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Home My WebLink About0349 SOUTH MAIN STREET - Health 3 qq. - - Sao? S M E A D No.2.153LY UPC 12534 smesdcom • Made In USA 9J9AWW WAVE GNBodRbuSourcin9 I LOCATION S 111 A G E V F R Vii T M 0. ��>q'i 50 a-, V I L L A G 1 N ST A LLEVS NAME L ADDRESS 3 U IL DER C F1 OWNER :SAT CMPLIANCE ISSED E O U 31 a � l , �� el/ J N G.--(:S-.Z Fins.._..��E.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 775W.T1...............OF.....1 �Ctns a I.�....-----------------------------•--•--..._...---•---- ApplirFation for Disposal Works Cnontratrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (*) an Individual Sewage Disposal System at: t .... 34q - ............................. L cation- ddress o Lot�/No. o Fl 9A E WQf 3y� SO[l GIYIeS :_..l•¢YL Vt�'�'.e...................... ......................-s -►••-- . .... �{ Owner r A Address f a 14MC0 3S0 fllir, S Gt,�e@ F._yG.Y.CI ----•-•-••-----------------•- ----------•---•---•---••----•-•••.......-•-•-------•----•-•-- ---••• ._...._....•-•-�... .. - ..................... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................._____...................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type 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 ( ) PercolationTest 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........................ •-------•---------------------------•---...----------------•---••---._......._......-------•---••-•-.......................................................... 0 Description of Soil-----.............--................................................................................................................................... ............... --------------------------------------------------------------------------------------------------------------------------------------------- �jn U Nature of Re airs or Al�erations— nswer when applicabl __.I_ da__9r��_..� ._ _ _ !�_ �'_ ag,c.... !Q--- ------------- -•- -------- - ---_-PI - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I ITL 1E 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. - - g--- ' Application Approved By...........................--- ----•- = 1'`' Date Application Disapproved for the following reasons: - ...=------------ =r:---------------------------------------•------------------•-•••••---•-- -----------------------------•-•-•--•---.._..-.-.--•----------------------------•=---------•-----•--------••-•---•-•--•-----••------- -. ----------------------------------------------------------- Date PermitNo......................................................... Issued.....1---------- -----------------------•------- Date �y THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA ,......Cr> FEE ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .._----......�.-GW ............._OF.....Ii rI�s c, ............................................................ Applirativaa for UWpaual Works Tangtrurtion Urrmit Application is hereby made for a Permit to Construct ( ) or Repair (*) an Individual Sewage Disposal System at: S ................_................................................................................ .......___...-------••------••----••-•------•------•-•------•---------------------............--•- Lgqcation-A,ddress � Lot No- To ....... ............................................. ..........-........................................................ ue 1. = ............... Owner fi Address ►W-a .............................................. 3so #Imam 5�cosr (Uar.� GPGrv/l�.cr, In.---.er...•-•--•....._......................... ...7----------------•-•-------------•--- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (P) a Other—T e of Building _-__-__-- No. of persons............................ Showers — Cafeteria Q' Other fixtures .......................................... 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........................................ a 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........................ 9 •-•••-•••••'-•---------'--...••••-••-•-••••••-•---__..._.•-••••-•-'--......-•---•......-•-----•--•-......................................................... ODescription of Soil........................................................................................................................................................................ W U •••-••-•-•-•'•-•"••-•--•-••-•••'•--••'-....•-•--••-••-••••-•-••--•••••......•--••-'•..........................•--"'-••-•......•••_.. --••--••••-•......••-•••••-'••"'••••-......---•••-•...•••.•••--- W x U Nature of Repairs or Alterations—Answer when applicable_..I S6o Gc��.S et c_ .............................l o ,__ t�_I________--_ Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 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.....I..,- ��G- L RJ.ri.ttUf l�s--................................... (! Cs ZDate Application Approved B _` 1,. �J :�..:Y �---- f PP PP Y -----•-•---••-_--••.. ------------------•••. Date Application Disapproved for the following reasons:----••--------'•-------'---•-------------------------------------------------'--•--••••---••'-•••'--•-.......-- ---------••----------------•-----•-------------- -------•-•-----•-•-------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued_....................................................... Date G N��SU4� THE COMMONWEALTH OF MASSACHUSETTS BOARD -�OF HEALTH J .1 Gu,>.................. b�e ....................................................... T:rdifiratr of Tompfiaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (-•,=) by - ................•---.._.......----•-----•--••----•" -----------•-•-• •-----••.........................._.....-----•-•-......--•-•----•-•--•--- - Installer c-- .............. ----- ---------- ------------------•--------•-•-•----------------..................-•----... has been installed in accordance with the provisions of TITI—R, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------------r^._____._C_-_` dated........ ...:...�.__-_.e-.!.^......... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................................•-•---.........•••-•....---•'••--•--...... Inspector.................................................................................... 3a14�lSG/J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF 6vmc Ile � No. ............ FEE., �`-.'.._J.... �iu�uu�t1 Turku �uaau#raiurt rruti� Permission is hereby granted..... ��1� C'_�.......... =�' _.__!...__________________ -•---•--------------••--....-•----------...........•-------•-••-• to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............. .............------...-=........,'=.......-------------------------••---••----------- Street as shown on the application for Disposal Works Construction Permit No.----`,.,�_.._---�2 Dated-------�___..:_ .. / -� r /^ Board of Health DATE. - : ...................................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS