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Home My WebLink About0203 STURBRIDGE DRIVE - Health j .5Ar -6 d� ti g) of r-- i i S M E A D KEEPING YOU ORGANIZED No.1®334 24 53L W4 IN WA GET QRWgp AT SMW.CQM THE COMMONWEALTH OF MASSACHUSETTS BOARD O HE L O�1 r l t.........OF.......... . .... .................---•--_. Appliration for Dhip sal Works Tonitrurtion ramit eh Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . :. ....-:...?I- 'u1?L'&g4 --. -•-•-----•----__..--d! -ck............................................. Location Address or Lot No. - .-...17 rAI---------------------------••••---:......--=----------------• ..........--...............................•...................................................... Owner Address a .......-- ........ Installer Address �11 Type..;of Building Size Lot-----_......................Sq. feet U Dwelling V.No. of Bedrooms_._ -----------------------------Expansion Attic ( ) Garbage Grinder (0 04`4 Other—T e of Building No. of persons............................ Showers — Cafeteria Ga Other-fixtures ...................................................... Design Flow........,.Sri..........................gallons per person per day. Total daily flow..........3-3.0-___-_-_._____.__-•_-__gallons. WSeptic Tank-�Liquid capacity..1,010®gallons Length................ Width---------------- Diameter_............. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.... .___.._ sq. ft. Seepage Pit No.....1-------------- Diameter®.............. Depth below •nlet..._...0......... Total leaching area. .....sq. ft. Other Distribution box (� ) Dosing tank ( !� z '-' Percolation Test Results. Performed by.._-__ ... Dat/n(i'y:ater 'tl.._ f_Jf.Z..°� ,al Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to gro •---.--J")...t�- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---•---••••-------- . 2 2 Descrip ion of Soil----- -•d �.• gonif is - a.. �.�`' _ - •- -� x1 '- 2 d ------------------------------------------------------------------------------------------------•--------•----- U 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 TITLE 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. ed .......•••------•--•-•---•••--.....--••---•---_•-•-• ............D............_.... . _ Dat Application Approved BY z� :_�.7-� sl '------ 1 Date Application Disapproved for the following reasons:......................................----- ........•---•-•••---------•--••-•-------•--••-•-•-••••......._... ---------------------------------•----------------•---------••---............-•------...............------•••--•--•••-••-••............•--•--••-•••--.-•••••.................-•-...................... Date PermitNo.......................................................- Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT a'14......................... .............r.'Lor?4 �...........OF......:: .. . Trrtifiratr of Toutphatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( v) or Repaired ( ) 1 / -------- --------------------------- ------------•----•-- has been installed in accordance with the provisions of 5 of he State Sanitary Code as described in the application for Disposal Works Construction Permit No �... ....____ __.____. dated.......7:_._ .Z._-_.Z. ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................•---••----------•---------.............. Inspector...............................................---------------------•-•-----.- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �7 �// ............. i'1�..!el.h.......OF.......... T� No....... (A FEE........................ Disposal Works T11notrurtion Wrufit Permission ' hereby granted ...•---•---••------••--•.................I----••-••-•-•-••--••---••••----•-•-••--•••-••••----•---•---__.--•--••-•--......_-•-•----------- to Construct ( or Repair ( ) a (dual S . r e Dis sal, stem n �4 str� '/................................ as shown on the application for Disposal Works Construction Per • No._..._ . ._�._.__ ate�d-----7____/7•_-:7 9._........ d He DATE--------------------------------•-----------•-••-------•-•-•------------••-•---- Boar o alth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Fxs.. '�• THE COMMONWEALTH OF MASSACHUSETTS BOARD O HE LT ........ .... .........OF....... . ...:... _. .fi . .. ... ..._._......_.-•--•• A l Apv tr auvn for Disposal Works Tnnstrnrtinn Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System. .. 4J, P � ..... .�. dr'�e ..... ---= -- ........................................ .._.........- --- - Location-Address or.Lot No. • -... ... --------------------•----------•--------- --------- .................................................. `. Owner Address ---------- Installer Address dType of Buildi Size Lot............................Sq. feet, U Dwelling No. of Bedrooms____. .__._Expansion Attic ( ) Garbage Grinder Other—T e of Building ............................ No. of persons____________________________ Showers Cafeteria a � .Other fixtures -- -------------------------•---------•----- --------------------------------------------- ........................................... Design Flow........ -------- __:.;_gallons per person per day. Total daily flow.._____ � 0......................gallons. WSeptic Tank I Liquid capacity__tgallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench No_____________________ Width.................... Total Length ___: ____ Total leaching area_____ __ sq. ft. Seepage Pit No __._: .._.__ Diameter:1+�.............. Depth below.•nlet __ _ __ g _.___sq• ft. Totalleachin area:__ Other Distribution box (�) . Dosing to ( L ` z �'� ` '-' Percolation Test Results Performed by. ___ '' �.__ __. _ _� ._ Date_ ----7.-�y Test Pit. No. 1.................. minutes per inch Depth of Test Pit.................... Depth to gro nd water-------'y� ?4_. µ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ i .......... +� !ts - DDescri ion of Soil.. •�W _______________ -------------------------------_..........................................................................................__:______________________________________________::______:_:___ U Nature of Repairs or Alterations—Answer when applicable................................. ........ ................. ................................... Agreement The undersigned agrees to install ythe,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 been issued by the board of health. ned ----- --- •-•----- ------ --•- .._..._ i Dat Application Approved By.._.. . ... !..r Date Application Disapproved for the following reasons:................................................................................................................ --•..................•----•--•-----------•---•---•-•-----•---.....--•-----•-----••-----.......--•----------•-•------------------------•-----•--•--•--•------•- ....................................... ' Date Permit No....... Issued............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEAL ........... ..........OF........A :.± ..... ........................ �rrtifiratr of Toutpliattrr , THIS IS TO CERTIFY; That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by y ......... Y................................................ ;,.. _ -•:_�"..../ t�6rl!L� _4 at .t.. " �� ...... R- ' `---- ------------ has been installed in accordance with the provisions of 5 of he State Sanitary Code as described in the application for Disposal Works Construction Permit No _._ ........... dated------- _f : ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE` ':: '.............. Inspector................... • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C�7 IV N __V o......................... FEE...... ....•-•-•••-- fit 19ilot1asalJgorkii wonotrudivit �erani Permission•'s hereby granted-- ------- ----------------------------------- .._._..._.... ....._.. to Cons ruct ( , or.R fir ( ) a n f'vidusl r ". s at No. _' tre1E as shown on the application for Disposal Works Construction Pe * No. �^___.__ ated....Zt/7 `71..'....... Board o Health DATE--- -- ......................................... `..... ...... 1255 HOBBS & WARREN.-INC-„RUB gH'ERS - t Ali`. ... •.. ,,,. ' :.... � .. �... �'-: :i�}'rz r =r �f ra►�o pipig !•-0 ti � 4�� O Zoe y, ,P�sC�YE �t 1000�gFrLGONL SCF7lC RNA �O P4 o l01 20 � 13 I ' �ov'� C) tit o k= F3AP,,oST-A P E OF E3[-� CGS of PE D. 1'JAET�R u''4 ✓:i +Ws E wq, -Ass o 6, lu,-, RpvQ oq IQ Pic �61I-. 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