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Home My WebLink About0089 CAP'N CROSBY ROAD - Health 8y cgrr. c ruby Q,Atervi►1� 13 5 M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE S FORE MIN.RECYCLED INITIATIVE CONTENT10%W CerofiaEFibarsourav POST-CONSUMER www.e mramorq SF izo MADE IN USA SET ORGANIZED AT SMEAD.COU I L0 C,Al.-ION' lE W A G E PERMIT NO. ,l;§ C, - , � VILLAGE INSTA LLER'S NAME i ADDRESS BUILDER OR OWN ER- DATE PERMIT ISSUED " M1a DATE COMPLIANCE ISSUED ,_ ,_ � - -�- _, � r, �;, �. �i � .. �eu rc fig' �i'� � .. 1t1 �� 5 � � . �� o c,� ,�E VV t. L6c TION J SEWQC,EAV, MIT u0. I—W5TI-LLER S U r E � ADD_RESS BUILDER 5 1.1 �,t�lE ADDRESS — — Ce Z&IK — — — — D I�,TE P E R NA T 1 — — SSUED - DATE COMPLI & acE ISSUED : . �. /� 97z- . � R �\ • ' .� �l` � �.,� �% 1 \ `� ' �� ` 'I ��\ � t �� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .......... .................................... ApplirFation for Uiipnaal Works Tonstrnrtinn amit Application is hereby made for a Permit to Construct ( ) or Repair ()� an Individual Sewage Disposal System at .._.....1�.. ..4 L .. :._..ern5by........................... --•.......: .............................................................•---..........---.._. at' Address or Lot No. !. , .1.?--._.•..........................;� ......... �.YLJ��1�......................................... Owner A dress ' aCl� c ----------------------- Installer Address. UType of Building Size Lot............................Sq. feet Dwelling—No. of;Bedrooms.................................._.........Expansion Attic ( ) Garbage Grinder ( ) aOther—Type,of'-Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------------------- -------------------------•••--.......-••••-•-- 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........................................ 1-4 Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 1...............minutes per inch Depth of Test Pit._._.___..______.__. Depth to ground water........................ ODescription of Soil-------------- ---------...--------------------------------------•------••--._._........------..._.. x U ..•--•-••-••-•-•-•-••••••...•-••••••••••-•--..._._...•--••-•-•-•--.....•••---••••--••-••••-••-•-•••••-••-...-•--•--•••-•••--••-•-•--••-•••••-•----••••-••.....••••••-••••••••--•-•••..............•-•--•. W U Nature of Repairs or Alterations—Answer when applicable.____.____7mue).. /�__ �_ _____________________________ --------------------------------------------------------•--•---••--•-----------•• ------........_..•••••••-•....•••-••-•--..----------------•----------•------------------------•----••••-••-•--•••••-•- Agreement: .. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTILE 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een issued by the board of health. / Signed......• - ... -- Da Application Approved By.. ,. i J •-••••�� . Date Application Disapproved for the following reasons:................................................................................................................ --- -------------•----•----••------•-•----••-•••--•.__...-•-----•••-••••••-•••- Date r PermitNo......................................................... Issued---•---•••---••-...................................... Date No.. -. THE COMMONWEALTH OF MASSACHUSETTS BOARD,OF HEALTH yy �» ....... ., ��'ry � .........OF..... .... . �� „ .............................................� Appliraiinn for ElinpnFal Works Tnntrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( f.) an Individual Sewage Disposal System at p beahop Address f d or Lot No Owner, Address F� i i d ,•Q q +A' t !�� Y / F��l�9 �d/...........11.... ` - „w?� f*tt" ............................................. ..__ _______X .._......__r' .:....._....gab::... ......... ..»..,.i.J!...... `4. . :_:____ ��::}..x Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................. .Expansion Attic ( ) Garbage Grinder ( ) A4 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 ( ) 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............... z �...C '!�` zx. =-------•-- -•••-••----•••--•----------------•----..._..--•--..........._. ..... x W ................................................ -----••••-------------------....-----------•--•---------•---•-------.._.....------............-----•-------•----•--•----_--------....----•---------••-- UNature of Repairs or Alterations—Answer when applicable..........t.----- /1 1:.a__../",:-:I.:`� ............................ --------------------•-•---------...-•-----••----•--------------•-....---••-----•---•---.._.._._.....•-•-...-•••••••-••------••-•------•----•--•-•••-----••--...---••--•-•-•-•-••••••---.._..._..•••..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of A.—. w. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a.Certificate-of Compliance has been issuedissued by the board of health. qq� Si ......�` ti, ,ti 4 �il i 1 '�lj ........................... .............�.._...........__........__._.�+ FI ...... . e� Da Application Approved By.................... __.l..C/'.. . K.......................... -•----el' Date Application Disapproved for the following reasons------------------•---------•-------•------------------------•-------------------------------------..........-•-- --------------•-----........---------•--•-•--•-----------•----------•---------•-------•-•......_...•--•••I-----------•---------••----••-•-•-••--••---•------•-------------•------•......•----.--•-•------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �' �:. ...........*......O F.............:.......... .. TntifirFatr of TuampliFanrr THIS IS, TO,CERTIFY That\the Individual Sewage Disposal System constructed ( ) or Repaired N by...... �.. a'..... .. ......-------------------••---•--............-•---•---•-•--------------.........--a _- installer f �.` at....................�... „!✓ t .......; . � f? �'� ¢. /s � .... has been installed in accordance with the provisions of T I;4z 5 o h State SanitaryCode as described in the application for Disposal Works Construction Permit No. ................................ dated .............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. A��DATE... 1. _� �• �•1•-_. Inspector..-•........................•---_ ` •-•------............•........ THE COMMONWEALTH OF MASSACHUSETTS _p .• BOARD, OF HEALTH ............. .......OF.... '��'..`. ' ` . � V ,� �in�no�ai,- na`��.,� �nnn�rion [.erntit Permission is hereby granted t ` ..... ...... 1,.. � �� '` . �.?' �. ..................................................... -- r.._. to Construct,(.-. !10 Rtpairl,.(,!..)- an Andlvldual Sewage Disposal System _ at No......._11 7�0 7 i yr'1'J p r> ,�!! f 1 , {.. '_*'_---- [-t:.•'!_-r ;fa.«...............'."..'_-'.___'_'__...._'__.' .'•. ! _':/=! ' Street as shown on the application for Disposal Works Construction it/No____________________ Qated.......................................... oard of Health DATE 3 -------------•----•-----------.... A> . FORM 125.5 HOBBS & WAREN, INC., PUBLISHERS g `R