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Home My WebLink About0054 EBEN SMITH ROAD - Health �4 c b.� N ................. ...... F:ms..... ......._ THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH -..............OF...... Appliratiun for Diupuual Works Tuntrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System al: •.-- ..... ............................. ._.... .......... --...... -.... 2 `'7�--- ...... -- _......... . ion-Address or . caner //�" c r Address Installer Address �- d Type of Building Size Lot_.�a.ld.. J-273 Sq. feet U Dwelling—No. of Bedrooms............:...............................Expansion Attic (�Q Garbage Grinder ( Other—Type T e of Building No. of persons............................ Showers � YP g --------••----...---•------• P ( ) Cafeteria ( ) Oter fixtur.�.......................................................................................................... W Design Flow..... ...... l d..............gallons per person per day. Totaaily flow--- :3•------ram` ...................gallons. WSeptic Tank—Liquid capacit allons 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 ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test 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........................ a --••---•--•-------------•---•••-••----•-•-•---•--•••••......------•--.....-•---...:.........--......... .----------- ------- -•-•.............. •-------------- ODescription of Soil........................................................................................................................................................................ 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 TIT I.;;:. 5 of the State Sanitary Code—The unders' ned further agrees not to plac the system in operation until a Certificate of Compliance has been by the o d of health. M ed. --------...•-- -------•....-- _. •DaAPPlication Approved By..-- ------ ,� ........... . . . . --...--------.......... *?4y � �.. ` Date Application Disapproved for the following reasons---------------••-•--- --------------•-----------------•-----------------•-----------...-•----......••--- -•-----•.................................•-•-•••-••---•---.._............------•----......•-------.....---------------------------------•••.-••---..------...---------------...-------•----........ Date Permit No......................................................... Issued_.-.1. ..................... Date No(-') Fics...... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH Appliration for Disposal Works Tonstrnrtion rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Location Address �"�--- or Lot,No. r A / ............. Owner Address Installer Address I. .� '''M' Type of Building �� Size Lot._. ::....__:"1�_'�Sq. feet Dwelling—No. of Bedrooms.._....... ----------•-------_---_-Expansion Attic (/vo Garbage Grinder (Ay aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Outer fixtures-c ... ...... ---•--•---------------- W Design Flow...... �� -----------------__..gallons per person per day. Total daily flow....... ._2�....:�`�'.................gallons. WSeptic Tank—Liquid capacity. ....... gallons Length................ Width................ Diameter................ Depth................ x . Disposal Trench—,�.No.................... idth.................... Total Length.................... Total leaching area..................._sq'. ft. Seepage Pit No.l 17,tP.... Diameter.......6��....... Depth below inlet.................... Total leachingarea.........._.... s ft. Z Other Distribution box ( ) Dosing tank ( ) q Percolation Test Results Performed by........................................................... 'f ,a ----•---------- 'Date.....-------••------•--•................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ .-•----•-----•••-••---------•----•-----••-•--•--.....•••---------------------------••--•••-----••-••......................................................... 0 Description of Soil........................................................................................................................................................................ x 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 TITTLE 5 of the State Sanitary Code— The undersigned further agrees not to plac the system in operation until a Certificate of Compliance has been issued by the board of health Signed :7(0l �-4w ••----•-- ...... r v Da e Application Approved BY �. ' Application Disapproved for the following reasons:............................. ............................................................. Date -----•--------------------------•----------••--•-•----•---•-•------......------•--•------•-•--- Date PermitNo.......................................................-- Issued....................................................... Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �t ................. Trrtifiratr` of Tomplianrr THIS j T� RT , That t o' Sewage Disposal System constructed (�r Repaired ( ) bR - - -- -- --- --- --- ------ st' er at: ....---- . • ......A 72..-- ----- -- ..al "__ --I,J.�,i' 3 d' --------------------------------------------------- has been installed in accordance with the provisions ofT��..f..f.4..5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N __ ,... ................ dated---------` `.tl•-�- ................. THE ISSUANCE 6F THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ ......� S� v. ------ Inspector---... � _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH = N ............!/.... ..........OF............&.4Z�� -..r:.......... Disposal r rant Permissionjs hereby granted... t ............................... to Construe, (�� r Repa ) an d S ' Idual Sewage' sposal f , em ^+ =:: ., f Street as shown on the application for Disposal Works Construction er i_t NOA10Z /I.... Dated....9 oA-�d................ /40..... Board of Health.' --DATE... { - d.............•.................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - - • � 2 2 .C,t`�( �Lc�w 11U ,c 3 t 33U G.PU, �j��._ 101 ISO % • 4-9C2�.P..0. F,¢o� . .awp (6�!% USte- l GOO 6,4L. ?Ir t •��¢P.�,4 -t)ISrOSAL PIT - uSE I oc+o GAL TOTAL •DESIGN = d.25 r��D TOT4N L ID,dt t_-( Ft�w = 306PD 2 - - s4, sef— - - 5Q- �fZGDLQTIOt.I LF&TE �� I�.! Z•". u 02 LX--% X - tyl 'ALA � ,rye 17 8o S4 Tod' Low '°oc I vco iuv Sob olt,.. -sox .4.G Sic f So+. GAL.FiT LEAc N 'a i, •i q waswev - ' �� ,off �.o• _.,.� �� CECZTCFCGL7 VLO'T- F'L.�>!�] cGlrTlt=� Tt-(AT THE. t°°0001>4- row 5taOwl.f 6-2F.�(=i5►.1 e--(:xtiIPLI-IS W ITtA T"i1: 51 DE A-I"G- /AWt> SC'TL-1ACt4 VC-a JlCeM _"T-', DF TNC- LOT t Cr PATC cZc.Gl 7 tt::Zr- v L�.tJc� SU2u�=Yv►._S TI-Il5 C�t_A!-I I; tJUT L'A;EO vt /��J oSYE�:�/Cl.li v A�AS��• -fME- U•,.U;7.) ro t�I i' ►�Mlty.1�_ 1__nT l_tt4c,:.� _--------- { 1:1 11 L_ .