HomeMy WebLinkAbout0124 SETH PARKER ROAD - Health .24 Seth Parker Road � -
Centerville
A= 170— 187
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Ks MEAD®
Na 53LOR
UPC 12543
smead.aom • Made in USA
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ASSESSOR'S MAP N.O.._ 70 /< PARCEL " 7 o 2--
-LOCATION � SEWAGE PERMIT NO.
,,VILLAGE
i
-c,�',r tie Ile
INSTALLER'S NAME i ADDRESS
l � 4e) r
lUr �c�/
B U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
6 7
3r 7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD IKHEA T
Ap lication is hereby made for a Permit to Construct ( 4I_`or Repair an Individual Sewage Disposal
,Aj�syste�aat, �2
41-1�
...............I A .......... ............ .....�_K!............................................
Address
Installer Address
Type of Building Size Lot_.Z.!h_`/,_ZX_W_ -----Sq. feet
Z Other Distribution box ( ) Dosing tank ( )
—................................................................................................................................................................... ................................
Agreement:
The undersigned agrees to install the afnrc8eoccibe6 Individual Sewy isposal System in accordance with
the provisions of'T'TIS 5 of the State Sanitary Code— The undersign rthe rees not to place the system in
operation until a f,@r
ce as een i ey the b d ealth.
~ «-_- ~ .. .................................... -' ---,---__--
»"te��
Application Approved 8y—.------_-.^���.��'������������----------_---'- ____11�'�� -.�"�a�=`__ �
' um=
Application Disapproved for the following reasons:.................................................................................-___.__________
-----------------------------------------------------------------------'--''---------------'----
Dat
Permit N
-70 Date
._ � FRs. .' ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H EA TRH,
F
...----�---
Aliptiratiun for Diupou�tl urki Tontrurtion Prrutit
Application is hereby made for a Permit to Construct (k)nor Repair ( ) an Individual Sewage Disposal
Sys - .._.- � � .. ,---•%.
-
.�' .. P s j^' Location-Address, Lo No
.................................. 3.. 5. ......__..._...._.-.._........ ..
Address
f
............................ ^ ...
PQ Instalier Address
d Type of Building Size Lot. .....Sq. feet
Dwelling—No. of Bedrooms._......."..............................................Expansion Attic (it/P Garbage Grinder (,4L"r
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
P4Other fixtures ••--•-•-•...._..----••••............................•..----•......•-----••--•-••••••----.._...•---•--------•--------......----•-.......--•----•-------
W Design Flow........''�..................gallons per person per day. Total daily flow------ .................gallons.
WSeptic Tank—Liquid capacityl.?n4:..'.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........................................
Test Pit No. I................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........................
1:4 .................................................................••---------•--•••---------•--••-••.........................................................
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
c,
w
----------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------_....
U 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 TIT 1-1 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a tincate of Compliance has been issued-by the board of�health.
Signed.... ..`:�........<'" s-� - 4 v,,
----------------------•-•---•----•- ------••-•-...I ......
Date
ApplicationApproved By--------------•......•----•------......---•----•--••-----......--•-•...............----........_.
Date
Application Disapproved for the following reasons-------------------------------------•--------------------------------•------•-------•-•.._......------....--•---
---------------------------------------------------------•--•---•-......----�---.................----•'--------------•--------•----- --------------------------------------------------------....-----
c^" Date
PermitNo........---- ....... Issued.......................................................
-Z Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Tprrfifiratr of Tomplinnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( }
by. � -� ------•.. •---------------- ------_-___-•------•----•----•----•-•-----••-------------•--------•-------_-_-_
1 ( +`I staller �
at .. - �.�i C C.. ........................................................
has been (nstai e` �accccordance with the provisions of i I T LE j of,The State Sanitary Code a descri-oo in the
application for Disposa lvorks Construction Permit No.___ _ -_.. dated.--. �_ _____________
- v-Z
THE ISSUANCE OF THIS CERTIFICATE SHALT. NO BE CONSTRUE® AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
7 - ZS ............................ Inspector..................•. � ...............................................
THE COMMONWEALTH OF MASSACHUSETTS
�� ..-•--F BOARD-OF _,HEALTH
rr 1
'
......i.. .. tr� lv.........OF.............. r....!1"
---
IN .__
UisposaL orku Tons t pion rrutit
Permission ism hereby granted -----•--•-•.•-•---�-------•••----•--...••••------------•-•-•-•---.....--•.......................•---••
n to Construct ( )/or Repa .. .-}-andi i�ival.Sewage Dispo al- s em
at No...__Cam-a''� c�1_ �c "f. .----- .. _
J.eet � t �<7
as shown on the application for Disposal "A7 Construction Permit No� ' ated.
..................................
Board of Health
DATE --------•--•--• -- ---------------------------
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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