The URL can be used to link to this page

Home My WebLink About0103 ELIJAH CHILDS LANE - Health �03 I 1'6AA CA iI d s A Ile TV j&e 171 - 273 T 1/// SMEAD -- 1 No.2-153LY UPC 12934 amaadx= • Mach in USA SUSTAINABLE FORESTRY OINWK GNbid Rbw So rft r , Iv � LOCATION SEWAGE PERMIT NO. VILLAGE \ I N S T A LLER'S NAME i ADDRESS t U I L D E R OR 14 1i�1►� �- DATE PERMIT ISSUED DATE COMPLIANCE ISSUED Z- -R a I �.�r �� bite�l-vn.. �� i .3 �3V �� ,� �'r ' ,, �. .., _w, _ I �.._ CO/ N...........t o.$-- F�$..�j ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...._.JD °.J---.........OF... `�'S�/c/z�b' � .................................. Apptiration for Disposal Works Tomilrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst , at: .......... :.'=........ ---•- .................................-------------....-------------....-....--------............._ Location_Address or Lot No. �� t i ..... -'��°- •- .................................................... ....... �-�= --•-----....... Owner Address .......----- .._...... Installer Address _ Type of Building. Size Lot_/�,.. � ...Sq. feet 4 Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (Ayo Other—Type of Building No. of ersons____________________________ Showers a YP g ---------------------------• ------_P ( )..— Cafeteria ( ) Otherfixtures ••--•-------....:•--••••----••---••-.-••- •••....-••-•••-•--•----••-•----•-•._..:_-•-•••-•-••••••-....••_... ----•-•••- W Design Flow.... _____________________gallons per person per day. Total daily flow....... ...................gallons. WSeptic Tank I—Liquid capacity/ gallons Length................ Width................ Diameter________________ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No./4647-��w___. Diameter----1-2g ':_._ Depth below inlet____________________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing ) aPercolation Test Result s Performed by....... ...`............................................ Date__I .�'Z3^.R�.! Test Pit No. 1_. �.minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ! t - ----------- Z ............... Descriptio of Soil Z ........................................................................................................................................................................................................ _....----------......_...---••- V 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 iI:LL 5 of the State Sanitary Code—The undersi ,ed further agrees not to place the system in operation until a Certificate of Compliance has been is Fed by the boar• of health. Sign g _ •-••-• ••- ��..- Application Approved By....... ••-•• � __. .. -/a / Application Disapproved for the following reasons:................................................--------- ...................................................... ...................................•-•••...--•--••-••-•-•••...._...•---•••••----••-••---••-•-•••••-•------•-••••---••••••••••••-•-••-----•••----•---•••-•-----•--•-•-•••-•------•_._--•-•---•-•-•-•---•- Date Permit No----------------•---._...----•--••.------•-------...:.::. .., Issued..... Date .NO..t...... •y:!. Fps..:-:': _.........f. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.................................'...:........ ......................................... Appliraa#ion for Ehapoiiaal Works Tonotrurtlon .snit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__........:..................................................................... ........................... Location-Address or Lot No. ............................... ................=............................................................ ..---•.--------- Owner Address W Installer Address Type of Building, Size Lot............................Sq. feet °., Dwelling Z No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building _..._____.. No. of ersons____________________________ Showers a YP g ---------------•- P ( ) — Cafeteria ( ) Otherfixtures ------------------------------------•----------------.....