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Home My WebLink About0111 OLDHAM ROAD - Health iir o�d,G,am Rocu9, asfervi(�P� SMEAD KEEPING YOU ORGANIZED No.10334 2-153L MADE IN USA GET ORGANIZED AT SMEAD.COM 4: � J r No ............-... Fms.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH : 'j . , ppliration for Disposal Works Tonotrur#iun Prrutif Application is hereby made for a Permit to Construct (/-Tor Repair ( ) an Individual Sewage Disposal system at,: 7`' .....�-°...___._Via...._.. ..._.. ......... ............................... {' tion-A ss or Lot No. IV Pi t ........... _ -------------MC�_r+.__ _®_�.,6. __�.._'15 . Installer Address Type of Building Size Lot-----Z; 9A!..O.Sq. feet U —No. of Bedrooms......... .Expansion Attic Garbage GrinderDwelling ( ) '4 Other—T e of Building No. of persons____________________•___-_-_ Showers — Cafeteria dOther fixtures ------ Q i1P e---------------------------.--------------------------------- ---•------------...------------------•... w Design Flow.......1Yx2 ____6.2..V_..gallons per person per day. Total daily flow----_....... WSeptic Tank—Liquid capacit}/&1-.0_W.gallons Length................ Width................ Diameter--.............. Depth................ x Disposal Trench—No. .................... th_....___ _. _.�Tal gth.................___ Total leaching area........._..........sq. ft. Seepage Pit No.--------aP_A..FDi nlet ,r� al leaching area D -sq. ft. z Other Distribution box ( ) Dosing t nk ( ) ei- /" ' aPercolation Test Results Performed by--_-106..... �- -_ -.. .._...•......_. Date..... _v.'.7 ......... ,_ Test Pit No. 1--- minutes per inch Depth of Test Pit -- Depth to ground water Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ s - --- 2 O Description of Soil....... .....0...... � `3F_____'------ t . -- x P . . . - ------1 ------------ ------ .........�' :�------------------- --------- w ------------------------------------------------------- U 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 TITIYE 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. sn , ----------------------------•---------------------- ............ �f Date Application Approved By...... •--• . -- ®= Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ...-•----••--•••-•-•.......-----•----••-•-••-•-••--••----•-•------••--•••--...•••-----•-----••--------------•••-•---•••--•••••-•-•--••-•••-- ----------- D------•-•-- ate--------------- y � PermitNo......................................................... Issued :: ------•-••^ ---........ ------.. Date ��_ f� ate► No................_....._ Fimic . ..11:-'"".... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOrt...........................................�` OF...... !°.. ............................................... Appliration for DhipasFal Workii Tinutrnr#iun Prrutit Application is hereby made for a Permit to Construct (-I`rorI Repair ( ) an Individual Sewage Disposal System at IVA --• --• •••• -•-----•-------------••------....... ... �.� LW+'ction-AddressE{ or Lot No. dAl A, • * __ --------- ----• ---------•- ---------.......-----•------ nerF Address :' ......................... Installer Address Type of Building Size Lot..... feet aDwelling—No. of Bedrooms.......:. ..............................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures '-=---------- --•--------- ---- --------- --- --------- •- -------------f; . . .;. W Design Flow.....:_ �. .:.. 't._' ._ ..__galIons per person per day. Total daily flow.__.._._____ _ _ %.. egalIons. Septic Tank—Liquid capacity,.0"1.�..44 allons Length.............•.. Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Wy'dth YTotal��L,�gth.................... Total leaching area....................sq. ft. Seepage Pit No......... h_�Dia r a .__+`Dept bel w•iV......_-y-¢�,. otal leaching area..2-4.3-----sq. ft. Z Other Distribution box ( ) Dosi J�T6nk !