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Home My WebLink About0044 EBEN SMITH ROAD - Health l C ben sM�Y� Ce I71 - ISS ----------------- A/ SMEAD No.2-153LY UPC 12934 onmd.com • mach In USA SUSTAINABIF FORESTRY INITIATIVE Crltll�dFmr4oure4o v r �� T i, LO CA , I N - EWA E PE MIT NO. VILLAGE INSTALLER'S " AME i A0D;RESS 0 U I l D R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r i r � • 1 1 ` � 1 � � �ti �� b '� ��' �`, -� No.......... FimB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® HIE T1-1 fWxr.---......OF...... ... .................................. Appliration for Ilispaii al Works Tontitrn.rtinn Prrutit Application is hereby made for a/fPerrmit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst Za ......................................... ....................................... Z71 Address or-.0t• ^^ __........ ......._.. -• •-----•------._.--- -----...e / Address a . .......... .. •---•--•--...-• �,. ., t..--------•------•- --•-•-••--------••-•.........-'`I-----••-----------------------------------•---.....-----... Installer Address Type of Bui ding Size Lot../_/!�._Sq. feet ., Dwelling—No. of Bedrooms.•..............................Expansion Attic ( ) Garbage Grinder (,6)440 aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other ......... W Design Flow... 9.2!2.._.gallons per person per day. Total daily flow............................................gallons. WSeptic Tank Liquid capacity, gallons Length.............•.. Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width_r. ..._............ Total Length............. ..... Total leaching area..............jj----sq. ft. Seepage Pit No._. 4�'b_.. Diameter...... � ...... Depth below 'nlet...... . ....... otal leaching area.-2,A4..7...sq. ft. Z Other Distribution box ( ) Dosing ank ) '-' Percolation Test Results Performed by... r .._.. �'� .....--..... ....... .... Date... =_.C[`. Test Pit No. 1................minutes per inch Depth 4 Test Pit.................... Depth to ground water........................ fzq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ OA4&4. Description of Soil . �.. 9�s,t� A-•~--7-••v- . V ...........................••----•--••-•....---.......-•-------•------•• -------••-------------------...--------•----•-•-----•--- ------------.-•-.................-------_...._ W x •----•------------------•--•-------•--•••--•---------------•-----•--••------------------•••----•--•--•---•-•-----•------•--------------•-•-----•--•---------............----------••----•-••....._------ 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 TIT I.;,,. 5 of the State Sanitary Code— The undersigned f .er agrees not to place the system in operation until a Certificate of Compliance has been i ;ep by the boa f li th. Signe --- . •.........••-- Date Application Approved By......... ........ Date Application Disapproved for the following reasons:----•-------•---------------•---•-----------------------------------------------•---------------------.......... .....:......................................•-----•-•-------••-------------•-----......•......-------•---•-••...-•--•-•-•-••--•-•----•---•••---••-•--••-----•-••---•-----••--------••------•-••....----- (� Date Permit No.............................•--•---------------•- Issued._. �- --O_ ---•--- -------------•Date- ---•------•------••--•^-- 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA No.._._._..7`v_... `-� '.--- THE COMMONWEALTH OF MASSACHUSETTS t ; , .•� BOARD OF HEALTH 44 _. may✓ ...................... . .. ✓,^�'-� OF.....e, .. .. Ap iratinn for Disposal Worm Tnnitrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: e Location-Address � j i or Lot No:•' •-- - ...............• . r._. _ .t. /n* - Owne , Address- ................. � Installer Address g Size Lot._.` ...,� >`r .Sq. feet U Type of Building .., �--•-••••-_ 1-1 Dwelling—No. of Bedrooms...... :.. ...........................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) f.