-------- ---------------- :.... Description of Soil................ .�4_ _ ��........... V --•-•---••-•-------------------------•-- x -------------------------------------•------------------------------------------- . ------•-------•----------------------------••------•-•-----...... U Nature of Repairs or Alterations—Answer when applicable--------k_U'._T?.2...... Agreement: .� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System'in accordance with the provisions of TITi..i; 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 bdT d ofrhealth. .-� Signed. "+ - - ,-- ; -- -- _.. -•-.. Date Application Approved BYE--•- 1r�..C _.. ~... ......... �/t�l�6 .......... ,----- ,----•---.- Date Application Disapproved for the following reasons-----------------------------•--•----------------•-------------....-------------------------•-----•............. ....--•...............................•----...-----•-•-•-----•----•- ..... -----------•-------••---------------•------------------•-•---• Date Permit No...........��r__ ...... ._ __ ----------• Issued................. ...•-•-----•-•------...------..._. Date —.._.._....._--_...------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF......... :.......�!..1!t:C . e.!?....... Tertif iratp of Toutphana THIS.IS TO-CERTIF/Y, That the Ind ivid"��ua_1 Sewn e Dispos 1 Sw'stem constructed ( ) or Repaired ( ) by -14 ~. ....• ' - Instalt at /- 2 _. .... . ... ' has been installed in accordance with the provisions of TITS' of ' ate Sanitary Code a described in the application for Disposal Works Construction Permit No......__ .._ . .._. da.ted........—'e .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTION'SATISFACTORY. W, DATE .................... Inspector..- � Lb......................................................... ! r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` 1....`�✓V .......OF.. �.: FEE.... , �. No �....4 6. .................. } io�r�asnl� ork$ Tono#r ion f lirrutit Permission is hereby g rad f. ±" "==_.: _ __...... to Construct ( ) or Repair (\-),an Individual Sewage Disposal System �.... ........ ................ ..................................................... Strect as shown on the applicatioir-Aisposal Works Construction Permit No�c�i'�_��✓�!, D'ated___..��. ............. �/ �la�ianl oI11calth DATE---------- -- -•------ ..... 1 `