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Home My WebLink About0618 SKUNKNET ROAD - Health to 9-- SMEAD No.2-153LY UPC 12934 amead.com • Made t USA SA ORAJNM ESTRY WITIATIVE Cardfiod R6�rSourcinp o I No0-AVA/ . ..��. :;. FEB... a................ THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH Appltration for Khapaoal Works Tomitrurttoat remit Application is hereby made for a Permit to Construct (vj'or Repair ( ) an Individual Sewage Disposal System at: -� .. ...... .................... Loca'o Addres or Lot No. ....... ��.m. s..... ....` ........._ ................................ .��• .x1s.. ... AcaJ�'. --................................. ` , a Owne Ad�iess a -V C1..(1., ........ ._(C.?L..................... ..............��--�+r1 s - c�. . ................................. Installer Address \ `.�0t�0 d Type of Building Size Lot___\50 0 feet aDwelling—No. of Bedrooms.............3-___------__-_-___-__-Expansion Attic ( ) Garbage Grinder (�)) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -----•-------------------------- . W Design Flow..............�V ....................gallons per person per day. Total daily flow............ .��..�...-...__..___..___gallons. W x Pt ic Tank—Liquid caPacitY. __ gd thns Length . ................ ------•--- ... Depth................ Disposal T nchNo � W / - - Total Length...2 %--.... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing ank ( )`` AA ' Percolation Test Results Performed by....... .. ............... Date......%...... aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a • ------ -------•-------....._.............-----•--•-----------•------- - ----•----- --••--•---•--------•-........................................... O Description of Soil.........n= 2.. ---..._�Q .._.._:SnA.---.....5-v..... ' ----- V ........................................ ..-... .,. ........ :Q_�----- � -f1 r 5� .....__..... - 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 TITM 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.......... ---..............� S7, �`A .-•----------•••---•-----•-----•--- -............................. Application Approved BY r: e... ... _. .................................... .............. . ........ Date Application Disapproved for the following reasons----------------................................................................................................. --------------•-------•-------------------•--------------.....--•-------------•--------------••----------•----•---------------------------------------------------•-................................... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSE-TTTS BOARD OF HEALTH ...........CqlPP.n.............OF..........,�' ..fJ�Ll.n.-9 .................. TertifirFate of ToutpliFaurr THIS IS TO CERTIFY hat the Individual Sewage Disposal System constructed (L e j or Repaired ( ) by.......... ............ -�� —�--•-----�.�--- Installer i at................ � .. o Ctiei, f- - A- has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. __..,�'_._91X................. dated---------------------------------............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... LOCATIO. � SE AGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER DA T E P E R M I T I S S U E D DAT E' COMPLIANCE ISSUED 3� s a . Y 3 uI yv s o ' �604 y No,y -. ....1....... �� FEs....::�..�................ THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH Applirtation for Disposal Works Tonstrurtion Vanfit Application is hereby made for a Permit to Construct (t_4 or Repair ( ) an Individual Sewage Disposal System at: l ...................................................... ...... -:_c.-....-----•---=....---..- •---•--•----..........._.._.............. '-- Location-Address ; or Lot No. ' — •-' ....__.....Owner--- .................................... ......................................_----- `'•---...... �`j -(- _ l� .a a�--Irl_� 7 ---r1 -- c.� aa\S ---....__._•-- ----•••. t � Installer Address -� Type of Building Size Lot... �U U 0 Sq. feet Dwelling—No. of Bedrooms..............)...__......._......_.__._.Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----------_•-- •-•--•••-•••-••-•••----•-•-••--•-••---------•••••--------------------------------------•_---•-----•••••-•••-••••---•-••••-•--•-••-•- W Design Flow...............,_\_0____............__..gallons per person per da Total daily flow.._.__._____: °5� g g P P P Y Y ...................•--•-••--gallons. W Septic Tank—Liquid capacit}'_1_" .gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No........4e.......... Width_____ _ _______• Total Length......IV...... 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 b ....._.ti�:'__�__ __�._CA___..-'=_..�___:`:1.�-- .......................................... Pit 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------------------------•---•-•---••----- .........._--------------------_----•-•----•----•--------•--•-- D Description of Soil......... :_ �""----------•--•• --- --'Qb_5 x \ -'�- ---------------------------------------------------------------------------- W VNature 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........ 4.. `F` • �- S ................................ n.-- Date Application Approved By........... :. '� &��%`�• Date Application Disapproved for the following reasons--------------------------------------------------------=-----------------------------------------------------•-- .......................................................................................•--••-----•••-•------•-•-•-•-••-•--•--•••-...--••-••--•••----•----•••--••-•-•--•-......... ......---------- Date PermitNo......................................................... Issued_...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH u n c.tA c `-�- -=�--- ...............................O F.......... ............................. ....................................... C�rrtifirab of Tompinanr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (i,•j or Repaired ( ) by........... -- n...`------------ -.-�-----5_ ------------------------------ --------------------------------------------------------------------------------•--------- ` Installer at--••-•••--••---`=• 0........... -�•-•....._ ,'. ..fin. •r-. -------------•- c c�.......... n .'=` ' ...................... 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 NoA�1 "� 0................. dated................................................ y . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector.............-...................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH \v '^ OF............ �................... s- No... ,. .....- FEE.......................... �i��ro�aal ork� �on��rnr�ion rrani� Permission is hereby granted...... . ___ _____ _________.__. `..... � -•-•••••••-••••.................•-•..........••••••..............._ to Construct (%,-f or Repair ( ) an Individual Sewage Disposal.System .. �v1� r. ' � � ( -kCat No.......... ..........••-•••-•-----_•--- ._ . . ... .`....... ' K!1 V - .:_l - Street as shown on the application for Disposal Works Construction Permit No..................... Dated..................................... ..1%� ✓ DATE. ��- �............................. ...•••-•---- ;IIoard of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ..� fI -DATA Si1JGlFs F'AMIL`� 3 BEUQDUtitFa IC. 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