HomeMy WebLinkAbout0225 HUCKINS NECK ROAD - Health 225 Huckins Neck Road _
Centerville
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SMEAD
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UPC 12534
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THE COMMONWEALTH OF MASSACHUSETTS
A. BOARD OF HEALTH
................OF........P.!f' U.S. . Cyr
Appliration for Disposal Works Tonstrnrtinn rnmi#
Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal
System at:
/yf/C/liN.?... /.4._2.T�........ ..�R.1 FV� ... ... ^_C eAlr,Rt j,CL.t� �-
..------•.-------- o.l -fit•'. ....................
Lgcajion-Address or t No
U tz n l' ....5_ 11 .RI,' st" s .... 11 ✓
Owner .................. Address
rW7 ....... .�. .G-. 1x-----------------------•............ 4 Rye ...�l �?.....AP....•--� ' '.0`'z----- ..
Installer Address
Type of Building --� Size Lot... feet
U Dwelling—,No. of Bedrooms..........a...........................Expansion Attic (kpo) Garbage Grinder (.Vc)
a Other—T e of Building
a Other—Type g ---x>,1-1.94__._....____ No. of persons---------------------------- ........................................................
howers ( ) — Cafeteria ( )
Other fixtures .----•------------ . . .......................................
W Design Flow............././_�....................gallons per ; - ?4?r1ay. Total daily flow............ ..................gallons.
WSeptic Tank—Liquid capacity/dP> '.gallons Lengthig..'6..`.'.. Width.. 12.`'Diameter________________ Depth_.Ss..S-11."
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No....... . Diameter.-_:6._`._...... Depth below 'n_le d �......... Total leaching area. .0...sq. ft.
Z Other Distribution box (� Dosing tank ( ) O' , Z A — f — 7f.
Percolation Test Results Performed AAb............. Date.
Test Pit No. 1. .Z....minutes per inch Depth of.Test Pit___/t'..._... Depth to ground water../VQ��Je I .....
44 Test Pit No. 2..4 g-:_._minutes per inch Depth of Test Pit...!z:'......... Depth to ground water... ......
............---------------------------------------------••--••... �------- •................._......--.--•�.----........-•--------•----•-----..._.
O Description of Soil...... 2--------r=�7/1+f1.S.. ....... t5!r.,�-�"?------ --- ire$ -tPn�l?....... alas::a-:C......
U -----------------------------•-----------------•----•--.....--...---•-•-••----------------•-•---•---------------------------------------•-----....-----•---•--............------
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 TITM 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued the ar health.
Sig ed------------
Application .Approved By---...... ,,. . ...... ---------------------------- IL Da
Datee
,. Application Disapproved for the following reasons:------••-----------------------------------------------------•--------------•.................................
............................•----•-------..........---------•-----------•-•-•----........---•----...--------•--------------......---------------•--------------•-=------------------------------•-------
Date
PermitNo.......................:..:. ......... ..•------..._ � Is�sued..--•-•-•--------•----------�----•-------••------•----
��v�c��-I^- Date
No._:.�:... .... FEB..............................
THE COMMONWEALTH OF MASSACHUSETTS
_. . .. BOARD OF HEALTH
...............OF........' .e "..........................
Appliratiun for Disposal Marks Tonutrurtion Prrmit
Application is hereby made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal
System at:
�r•��°..`,!R�/C e e.. 4, .....leff..................
Location-Address or.Lot No.
•= ll � _.. ......_5 id ' ................................ „���0��-n� �� .........................=-�� =�f'�'
wner
a _L l.. r- l.!. ,..1' ......_... ----•--_.... �c ..... .. . . Ssd�
Addre
e
Installer Address
Typegf Building Size Lot..d d,�.50.0...Sq. feet
1Jwelling—No. of Bedrooms........... ...........................Expansion Attic ()vc) Garbage Grinder (toe)
Other—Type of Building ....ri .a✓A........... No. of persons............................ Showers ( ) — Cafeteria ( )
d . Other fixtures ------------•-----------------------•--...--•----------•-•••-•••--••--•--••••••-•--•----•--••-•••-••--.......•-•-•-•......-•--•..................--•-
W Design Flow............./Z.O-..................gallons Per Vfs'Pn/lfefla . Total daily flow........... r---•--•-----.._...gal Ions.
