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Home My WebLink About0137 STONEHEDGE DRIVE - Health (�Ac or, bcl,rrns f iI I k I SMEA® KEEPING YOU ORGANIZED No. 12034 2-153L BE SUSTINAME FORESTRY YIN.RECYCLED IN W VE CONTENT 10% Certified Sourolne POST,CONWWR wwwApralr+m,mY •i0110{1 /�� MADE IN�USA ��p�/►/�!� W OR�AI$MEAD= , v Ee 1_1vdv 641- sr a_ No...i _ --- Fps... .�: THE COMMONWEALTH OF MASSACHUSETTS (, BOARD HEAL H "I . ... OF......... Z pphratiun for Disposal Workii Tonstrnrtinn rjerutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage osal �Ty.s tem .�. � .. : ' ... .. ....... �....... ....... ... 4 .cation ress or Lo o. .... �.. �.--� .... . d.C.... C ..........ij. . ,..:.... .............. W . O Addres ..................... ................ ........................................._. nstaller Address Type of Building .� Size Lot.:..........................Sq. feet Dwelling Building of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures ./� •-------------------------------•----------------------------------------------------------------------------------------------------- W Design Flow.....................S-00......._gallons per person per day. Total daily flow......�.. -------------gallons. WSeptic Tank�-Liquid capacity, allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width........ .. Total Length........... ........ Total leaching area....................sq. ft. Seepage Pit NO........ .......... Diameters _. Depth below inlet...... Total leaching area_._ .e: .cq. ft. z Other Distribution box ( ) Dosing tank Percolation Test Results ormed b ,._ ,.{_..._..................... Date............_........................... W y..__�. . i Test Pit No. 1... minutes per inch Depth of Test Pit.................... Depth to ground water-----------------------: f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil.............................. U .......................................... •----- ......---...-------------•-------------•----....-•------------•------...---------------------•...................................................... W -----------------------------------------------------------------------------------------•--------........--------------....._...------------------•.................................................. �j 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 the board of health. Signed -•--•--••----•--•--•...................•------------••-------- D/at t Application Approved By-----� = ............ �r� Application Disapproved for the following reasons----------------------------------------•------------.......................................................... .................................. ........................................................................................................ ....... .... -------- ---------••-•----••-•••---....-••--.--•--- f� Date Permit No......................................................... Issued......... -- �D .. --.........---. Date� �, L,- 17 THE COMMONWEALTH OF MASSACHUSETTS BOARD HEAL H I d •... w . .. OF_. ..... �', -------------- Appli-rat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage D'Sposal system . t3tton• cress - or Lot ....,..... Alt. .. ri .. , . s°v� I oc .............. O� O Addres ..<............................................Installez....................................... A""` .+ .,............................................. Type of Building . Size Lot............................Sq. feet g �...................Expansion Attic ( ) Garbage Grinder ( ) , Dwellin o. of Bedrooms..............:...... . Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Aq Other fixtures ----------------------------- ------------------ -----•--•--•---•- ..................... Design Flow........................ ,alions per person per day. Total daily flow----- �", .. .._.gallons. W_ Septic Tank Liquid capacity "a allons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total.Length-----------__....... Total leaching area......................sq. ft. Seepage Pit No------ ..___.._.. Diameter. &2''" Depth below inlet...... .... Total leaching area.-_. ;t" , ft. z Other Distribution box ( ) Dosing tank ( ) .� 6 µ ~' Percolation Test Results ormed.b � �s . '' ................. Date......_................... . _ Y rii ... Test Pit No. L.._. _..minutes'per inch Depth of Test Pit.__................ Depth to ground water....--._.._: -- Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...... ----------------- ....................... ; --- ....................................-----•-- ............................................ ----••---- xDescription of Soil............................... = ...------......---------------------...........------------------••--------------------------------• 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 the board of health. .g k� Date A Approved PP roved By.... ' ate Application Disapproved for the following reasons:---------------------------_ - ........................................................................... ........................................-.......................:............-------------•----......•--...---•-------•-••-•-•-•--•-••----------------•-------•--------------------......_.............. Date Permit No........................................... Issued..........-- Date THE-'COMMONWEALTH OF MASSACHUSETTS-%'':;+ BOARD OF HEA TH. Y �. ..'.;...'OF.::..... ........ ......... TH :0 CERTIFY, t the Individual Sewage Disposal System constructed ( ) or Repa red ( ) by -. . - ��- V 'V d - ^-;•' "v_iN'•_ •1.,•' •iP ., 'fit •"$- ' , has been installed in.accordance with the r >saons of Article XI of The State Sanitary ode s esc ibelTJl"ni the _ .. dated.. a5 application for Disposal,Works Construction Peranit No................ .... `. �_... F, THE ISSUANCE OF�:YHIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE SYSTEM "Oe�ji�.`X'FUNCTION SATISFACTORY. DATE--•.......................................... Inspector. THE COMMONWEALTH OF MASSACHUSETTS ti r BOARD QF HEALTH NO... ......... .. FEE......... ............ Permission is boreby granted......... ........ �.�.............................................................. to Const ct ( ora Repair ( ) a!i 1 ividu>1 age isposal Sj�s sm . ,r r ' vi rt ... ....... as shown on the application for Disposal Works Construction P ut No. . ated ._ ................. 'y ...................... r » Board of'1161tli- DATE.............. - - ------ FORA 1255 HOEIBS & WARREN. INC.. PUB'_;SHERS f` No.i.3_Y__7._.. FEB..... .................... THE COMMONWEALTH OF MASSACHUSETTS �JJ BOARD QF HEdoLTH r —. ...-....O F.......... ie. -------I------------- Appliratinn for Uiapaoal 18arkii Tonolrnr#iun Prrutit Aplication is hereby made for a Permit to Construct ) or Repair ( ) an Indivi al Sewage Disposal SysteV-at ; [!�-J..L.......... .._..._ 15.-•--•-- -- �- . cation-Address or L r O `fig 7�; .�:.�_l�F:....._. �....:1�-lJ.�y..JP1.:........ .................. -/�S'-- --�f•-�=-•1b-�•u�---._�c�.... __._l.{:�la,_ y•q•rr��rr �.1�1 ner Address .� x....... C......... - .. .- . :...._ _ _._. nstaller Address UType,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' Other fixtures . ............................................................. -......................... W Design`Flow............. lions pfr person per day. Total daily flow.,,.. ....-•• --•---- gallons. W Septic. Tank Liquid capacity_ ._ _..__ allons Length................ Width................ Diameter........._...... Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area. :_._..__._....sq. ft. >� Seepage Pit No._j---------------- Diameter/V; ...... Depth below inlet.......... ....._ � �Total leaching area. � . ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ [i, Test Pit No. 2________________mimites per inch Depth of Test Pit.___...._..__.-.____ Depth to ground water_______________________. O 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=T undersigned further agrees o to e the systempi operation until a Certificate of Compliance has been issue the ar o hT Sign ...... ...... - ate Application Approved By 6? _ r 1 �J��7 ' Date Application Disapproved for the following reasons:_------------------• -----------------------•----•---------•••---•-•----•-------•••-•••-.....-•------•-_..... Date Permit No. .. Issued. `S . . .. -- -1� I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applirafiatt fur Big oiial Igor ii ( Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ..... ..... ......... ...1...; __. ,E... .. t. 'i . ...1.. ..�._...._ ._� _...... .^. cation Address {f .^ - :. ��- or Lot •^,y: �'?„„' Le. (�.: td..r .•`' .S.l.i ;_ ` y L�� p �ddressf � f _ s , .^.. nstaI er �._ . .... ., s , d TYP of Blding " Size Lot..........................•.Sq. feet llin a g . of Bedrooms...................d .................Expansion Attic ( ) Garbage.Grinder ( } 44 Other—Type of Building ........................ ... No. of persons............................ Showers ( ) — Cafeteria04 ( ) Other fixtures d _ •------.......................................... ------------------ W p --------- ------------------- Design Flow lions per person per day. Total daily flow.. .-..--�.----.gallons. Septic l nk Liquid capacity. .. dons Length................ Width---------------- Diameter---------------- Depth---•----------- W ' x Disposal Trench—No .................. Width .g ..... Total Length........... . Total leaching area--------- sq. ft. Seepage Pit No...,/................ Diameter s . . ._.._ Depth below inlet..._.........__ Total leaching area.._ .f' sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results, Performed by..-----------------.................................................. ---. Date........................................ Test Pit No. I.................minutes per inch Depth of Test Pit-------------------- Depth to ground water...--................... fz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................--.. -•-•- Description of Soil.............. :- f .................................................•-•---•- -•-•-..........................................................-• ............. U •-•----------------------•----------=--•-------------------•-----------------•-----......--------...-----..._..------------------•--------=--------.:....-----------------•------••--------------------- W jNature 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 no to � ce the system&i operation until a Certificate of Compliance has been issuedrby,the bpard of''healt4,:e,) �F.f ' - (eoo-• '�G' ;. ,�^'t Signed .r r ._..P... 3-•- -•---:f ,.......... r.. ^�^-"'......................................_.. APPlication Approved BY �✓ `f � Date .Application Disapproved for the following reasons:....................... --•--•-•----••----•-------•-----------........--•--•----•-----•----•-•-•----------.... ---------------------•----------------------------------•-••••......--------------------•------............••••••------..------•.....-•••••......----••..........-•-•---•-•-•-••--•......• ............ Date . ./; ....................... Permit No. Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH - X. r� TH �.�R I Y;.. a e Ind e g tlli: constructed ( ) or Repaired by ;, -ors- _� ;: ,.;P'' --•--------•------------- .----------•-••---•-•-------•---- installer }� .... ....... ........4.. ... ....... has been installed in accordance with ie provisions of Article XI of The State Sanitary Code as ec.. bed in 'the application for Disposal Works Construction Permit No------------------------------ .......... dated-----/- �.-�. -:-am--- THE . � ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUI,A ANTEE THAT TIME SYSTEMI ,� � ° ATISFACTORY. ......� .DA Inspector '64- " THE COMMONWEALTH OF MASSACHUSETTS BOARD OF—, HEALTH >> fk V No. .... :.... i.......... FEE_ . ...,,a.r----" . Permission is hereby grant �.._ ;.:_ f .................... ..*.` �ff ..... to Constr t ) or Repai ) :an`Individuzl"6sefs�ge Disposal ys at I\To.__ f .f.-:�.... .. �r �... r �.. i. .,._. ,rtt ,� .._.. ........... 'Vstree as shown,on:t, e application for Disp sal Works Construction 'er iit a. . Dated-l.-F�: ...` , ...... ......... .� ..�� Bo n t1l FORM .1255 HOEBS & WARREN. INC.. PUBLISHERS � .