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Home My WebLink About0112 PARK AVENUE - Health 112 PARK AVENUE CENTERVILLE A=207-029 M SMEA®® No.2-153LOR UPC 13534 smead.com • Made In USA LG,CATION , /' SEWAGE PERMIT .NO.. VILLAGE INSTA LLER'S NAME & ADDRESS ;zA B UI*LDE R OR . : OWNER j -- DA T E PERMIT ISSUED DATE COMPLIANCE ISSUED ".11' G _ � � Cl L _ /P -off ✓ 1 THE COMMONWEALTH OF MASSACHUSETTS 1:71 � - BOARD OF H ALTH �.. OF.. .w.ws�A .......................----............--------- Appliration -fur 43Wpoml Works Tonstrurtion Vrrmft Application is hereby'made for a Permit to Construct ( ) or Repair ( )�ividual Sewage Disposal System at:p Cx -e/►1 �1- —a -- n Location-Ad ss or Lot No. ........ A ..... ............. .................. ----...-----------•-•----........................... Owner . .. Address Installer Address d Type of Building Size Lot____________________________Sq. feet Dwelling—No. of Bedrooms.--__-3__--_--__••--•-------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -------------------•_-_-____ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P4 Other 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--------------------- Diameter..........•--------- Depth below inlet.................... Total leaching area-----.------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- ---------------------------------------------------------------- Date--------------------------------------.. a Test Pit No. 1................minutes per inch Depth of Test Pit-..----------------- Depth to ground water.........-_--.-..-.----- t1 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--.----_-___-_-----_--.. P4 ------------------------------ ------------------------------------------------------------- ••------- ----•--------------------------------------------------- ODescription of Soil-------------------------------------------------------------------•--------------------------------------------------------------------------------- -------------- --- x U ---------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ------ ----------------------------- --------------------------------------------------------------- - - - --- --- - --------------- U Natur of P.epairs or Alterati s—A s r when applicable..._.. _.._ ._. Q.B_D.._�C �............. ---------------------------------------------------------- Ag ement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b tssued the board f a Signed-- ---�--------- -------- ...-�-•- 1 -------- "' // �---77__ Date Application Approved By........... 17 Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------•--------------------------- •---•--•-••--•---••---------•----•--••-•----------•-----------•-----•-...•---•-------•-••-•--•-•••---•-•.-------••--•--------------•---------------------------•----•-----•-••--------------••-•------•- ® ------------------------------------------ Date 7... Date PermitNo.- 2,2----•----••-----•-••--------•-------_•_. Issued.....__-�7� Date ,sr's TH:E COMMONWEALTH OVA,-MASSACHUSETTS ":• I. tr s s BOARD'xOF HE<ALTHlop c� .... .............O F..... fI Y . �px ifir�#r of f�mrm li rcrr . THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Installer } at----------- 140-'------- --------------------------------------------------------------------------- -------- - ------ ..................... lias been installed in accordance with the provisio`iis of articleI of The State Sanitary Code as described in the e,... application for Disposal Works Construction Permit No 'j . .`-`_r .... ................. dated...._ _ -b THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE ` SYSTEM WILL FUNCTION SATISFACTORY. DATE__ t Inspector x -. . r F 4E 0 'MONWEALTH OF MASSACHUSETTS, BOARD OF—,-,HEALTH �r: S". frli ........... No....... 7�' r Ad FEE .. ;ES.�� ... Nor k (IT ottlitrur' " } rruttt Permission is hereby granted.......... ...A.I..... ........ ............................... to Construct ( ) or Repair ( an Individual Sewage Disposal System. atNo.-- ------ ,�• .----•-yyf+ /� = G "--•---... =. t'a" t±lr �------•---------•----=--------------------••-------------......_.._..--••-•---•-- ;,. Street as shown on;the application>:for,,D}sposal Works Coii�iiaction Permit No------ ----- Dated------- _ ....... r ------------ - ------------------- ................ F DATE---------------------••-• 4 ra of Health },, r- Y.,k a f4..5'..xv. „�'n„} i FORM 1255 H0665 & WARREI� NC.. PUBLISHERS u l > t as t... ' r�'r§`:*....SSA. „,;rwt,,�•f. ^��;?.j4ri * a tl. .................... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H AuT. ....r� 4!:) ea ..._O F.. . .......................... Appliration -fear EN-rip ial larks Cn�ktS#rurttoYt rruti ✓ Application is hereby'made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: 0^4 ._.._.....• . .. �-----...--• •--- ... ............. .. ....A ------ .__.................................. Lo anon-Ad ss - or Lot No. -__..... ..................................... Owner F Address 4t' W ` k Installer a '[fu '13 Address Type of Building �'Size Lot__________________________Sq. feet �-, Dwelling—No. of Bedrooms.............................................Expansion Attic,..( ) w Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons. _ ShdQe§.. — a yp g 1 -._ Y i( ) Cafeteria ( ) dOther fixtures ..... ------ ------ -------------- ------- F �. ------------------- .--.---------- ------------- -- W Design Flow----------------------------- gallons per person per day. Total daily, flow..---_ '___-•--_-...._, , ._--gallons. WSeptic Tani.—Liquid capacity--- " i"tllons �'` ,]length---------------- Width................ Diameter__'`� xDisposal Trench—No_ -------------------- Width--- ---- I Total Length..__________....__._T—otal leachingllzrea--_------ ------- ft. 3 Seepage Pit No..................... Diameter T.__-,__ 2' Depth..below,inlet_..._.______________ Total;leachinlarea..__.___.____ __,sq. It. z Other Distribution box ( ) Dosing t Ak,,( � r � Percolation Test Results PerfdrrPaed by --- �--a� ---------. --------- Date-------------------------- ----- --. a Test Pit No. 1----------------minutes per titch�t Depth o 1 eN Prt _,:_..... Depth to ground water-... _ .-_.-.--_--_.... L� Test Pit No. 2................nilhutes per inch Depth of'�Test.Pit-------- Depth to ground water------------------------ ----------------------t� Description of Soil ......••---..,,---------- :-----••-------------•--------------- V ------------------------------- ------------- ------------------ ----------------------------------------- ----------- ---------- ---- --------------------................... 0 Natur of Repairs or A ertti s--A r when applicable "�,` -- -• = Ag ement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t. the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued W the board„gf I a Signed. 4•••-•-•- -_ - .2 + k' Date Application Approved By---- ...^. '^;F __ ..... � Dated Application Disapproved for the following reasons__________________________________________________ .. . •fix firms ,� - �•� --------•---------------- ------- ----..... h1 __. ................. __._ _......_•..___________ '� '�} .._.. --__ __.-- S .F �t+Date A�� Y�. dy n A s�k.� - Permrt.No. iAjo as Date i