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Home My WebLink About0129 EAST OSTERVILLE ROAD - Health (2) Ca,�- (�S•IexV;Il e lJsr villa rh 00 O 'I i i i N SMEA KEEPING YOU ORGANIZED No.10334 2453L. MADE IN USA CET ORGANIZED AT SMEAD.COM THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF H EAL r.-ILj I P- -.- .. ....�JO - .. OF....... :.. ............. ApplirFatiou for Diapos al Works Tons rnrtiun thrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal �tem at• � �.. .. ..._._.. ................ ..- , .... .._... .. ocation, dress or LotZo. .... ......... .......................•.... ........---.......F __.. .... .............................................. er O Address r W Installer Address Y T of Building Size Lotl 5" 0 1_.7---Sq. feet Dwelling—No. of Bedrooms.._.._ ________________________________Expansion Attic ( ) Garbage Grinder ( ) py Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ------, 4....................................................... W Design Flow........5'a•.--•............. gallons per person per day. Total daily flow-------------- ................gallons. WSeptic Tank—Liquid capacity! ....-___ a ons Length................ Width---------------- Diameter________-___-.__ Depth................ x Disposal Trench—No. ......:............. Wi ................... l Length__............... _ Tot leaching area....................sq. ft. Seepage Pit No---- —Di ._.•.1.------.. .. i 1 leaching area: 8. ...sq. ft. Z Other Distribution box ( ) Dosing t k ) 0,�'CG — — �— 7 7. Percolation Test Results Performed by._ . . ...... f...!l...e.......... Date... _-_ .:_I ----------- Test Pit No. I................minutes per inch D pth of Test Pit.................... p ground _......_ Depth to water........................ (i Test Pit No. 2........:.......minutes per inch Depth of Test Pit......:............. Depth to ground water........................ X; �.. Description of Soil e = � l .............. 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 TITLL 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 alth. / gned ..................... �...1 ---••----•- •-- ..5 ---. 7 �� / Application Approved BY---••------•- •-- ---. .. -• - • --�1R................•-•-•--- -•---j�----�-�-`--�-7-- Date Application Disapproved for the following reasons:....................... -••••-••-••-----•••---•......................................•--•... ......••...... ..-------•----------•-•-•--•--•-••-------••---•••-••--••-•••------•-••••---------•-......••••••-•---•-•--...............•--•---•---•---••••-••-----•-••••-•-•---. - -- --------- ----------- Date ier'_li3t NO.------:..--•-••......................................... ISSlied__.....................................................J57— Date "y ^ s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL "T ............ �t!�+!a.'y ,....OF....... Appliration for Dhipaoal Wore Tomtrurtion Profit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at t, . ocation dress or Lot No. �',•* 11 w er Address A ................................... Installer �'`� Address r 4+. t T of Building '` Size Lot........I.................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ______ No. of persons____________________________ Showers — Cafeteria Pa Other fixtures - -- ----• . . Q t�1............................ Design Flow______ ................ all s per person per day. Total daily flow.______. gal W -- --------••---_..gallons, Septic Tank—Liquid capacity� s Length Width. Diameter Depth _... x Disposal Trench—No. Wa al Length To leaching area....................sq. ft. Seepage Pit No. Di +----- --_-- e tz bl'� elwo i ____.... tai leaching area__ q. ft. Z (Other Distribution box ( ) Dosing t ) d �� , -� /;t—*? ` 77, '~ Percolation Test Results Performed by._ ._____,.le......__ _.___-_. _.__. Date__.! ______-__-- . a Test Pit No. 1................minutes per inch D pth of Test Pit.___.: _._________ Depth to ground water........................ Test Pit No. 2................minutes per incli Depth of Test Pit.................... Depth to ground water........................ \ p+ 4.' D Description of Soil ` _'____.....:. '�1��......-P!-f . :.._-•"3 ---�� --- x ___-------- 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be!,*sued.by,,t4e bpard of Walth. gnedf .:_.. _ loo, � Date Application Approved By --= .. ... ------ -- -------- ---- Date Application Disapproved for the following reasons------------.................................................................................................... ---------------------- ------------------ ---------------- ••---_______ -•---...__.._..-----------•----------••-----•.._..•-•--•----•-••------------•-----------------------------•-••----•----------- Date PermitNo.--•............:............•-......-•••••-------••-•-•• Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA H�� .........................OF.......:...:..:..:..._:,:..::..........................................-:.<.;......... TPtifirair of Toutphatta THI TO RTIFY 1` h e Di osal Syst constructed ) or p ired ( ) by W ______-• •• -- •- - _-' --------- ---- {.«�/ has been"installed in accordance with the provisions of T Y 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No,(.? -•-?V-jo--------------- dated___-� ._ .�1" THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE:CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. x' DATE...........:'.. .__ ...� �: ............... Inspector........�------/ ----------------------------------------------- �T n THE COMMONWEALTH OF MASSACHUSETTS BOARD W, HEAL- OF................7 No..........e .....-••_... FEE........................ Permission is y granted....... ¢...................-- - ±_ to Construct ) Remit ( n id ys atNo. - .................................................................................................. -••-- --•- ---••-•-•-•..._.....•••••- ` Street r as shown on the application for Disposal Works Construction Perm o.____ :: _ _ Dated__ _____________ ---•-------------- DATE. -• .. •--••••- . 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