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Home My WebLink About0006 STAGE COACH ROAD - Health 6 STA�� Cova Rd. Ct Ot rv;cce S M E A D No.2.153LY UPC 12934 amead.com • Made In USA MWM5RY INITIATIVE Cordti�dFibarBoumNp �k No... s3 Fizs..�..�..�............ _ THE COMMONWEALTH OF MASSACHUSETTS �. BOARD 9F HEALTH �1 .............A�aA-2....OF..... .... .4Wd7!,!V. �l�% - -------------- Appliratiun for Diipusal Workii Tunutrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage tDisposal System : c�.. _. .......eL.1............................................ _.............._........_......_.......... .. JJL��i ress or Lot No. ...... .._... Lsl.C._�_ .................... ............... .... ................ Owe ...... Address-' ............. W `7�. ...........................•---•.......--••--•--- Installer Address Type of Buildings Size Lot...........................Sq. feet ,., Dwelling 0. of Bedrooms....:.......................................Expansion Attic ( ) Garbage Grinder ( ) Other—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 capacity............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 ( ) )--4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ -- ----------------- -------•-•-•-•--•----•-•-----.............---...-----..............---.......----•---......---------------••------......-------•-- 0 Description of Soil :. •----•------•-•--•-•---•-----•-•-•----•---------------------•------.....----------------•-. V ---------------------------------- -•------------------ •------------- ••------------------ --------------------------------------------------- -------------- •--•---------- -----. ---------- W ................---------------------------•----------------------------•-------•----•--•----------------•-•----- ------------ UNature of Repairs or Alterations—Answer when applicable______-r`__�___....''_..-l�_U ._. ...... ................... ----------------------------------------------------------------------•------------•-----------•-----------------------------------------------•--......---------.............------------....--•--..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITLL 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 thyboare hea t Signed ,. / Date Application Approved BY-----. ------. Date Application Disapproved for the following reasons---------------•--•---••--------•--•-----•--•-----------------•-------------------------------•------........._ .....................•-----------•----------•-----------------••-•---------------•-------........-.---•--I------------.......----------------•--•...------•------------------••-------------------------- Date Permit No. s•-'-�� --------------- Issued....................................................... -.-.... Date .1 -.-•..................................................... No...A.......... THE COMMONWEALTH OF MASSACHUSETTS _,-_., BOARD .;F HEALTH/, 0 .11 ............. .......... .... . ........... ........................ Appliration for Disposal Works Toustrurflott Prruat Application is hereby made for a Permit to Construct or Repair Individual Sewage Disposal System at-._, A .............................. `4 , ............. .......L;....;.I. ................................................................................................. X 1, 7' Location:—.Address or Lot No. ............ Owner......... Address..................................... ............ .......... Installer Address Type of Building Size Lot............................Sq. feet 1 4 Dwelling_L �o. of Bedrooms............................................Expansion Attic Garbage Grinder PW Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ................................................................................................................................................... W. Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid'capacity............gallons Length................ Width___.__.__.______ Diameter__.__._____._... Depth...._._._...._... Disposal Trench—No..................... Width_..._.__....._.___.. Total Length._____.............. Total leaching area...................sq. ft. Seepage Pit No..................... Diameter________.._____._.__ Depth below inlet.._................. Total leaching area..................sq. f t, Z Other Distribution box ( I) Dosing tank ( ) 1.4 �_4 Percolation Test Results Performed by.......................................................................... Date______.................................. Test Pit No. I........:.......minutes per inch Depth of Test Pit__._____........___. Depth to ground water..___._......._.._..__.. PL4 Test Pit No. 2................minutes per inch' Depth of Test Pit._____........__._.. Depth to ground water..._____.._......_..__.. r ..................4?.................................................0......................................................0..........0................ 0 Description of Soil.sZ�:a:�fe ..................................................................................................................................... .............7............................................................................................ ................................................................................ .............. -------I............................................................................................................... 2--------.............. ...............0.............. U Nature of Repairs or Alterations—Answer when applicable........ 4"" ..................................................... ........................................................0.......................0...........................0........................................................................................... 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 I operation until a Certificate of Compliance has been,issued by theeboard of heafth.,X Y Signed....... ......................................... ................... ............ D Application Approved By....... ........ .. ......!� Application Disapproved for the following reasons.................................................................................... Date -0.......................... ........................................................................................................................................................................................................ Date PermitNo....... ..................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................... ......OF.......tf.... ................................................................... Tertifirab of Tautplitturr CIS ISM '4CER TIF Y1 That the Individual, Sewage System constructed or Repaired byo..L,!._.. ........ ...... --------------------- ......2� ........ 4�.. ....... ...................0............................................0- ✓ _1itstaller at........................... ........................ ............. ?"', ............................................................................................................................ has been installed in accordance with the provisions of TITLE 50 he State Sanitary Code as described the application for Disposal Works Construction Permit No._ ................. dated..- .40.� ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST D AS A IGIUARANTE7 THAT THE SYSTEM WILL.JUNCTION SATISFACTORY. DATE.............. . .............................................................. Inspector......... .......... ...... .. ....... . . ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..A7P . . .......OF.................... Z ............. Totts!tr Prrafit Permission is hereby granted...... 4* ........................................... t C ` t .�c.t ( : 'Disj�qsW o onsp ,L-r4n Iddividu9<5_ewagj[ Sy's em ---------------- at No-t .. . ....... --------------77�.............................................................. Street V1.I -"'71-3 Dated as shown on the application for Disposal Works Construction Permit NoAP.!!L.&......... I�edil�e. . ............................ DATE ................. I...... . ............ Board of Health 7-------/--- FORM 1255 A. M. S6L-\I-. INC- POSTON LOCATION SEWAGE PERMIT NO. VILLAGE cEW1rE2V1LLC I N S T A LLER'S NAME i ADDRESS - t p M rco W� d U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � I -b1 / �� i� � I . , / , � s� \ � � �� No.. 2. _. .. Fwic.... " THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH J,? 1 12 , .. 69 .....OF..... .. - ,pplira#ion for Disposal Iforkii Tomitrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t _ . Loc Address -------------------------------------------------------------•- ..... ...... zz. -- ... .....or Lot No... e Address Installer Address UType of Building �. Size Lot____________________________Sq. feet Dwelling t No. of Bedrooms.--..•__-___•-__. ...................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures - ------ --•- W Design Flow... gallons per person per day. Total daily flow.............. . g --•-- ---•------ gallons. WSeptic "Tank Liquid capacityl allons Length---------------- ��idth_.....-------_. Diameter---------------- Depth-------------- x Disposal Trench—No..................... Wid 1........ tal Le Total leaching area--------------------sq. ft. Seepage Pit No. Diameter. _ In e 'Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) G a Percolation Test Results Performed by--------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_--__.---------__--.-_-. GTA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-.----________--_---. 0 a ••••••-••••----------------------•-•----•••••---•••--••••-•••-••••••••-•••••......---•-•-•.....•••••••-•-------•-•--••--•••----•----------•---.............. Description of Soil---------------------------------------------------------•-------------------------------------------------------------------------------------------------------- x U -••••-•------•--••-••----------•••••------•---••--•-------•••••••------••••-•-••---••-•-•••••••---•••••-------••••--•-•••••-••---•-••--•••------•-•-•---------•-------------•-••-------••--------------- 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 Article XI of the State Sanitary Code— e unders• d further agrees not to place the system in operation until a Certificate of Compliance has been Asue h. Signed-- ---- -- ----- ----•-------------------- /Da te Application Approved By....... did =" - - - � Application Disapproved for the following reasons:.......................... ------ ............. ----------------------------------------•--------------------------------------------------•--------.....--------------------------------------------------------- ------------------------------------ Date Permit No. Issued l� �---------------------- ate i No. '.. THE COMMONWEALTH OF MASSACHUSETTS BARD OF HEALTH r ,_ ,pliration for Uiupotial lVarkii Toistrurtion fumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t: _ -- _M y1_Q� EyJj}„yam yL-ocati -Address \/j or Lot No. -- � �d+"✓aY' .-•--- °'-' _i"R 0.✓ _Xp�,Z�---,; -`"------------------------- ---... .......... �'.�' •- ........................................................... ........ W Address a ... 'ta' Installer Address U Type of Buildi g Size Lot-__________________________Sq. feet a Dwelling -No. of Bedrooms...._...._______________________Expansion Attic ( ) Garbage Grinder ( ) aOther-Type of Building --------- '.............. No. of persons...................... Showers ( ) — Cafeteria ( ) Other' fixtures - -------..-•-- ---- -•--•----- -------- -----------•--------- -------•--------- --------- -- -- Design Flow............. ...... . --.gallons per person per day. Total dailyflow--------- :"_______.._.._....gallons. WSeptic Tank Liquid capacity, gallons Length................ Width---------------- Diameter--------- Depth.-.-___-____.-.. x Disposal Trench-No..................... Width._ ____ otal Le th ,�` Total leaching area.._____............sq. ft. 3 Seepage Pit No--- --------------- Diameter fif� ' __ '^tsel {�irt _ ,�° Total leaching are a....--------------sq. ft. 'y' Z Other Distribution box ( ) Dosing tank V W Percolation Test Results Performed by--------------------------------------------------------•------..._--•-•- Date------------------------------------ .. Test Pit No. L...............minutes per inch Depth of 1�est Pit_____-__-__----___ Depth to ground water.---_-_-_--____----_--_. 44 Test Pit No. 2________________minutes per inch.=_=Depth of..Test Pit...................... Depth to gr`oind water.......----------------- O Description_of Soil---------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ --.....--•--------------------------•--.....-•---=-----=------------•-------------------------------------------.....------------------...--------------------------------------- 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 Article XI of.the'State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been }sue t boa of4rp—lth. Signed = ...... = Y ................................ +� Date Application Approved ..- . r F ------ , t°' . Date Application Disapproved for tl etfollowing reasons:..........................................--------------- ..................................................... ------------------------------------------------------------------------------------=---------------•-•----------------•------------------------------------------------------------------•------------- Date Permit No----------=--------------- -------------------------- :; Issued----------------------------------------` ------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1........... J OF. !`�.:: ........................ (Entifirate of Tomptlaurr TH S TO E I'Dew F,Y�Th e Individual Sewage Disposal System constructed (r-'o Repaired ( ) by-------.. .. ... ' e ------------------•-•------..---------------------------------•--------------------------......,-------------••------•------•---- { f'I Installer} f. at........... has been installed in accordance with the provisions of,Article XI•°of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...., ;? Erf----------------------- dated------- _ gyp ,-- -------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUA NTEE THAT THE SYSTEM WIL FUN TION SATISFACTORY. DATE10 ---------------..... Inspector.. 3 THE COMMONWEALTH OF MASSACHUSETTS k {'t BOARD OF HEALTH ...........,e0 Yy...i�.r. ......OF4_..?` { f -: t if :: FEE (Y NppOr � ?. - • �i,�� Wui Permission`is.hereby granted-.... ..� ---to�Construct ( Repair ( ) -an Inage Disposal System at No._ .: 4`i f Street a/ ........... ------------------- c as shown on the application for Disposal Works Construction Permit No _ Dated....:-,lt .......... ._. eal .......... � .._...... r. DATE. �l !' --------------------------------------- FORM 12 5 HOBBS WARREN. INC.. PUBLISHERS