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Home My WebLink About0337 WHITE OAK TRAIL - Health 337 WHITE ®AK TRAIL Centerville A = 192 - 235 SMEAD No.2-153LOR UPC 12534 Mmead.com • Made In USA 01MlnN11i40Y00UC w A OF 11*;R MM� (�J/VL .. FEs... ..................... THE COMMONWEALTH.OF MASSACHUSETTS BOAR OF H ALTt-� ----------------OF.... .�pls�'l . 3 Appliration for Disposal arks 'Toustrnrtinn rumit Application is hereby made for a Permit to Construct • ) or Repair ( ) an Individual Sewage Disposal System at ...WALL.. 0 .....rgea.L........ ...............5.1 L cation-Add ass r hf�, t No.. �� gg ,j g1111 � or Lo ... u�4�l<.t �� JL. _ems Q�: -•--•--•-._..._ �y. rl ...- ... .�'P w ! .\ Ad/dLess q� .�_`.... Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........................ ..................Expansion Attic NO Garbage Grinder Other—Type of Buildings, � . � . No. of persons....6.................... Showers ( ) — Cafeteria ( ) Otherfixtures ---------------•--------------••--------•----•----------•-----•------------- w Design Flow.......... ............:------.........gallons per person per,day. Total daily flow........... ..............gallons. WSeptic Tank—Liquid capacityk _gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No....... ........... Diameter........1�._._._. Depth below inlet.......(*...._..... Total leaching area24..y......sq. ft. Z Other Distribution box 6_4 Dosing tank ( ) l ~' Percolation Test Results Performed by......:�...... �l.t _.� - ✓ ..__..__._.. Date..2 �z/..7Q.............. minutes per inch Depth f Test Pit..Q-_k............ Depth to ground water�...i�&.__........ Test Pit No. 1_ __ .... fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..... O Description of Soil......0 •� A- ...... � = ... . � w .✓ --•--------------------------------------------------------•----- 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 TAI TLE 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 the board of lth. Q Si co ' o ��,�J Date Application Approved By....... .._ . •.................••-- ...... �... d Date Application Disapproved for the'f ollowing reasons:.................................................................................. ............................................•------...------.......------....------...•••--.....----•-••------•--•••-•------•----••------•--•------.................................................... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O�11 (� Q.................OF.... :... <?rn ...........:.:.................................. (9rdif iratr of.TontpliFanrr T IS IS TO C TIFY, T he Individual Sewage Disposal System constructed ( ) or Repaired ( ) by_. —' - Insta has been installed in accordance with the provisions of T jrof The State Sanitary Code as described in the application for Disposal Works Construction Permit No3.�......ff 7 O dated l j .................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ` ........... Inspector__..- DATE.-----h.a:_�.��...-�------•-----:.....................•- -- �•------•----�----' C ---------•-•----- V& 69) \ 7 LOCATION � SEWAGE PERMIT NO. VILLAGE I N S T A LLLER'S_ NAME i ADDRESS l UILDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r 3f. ` .. C� 8 No......... 1....... Fxs... 3c.'...: �...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.......... .............t....... ........---........---............•-•-----•--•------. Appliration for Disposal Works.Toustrurtion Prrutit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at,, ._ / ..............»»»....-.»..-..................•................................................ ................................... ~•_-- -- ` Location.Address v i j 1 : 1 l (�17/� � ' �. ,07tttNo.�i [�SS U /1 —i } Owner {! i # + Address ....: ................. ✓ Installer Address UType of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms___________________________________________Expansion Attic (1{�;)y Garbage Grinder (1/0 aOther—Type of Building!>.....l___!�.:...�*------No, of persons__.��.................... Showers ( ) — Cafeteria ( ) < Other fixtures ..............-----•----•----- W Design Flow........ "'- "............. .........gallons per person per day. Total daily flow............. _:_.........................gallons. W Septic Tank—Liquid capacity ...gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width..................... Total Length...........:........ Total leaching area....................sq. ft. Seepage Pit No.......1-.____-__-- Diameter.......! ......... Depth below inlet................ Total leaching area,2_�!..._......sq. ft. Z Other Distribution box (,,e) Dosing tank ( ) '~ Percolation Test Results Performed by............. .................. :__._.____..________._________..__. Date..= �] z f Test Pit No. 1.......�-....minutes per inch Depth of Test Pit-�_..j... ...... Depth to ground waterV�UqE-:-........ 4� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .....--••----•-------------•-••------------------•---------•••------...--•-----.....------.....--••-........................................................ Descriptionof Soil = ..............---•-•------ -•••••------- ----•----------------•---------------------------------------------------...------------ ...................................................................................................... ----------------••--------------------------------•---------------• ----------.............. W --•------------------------------------.......---..................................................................................................................................................... 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedd�by the board of health. , f / Signed'?v'5-1 /�✓c�r •� == `1�.- _�- ~�..__ !�._�.�:.f��..... f . . -- . Y � i ✓ +r Date __________ll��==�_G / ........................................ /Application Approved By---.... c�4 Date Application Disapproved for the following reasons_.................._..................__.........................•-----------------•-----.. .........-•- --•..........................•--•--.....---------•••-••------•-----------•••--•--------•-•-•-----••---------•---------------•-•--------•-----•-----••. ................................................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF............. ....................................................................... Trrtifiratr of Tomplianrr THIS IS TO CERTIFY, That'the Ind.vidual Sewage Disposal System constructed ( ) or Repaired ( ) / C V l V Installer at---t/................. �•. .... .G�.c._Gf_...�u.f 1...... J f4Gj ..:.( .0 wl.: = �"��c�/a�.�/i_,.....a_.......... has been installed in accordance with the provisions of T/11IyE 5 of The State Sanitary Code as descri ed in the �� application for Disposal Works Construction Permit o / f___.___�__-__ dated_..._1f..:.._.` -------------=---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ` Inspector -L1 ......-•-------•--....----••......•----- THE COMMONWEALTH OF MASSACHUSETTS ......................BOARD /OF HEALTHr 7 . OF... .ram:_",_.. � f'. <E_. � v 1p '..........t:....._.. No:''.................... FEE�...'.............. Disposhl World Tons adion Prrmit Permissions hereby granted-.=- "^z ................................--------------- ............................................................. to Construe ( ) or Repair( /) an Indiyiduf41" Sewage Disposal/System / .- ______.».....__......._.......__.................... ................. ........................... / Street - f` as shown on the application for Disposal Works Construction Permii No./ ..I____ Dated_._. "_�.'_ ._G_ / / DATE......... .•........ Board of Health ' �,1AO . FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - •t>a.TA. Stavl,�t_E �A�nt��/ }-�� sc�eootic � ` • ;;s .:, ��.,� �� ►AO C Arrsct-6 (G;-RI Qt:>'E✓ _ 60 T.>AI LY Ftow %to 'k t 33co G.Pt7 \ e•. 1P_YT'1G T'4"K a 3SO.t i5G % A-9i4j6.P•10. + f � k SPOSAL 'PIT - USE-. Iocoo GA.t_-. Q StliEtc/ALL• Ae1=A = c5O s-F. G.P.D- 8UT'TUNI AC�A r ST=. PfoP• '' 9�'. I .C, ✓D_C�.PL�. O PIT TAMV- T . 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