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Home My WebLink About0180 BUCKSKIN PATH - Health 180 Buckskin Path Centerville A= 191-126 i i i uu UPC 17534 II!, �� No.2153�COR I!.ro� KASTINGS.UN No.... =-- -•- Fps.. :.' -.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _• f � OF........... ....... ... ... 4t` Appl ration for Diipoiittl Works Tonstrixr ' n �rrrntd Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat: �-- - .........................................- ------------------ - -- ............. VV Lacatio d • or Lot No. ... * .. . ...�T..._...__I......... .................................... ......•..------........................_..... ....�.!�... ........:. Address � ......... —.............................•................................................... Insta er Address Type of Building Size Lot.-,_........................Sq. feet aDwelling—No. of Bedrooms......:......._ ...................._.Expansion Attic ( ) Garbage Grinder ( ) p,t Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Design Flow.Other fixtures ...::...:.......gallons per person per day. Total daily flow:_......_........... .................................• W ,gn •-- g P P P Y Y ............................................gallons. WSeptic Tank—Liquid capacit} 00 .gallons Length................ Width................. Diameter................. Depth................. x Disposal Trench—Nro�..................... Width.._...rr...._........ Total Length..................... Total leaching area....................sq. ft. Seepage Pit No._�L,�,� ^^ Nftiameter.....)X �2:_ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (;/� Dosing tank a Percolation Test Results Performed bY...........................................•--•------............_..._.... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LT4 Test Pit No. 2................minutes per inch Depth of Test Pit.....................Depth to ground water........................ x ----............................................................................................................................. 0 Description of Soil.......................................................................................................................................................................... ".4 -----•......•----------------------•------------------------------•-------------------........--•..._-•-•-- ------------- _ U Nature of Repairs or Alterations—Answer when applicable..__ . .. . .. ...___...V... _.�__„__ _.. l- •---•--•-•---•----••--•-----•--•••-•••---•-•-----•-•-----•-•------------•------••--•--•-•-•--•--------------------------•----------------------------•-•-••------.......--••-••---•-.........-•-•-...... Agreement: The undersigned agrees to install the aforedescrib'ed Individual Sewage Disposal System in accordance with the provisions of iITALE 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. Signed...................................................................................... Date Application Approved By.............C --•----- --- f` -•-•-•-•-•---•................ Date ........ Application Disapproved for the following reasons----------------------------•-----•----...-----•------_-•---•-•------------------•---............-----.....------ •--•••.....................•-••••-••••--•---••....••---•-----............-•••---•-------••.............-••------•------...-•--------•-----•-----------••----•-•-•---•-••••-••-•--••-••-•.....--•..._.... ��++,,.� 51 Date Permit No............t2._ 'lir-_ -------------------..... Issued_..-•---....---...--••-----•--.............. at....... Date '�+'„^.-...ry M;. • y.:r4 ,�9 ` w.. —•.t�..+.,.:is..�.,�f-y:wv��•'�'��..«w"�=.+�+�"��•ra'" �aa+ fir.} ey. �.:v�'i!'�i' ,• ,� �r No.......=------------:... FEB.............._.... .._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................OF........... ..................... Appl ration -fox Disposal Works Tonutrurtion lirrm'd Application is hereby made for a Permit to Construct ( ) or Repair ('' ) an Individual Sewage Disposal System at: .....,..._...._..»..»_............... ... ,..__..... `...._. _ ..._.....---..._...._------....... •--- -_-- ----•---••--_•---•-....... .......----•-.. Location-Address or Lot No. W .....` �,.»�..-- •--- •» '—Ownei......`-`,.:�= .M ..... ... ....... ..........................».. Address ,., ----.•••_•..... .....•--...........•....:...... ..........=..--------------------------- --------------------------------------------•----------_---------_........----•-............------ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building �__. No. of persons............................ Showers W YP g P ( ) — Cafeteria ( ) a' Other fixtures ------•-------------------------------------•------ W Design Flow............................................gallons per person per day. Total daily flow............................................ WSeptic Tank—Liquid capacity __gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area......................sq. ft. 3 Seepage Pit No._I�r QA-Diameter.... "Depth below inlet.................... Total leaching area..................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........................ L� Test Pit No. 2................minutes'per inch Depth of Test Pit............_....... Depth to ground water........................ a 0 Description of Soil........................................................................................................................................................................ W U •-----•----------------•----•-•----------------•---•--•----•---.........----•---••-------•----------.......-•-----------•------•-•---------------------......---•----•----••_•-•-_--••_...-•-----•-•-••. W U Nature of Repairs or Alterations—Answer when applicable._..Z . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL L 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. Signed...................................................................................... Date Application Approved BY �..:.-.:-- ....._..: --------==L-. `........�'--.. - ,._. - Date Application Disapproved for.the following reasons:----•----------------------------•--•---------------------------------------•--------_-•--......._............» •----------------------------•---_-------••-•--------------•--------------•-----------.....................------...........----------------------------------------------•-•--••-----------•--••---_._-- Date PermitNo...........9.2 .S1�:......................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ia. ,., , ........OF............1( ..13P Q�a•f.................................... Tnrtifirate of (Eontplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�) bY------------------ � ......:.?:...!....... r:.... ............. -------------------------------------------------•--------...---:...............--•-•-....----- :. Installer /) ata �t •--...�!"�:.. g.(�1_, » � .......�!1_..- Y�c =- .....................W.7................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......... �'9'__. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. — ).!:: 9 Inspector---...............................t ................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH P y _ . r No... = t FEE.--_ --1.............. Disposal Works Tonstrurtion rutit v Permission is hereby granted........ --•-(;;7 e-' . 1!?�...........11 = = to Construct (, ) or Repair ( ) an Individual Sewage Disposal System at No._ *PJ•„ . nD, s . 1� - ------------• = ,-------- -----•- - t✓ " v Street as shown on the.application for Disposal Works Construction Permit No--- Dated.......................................... Board of Health DATE......................... .....................f--......................... LOT NO. : ADDRESS:taawoovvs OWNERS NAME: `I,A � SEWAGE PERMIT NO. : NEW: REPAIR: r/ DATE ISSUED: DATE INSTALLED: f INSTALLERS NAME.: INSTALLATION OF: WATER TABLE: FINAL INSPECTION BY: � _ D(IAWING OF INSTALLATION ON REVERSE SIDE: �= a.A c '