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Home My WebLink About0034 SUMMERBELL AVENUE - Health 34 SdMMer bf,tl Me C tkttrvtttt ZZ6 , fly$ D ®�® S M EAD QD No.3-153L.Y UPC 13934 smead.com . Made In USA `ggsaa0 SUSTi41 YMLE FOR INITIATIVE Certified Fiber Sourcing wwwApropra—rp No... ........... •--: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----------TOU).n.......OF......It� •J�.0 6 -----_-_------------------ Appliration for Dhipati al Norbi Tomitrurtiou Vamit Application is hereby made for a Permit to Construct ( ) or Repair (L-7 an Individual Sewage Disposal System -•............��.._ YY1 if .c �� .... :t�- _ .........-. ---------------------- ----------------------------------....... --------- ------------- Location.Ad ss o t No. �.�1�.�. . .tayh.........` i_� .�r �r�....... ............. ...----------------------------------------- O ner Addre -Cciw.b� .. � Yl. ---------------- ,�.... 'Y.L..t.11-.'---........---------------•----•---. Installer Address Type of Building Size Lot............................Sq. feet , Dwelling—No. of Bedrooms............................................Expansion Attic (' ) _.Garbage-Grinder ( ) Other—Type of Building .....0...................... No. of persons............................ Showers ( ) — Cafeteria ( ) a' 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 ( ) Percolation Test Results Performed by.......................................................................... Date..-----•............... • *------------ Test 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........ P4 •-- ............ . ...... -- Description of Soil . . - ---- W7- - --.-•-•--. - ----- dl�t.. . j --- U Nature of Repairs or Alterations—Answer when applicable....1_-A.010..�_.._._.. Yi_�G.-_..-__�__`�.DDt ----------------------------•-----------------------------------------------------------------------------------------------------------------------------------------------------------............---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1:;�.. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is ued by the b -rd 341 ealth. igned d 12rJ r 1112. �a j Dat Application Approved By........... • .----•--------- -- • . . !..%.. .I..........-..... ....1�-_-•Z -.-T Date Application Disapproved for the following reasons:................................................................................................................ ....................•--------------•-••--•-••-•••......._._...----•-----•------•--------•-••••-•---•---...--••••-•-------•--•---•----------•----••------•-••-- ......................................... Date �_7— PermitNo......................................................... 7 "---------------------- Issued_--•------------------------ ....•----•-----...---•--- Date ��. l7 r ' No----...........--------- F�s.�„ ., '.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ own........OF....: - .... -_-•--•-----_-_---- Appfiration for Uiipnaal Workii Tumitrnrtion Vamitf7 Application is hereby made for a Permit to Construct ( ) or Repair (4-n an Individual Sewage Disposal syst �tk ........... ..- ►�- -....---- ------ --------- ----------_-_---------------------------- location- e s o t No ...........leuA 11. J M..._....` . . ._... Y ......................................... wner Addr s j Installer Address vType of Building Size Lot............................Sq. feet Dwelling-No: of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p`�.1 Other—Type of Building _______________________ No. of persons....:----------------------- Showers ( ) — Cafeteria ( ) PaOther fixtures .........-•-•-• •••------•-•••• --•- ____ ..................................... d 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 ( ) 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........................ /» -•-•-•............ ..........••---•-........:--•----•••---.._.._........._._. O Description of Soil-----•--------=`` / --_ - - - -- �/ - _ --�'�,,-r -----��-� f� V ..---•-•••...................................... •--•••-•- - f ----•--• - U Nature of Repairs or Alterations—Answer when applicable.-__ ------f1)(6 o-__ 1-0). - ___.f.� M _____ a piT -•--------------------------•----------------------------.-.---•-----------------------------•--------•----..•-.•..----------------•------------------•----------------•---------------........--•••••. Agreement: The undersigned agrees to install the aforedescr'&d Individual Sewage Disposal System in accordance with the provisions of TITLr. y g g p y of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Signed r_....- = --- Date �L �'L ---� 7 Application Approved By..••_ �:;.::_.._..-.......1....., -�L/- � � vF-•------Y•--Date ._..----•--- ....... Application Disapproved for the following reasons:------------------------------------•------------...----------------------------------------------._...••------- .......................................................•---------•--••-•..._.....••----•-•-------._...--•••--••-•-••-•-••-•-•--••---•-•••-••---•••--•--••-------------•••••---•••••--...---••••-------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................lO.W.V .....OF...... Q. .. .................................. Tnrtifiratr of Tompfianre THJ,S ITOr CERTIFY, That the Individual Sewage-Disposal System constructed ( ) or Repaired by ._._.......e.. '-.. :f l! .f� �f,. `�...._.S � �--e........................................................................... nstallhr ..................................................�)Ica(hb...... has been installed in accordance with the proysions of j 9f The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ` .____ .................. da.ted_.. _ ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM'WILL FUNCTION SATISFACTORY. DATE............ 7 7�' Inspector.... .................................................. THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH 7� . Y1,.......OF.. �, Y: ' }} .1,Q.x . Q y. ....................................._.. /f�� ..._.._.._..J....�l� FEE ".�.�,,+'........ Mop $Vorao TnnartPermission is hereby granted ':_ .._.: .. _ _ F._____.f______- 1 _ _ to ConstSt ( ) or Repair, �- n Indiv dual Sewag isposal System at No. =" °� 1('1�- .P' _ '. .._... �'......-- E -...--•- .._...... Stree�. as shown on the application for Disposal Works Construction Permit,-Nb----- .,.t'__"ated___------_-- --- DATE---- • ---70 ........................................ Board of Health - / ---------------�•-- ---•-- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - LO-C A T ION S w G E PER°MIT NO. VILLAGE P INSTALLER'S NAME & ADDRESS -cW -.F94 OR OWNER e 4 DATE PERMIT ISSUED ' v DATE COMPLIANCE ISSUED ;4f