Loading...
HomeMy WebLinkAbout0019 THOREAU DRIVE - Health �8n`Cccvl��e iqt - 233 I T SMEAD No.2-153LY UPC 12934 smead.com • Made in USA #A Q- ) OWN", INITIATIVE 4ud14d Ra►Sourcino � A THE COMMONWEALTH OF MASSACHUSETTS BOARD �C,OOF H E LT I Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal le- 1? 1. x4v-1411W A ----------- ......... ----------­1!�� ....................................... ------------ —.,o 6 1 ---- --- ------ ------ ......Itna­...................................... Pner Address Installer Si: ress P4 Other fixture z Other Distribution box Dosing tank ( ) r — Description of Soil------- 44,10 vi- r --------------- 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 undersigliqq f urther agrees not to place'the system in operation until a Certificate of Compliance has been * ued by the board c Date Date ........................................................................................................................................................................................................ Date ' Permit No......................................................... Issued............... n"u ^ � � LOCQTI� ' �-�e // .�SEWAC,E PERMIT -.1.10. _cy 0, _ _ _sue h,r� 11�STQLLERS ,lJ�ME� ADDRESS BUILDER 5 Q [ MF— ADDRESS -- DIQTE PERMIT ISSUED 1� ��— D ATE COMPLI &MCE ISSUED=�� � r AU 7 l 61 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF ----------------------- Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Lo"Calion-Address or Lot No. Installer Type of Building Size Lot feet Dwelling--No. of Dedroomo---l.­----------------------------Expansion Attic ( ) Grinder ( ) Other—Type of Building ---------------------------- No ofpersous----------- Sbo.,ccs ( ) -- Cafeteria ( ) ~L4 Other fixtures -------------------------------------------------- -------- ----------------------- -_.-----------'-_.------ D ' Flow............................................gallons per person per day. Total daily 8o«.----.----.-----' .gallons. Septic Tank—Liquid cupac ��---.�uUoos Length-__-_- �V�bb-----. D�m�er-----' Depth-----_ DisposalTrench—No --_--_- VV@t6------- Total Length.................... Total leaching area--.-----.-sq. 6. Seepage P6 No--------------------- .................... Depth below .. Total leachingarea----- ----------sq. f t. Other Distribution box ( ) Dosing tank ( ) 4�0_ ^{/c '20. -- -` Percolation Test Br,obs Performed bv.................................................................I-'7VIutT-4.-.------.---- � Tca Pit No. l...............minutosporincb Depth of Test Pit.................... Depth to ground water .------- 1:14 Test Pit No per inch Depth of Test Pit-------------------- Depth to ground water......... ---- \ | [) -_-.-'''''—_[] 2� � uturoc6 Repairs or �]K�xt� —Answer _-------.---._-.-.---..°-..`---_./___-' _-_-'''.'---'-_-''''--'------__._-__---_--_--_-.__-----.._--------'---_-' � Agreement:` _ _ - The undersigned ugrcco to install the aforc6cocribed Individual Sewage Disposal 5votenn in accordance with the provisions of Article XIof the State Sanitary Cod —The undersigiled f urther agrees not to place the system in � oycm1ioo until u Certificate of Compliance has been issued bvthe 6our6'.ofhealth. � ............................ .�,--' '--- � ae ��y�u600 ______________ ' - - �/ 44~t-y .2ate . '� Application Disapproved for the following reasons:................................^--------.—.--........................................----- � _.----_-_.----'--_---'_'_'_-.--_-------'------.-._--'--'_-___-_---'_-.-_---.-_' Date Permit No. __ Date THE COMMONWEALTH OrwAsSxoxussrrs BOARD OF HEALTH ------' has been installed in ac ordance with the provisions o Article de as described in the THE ISSUANCE OF THIS CERTIFICATE S L VO BE CONSTRUED AS_;�"N'4�4 THAT THE SYSTEM WILL FUNCTION ATISFACTORY. DATE.............. . .... ........... Inspector........0- ...................................... THE COMMONWEALTH OF MASSACHUSETTS 76PI BOARD OF HEALTH Xns !;,5 I Ftct r Ind Street as shown on the a W I "I T RTIFY, That the Individual Sewage Disposal System constructed Repaired ,pplication for Rposal Works Construction Permit No..................... Dated.......................................... ...0_4_ _ -7 DATE,..&-4,r4 ........ ... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i � I i I Z E,-7 r � d c s s� V 3 /q W1 IAM f ! N 'Y E A� rfi r �1v �A� QQ+vim .. 'PL Cc� - ' o&,K) L-C)-r Ce-V-S"T G-?. I t_LE[ NDS -n4 A.-r "TN E FUCJI.J D47noo - c-C-TJ t v I I T++I $ ALAQ C1001=6Z►.,4;5 F Tc.> 71A 24.)N I Qc, l..kW S ©t= TF�E Tv',A..1 ►J- v I+ �A.2 tJ S i�.�tr.�, �1..15,N �'. �t��l_l.. I iJ C.... i Q = 4-0 'PT ZcE �Tc=-P_ tTA. > 3u vS 0 ZI - 7(0 r f I t Z c, ki e 4p�.WtLL1AM�_,Yy C. U N Y E Al Sa 19334 fsrt 'rNoe-�a� QQIQt� �' �' L.C) PL-1s,ha %---nT" C!3,<E-S �./I t- LE , l4 t C.tA �-/-\ND5 11a A,-r TH t Fvv w DAI-Mo u 'CE',EC R C s V ► 1 o" -T ij t S pt.,AU CUw FU t?r--A S Fv I -t-v MA� ?..CaN 4 QC-, ��{t_kW s or- T E .t..Q ►J a r T3�,� �.�<5Txh,rs L G, IN ', KA,4,U, 1►��.. '=T