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Home My WebLink About0107 PLEASANT PINES AVE - Health (2) 107 Pleasant Pines Avenue Centerville A= 233 —056 SMEADO No.2-153LOR UPC 12534 amead.com • Made in USA 4�cvc� �J unnt LOCATION , SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS l j ,(Q '-c A c,-, 3 U I L D E R OR OW °ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ® �� R CLW 12 tl No....8 2=l1.r Fpc.....s ts. .. e, / O I THE COMMONWEALTH OF MASSACHUSET S / BOAR® OF HEALTH - oF........, ,,,P ---------------------- ApplirFatiun for Diipus al Works Tunitrurtiun ramit Application is hereby made for a Permit to Construct (A,-)"or Repair ( ) an Individual Sewage Disposal System at: ................_...............Z` -, ��.tQrl1 •- �T ��. -N•-.-.........................................--------------- Location-Address orLoto ....MfY /A..o 54 /�� ../5y �.A.... V........ ......e%3... X4R Own r Address Installer Address .� U Type of Building Size Lot____, c ._ t r., Dwelling—No. of Bedrooms...........Z............................Expansion Attic ( ) Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers ( ) - Cafeteria ( ) 04 Other fixtures -------------•-•--------._... -•----•----•---------------------------------------•--•-•-•---•------•--•--------•-----•-----•-•------ W Design Flow.....................sue.5...............gallons per person per day. Total daily flow____.__...._... Z.0.................gallons. WSeptic Tank—Liquid capacity./%<0dgallons Length, -Width. �- _._ Diameter................ Depth....4"-&-. x Disposal Trench—No..................... Width.................... Total Length_......_._.j_.____ Total leaching area....................sq. ft. Seepage Pit No.......,/.......... Diameter�e3_............ Depth below inlet_'.'..._4........... Total leaching area...S`Q..._ Z Other Distribution box (p/f Dosing tank� a �F Percolation Test Results Performed by...... g ........................... ..•--••----•-•-•_... Date..... �tN MAssgc a Test Pit No. 1----------------minutes per inch Depth of Test Pit....._.i_v _..___ Depth to ground water_._ .. ._. ti ►"' * g P9dA AN <n (z, Test Pit No. 2•-_____o�D�._-%minutes per inch Depth of Test Pit•___-1'Zo _._.. Depth to ground water.. cz- a ................................... v_..Ya� AAAN y O �W10,"TT705 O Description of Soil Q_.... ... •��R�i '----- --- u S'��' ----------- W ................. ........................................ ---Ally _l�' ��...__�X e__, ................. 4J6�_.� T .�-- CIS/OIVAll- -- ..... 0 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 TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha en issued by the boar of health. Signed `�"� _ � ......................................... D to Application Approved BY E ,_ ,,.. ,� ............................. . ....•••-- Date Application Disapproved for the following reasons:................................................................................................................ --......---•--••--•--••--•••---•--•---•--••-•---•••--••--•••-••-------•-••••-•--••...•---•••-••----•-----••---------•-----•-••--•----------••--•--••------•••-•-•-•-•---------•-•------------•.....----- Date PermitNo......................................................... Issued.----...---------------------..........•---•----------- Date Fnic.. ........................ THE COMMONWEALTH OF MASSACHUSETTS- BOARD OF HEALTH ......7.0&.1.IV..........OF........... ,I/, ..t.................... Appliration for Klhiposal Workfi Tomitrurtion ran fit Application is hereby made for a Permit to Construct (A,,) or Repair an Individual Sewage Disposal System at: ............................... ..................................................................... Location-Address or Lot No. ..........C-45;4J7__.-- Ow'n"er �dress .......... ............ ........................ .................................................................................................. Installer Address Type of Building Size U Dwelling—No. of Bedrooms..........-3............................Expansion Attic Garbage Grinder 4 ok Other—Type of Building ............................ No. of persons......_..............._.._.. Showers Cafeteria P4 Other fixtures .................................................................... -.!Il ...*---------------------------------------------*-----------"------------------ W Design Flow.....................*:rS...............gallons per person per day. Total daily flow............._.3.3.0................gallons. 9 Septic Tank—Liquid'capacity/,.5.'O.,Ogallons Length 1.o..':7.6."'Width..;��-.4?._. Diameter................ Depth.... W Disposal',,Trench—No. Width.................... Total Length......_......__...._ Total leaching area....................sq. ft. Diameter.,x,a.............. Depth below inlet.....J:;�.......... Seepage' .......... Total leaching area..S:�5,6....&q�tdeo Z Other Distribution box Dosing tank Percolation Test Results Performed by,..... 'Y-�a. .......................... Date..... .!Z -OF Test Pit No. I--------;� minutes per inch Depth of Test Pit........e,X...... Depth to ground water.... Test Pit No. 2.......�_-.minutes per inch Depth of Test Pit__...,.!z_."'_ Depth to ground water_ MAN .0... ............................................................................................................................ 0 Description of Soil_.2�/'/... Sc .0 - ,4e—— ... ..... ., &... X.&U--------- .- !?- ----_--------- ... ND_12705,c� ............................................................... ......... ............................ U -................ ---------- ............................................ ................... U Nature of R�pairs or Alterations—Answer when applicable....................................................................................... ......................I.................................................................................................................................................................................. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of The undersigned further agrees not to place the system in 5 of the State Sanitary Code operzqi6n until a Certificate of Compliance hasb!gn issued ty�he board of health. Signed.. .............11 . .................................... ............................... Date App1KRti6ft'Apprpved By..- .... ...... 15,0.021............. ... '0' Date Application Disapproved for the following reasons: . ............................................................... ...............................................I......................................................................................................................................................... Date lFf, Permit No............... ........................................... i Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ....OF......... ............................... Tatif irate of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (LP,) or Repaired b ...........&..C.04 :14 y ju,��........... .................................................................................................................................... Installer at--------- W -------- ----------- . . ............................................................. - 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 ............... dated_...-,_ ------ _--------------- THE ISftAN E OF THIS CERTIFICATE SHALL NO-T-BE.CONSTR.. S A GUARANTEE THAT THE SYSTEM Wy , NCTION SATISFACTORY. DATE..Zl/....... ......................................................... Inspector._... -----------------...............---------------------------------- CO STR.... ............... " THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... FEE...7-e.- ... Disposal Vorkg T-FaInarudion "prrutit Permissionis hereby granted.......................................-................................................................................................. to ConstruetAr"I epair or R ( )-an Individual Sewage.'Disposal System.:�0 .... ! tNo.........r.k..r—SAr....... --------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit Nq.--__-.� ............ Dated.._7 h ........... oar of e ...................................... ----- ---------------------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ` ----- - - - - --�_; - 1a--AL.L Et.-E�/. 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