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Home My WebLink About0293 WHITE OAK TRAIL - Health 293 White Oak Trail — Centerville ' A= 192 —228 No. 42101/3 ORA ESSELTE 10% 0 0 0 0 � o a ML I I i i I P� ;2P </ z �f �F�s.. Z!J.�...... No. ............---•-- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OFHEALTH -ro d?;..............OF....BA ........................................ Appliration for Disposal Works Tonstrur#ion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . -------------------------•--............. Locatio •Address t No. .. 4. 1k-- -----------•............ .: ...... t: '......--- ner ALess,,.. w mu ... =....I _ ac A. •-----•..........-•-•----- Q.1.a1.-. 7" .. d..._ ............ a Installer Address , J d Type of Building Size Lot..! � ,�_. ____.Sq. feet U Dwelling—No. of Bedrooms......_3................................Expansion Attic (0 ) Garbage Grinder ( ) per, Other—Type of Building )-.p 9Sv:.k.---..... No. of persons........:3................. Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... .. ---------- w Design Flow.......... .........................gallons per person per day. Total daily flow--------.3 3...0....----....•......gallons. WSeptic Tank—Liquid capacity./ ......gallons Length------4........ Width.....k-.... 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 ( ) --77�� '-' Percolation Test Resul Performed by iG.s�A.�......gm-.of ................ Date...... ........ ?. --- 0 .. Test Pit No. 1.... per inch Depth of Test Pit.................... Depth to ground water---_�v.W Test Pit No. 2................minutes per inch Depth of Test Pit.-----......--...... Depth to ground water........................ ----•-••-•-•------.....•-•••------•••--•--••••---=---••••---••••........................•-----------.......................................................... 0 Description of Soil.d--...-3.. S..0.&�UA...I.......-. w ............3.-........ '!.c_ ......G'#VR41------------------------------•---••--•---------_.. ..--------.....-••---------------••-----•.... -------------------------- -----------I-...------------VAA.y... � .�.st� 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 LI`: .E 5 of the State Sanitary Co e— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be sued by the board Sig .............. -_.. r� Date Application Approved By..... ......... .. .J 1.. .�c/............................. ....................Da.--.............. Date Application Disapproved for the following reasons:................................................................................................................ ------------------- -------------------------------------------- ------------------ --------------- •---------- --------------------------------------------------------------------- ") r_ Date PermitNo......................................................... Issued.----- --------...`...-- Date LOCATION SEWAGE PERMIT NO. VILEW"- w 4t IN.STA LLER'S NAME & ADDRESS b e5 Del l )rtiw C v,-�er/ie Il e BUILDER OR OWNER Eg DATE PERMIT ISSUED k DAT E COMPLIANCE ISSUED 7 Yr I .. No..- -- Fz�s ..�!�-- -. . k THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH ...v�.�..............OF....� r..__........ � . ,�epplirtt#iott for Diipnatt1 Works Tomitrurtilatt .erutit Application.is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal h System at ...... 1. :�q a'.. .C�?. .. '? 1. Gkl� vi.A/C... ...........:�- .... s .. .... .........._............ - Location-Address —. r Lot No. F _ 1. ... a t. ) ._.. — `, a'! _ 'r... ......•......i.X... .... ��,h4...V..................•--•-. ,,. ......l .ta I�3. .x ' ner Ad ress s......c: .......................... ! . .... . �. _.1` r ..... .: .�,�..7 1:_!I L.........--- Installer Address Type of Building Size Lot.. ..3.....Sq. feet U 21 Dwelling—No. of Bedrooms..................... .Expansion Attic (0) Garbage Grinder ( ) p44 Other—Type of Bilnlding_k1A MS .k......... No. of persons--------3_________________ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------------------- W Design Flow..........ff_0.......................gallons per person per day. Total daily flow.........,_�...0...................gallons. WSeptic Tank—Liquid"capacity._'19�.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 ( ) �. f x `" Percolation Test Results Performetd,by .__� k 11��.�..... ��T �................. Date..__._/l__.. " "� r - i •!fir t Al Test Pit ;�o. l________________minutes per"inch Depth of Test Pit,__.__._...._....... Depth to ground water.._�::._........._•.''" �r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_-__--__-_-_..._____- Ra' •----•-•--------------------•-------._._.........:..----....._.....--------------••••--•-•--•----•--......................................................... 0 Description of Soil..._.._......L. .�k1.. ... '' -= -•----•-----------------------------------------------•---------...---------------............--.••--- V .....................•--••- W ••-•-•.......... ......... ----- ........ ---- ' =Q s' -------------------------------------------------------•--------................................. U Nature of Repairs or Alterations—Answer whk`n applicable._____.......................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance.with the provisions of TITIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the board pf-h altf ,d / ' ' '/_ Sign d. - ,�L-� R � � !! _,,.-•-'''' r Date Application Approved By..... •- •• f aEr`t ...........................�- Date Application Disapproved for-the following reasons:................................................................................................................ ...................••••-•.......•••••-•--.......--••••......--••-•••--•--•-••-••••-•-••-•----••--•-•--••-----•---••--•--•--•••----••-•••••................. Date Permit No:........:..:...... - Issued - Date S ; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s494.d ..: , . ...............................f!.. . .................... } . } T&' irtt"i of Tontplittttrr THIS IS TO CERTIFY, That the Individual Sewage"Disposal System constructed ( ) or Repaired ( ) ------------ Ins aller r at...... ='.1 ? — 10 i C �� I �?- I�� ---......_�_� �_..r�� r . has been installed in accordance with the provisions of T �. `r' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._'t,J°__.XP1e.1.................... da.ted---:/��.._ ....................... THE ISSUANCE OF THIS CERTIFICATE SHALE. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................'.................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7� ....- .... ............................... No...... rrt......... .FEE...�... ............. �i��r�a��t1 ttrk� ��tt,�irttrfirn �erbti� . to Permission is hereby granted..... .4``:.11 .......................°r w to Construct ( ) or Repair ( ) an Individual Sewage Disposal System , at No..... ......................1.i--.------r`- '�, �t 4. ^ 1 Street as shown on the application for Disposal Works Construction P it No.. ............ Dated.._. _'�." 77 '__•_-__- t =` Gt t�l •----------------•-. Board of H�e DATE.....................................................................•......... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ''' "'- - _ 4A- A&I L,-.e F _,.,tea .-1..+...• r, . 45 4AW i.� TLav- TOTAL vFSI6N = .425"j C�•�tL�. °IS r->T :. 'Cs l t.�� S=L!>�A;' -3� c.'-.,F;.I i• VWC,6L1,TkQQ tta'T'E �r'IQ ZAAIQ' 0z f, a Mir I r ,• , 1 1 j2 �t`Tr r '10r pup ttca,m �� _`��i l- L..-�_ `"s�13 � .•"ff ass �� if'.+'Tii i�'. •K 0. 1 +v ^ luv. 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