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Home My WebLink About0542 SKUNKNET ROAD - Health S M E A D No.2-153LY UPC 12934 smead.com • i ade in USA SMANABLE WITIATIVE CYttlflidRbYfBourcinp r No.. -....a� 61J Fxs...a,lv. ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH NOWT...................OF..........)..Chif�5'T t_...................._... Appliration for Uiapoiial Workii Tonstrurtion Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at* \ ' i (� un K(e. C 1,\ cQk n --....... _................. ° --------........---.......-•---•------ ................. --.._..-------•--'. ----.......-------•-•-----•--...........-- --.----•-Location-Address �- nor t No. - .... .G `�.... k= .. . ..................•.... .._...... � . n.�. ... -............. ----- ------ • Ow dress w \ .. .... "fir 'ems ..... ` -- a Installer Address UType of Building 3 Size Lot... ., 11_......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (Q P '4 Other—Type T e of Building No. of persons....................... Showers � yP g ---------------------------- P ----- ( ) — Cafeteria ( ) dOther fixtures ------------•-- -••----•--••--•-••....................•-----------••-••......-•••-------- ..................... W Design Flow........... .......................gallons per person per day. Total daily flow__._.........-3 ®..__............gallons. WSeptic Tank--Liquid capacity-l(No.gallons Length................ Width................ Diameter__._____-___-_ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.......I............. Diameter.._...1 ..5�.. Depth below inlet...../........... Total leaching area.,�.,,�..b__sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...._..bc 'c ........ ..... y -................ Date_....__�1,"_ .. a............ Test Pit No. 1... _ ._minutes per inch Depth of Test Pit.................... Depth to ground wate ---.---__----•--...____. 44 Test Pit No. 2................minutes per inch Depth of Test Pit...............•.... Depth to g o d to . __ ............. ---------------•---------•••------------•---• . Description of Soil-------�-�........ O`r`�--•---k.....S I s 0 Ux -----••-----�=...........•• c� e I --.-----. •--••------------------ x ---------------------- "L ------------. ��. •--.��•r�� 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 MIRE 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. aall Sig d Y�.... \� — Cc: o --.. -----..... Date Application Approved By.....-- ... 1 f) Date Application Disapproved for the following reasons-..............----------------------------------------- ------------------------------------------------------------------------------------------------- 0 Date Permit No......................................................... Issued. -` r� :u....... ------- Date IN SEWAGE P LO CATION GE PERMIT N E IT 0. Z-0/ # — & VILLAGE INSTA LLER'S NAME i ADDRESS Awl R UILDER OR OWNER 7-4 DATE PERMIT ISSUED F0 7 COMPLIANCE ISSUED d (, s . e 3 G 3R 6 i N o................./ �`6... FEic R} -..-'... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH oven..................OF...........1.:..C%�..rtis"Y c. c-...._..__..........._....... Applirtttion for Dispanl Morkii Toga uurtion ami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address +.. ^^^ r t No. \ ! Owner--,,,, wner dress aV e.......................................... YVO -s ..c_i..L...... � .... Installer Address Type of Building Size Lot._.\�----.`.... ......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (W)D PL4Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures --------------- -----•-••-••......--••-•--•--•--• . W Design Flow ...._. .. .......................gallons per person per day. Total daily flow............. > .��...............gallons. WSeptic Tank. ..Liquid capacity109?.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width....__r......... Total Length....... ........ Total leaching area............_......sq. ft. Seepage Pit No.......I-----------__ Diameter.._...1 x.S_.._. Depth below inlet......G_......... Total leaching area.��__�/_.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...... ? .......ac . ................. Date........ .....1.�........_.. 04 Test Pit No. 1...'/'.?.'---..minutes per inch Depth of Test Pit.................... Depth to ground wate -________--____-__----. 44 Test Pit No. 2................minutes per inch Depth of Test Pit-.--...:.-...:.•.:..Depth to g o nd�te D Description of Soil--•---O!t�..-••..-�-�Gfn------�-------S�„i 5 . . -------- ( "'4 tea'8 GC P�V�-�-------------------- .._ 1 V r W -----•-------------- ---------- .......TrAN 1-------•----!'n.t;t.....:� -Nl...-- ------------------------.Q j -----•--•-----------•-------------------•---- 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 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. Siged_.C PS , -----••---...------ �'...................... 7 / Date Application Approved B .. �... .._.. •---I'................................. PP PP Y Application Disapproved for the following reasons:............................................................................................Date..................... Date PermitNo.................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF ,HEALTH ....... J n..............0 F........... &'.r... ...�x-- Tnrtifirate of TompliFanrr THIS IS TO CERTIFY, That�the Ind: idual Sewage Disposal System constructed ( ✓<or Repaired ( ) by......... ------ ----....-•--- ......---------------•------------•-........----------------•---...---------------------------............•••. rnstaller a .at \ ----------••------•--- - ............................................................... has been installed in accordance with the provisions of T r 5 of�The State Sanitary Code as desc ibed in the application for Disposal Works Construction Permit No.AJW_._.__��_�P.�.._... dated-_/ _-_ . .. d_'..__.__..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WI L FU COON SATISFACTORY. 1 DATE--------- �---._�- --... ......................................... Inspector.�.--- ................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..r 1 No...._.. ..... FEE........ �i��o�tt orko �on��rnr#ion �ermi� Permission is ereby granted__n- ....r__.._�.`--......-----•--------•-••----•------------------••--•--•------------••-•--------.........-•----•.............. to Constru�c`t ( ) or_Repair ( ) an Individual Sey�rage Disposal Syste� `i at Stre as shown on the application for Disposal Works Construction Per it o.. ._ __ _..._. Dated../ ...................... .......... `.......................... DATE ...................................... oard of Health FORM 1255 HOBBS'& WARREN, INC., PUBLISHERS _r)r_—_Jsi4�-►.1 T;> ,-I'A • ��ll.yaL.L-.: �CMtt_�? � KL-"27T2'L`t7�Vl .✓�+�� ,,,,.. r. �1."'�"--•�.r.... 4 h ��-.�'tc `r'n► jk = 330. ISO % • 4 5 6.Po. �wF'��,at_� t=�1 f" - USE fOoo C•�L�.l.., IS 'Z..S Larrom Aet A= co sr-". 0 vor TOTAL. T>E-S16W = .-i25 ! r-C>TA L. 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