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HomeMy WebLinkAbout0406 SOUTH MAIN STREET - Health 00 q 5 M E A No.2-153LY UPC 12934 smeadcom a Made In USA FO�RESTtr1f WITIATIVE C.niBodFi�rsourcina L O CATION SEWAGE PERMIT NO. VILLAGE I N S T A JL LE 'S N i ADDRESS tli'C�`R OR OWNER DATE PERMIT ISSUED _ DATE COMPLIANCE ISSUED � � o . J V co y No � .... ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H, • M,"W Appttratiou for UWposal Workii Toutitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .� .. 4_ i4No.:�t� orcati Address ner. 1 ddres ...-- ............. 't ....................................... Co - L-�... J --- . .............. � Installer Address d Type of Building Size Lot_1/0d©09 Sq. feet U Dwelling A!'-'No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 44 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 ( ) '_1. Percolation Test Results Performed by --------------=------------------- Date........................................ ,.a Test Pit No. 1................minutes per inch Depth of Test Pit............_....... Depth to ground water........................ f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil------•••-- -------------------------------•----•------•--•----------------------------------------------------------------------------.....----------- x U ....-••---•--•----•-------------••---•---•-----------•----•----•-•-•-....--------._....___.....•-----•---------•--•-----•---•-----------•---------------•----•--••.................................... ---------------------------------------------------------------- ----------*---------------- ---------/......................... - -- ----------- U Nature of airs or ltera ns—;A saver hen applicable._. Z__10_Q _ ---- ------------- 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 is ued by th bo of health. Sign( ___ ._. --•-- ®� � Date Application Approved By............. _1...: .• ............................................ ........ cis- — D ate Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------- -----------------------------•-------•••-------------•••-----------------------------......••-------...--•-•--------------•--••----•------•-•---•--•----••--••-----•----•--ki 3® 1 Date PermitNo......................................................... Issued_... —------------------ Date THE COMMONWEALTH OF MASSACHUSETTS wk BOARD OF HEALTHY ..........................................OF..................................................................................... vEntgfiratr of Tomlittattrr TH TO Y, the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...... ................................ ------------------------- ... --- --•-- --•---..........---...--------•---- I aller at .... ..--•---- has bee installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__<9 1.`.__ e ........ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... No.-- F .............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......................_ ---------------OF........................................... , ppliration for Elhgpaaal Works Tnmunrtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System. �.. x. f .a o ati Address or Lot No. V + ner d esJ W r ' 4 Installer Address �y, d Type of Building Size Lot............................Sq. feet U Dwelling AeT*4o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers � YP g --------------------•------• P ( ) — Cafeteria ( ) Otherfixtures ------------------------------------•--•-............................................................................................................ 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........................................ Test Pit No. I................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........................ ODescription of Soil -" --•--• -- -------------------------------------------•----•-•-•--•------••-•---•----••...--------.-•------•••-.----• -•--------•-- x UNature of Repairs or lterat ns-A wen applicable t ....................... ---- -----•--•--- ---- -------- -------- -------- ---------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions.of TIT1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been s ued y th boa of health. Signed . ........4----••-----•-------•---••-•-------- ............................... Application Approved BY .. "....................................... Date Application Disapproved for the following reasons:................................................................................. ......••. - ---.. b-716- - ---------------------------------------------------------------------------------------------------------.------------------------------------------------------------------ ........... ---------- Date Permit No......................................................... Issued---- -- 4�"a ".. Date I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... �r�i�irtt#r of f�nrm�r�i�nre THIS 0 C R Y, the Individual Sewage Disposal System constructed ( ) or Repaired ( ) •--•-• .---by InsMller at_......... --•- . --- ------ .. has bee installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit Vo__________----------_t'__-.S_...... d-ated:............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................0 F..................................................................................... No... 1' FEE-----`.................. Ton udwit pamit Permission is hereby granted...- ...... ...................................... to Cons tr t or epair.( ) Indij ua"Senwacge sposal System at No. r � Street as shown on the application for Disposal Works Construction Permit No................... ated... .... and of Health DATE... ". FORM 1255 HOBBS & WARREN. INC., PUBLISHERS