�� /" `4 Percolation Test Res s'f.. Performed b ......_....pt ............................................... Date..9��4A' Z aTest 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.L...-._...._.._.._... O +�_- _ r. Description of Soil................................................... ?�- --•---ems ... .. .. ........................................... •------------ ------------- W -------------------------.............................................................................. ... V Nature of Repairs or Alterations—Answer when applicable.............:................................................................................. --------------------•-•--------••...........-=-••-••---•--`--------••._...............---•...:.......... ------------------------- Agreement: r t The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System-in accordance with the provisions of T I T U 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. F . r r r S- ed ---•------- .................................................. T Date�O^ Application Approved By ------------- ... f --------- Date Application Disapproved for the following reasons:--I..........................................................-----------------••-•---•-•-•-----••-------•••--- .............•---•--------....•••••••----...--••---••••••••-•-------------------•-=---••••----------•••---•---------------•-•-------------••------•----•-•............................................. Date Permit No............................................. Issued- -s .......................... Date THE COMMONWEALTH AF MASSACHUSETTS BOARD OF'\,HEALTH TntifirFatr of (Samplignrr THI S TO CERTI T at I1le Individ Disposast constructed ( ) o r Repaired ( ) by ...... .` " aInstaller " ,�d has been installed in accordance with the provisions �T Lr t o The State Sanitary Code as described in the application for Disposal Works Construction Permit :........................_............ `�. _ --.-•--_.._...._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® S A GUARANTEE THAT THE SYSTEM WILL FUN5TION SATISFACTORY. -- DATE............ ...................... :Ins 17777�, pector.... THE COMMONWEALTH OF MASSACHUSETTS ' -BOARD HEALTHY : .-�.....e ...OF No......................... _............•-•--- �i��a�at 'Permission is ey granted... .lwt- r -ir(#c>.....• -- ... ... to Construct (4OT or lepair ( ) a nd'vidual Sewag Disposal Sys e oT^ m e MV ee *� as shown on the application for Disposal Works Constr n Pe i o�_________________ Da d'/ ", .�...._..... % DATE_.__._� . ..........................•.... Board Hedlth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - LOCATION SEWAGE PERMIT NO. 41-4- -11z VILLAGE v �S'TFip�r/LGF Jul/� INSTA LLER'S NAME i ADDRESS ke COGS s-S —7k-4 W,-,e s l�y�s7' Y 0 /11 a 24 73 U I L 0 E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED � _ I Z2 31 Z , �' 00 ' p�:rlGt�1 t7,4TA _ ��. ��- t'�r•t � �r.fi.�z,,,. IriO C�AtZB oG.E G21 f.tC�t=.SZ - i (NO • b 4 33o G.P.b. USA- l oOCU 6�.t_. [�E.WQ.LL AeEA = l S0 S.F. 1 i ic�o SF 2.S = 3 7S G.P.D. `7A . So 55'. I .c> SO S.F.D. TOTAL -r->ESl6Kl = 4ZS G.P.D. ToTQ t- t>d l f`,-f FLow - 330 6.PD. DI=IZGOLQTl0LJ ONrE : J",Q 2-AAIW* OIZ n k000t?TY G,t" y� say [ - r..�.. r Tot PWO IL160.b a �•, �P pe 4 P � PA loon f 5-).O fi 4 fW. 6AL. ... 'box `iG S T�nc to /Z tuv loon q�'� iNv. tw. M GAL.- FIT i G (�a%.�1�Z «. y � WAS1•IQD c� 1.1 CEQTtFIED 'pl_b"(" PL.IS,{..) LbCATlvl-1 dS,' f1L. - —1 Let M4 C M IZ T t t=-( . T t-1 A T" TNT 5 taoly►J PL b"" . 1Z r r-- t~.c I.1 G E: Wr--Q(=ot-•1 WIT" 'i`Wi►: StD� Lt►_I� /� y QtJb SET��ACtG >~CQvt�EMt uTy Os= TNT4F-`S•- -To w w or-- Q'-u B L-9 UATG 3�� gz • u�c twC- B,4 XTelz. 4 c2cGtS rc.ri=� t-�uc� Tt-Il'S PLAW -, uoT ZASGV 064 AN osTEevlL-uc a tl4-;rcL)AAl._W i �,vc,�i�� 4- T44c-- UFt=,�(-�. Gi4ouLr> APPL_I GAt-,l-7 t.F;t• f',Ca u-,Ui-, T"" 0rTr•VMo4 lc)'T' t_tNa45 --