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Home My WebLink About0159 MAIN STREET (CENT.) - Health 159 .Main Street Centerville A= 208 -- 146 _- /// 5 M E A D No.2-153LOR UPC 12534 smead.com - Made in USA �OcYc% a; J LOCATION SEWAGE PERMIT NO. S` l VILLAGE INSTALLER'S NAME i ADDRESS 3 UILDEIII OR OWNER' - rv,�;t L DATE PERMIT ISSUED >f DATE COMPLIANCE ISSUED yam_f� .. �� . -- ,r ,r i �� ti ��.'� �D 7 `'i �. ;l No.._.. .. Fxs.....��.•................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ---------OF..... ................................................. Appliration for Uhipuual Works Tontitrurtion rrmit Application is hereby made for a Permit to Construct ( ) or Repair` ( an Individual Sewage Disposal System at: 0 ,�, Loc ,ion-A .................................Lot No. Owner Address Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ......... No. of persons____________________________ Showers — Cafeteria a' 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_-___:_______-__-_-____. (Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 ------------------------------------........................................................................................................................ O Description of Soil.............. U -•--...._....-•-•---••-----•••••----•-----•---------•--------•----•-•-•--•----•-•--------------•--••-••-•--•-•-•••----------•••-----------------•--•----•••••••----•-------•----•-.•-••---------------- W ...........................................................................................-------------------- �------------------------------------------------------------�------- UNature of Repairs or Alterations—Answer when appli,a leeei7LA:?�.' ------..00/4- -----------------------` ------ •-------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of !TM-E 5 of the State Sanitary Coge— The undersigned further agrees not to place the ystem in operation until a Certificate of Compliance has be ed by bo rd ielth. Signed_ ...... ?s.. W.. Date Application Approved BY �...: .../.. ��-� •--•-- .................•-................ Date Application Disapproved for the following reasons:................................................................................................................ ---•---....--•------•-------•---•-------•-------------------------------------•---------......-------------------------•---••••--•-•••......---••••••••••-••--•-••-•-••-----•------------- ------ Date PermitNo-------------------------------------------------------- Issued-....................................................... Date - allo........ .........1- FRs.....��.................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH '.-. ._.-..-..oF........... .:.--- ......................................................... Appliration for Disposal Works Tontrnrtion Urrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: + ....L�9---....... ........ ......... _'� ------------ .. .. l =� � .... .................••--•-•-•------•-----•---or Lot N o......------...........---................ Owner Address r .............................................................. ...............•--•--•------•-•--....._ ---••-•-----....-•----...-----^----•-•---- -% Installer Address Type of Building Size Lot............................Sq. feet 0-4 Dwelling—No. of Bedrooms............................................Expansion Attic ( )Showers Garbage Grinder ( j Othe'r'z—Other fixtturedin....__.--•-•----•----••- ••---•--No-•-of---ersons----.._-.._........................•----......._.....-----......-•---...........---- p, yP g p ( ) Cafeteria W Design Flow___________________________.................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length----_--------- Width................ Diameter________________ Depth................ 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ (X, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............................ Description of Soil......... . -_--_-_____••--- x x --------------------------- ----------------------------------•--•----•------•---- ------------••----•- ` -- 2,r U Nature of Repairs or Alterations— n wer when applica le.," �'^� r , Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT I:;�. 5 of the State Sanitary C,°O j The undersigned further agrees not to place the stem n operation until a Certificate of Compliance has beer,issued by e bo rd . ieaith. . Signed_: •--••-----------------••---••-•----------•-••---------•---•--- ...................... Date '......,._ Application Approved By___ °' t_ __. �' ` -� • y_ .......... .............••----_------ -...._•--------•--• -•-........... . / e Date Application Disapproved for the following reasons-------------•---------•--------•----•--..-.-.-------•-----------------------•--•----------------------..._-•---- ..---------•----•------------•-------...-•---•---•------••--------------••-•-•-•--------•--••-------•-•-'----------------•••-•-•-...----•------------••---••••--------._...------... -•----•----- Date — PermitNo..................................-...................... Issued....................................................... Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ....3....OF..... ............................................ (err tifiratr of Tomixlianre THIS IS TOY, That the Individual Sewage Disposal System constructed ( ) or Repaired by--------------------------- --•----•-------------------------•----•-----•----------------------------------------------------•---••---•--------•-•--------•---------•--•-------•---- at.•----•-••--..__...:__ "•---•--_ 'tit= •`-''--- -----•In r � 6'.A ✓i!' has been installed in accordance with the provisions of TIT T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._-c -- x dated__.............................................. THE ISSUANGE'OE THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL 1 FUNCTIONS TFSFACTORY. `� 1--1 � DATE........... ------------------- Inspector....---------- -�- =................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF....... No ..... ..... . ._ FEE .... Disposal fors Tuontr ion rrmi# Permission is hereby granted-----.:w'�_-.. -- :_....-- to Construct ( or. Repair <an Individu�� SevvaDi posal Saystiftri atNo------------- -----•----- .-------._ ?"...._._....... ''�� ..........................................-- Stree as shown on the application for Disposal Works Construction Permit tNo._____l� ......JDat��,_�.."y_?��__.:��....�'�--- !;_=._ 4=7r.-'•---.................................Boar o�alth DATE---•-------��-"`. ---- --------------------------------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS i