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Home My WebLink About0424 SKUNKNET ROAD - Health o ' S M E A D No.2453LY UPC 12934 smead.com • Made In USA wmanvE cwe.a�so�►� p N LOCATION SEWAGE PERMIT 0 VILLAGE I N S T A LLER'S NAME i ADDRESS Z206 =a(-- �3�tiyr��3Lr� e U I L D E R OR OWNER a A. DATE PERMIT ISSUED c��gff3L _ DAT E COMPLIANCE ISSUED Jo �� 4 ti. O �� i � s-. 1 �o y�� NCI , — - - . �� '= i(f%E L� 4 �N � 1��42 .............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..............OF....... 4.e.-•---- Appliratalan for Bh4poii al nrk.5 C�nnitrnrttun ramit Application is hereby made for a Permit to Construct ( L,)'**or Repair ( ) an Individual Sewage Disposal System at: �� .............� `�.-' --- ......................... .....--••-•.....-----•--.....---------_..._. ..-.............------................... y --Location•Kress . � or Lot No. ....--••---`�../_��i ........... - --:::�:..."...8�- .:.�i. ............................................. ............................... Location s..... \ ' Owner Address Installer Address UType of Building Size Lot.._1_��___9Q.®....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (IQC) aOther—Type of Building •_______________•_--___----- No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures .............:.•--••------......--•--------•-- w Design Flow...........\.\�.....................gallons per person per day. Total daily flow-------------- _ ..............gallons. WSeptic Tank—Liquid capacity�lQ.....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 to ( ) `-' Percolation Test Results Performed by............`3_- / ! .. ._.. _., 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........................ R+ ---------- xDescription of Soil..... - -o�...........\�c��--•--._ ..�. ��-9 � �--•....._ ......... .......................................I.^ .....v------------............. _-• 1.^..------------V.& .... =5 ............................. w UNature of Repairs or Alterations—Answer when applicable............................................................................................... •------•-----•--••••--•-••-----•------•-----•-•--•---------•-------•----•--------•--........--•-•---••--•---------------•--••-•••-•----•--------•-••-•---••---•--•----•---•-_........-•----••---------- Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITT,;�. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beer'issued by the board of health. X_� Application Approved B .._ _..:.. . -- � y" Date Application Disapprove or a following reasons-----------------------------••--------------------------------------------------•--•--••--•--••---•---•---•----- ------------------•-------------•--._.....•----••----•--------•-----•----------•-----•--•----...-•----------•••-----••---------••---•-•--•--•-•--•••-•----------•-•---•-------••••••----•-•----...._.... Date PermitNo......................................................... Issued....................................................... Date .w ........................ Fss.3 5 ........... • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �W.n............_OF......�.�C.n,>..�c� Appliratiou for Diipuiittl Workii Tomitrurtiou Famit Application is hereby made for a Permit to Construct ( C-)0"0or Repair ( ) an Individual Sewage Disposal System at: � -------------� �V. =n -� - ... ..... ......_. ....... ..----- --•-•-....... Location- ess or Lot No. ..... rn e . .. .. 1... .........).1. .................................................................................................. Owner Address S ................................ Installer Address Q Type of Building Size Lot.._�5 0....Sq. feet V Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder NQ Other—T e of Building ............... No. of ersons._...__..................... Showers — a Other—Type g ------------- p ( ) Cafeteria ( ) Otherfixtures .......................................................................... ----------------------•---------•---•--...... w Design Flow...........v o...........f.�....'-�...gallons per person per day. Total daily flow--------.--_-_3.3.-_--.......__._._..gallons. WSeptic Tank—Liquid'capacity., 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 tanl�( ) + L O- t a Percolation Test Results Performed by------------- Date_.__, ............................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 ...- O Description of Soil-----Q.... ....--------- C�Gcvrn ._.. 5` �--------------............. c, •--••-•-------•------------ w UNature 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 TTL, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ssued by the board of health. ne ..... .....cn r`: ............. e Application Approved B .- ..t... .........`�. ..................... � Date Application Disapprove or a following reasons:........................................................................................................ --•--...--•----------•-------•-------•--•---•--------------••----------------------••------------•.....-•--•-----------•-----------•---------------------------•--•----------------------------••------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O�HEALTH .............` .............. ..OF...........................G`...... ....."........................------. TAT rrtifiratr of Tompliaurr THIS IS O CE TIFY, That the I ual Sewage Disposal System constructed or Repaired ( ) byL\R .. ....v....:ry ----------------------•--•----------------------------------------------........--•-•.............-•-- r i ' I staller /� � QUA,n _ has been installed in accordance with the provisions of TI i L ; 5 of The State Sanitary Codas scribed in the application for Disposal Works Construction Permit No---K -17. ................ dated__.` /.v.�_ �' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........-•-----••....................�...�_....'�1i......-•--•..... Inspector....,, 1_............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH, ......OF....................C� �.s-:TG.... r- c�� - ................................. FEE.._..................... Disposalrkii Tuno .eruti# Permission is hereby granted..........\ 5 `.-�...... S ........................................................... to Construct (k.,)"or Repair ( ) an Individual Sewage Di osal System at No.------. ....---....... ..............Z-Y r`' - C aC' (V t-• �. ------••.....-- Street as shown on the application for Disposal Works Construction Per 't N0._� .� _ Dated.._ .a�'.. .............. ------_._...�_1..�__-Az!-------------------............................................... V'))_4 Board of Health DATE.---•---------------------------••-... )f�� FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 1.10 GAtZf�AGE FRt♦1t:�cjL �� •• 1 't s G.p•D. (��taao . mat a� Ft.,cw L 1 O 3 3 .o , SEPTIC T"A+-14 = =33o d Iri0 °: • 49 5 6.P.D. 43•/ U Ste' %OOy 6 AL.. ;. .. ` ......_ . 0-3 7?ISROSAL PtT u�.E loan Gd_ � 4". 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