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Home My WebLink About0498 SKUNKNET ROAD - Health ct �CtJ q- 0 93-00-51" 5 M E A D No.2.153LY UPC 12934 amead.com • Made in USA WAWAbMWAAM CwtlBidFi�rSoureinp I 9 ' �� L0CATIORI SEW AG PERMIT NO. , VILLAGE cf/tip INSTALLER'S NAME & ADDRESS BUILDER AR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 71 ;�, ToLi 304 a q �4 3u No. Fus....:.G(....................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH lyst 9� Apliliration for Uiipngai Worko C outitrurfinat lirrmit Application is hereby made for a Permit to Construct ( ) or Repair \( ) an Individual Sewage Disposal Systemr at: n�\ \'�- 1` •Lo on-Addres r No. ....... ......... �. ............ a ......... .... �'.�..Z-_ :5=....................................... Owner ----••.... Ad ress - . ..................... .^ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............... _........................_Expansion Attic ( ) Garbage Grinder (jc) pa, Other—Type of Building _________________-_------ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow............... o................._...gallons per person per day. Total daily flow........... . ..................gallons. WSeptic Tank—Liquid capacity._Wo—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 Percolation Test Results Performed by....... -.0-JAi-_r.P ...... .... ...._ e......... Date......' Test Pit No. ]................minutes per inch Depth of Test Pit.................... pth to ground water........................ f� Test.Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....-.................. a ----•---•------------ ...................--- --------------------------------------------------------•-------------------------------•..........-...... O Description of Soil ...... .. � l b••o.,..•------•-----•-•-•--••-------------------------- --...... -----•------------: U ------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------............-- 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 TITS, 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 board of health. Signed..... .... ..... -,- .,_Y±n........... .............D-•.........._.... Date ApplicationApproved By-•-•--•--•--•-•-----•-•......•---....••••-••-•-••-••-•-•--•------•...................••--_....... ........................................ Date Application Disapproved for the following reasons----------------•-----------------------------------------...-----------------------------------------•••---_... -•--...---•.............•-•--------------••-----•----------------•----------------------....----------------•----••-•--••••--•--••-•-------•-----•----------•-••--------------•------•--------•••-•----- Date PermitNo..............................:..........•------------... Issued....................................................... Date No. _... .. --- ----- F>cs............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .........................OF................. , pplirFa#ion for Disposal Works Toatstrurtion .erutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �� tee~-�C �Lxz- ....... ...... ...... ......._....... •--...••-•••------..._........--•--•---" •.....---•••••-•-•............--.......-- ......... Loqati.n,Address._ 44r Lot No. ......,.,.r.._: _ ............:§h-..............................- ......... ...................... ....�..C_Kjk ........... Owner. Ad ress W _.. .................................... ...............................•... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...............a..........................Expansion Attic ( ) Garbage Grinder (Q§ Other—T e of Building No. of persons......................_______ Showers — a YP g ---------------------------- P (----)----...Cafeteria ( ---). Otherfixtures ------------------------•--------------------------------•---••=•-••--•-•••••••••----------•••-••••-••-••-•-- W Design Flow............. ``•.............•......gallons per person per day. Total daily flow...........-73.0_____.._. ........ WSeptic Tank—Liquid capacity..V� .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 ( ) Percolation Test Results Performed by....._�>-k.._V-1:(....... . ..... Date....`'{..",.. ...... W Test Pit No. I................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........................ •--•---•••••.....••-- •-----•••••-•--•-•-•-----••••-••----•-•.....--•-•..........................•• � ......................................................... '=" ` =� o r.Description of Soil--••••�- -- ...... ••. ------..\ - -----------------------•------....---•-----------------....--•••••--•........•••. V ..•-•••-•...............•••...-.....0:...--•z---;`--•-•••-•-••---..............=•-............ '-•`` 5 .............................................................................. W ......----••...••-----------------------------------------•----•---.........-----...-•----............--•...•-•.........•-•------•--•......•-•-•---•-•-•-•••-•-••-•-•••••............•................. V 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 TITLE 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 board of health. Signed.--- r i4rr�r�s.,. .Q� ----_-— `. V....----••. .............. -•-- --••----•----•--^- - •----•---•--Date I ApplicationApproved By.................................................................................................. ....................Da-•.............. Date Application Disapproved for the following reasons:................................................................................................................ .................•-••--•••...........-••••••-•-•--••-•-•••••...-------•--•...-•-•-----••-...•-••---•...•.•---•-•-•--•----•••••••--•••••••---••-•••----------•-•-•--•--•-••----••----•••--••-••.....-•••- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........� �':.:�-� ..........OF...........: .`..`..... -2.: ........................................ (Irr#ifiratr of Tomplitaatre THIS IS TO CERTIFY, That the Indiv' al Sewage Disposal System constructed ) or Repaired ( ) Installer � e 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 No......................................... doted_-------------------------..................... THE ISSUANC,E OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WIkl. FVNCTION SATISFACTORY. DATE__. ..................................................... Inspector......-oe _. ....................................................... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OE HEALTH ........ ..........OF................. � `L .. 7\ ...:. No......................... FEE........................ Diflvos�a orb Tonstrudion erutit Permission is eby granted �� .....................(-�. ............................................................ to Construct or VP air ( ) a . Individual Sew{age DisRo System �) Street lop as shown on the a pli ion for Disposal Works Construction Permit No__________ ated.......................................... ----------••-----------------•- --------------------•.------------------------•- �J --.....-----• •............................... oard of health DATE.._..�_�i�._---_- •-- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS -!50qEE7- I oL-Z -;.fstcj' tr- P-AmiL-{ 3 8tzeoous . . Avg, w+.t FLow • 3 it t t to 3?v r.,Fcb 3Mj-ttc �rA.�jK s 88o ><ISo yo 445 t LwAc4A F•t ui E:'1- PL" Stc�wA,L.t_ l�tz�,o• t -t8 SF. ' . _.... . , . T.� ;_ ; ;. }� j ; .; ; f , {.:N r=r -: �-� mod'+!��C�.oB)C.2.5) = l94•G.RD. -•-- -- : � . : : .-- : -_ r'��"'�'- `�_,� �`" .. ' ` ' BoTT•oM A -" . < z88 'SF + E ~ ; TOT4t_ 'VESl6N dg2 6.Pv. E. , Pr-¢coLATI o Q IZdTr-- l IU AoW 0 : ...... .. .. .. ._ _. .._ .;_._. .... �____ �- �...__.�.�_..�m. ''-vLL,,,...mot-� - +. . - ,•,. 77 �TAtt_ of �DISFbSQI. "�D � I. : • . 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