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Home My WebLink About0141 OLDHAM ROAD - Health WR oI d hcc m R", OsWv I12. j S 7ME7A DO] KEEPING YOU ORGANIZED No.10334 a-153L MADE IN USA GET ORGANIZED AT SMEAD.COM Cow) No................_....... ....3.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD FOF HE LTH ............r ....OF.....: .. .... .....:.. :...... Appliration for Uhipoii tl nrkii Tonotrnrtinn ramit Application is hereby made for a Permit to Construct ( -en or Repair ( ) an Individual Sewage Disposal Syst .... ... ......... -------------• --•-----•--------••-•--•----.......-•---- .. ---- - L on ess t No. ----.-u-=- ........4 ....... ._ -- ............................... Installer n Ad ress W Owner �:Ni a r. ....... .......... . ----------------------....._ _ :. -------..._.. -------- - dress Type of Building Size Lot.. Sq, feet Dwelling—No. of Bedrooms..... ..................................Expansion Attic ( ) Garbage Grinder ( ) pa,, Other—Type of Building -______-___-•............... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ._. _..___ W Design Flow.......... x___._gallons per person per day. Total daily flow.....33.0...0`TLDE.......gallons. WSeptic Tank—Liquid capacity%..-_:_ a Ions Length................ Width................ Diameter-------------.-. Depth................ x Disposal Trench—No..................... W' th...<- ._... . ToV Length_ ................ Total leaching area....................sq. ft. Seepage Pit D ... ............... ep t_......._. otal leaching area..................sq. ft. Z Other Distribution box ( ) Dosing ank ( ) ®� �✓ Percolation Test Results Performed by '�... G¢ ---- . Date_. �a��f ' `� ..minutes per inch Depth Test Pit.................... Depth to ground water........................ Test Pit No. 1... df �Z4 Test Pit No. 2................minutes per inch D pth of Test Pit.................... Depth to ground water........................ - ---- ----------- O Description of Soil - - �._.`n�. _.... ...". — /;0,------------ V .............•------•-••--•------•-•--•--•---•--------------•-----------------------......-•-----••-•--•----•-•---•................................................................................. W ------------- ......................................................................................................................................................................................... V 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 iITIL- 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. Sig d ....... ................... •-----•--------•-------.-_..._ ... `�' �6y� ate Application Approved BY_...... � _.__ _ ... . . l�f��l � ��-?-: •: I Date Application Disapproved for the following reasons:-----•-----•• ------------------------------------------------------------------------------------------ .........-•-•----------------•---._.......---------•------------............--------.........--------.-•-•-----••--•--•--••••---•--------•-•-------....--•••--••--•--•----•---•••---••-••---•----------. Date PermitNo......................................................... Issued__ • ...........................------.._...._ ...... Date �y llell No..............._....... _............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . . .------..... ........ .--.OF...... ...:........:....: ........ Appliration for %posal lVarkii Tontrar#ion Frrutit Application is hereby made for a Permit to Construct (10 or Repair an Individual Sew a a Disposal Sys' _ ..... .1..� -- ...... ..�.� ...... ........... lLoft4on ess `/" ' r,Lot No I I:!'rt�locwta!F �i,✓7 ff' !" --i- -•--- ......•= ............ .......=-�...I.✓.....b... Owner A°d°dress - a (f .........................-•---....---•••......••••-----•-•.........••-- .............................. ''___ .,!!e 2 ., -_----•------___---_______-•----•---•------------____ Installer / Address ,, Type of Building ' Size Lot............... ....Sq. feet Dwelling—No. of Bedrooms----- ...................._.............Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a+ g fixtures ... __.._._._ ---------- W Design Flow....Other ` ._gallons per person per day. Total daily flow----- .......gallons. Septic Tank—Liquid capacity/ ... a Ions Length_______________ Width................ Diameter................ Depth................ W Disposal Trench—No_ ____________________ W,idth______:G........ Total Length. Total leaching area--------------------sq. ft. -------------- Seepage Pit No..`�. D�}i Yn ter._. eptll"�e1' et._._______p� __ otal leaching area..................sq. ft. z Other Distribution box ( )% Dosing ank ) /" ` ' Percolation Test Results Performed by. .___.. -"._ ._! Date__AJ . .__ _�__.______.. Test Pit No. 1__�.___minutes per inch Depth Off Test Pit____________________ Depth to ground water----------_____________. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ / f ----•---------------- O Description of Soil... ---- ._.`a�_ -__.. `",.........� -,"'------,j .`�___. x U ----------- •----------- ---------------------------------------------------- ------ -_____...... 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 T'ITIE 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. Sigd.......... ..............•--.._.._....----•-•-•--•--•-•••-•--•-•--•--•••••••-•__--•- ��'t ate Application Approved BY �f f• 'rr J �iJ- •__ , ....................... = Date Application Disapproved for the following reasons:................... -•--•---•••--••----•-••-------•---••••••--••-•-•-•---•--•--.......................... ....-•--•-•................•-----•-------•-------------------------------------------------•-------------'---•-- ... -..--------•-----------------------------•--•----------------------------•••--••-- Date Permit No. ....:_---•=•••--•::............. Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ . f0$ n !.... ........._................. wrtif iratr of Tontpliatta THIS IS W CERT FY That the Individual Sewage Disposal System constructed (' or Repaired ( ) by............. .._.. ........ ,�/ ----------- ------------------------ ...............................................................has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__. _______ ,".�~.____:____ dated_- _____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ '"::�':... .............••--------•-------•---. Inspector--•---- •--•---- ------ ---• ....................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD,, OF HEALTH ......OF.. e d-L'J �i��o,sttl ork� �o trnrtion rrntit - Permission is hereby granted.........et--. ...... =, .� f_"�?__------------------------------------------------------------------------------- to Construct or Repair an Indivi ual Sewage Disposal Systemat A f- �t � , .P Street .. V' as sho non th application for Disposal Works Construction r t N ____ _________ Dated___1... _._....__.___ _._..._.... -•• _•_ - --------------•---.._.. Boa d of�l DATE----u '°Z� -_�....................••-•-----------•---••--- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS LOC SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS ,411171-`��4e 1 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED l �� z� � � �� ° �� j �..iC7 C�AtzsAG�• GRt 1.lD�. G+t..�j�, �C+�T+�' Ito 3 t SSO 6.p17. tG TA"V- 0 %s + 4-997 6.P0. /4(�•!XJ / ,` uS�- 1000 -GAL.. -~ � 1 bI5P0�AL PIT - uSt= loco (GAA-. U)F= C/4LL AeEA = (SO S F. 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