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Home My WebLink About0045 HEMEON ROAD - Health L3 i i I i I I I I I i i i i ��/ . . SMEAR KPP_PING YOU ORGANIZED No. 10334 2-153L MADE W USA GET ORGANIZED AT SMEAR-COM Igo.-- THE COMMONWEALTH OF MASSACHUSETTS a' BOARD OF HEAL.T 1_ 5 r. j� _ Apphratiou for 43iopnoal Works Toustrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SWygstaj ... .: =--...... Location• ress � t o .. ... .�c^ .. ..4.7. ........... es {4 Installer Address Q Type of Building Size Lot... �.a,&..Sq. feet Dwelling-47No. of Bedrooms................./......................Expansion Attic ( ) Gai bage Grinder ( ) `4 Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixture Q -----•- ------------------------ •-------------------------------------------------------------------------------- U �oper person per day. Total daily flow..... -- C gallons. Design Flow...................../Septic Tank L Liquid capacity_ on Length................ Width................ Diameter................ Depth__._._......___. x Disposal Trench—No..................... Width............._...... "et ... Total leaching area....................sq. ft. Seepage Pit No..../-_--------- Diameter � Dep� Pelov9oin ... Total leaching area....... ..........sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..............................•---•---••----•-•----••--------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................mimttes r inch Depth of Test Pit.................... Depth to ground water........................ ........ 0 Description of Soil................... .................................................................................................................... X V .....--•----•------•...-•--------•---------------------•--------------------•-----------------------•---•-----••--•--------------------------•-----------------------------------------•--•-•••......•-- 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 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 he board health. r /� a Si ed------ Sam! L1. ...---•-- -••-------------- / at ,Application Approved BY------- ..._ /• �� 7a'" Date Application Disapproved for the following reasons-------------------------------------------------------------------------•--•----------------------•--•-•-•--•--- ---------------------•-•---------------------------------------------------------------------•-------..._...-------------------------------------------- ---.......................................... Date Permit No........................................................ Issued......../ /� Date No... F�$..., L.................. r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH-,. 4> ;, g- Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syste? at Loca �, �&' ;,d�'I`+ �y.dam=..9.�'�' .:y�"-•--- ' tion-A ress f F fpr, t' N�° "�`- �"Sr7: i,•�,y&:` :, Car t +,�.s.lN.ti.vS.-- Sr-r$,ie!t' -... .��,...:�.....-......... .. f� ............................. ........ Y i ess ... Installer Address. Type of Building Size Lot___ l� Y�. _,O..Sq. feet Dwelling-�'No. of Bedrooms................./...................._.Expansion Attic ( ) Garage Grinder ( ) Other—Type of Building ______- No. of persons.,-------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow..................... xr_:�Zi... .gallp per person per day. Total daily flow......... . c .._.gallons Septic TankLiquid capacity. Length................ VG'idth.... Diameter________________ Depth................ xDisposal Trench—No.............. . Width ........ Tg IIL�n �,e+ D +° Total leaching area_____.__.___.__.____sq. ft. Seepage Pit No.. l:_...:....... Diameter �. . Depi`belo in eIt........ ......... Total leaching area........:....:._._sq. ft. z Other Distribution box ( ) Dosing tank ( ) `-, Percolation Test Results Performed by.......................................................................... Date........................................ H Test Pit No. I.................minutes per inch Depth of Test Pit----------_......... Depth to ground water_-.--_-.-.-----_- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.-.---_.-______--_-- Depth to ground water.......................... � •--------- -- ..........................................................-----------•----•------..........•-•--•--•----•.....•-- ODescription of Soil , tea.:. ..........................................------------------------'--•-------------------------------...--••------ ------------------------------••-••------. U 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 of health ram` g �� r..... � Si ed :_ r ... k L :.. D tee Application Approved BY..__.... �. .. ' Date Application Disapproved for the following 'reasons:----_--------------------- ------- -----------------------------------------------------------•........... ........-•----------------------------------•----•----••-•-...__...-•----••...........••••--•-----•-••--•-----•-------••-•--•---•-•-----••-•------•--------••••-•----------••-••••-•-••......-••..._.... Date Permit No. .. •........................ Issued... ---------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 01.1prfifiratr of Tantphatta THIS I, 7'0 CE TIF /hat t�e Individual Sewage Disposal System constructed ( or Repaired ( ) by y f Installci d' -y� q F . 3 �r I has been installed in accordance with the provisions of Article XI of' e State Sanitary Cod as described in the application for Disposal Works Construction Permit No----_---------- dated-- :..---.----------_-_--..._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS'A GUARANTEE THAT THE SYSTEM iAfILL FUNCTION SATISFACTORY. DATE Inspector .... ............ .......................................•- �.. . THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT., 4 .......... OF....... ..................... NO.._.. .tv!...L..... FEE. .............. Perinission".is ereby iranted y �"( `s' .._ . to Construc .,e air (-^ } n Indi'vdual Se«age.Iis osal Sys�'im at.1\r $r a O a r. . ^ .. r. Sheet77 f t as shown on the application for Disposal Works Construction Peiti it N6 "" Dated_' ................... ff / rY Board of Health DATE....... ._.......:.................................. FORM 1255 HOBBs & WARREN. INC.. PUBLISHERS t.