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Home My WebLink About0246 STONEY CLIFF ROAD - Health 246 STONEY CLIFF ROAD Centerville A= 190 - 156 SMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN,RECYCLED INITIATIVE CONTENT10.1 Certified Fiber Sourcing POST-CONSUMER www.sfiprogram.org SFl-01M MADE IN USA GET ORGANIZED AT SMEAD.COM L -3 CAT M. SEWAGE PERMIT PC. V.1 LL A G E (2 Lr INST AJLER'S Aft.E Z ADDRESS 9 UiLDER 0R OWNER tj QATE FWiT ISSUED ZC l h is s Mlle `J c� 604 /0 toil p || ��'��~~��" ~ " " FEB'Z.f.9_��_ THE cowMomvvsAcrH OF mASsxc*ussTrs U�� V� ��^"" ^ HEALTH ru�� p �.- ��b� �� *� .~----' -'^^~~^��w�--.'.'""--A�L.��'�------ � �� * Disposal �� - -nrn-------- �--- -- --n_--'-`-- ----�-~- ~~------�-~�-_- nr~-_~~~~ Application is hereby made for a Permit to Construct ( ) or Repair ( Ll-�- Individual Disposal System at: (-lm,�-----.. T1^ 'Q'' Ile -------------' � L� m� --,....... __--~_-- ---'-_---'---____ -------- -'-'-__----'--'-'---. ner '- _--------'--__- ---'^ '�� ~~'------'--....--'__----.. Installer Address Type ofBuilding Size I.oc-------------'Sg. feet Dwelling--No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder AA/P � Other—Typeof Building ---'--------- No. o{ persons............................ Showers ( ) -- Cafeteria ( ) Otherfixtures -----..-_-..---.---------------_-----..__-____-_______________________. Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter----'-- Depth-----_- leaching area....................sq. ft. Seepage Pit Nu------- Diaozetec----.--' Depth b� �n= � �'---------' Tota arca--..----- � �� [) 'og. �8�rD��r�nz600bo� ( ) Dosing t�o�� ( ) | '- Percolation Test Results Performed by.-------.---------_.-.-'--.................... Date........................................ Test Pit No. l................miouteaperino6 Depth of Ieat'Pd.................... Depth to ground water........................ �T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ nu ................................. --------------------------- _-----'-...... ------------ _............ ___ 0 Description of Soil.___--____-__''-----__--'-'----------------------'----------------------'---'--'' / -----'---'-'----'--'-..----'---'-----'------------------'------------'-----'--'---------- � ---'-'-'---'----'-----'----------' . ^4 � �u�� o� | The undersigned agrees to install the aforcdcacribod Individual Sewage Disposal System io accordance with THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEALTH t f �. � a •� 1 E�J.V PJ ......t.... ................OF......, .. .!........-''.......:j.------. . ..._............--- Appliratiun for Diupuual Works Tunutrurtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( n Individual Sewage Disposal System at: ............. _----------------------------------._---------- .....r... .....-........... ...-..._._...M1..... - .............................. ............................. ��""' a. Location-IfAddress or Lot No. f zs �i.' / 11 : �c •-- ---- ----- •---•--------------------------- ..........--...................................................................................... 7' a Ad ress Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms------_______............... .........Expansion Attic ( ) Garbage Grinders j p, Other—Type 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------------•--•••••••-•-..._....-••-=...._...-•----...................................................................... ODescription of Soil................................................................................................................... .................................................... x U -•••-•••--•••-•-••-•---•-•-•••••-••-•••--••-•-•-•-•---••-••••-•••---•-•--•----•---•..._........•--••-••••-••••••-••-•-•--•--•-•••••••---•---••......................................................... ----------r -----•-- ..... 0 Nature of Repairs or Alterations—Answ r hen a plicabe._____ ________ _.t �___ �_!_ !_..__ s ?____. ..................................�t_�_�......��_-_--- lac . ,<__.._____._____________._.._______._._____.__._______.__..._._.__.__.._..._._._______..........__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITITE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been dly the board oealth T Signed_ � . �'� 1 __ ---------- Application Approved B Z _ ,4: --______�__�__`_- ------' � 6� g Date Application Disapproved for the following reasons:----•-----------------------------------------............................................................... ---------•-•-••••-••---•••_...__...--•-•-•----••---••--•-••••••--••-•••••---•---•••-•---•----•-•._...•••--••--••-•-••-•--••••---••••---•--•••-•-•••••••--••-•---•------• •-•-•••----••-••-•••-•-•-•-•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH Crr#ifictt#r of Tuutlinr�e THIS IS TO CERTIFY,That the Individual Sewage Disposal System constructed ( ) or Repaired (� b y .....s��"��'' �. �y,R r ----- -- --- -- -•-•--___ -----------------------------•---•-------------__ sF ! ' I stall, at .'` F fed !a t ! ° � - --•---•--••�--�............. - --•-• -f••-----• ••-•-•--••- _.__.•-- has been installed in accor ce with the provisions of TITS of The State Sanitary Code as described in the application for Disposal W rks Construction Permit No__________________ ___L'-7__5.__.. dated.......- _�_�� ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEAIrTH/ 't...'.. ....... .. .O -�/fi. ..,.l _s ............. FE �iu�ruu�1_ u�k� ��n��riun rruti# Permission is hereby granted...... _ �z t -} x< i ` to Construct ( ) or Repair (��`an Individual Sewage Disposal System ' at No.•••''` co ...... =� r�-f_-=•- f f .................. . ¢ d, ..... -,f ! 4 r Z rrF kStreef i"or *' o as shown on the.application fo isposal Works Construction PerM.t__ Q ' �� -• Dated_.____�-_' L.:�� .___.... �. , % -- .-^-•� Board of Health DATE.-..,., .. F . ............................................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS t