HomeMy WebLinkAbout0133 HUCKINS NECK ROAD - Health 33 No&K,*A,r jvt c A r`d
SMEADI
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
SUSTAINABLE
MIN.RECYCLED
1111 INITIATIVE CONTENTIG%
C.= Sow POST-CONSUMER
Inow
MADEINUSA
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FEi&.. .................
No.................. THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF, HEALT-u
.......... ............ ...... ---
Apphration -for Bifipoiml orho Tottotrurtion Vrrmft
Application is hereby made for a Permit to Construct ( or Repairan Individual Sewage Disposal
Systema : -............................... ....... ................................ ........................
Location-Address or Lot No.
.......4a
---------------------------------------------- .................................................................................................
Address
......... .........
Installer Address
Type of Building Size Lot............................Sq. feet
U
Dwelling--f'—No. of Bedrooms--------_---L_---------------- --------Expansion Attic Garbage Grinder
Other—Type of Building ---------------------------- No. of persons._____--____--_________._- Showers Cafeteria
Ga
Other fixtures ----------------------------------------------------- -----------------------------------------------------------------------------------------------
Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity------------gallons Length................ Width_.___._....._.. Diameter.__._.._..._... Depth.--._.._____---
Disposal Trench—No- -------------------- Width----_____________-__ Total Length________________---- Total leaching area-----------_-------sq. ft.
�4
Seepage Pit No..................... Diameter_________:_-_---_--_ Depth below inlet.........__..__.___. Total leaching area------------------sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------------------------------------------------------------------- ...... Date-----------------------------_-_----
al
Test Pit No. I................minutes per inch Depth of Test Pit_.___............... Depth to ground water...___________--__-..-..
(� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_..__.__.__.__..____....
j�'/—--------------------- ......... ...................................................................
.................--------- ---- _.____ .,---9 t ]��
0 Description of Soil-------—.1. ----- ------- -!-------------------------------------------------------------------------
... ...........7
U ----------------------------------------------- ....... .......... -- - _ ----------------------------------------------------------------------- ------------------------------
-------------- ----------------------------------------------------------------------------------------------- ---------�-------------------
------W__' / ------ --- -.,___--__._._.----
Agreement -- --------------
U Nature of R.�pairk.or Alterations when applicable......��L applicable._....____.--------- ------�:
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 Dei�n issued by the boar health.
------------------------------------------------
Date
Application Approved By------------- . ........ . 7------ ---------
Date
Application Disapproved for the following reasons:-------------------------- .....................................................................................
....................................................... ---------------------...........................................................................................................................
Date
PermitNo......................................................... Issued......3-------- ...................
Date
----------------------—------------------------------------------------------------------------ ------
5,
s
NoFsa..............................
THE COMMONWEALTH OF MASSACHUSETTS
J ' BOARD OF HEAL -A,
` ......OF................ .�'�""��' ..-.-...-. ....-...
V
Appliration -for Di-qVuli'ttl �rkii Tanfitrurtion Vrrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Syst a
'------------------- ..
-
--�4 Location-Address or Lot No.
.. ...... .....................!................................................. .........----.....................................................................................
W Address
--•------•-��--3S-•--• ------------------------•-------•------------------ -••--•-•--••. --••-•---•-•----
Installer Address
U Type of Building Size Lot____________________________Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion.Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons------------- Slrow'ers`.,( ) = Cafeteria ( )
Other fixtures --
W Design Flow............................................ per person per day. Total daily flow............................................gallons.
W 'Septic Tank—,Ligtiid:capacity:'"-__.____gallons Length................ Width................ Diameter---------------- Depth----------------
..Disposal Trench—No-____________________ Width-------------------- Total Length.................... Total leaching area..•-----------------sq. ft.
Seepage Pit No---------- Diameter____________________ Depth below inlet.................... Total leaching area..________-_______sq. It.
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--_-____-___-_____-_--..
PL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__-____-______________
D Descripti
----•-
Wi
of Soil --------- T� -shy `--------------------------- -
IW44.....L.44-a .
U Natu e of 1pail-s or Alterations Answer when applicable.-.. o------- -- y� � --
. E �f ��7�`�.lY-"ri^✓�+•-___--_ ___________________
- -------- - -----------
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,4Compliance has been issued by the boa 'f health.
/ - '�. -
Date
Application Approved By--------- J_- - ••.
Date
Application Disapproved for the following reasons:.......................... ............... ------------- ----------------.....................................
----------------------------------------------------------------------------------------•---------....---------==----------------------------------•--------------------------------------------•---
Date
PermitNo......................................................... Issued...................-----..........-=....................
Date
t '
THE COMMONWEALTH OF MASSACHUSETTS'
BOARD OF HEALTH
it . ..........oF.......... ..........
�px ifiratr of Tnmpiiatirr
TH IS C IF hat the ividual Sewage Disposal System constructed ( ) or Repaired
by- W
a % I ............. eT
r _ ". A`" ------- ---- -- -- ..............
has been insiF, led in.•accordance with the provisions of Article.-XI of The State Sanitary Code as describ d inn the
application for Disposal Works Construction Permit No.___... ._.J. �_.__.__ __?__.___ dated_--- ___..`__::�. ............ ___._.__.__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ED AS A UARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY,>°
DATE --------------------==----------•-------•-•- Inspector--------- --•--------....................... .................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD i 0,Jf 7S •
HEAL........................................... i ........... of......... ......_ a�
o......................... FEES~:.'-- ""
.........
tt n t iti� erm it
erm te ' T
.. --- .._._...Pts
to Constru or ep •. ( an Inds idual A enrage is osa ys m
L2 ... ---------------
Street
as shown on the application for Disposal Works Construction mrt N Dated_ '_____ _____________
- Board of H
. . - ealth
eal
DATE. Y-- < = --------------------------------------
FORM 1255 HOBBS & WARREN; INC.. PUBLISHERS--
v Ire 75-27
LOCQTIOKA ' SEWQ4::StE PERMIT MO.
/:M Huck nwNeck Road —Roy Latimer. — — — — — —
I` �/I LL/�C►E —Centerville Mass— — — —
WSTaLLER S LI&ME 6 ADDRESS
A.. G. Griffin Inc
— - - - — — — — — — — - - - - —
Vil.L&gQ-aQua= M=sloris kilns,Mass — — — —
bUILDER 5 1J L VAF- ADDRESS
— —Hone�Q Latimer
---
DATE PERIAIT ISSUED 2-24--75 — — — —
DATE COMPLI & aCE ISSUED : — — —
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