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Home My WebLink About0057 STETSON STREET - Health (2) 5'1 64e*5an 5-��- 1 I� f f SMEAD No.2-153LY UPC 12934 smead.cam • Made In USA SLWANABLE FORESM IWIAWE CerdRed Fiber Sourcing www.sfiingn moro THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH `lam t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �' _Z_ ......-- •J.r C?Sn w -Sf/�E�..r....................... .1�,Y�A.0 is....... ..............., ... ...-........ ...-.-...�1.- r�.C...:...Lo i.n a� ................................... ................................... ..or Lot No..•....................................... %1,aG Owner -Address a .....•••...,7af:.....�1! . -.. .so. :s......... ............................................................................................•.... Installer Address QType of Building Size Lot._c2'4....1`. -....Sq. feet U Dwelling—No. of Bedrooms.._.Z.................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ......... No. of persons............................ Showers — Cafeteria a � Other fixtures -----------------------------------------------------------------------------------------------------------------------------•----------•------------ W Design Flow..........%3-40............. X.,_.gallons per person per day. Total daily flow......._7. _.0.............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth.......... W Disposal Trench—No................. W'd ....... Total Length.................... Total leaching area............ _...sq. ft. Seepage Pit No../4LI0J_AGr)iamefer.................... Depth below inlet.......--------- Total leaching area. q. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY--._...-••----•-------•--•------_......................................... Date........................................ aTest Pit No. 1----------------minutes per inch Depth of Test Pit......._....._...... Depth to ground water--_-:_-________-_______- G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to.ground water__-_-______-___-___-___. -------•-----------------------------------------------------------------------•-•..•....•.......---......................................................... 0 Description of Soil....................................................................................................................................... ----------------------------------- U ---------------------------------- ----------------------------------------------------------------------------- --------------------•-------•---•-------------------:: 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 Article lI 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 boa d hea h. , y , Signed--,/� .............................. •• -----•......---•------- ,� ...................Date .......-•--- Application Approved BY--- = � � ---41............................ Application Disapproved for the following reasons______________________________________________________________ ......--•................... Date Application -•--•--•-----------------•---•----...------------------------------------------------•--...-•-----------•--•--•----•--•-••-••-•---•--•---•------•--•--------•-•-•-•-••--•---•-•---------•-------........ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :'..< ... 1 .". .................. OF°..... . M .Cat'. .°...... ................................... it tivit fir Eligvati l Ovrks Tanotrurtivu,panfit Application is hereby made for a Permit to Construct ( ) or Repair ( ` ) an Individual: Sewage Disposal System at: - . . ............��.{ G P'� fit. .... - .Nrt�x.' 1 .. °.. ... • i ......... ......... .................. ........................... ................. _............................................................ Location•Address or Lot No. .........C..I-...f.. ./.d E« '.'•..... .1.:�:3'::p Y..:�. ......... .................................................................. ........................... / Owner Address ...........,l..fi. •...,: :�: ::. '. :�:.....,: .. .r. `: .......... ..................... ....................................................................... ....n • 4 � Installer Address Q Type of Building Size Lot..;.... :.:: :...:.._._..Sq. feet U Dwelling—No. of Bedrooms.....,,.�c- .................................Expansion Attic ( ) Garbage Grinder ( ) '44 4 Other—Type of Building No. of persons............................ Showers — Cafeteria 0.4 Other fixtures .............................................. Design Flow....... '_ ......._ •.....gallons per person per day. Total daily flow__._.._., "� :`?........................gallons. USeptic Tank—Liquid capacity.......:_.--gallons Length................ Width................ Diameter................. Depth................ xDisposal Trench—No .................... Width .............. Total Length........... Total leaching area ...._ ....sq. ft. Seepage Pit No..r r f .�,: 1�iameter .........._Depth below inlet...... ......._ Total 1"eachirig arearsq. ft. Z Other Distribution box( ) Dosing tank ( ) � Percolation Test Results Performed I)v........................................................ ................. Date............-----------------------••--- �_l Test Pit No. I.................minutes per inch Depth. of Test Pit..................... Depth to ground 'Water__.--_-____._---__--_ -- f� Test Pit No. 2..............:.minutes per inch Depth of Test Pit-------------:....... Depth to ground water-_.--___--_____...____-. ---------------------------------------------------------=-•-•-----•---------------------------•-•-•......................................................... 0 Description of Soil---_-----=------- --------------------- ••--------------------------------------------- =•------------------------------------------------------------------ �.. ,.. 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 Article XI 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 o lheaAh f _ :...:. _... :.. Df.._. ' .... . rc ate Application Approved By_-_'::�......... . .�.................................- z� ' ........................................ Date Application Disapproved for the following reasons----------------------------------------------------------------------------------•-•--------•----•---•-•••--_... ...--•-------•-----------••-•----•....•••------••--_...--•--•..............•-•-•--••_..: Date Permit No......... ............................................... Issued---....,------------------.............................. ..................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF7 HEALTH r a.}........ '�lb°''�6PF .'�.�+.��.ie?eYJF �pI`$$f�r�$•� �f ��I$t�lt�tnrr T SjIS TO �E .,TIFYa, That the Ind)iid(,ual Serfage Dl�sposaI System constructed ) or Repaired ( ) by .1 . ,, OR has been installed in accordance with the provrsionsofticle XI. of The State Sanitary ,ode as desc lbed in the application for Disposal Works Construction Permit No......................................... dated _ : ___ _ ..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAN EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector............................................_....................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � ? ....... OF....... .. .. :...... �l............................... . No....... ..�. FEE.....,. ..... $r Permission i hereby granted t to Construct ( orR,epa>r ( ) corn indlvnluka Sewage Disposal.System at No.... ' "" ` � --- ��--- ------.-••-- ............................ F r h s ;jr _Street as shown on the application for Disposal Works Construction P ft4,No. t �Dated.... �� K- d '.`�'.".----• t; .........---••- Board of*;136alth DATE.---_--:--_---------- -------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUSLISHEP.,S