WSeptic Tank—Liquid*capacity/.09A.gallons Length e_?•..6..". Width.&1_...,.a..'Diameter................ Depth..5_'&"
Disposal Trench—No. .................... Width...
x ................. Total Length.................... Total-leaching area....................sq. ft.
01
3 Seepage Pit No......../--------- Diameter.....e...'._`............ Depth below nlett,5. ___ Total leaching�area..Q..0_0._sq. ft.
Z Other Distribution box ( Dosing tank ( )
aPercolation Test Results Performed by._/Zo.,v- 4-x-[>.._ ............. Date__,
Test Pit No. 1_'_. :....minutes per inch Depth of Test Pit....J: ....... Depth to ground water..AVoA!+�-__.
(=1 Test-Pit No'. 2..K.�—_..minutes per inch Depth of Test Pit...�f:L............ Depth to ground water---A_-o.eme......
-------------•------••------.._.......---•--.......-•-•--------.... ......---•-•---......
O Description of Soil.......<`�.r...t.-L .....r_°.€_,�$l_--s.e....... .i- ----- z�'•4-M--�•n/-.:!------T*
W ......-••-•••-•••--••-•--••-•••••-••-•-•..............•-•••••-•--••---•--•-•-••••---••--••....--••-...........•...-•-----•-•--- •••---•--••--•••--••-••--••---•---•-....•---••......•-•--•-••-•---••--
W
x ----•••----•---------------------------•••-•----•------------------•-•--•-•-•••••-•------•-•-••-•--.....-•••----•---------.--••-•-•--•--•----•-•-•-•---------- ----------------------
V 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 TI'1Z 5 of the State Sanitary Code— T undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu the of health.
Sign ----•---- ................................
f Date
Application Approved BY Gulf ;w . . --'`t•_.�L�/.
Date
Application Disapproved for the following reasons:.................................................................................................................
--.......-•...........................••--•----....------•----.......----•-••-•-------------•---....---...---------------••----------------•-•------------------•-••------..............................
Date
Permit No......................
............................. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OE HEALTH
............. .... ::..f.OF.........
. +. ,. �` ............................
Trrtifiratr of Toutplittnrr
;TH,�, I� ONCE TIFY, That the Individual Sewage Disposal' System constructed ( �r Repairedby f E t'} ...... tr 11! .'.....-•---------- --- ._.._..
Insthl /j f
at.."'.. _. �..r 'J'�--_... ::_Ll.t� �+� ' ' � _._.`:-- - ..
has been installed in accordance with the provisions of TIT he State Sanitary odd as &scribed in the
application for Disposal Works Constructio&'Permit No _ dated AttZ'___
THE ISSUANCE 'OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector.......................................... :----.----••--------------•-•----------
THE COMMONWEALTH OF MASSACHUSETTS
f BOARD O . HEALTH AI
NO ........... v FEE.... ..ti+............
iu�ruu�t ku un ttr#ivat rrrAft
Permission is hereby ranted._~ ________
to Construe ( or Repair ( ) di u Se
to Dispoosal Syst
at
// s/. =
� Street
`as shown on the application for D1 sal Works Construction rm ��,o________ _________ Dated..:__:/:-_-__:_.............. -.-
Boardealtli'
• '
.........................................
DATE...... ..f� 77 --
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS.
LO CAT ION S E �
3 AGE PER IT M0.
VILLAGE � .
INSTA LLER'S NAME -A A-DDRESS
8 UI1DER OR O pfR
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DA T E P E R M I T I S S U E j9 .7g
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DATE C 0 M P L I A N C E ISSUED l
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LOCATION / SEWAGE PER IT N0.
VILLAGE
INSTALLER'S NAME i ADDRESS
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9 U I L D E R OR OWNER
DATE PERMIT ISSUED / 127Y
DATE COMPLIANCE ISSUED 40
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