- -- -------------------------------------•--------,--------------------------.------.� -------------. ......................... Design 2�y- gaos per person per day. Total daily flow -- melons.----- Septic Tank qaPa tYd�ta allons Length Width D>ameter-------•-------- Depth_...-------•---- Disposal Trench—No_____________________ Width_ ._.....__..____.. Total Length................... Total leaching area............. sq. ft. Seepage Pit No.__�?�x: `�:`___ Diameter......( :_______ Depth below inlet...... . ...... otal leaching are _d..........sq. ft. Other Distribution.box,::( ) Dosing ank Percolation Test Results Performed by.., _ _____. Date._7 " . a ----------- Test Pit No. 1................minutes per inch Depth f Test Pit___._____.__:__.___..Depth to ground water ___.______.___._____. 4.1 Test Pit No. 2................minutes per inch -Depth of Test Pit.................... Depth to ground water........................ a ...---- o -W .. �. .. � Description of Soil..----- ---Q......'�...-- '�+►�...._.. _r.�:. - --�..*J_d3�.a _. � -- ---- __•`-` .f.`-'-- - -.. V .--------------------------•-----•--•-----...._-•----•-•-------•.........-----.....•-----•-••••......••---•....•---------••-•--•-•---•••-•-------------•...---.......•••-••--•---......--•-•----------•-- 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:I:'IZ 5 of the State Sanitary Code—The undersigned furtlier..,agrees not to place the system in operation until a Certificate of Compliance has been issued by the board-of health. � ✓ r�, w Signe .- � i`'� _.......--•----.------ :��fix .---------- `:�' ................... . . - - Application Approved By...... Date Date Application Disapproved for the following reasons:----------•---------------------• ------------------------•-•---------------------•--------••_-_.... ------------------------------------------•-----------------------------------------._.......--•-••.......---•-------------_._.------------------------------------------------------------•----••---•--- Date PermitNo......................................................... Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ALTH ........:.:. ...........................OF............. .. -. ............................ irdifiratr of f ompliFanrr TH 1 T That, In' i ual Sewage Disposal System'constructed ( ) or Repaired ( ) by d�� ..-- ............. -- ........... ................ .. . . ....._ . In e r -- -- ----------has been installed in accordance with the provisions of 5 of The, State Sanitary Code as described n the application for Disposal Works Construction Permit N __ ______ ....... ____?"f da.ted___,, .' ._. - ., ----•----- THE"ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTkM WILL FUNCTION SATISFACTORY. In rr P DATE...... `�.�..fl`�...................•------------------ -----�-----•--......-•-----•--...._......-- THE COMMONWEALTH OF MASSACHUSETTS �5 BOARD OF, EALTH l(� .............................OF................. No........ ............... ......._..._.._.._..._........ FEFI.3�......... Dispnis rh v mi# Permission js h eby granted......... t ............................. ......... to Construct ( or Repa ) an ivi al Sewage D eystem at No... . ---- Street as shown on the application for Disposal sWorks Construction Per 0_______ __________ atedr./�.9,•--X --_ + R •- „"� /0 «' oar'd f DATE. ......................................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS •.ti_, ' d , 1�F''T"1G _Pp�K = ��OJ irjG ''J® * 4�tj�.F'•D. u5�- t o00 .Srs L— SPo<At_ PST - uSEv locna GAL— UA tk/ALL AV-'=- - tSD S.F. 13sr-r04A ACEA= 9�O ST=. tP PeoF -42S G.RD. 2'70 _..• .. To-rA L v 4t of r-cA•�v = 33D 6.1?D. 714 PaoP a 00, �fdGDI.QTlOti,1 21�T� I itJ 2./vt(IJ• C)2 ASS. �.•.-••+� _ �.'7'.H+ i Tc-r Pw,> 'fox 9r,•� �'iE�IC 1� �s. 41 Sa o\ loco se ,Nv. tw• AlPIT w�ru wAs++ n q L b�C AT I O" tr t•1T'gr4A!t I LZ /�=& /3 tJ o �c ray-.�- �C.l`.L t,_. � ►I . 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