-----------------------------------------._...-------------•--.....----......_..------_--_-- W Design Flow___________________________________________gallons per person per day. Total daily flow............................................gallons. WSeptic Tank L 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__ _ ....................... a 7 1,,- ; 04 Test Pit No. 1__ _ -._minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ` t O _... .............................. Description of Soil .. _. �- « f ".. W Nature of Repairs or Alterations—Answer when a•••licable..............................._................................................................ ----------------- ---------------------------------------------------------------------------•---------•-----•---------------------------------------------------.._._.._...••••••••----•-••---•------•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 health. Signed - Y-----••-•---•------------•-------•----------------•• ...... r r , Date Application Approved BY---•�..�..._, ! .__ i _. ._ .. .. >:,?�.............. F . r late - Application Disapproved for the following reasons_______________________________••_=__.._._.._._..._..._________••______-_-_----------.._.__...________......:____ ...........-••-•-•••--•-•----•--•----• •••--••-------•--••-•------•-----...._•••------•--••-•------....... Date ,r PermitNo...................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ....'Na 4t::........4r }.. ......OF............ ,.. Tntif iraatr of TOmpliaana T� S IS TO CERTIFY, That the Individual Sewage Disposal System constructed (�') or Repaired ( ) by =, s ` `�'' : ..... . '---- .......... ` .... AnstaJler + �'t ,F has been installed in accordance with the provisions off'T .T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No f_.___ _':_______. dated....... '" °________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI FUNCTION SATISFACTORY. DATE....................................�-� .......................................... Inspector.... THE COMMONWEALTH OF MASSACHUSETTS Tf BOARD /Op.,F HEALTH � �� No"..... !: FEE,,,.::? �''....- .... Rquisaal lgprkii 0-Vons#rudion andt Aj Permission is hereby ranted... ----- ' to Constr ct ( or Rje'p`re ( an Individual Sew9ge DlsPosal/-System r at No... tf ��. � :� 'a to•`E+ -a-------------------------------------------------- Street ---�'��{ ; �y,,,,•- �•�°-.•--7. .r'--•-----�-^at-�-l'-^-- -- - '�-�-- - �,_ _• - } as shown on the application for Disposal Works Construction Permit No.___.,.,*. ,_______ Dated... `. _ t .......... .................. Board of H t `ir i t altl;--.."" DATE------- - ............................................... / FORM 1255 HOSES & WARREN, INC., PUBLISHERS r. u0 GArtFSAG6 C��I f.tD�1Z ;{ t>&t Lq FL,ow a t Ib +c 3 • SSC> &-p•D. Ld . ��-Ic `rAutc = 330� Igo % • �5 6.Po. / use t000 sal_. l3f l$ ,i' LSPo�AL PIT - uSE IOcao GAL:; 4M;N SMEWAL.L AZEA - t50 S.P. O / • 1 SF � 2.S + 3"7S G.P. , � • � Bcrr-rZM I A0 A r SO ST-. j TOTAL -V.>ESl6W a RD. N / t='c•.ow 5 � ��c/D• r� 3/ �- CAD PM$ZC-DLQTIOU QeTE 2�t lKJ: " gal' s o¢ L�51S. } FWMARD A. A. .. BAXTER No.2-,04815 QNAI ��ST 2-Z�-BD Tor ;140 t4OLe i ,SJ$$�/(r 4I WV TAWK 0 }. SaU�y t000 ° 1w 'i• �✓mac- GAL. Sg,Z $�.�. LsAao PIT WAS►IED r { I STONE j sAAJ.0 CCEIZ PiaD PLC> PL./a4�i L C.CA T l O" GSJ.76Z/I L 4-S Rz47 /3 V o Sc c,,LE SC.1�L- •- l�o warms _- � , I CGtzT11=-{ T�-dAT THE �Ovle DATtoil 5&AOVJu PLA�1 Rai=cam 4 t-lF:t-L-,nw 'Ccvv1PLVS w ITN TO : 51DE•LlWC-- I B� A•wp }C.T1-,>ACtG L'G4uiCGticGuT; OP T" -tow►. I or -eaWt l4TASLt3 PL • BIC. �d 3 �� , L ' CaATG 3` Q ,�� Y4c4��,.�.�J� Q ,V J C�•xJGti-�-� accls cc=rZcD 1 A WD 5uevcYoes ' '- TH15 FLAW 1a ►-JOT eASGV 0" AW oS?F-lZVK-LG - 1tJSf`:JC.�J i �ive;\�1=�! T�ac� UFe~'S�T-�, SiicwLD c_ u��c►� GTcCM APPt CANT tik�r Ta l� ►N�: i Lo'c' �t r~t� �L A F.! ; SM A f—