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Home My WebLink About0263 HUCKINS NECK ROAD - Health �� v1� R�� No...... .... FEa...21................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HIE _ TH � �� -�13I _. ._---------OF.... .............:. Appliration -for Bitipotitti Vlar,kii Tonitrurtion Vrrntit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System al. j, -------- JSG 2 M 25 - / L anon- rs or Lot No. a ...................................... .... . . •• .•....................•. ......-.. ---- •-- --- - ----------- =..................................... Installer Address ______-----S feet U Type of Buildin�i ` Size Lot.�./_ ._.� q. Dwelling,1Vo. of Bedrooms------------ __________________________Expansion Attic ( ) (garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ....... ....................... . . d ---------- Desi n Flow__ __________________ �� Mons per person per day. Total daily flow ---- .___'��_. �_._._.._.. Mons. W g L��--•-----•-•----g P P P Y Y g� WSeptic Tank- Liquid capacity/Wogalions Length---------------- Width-------.-------- Diameter--.------------- Depth---------------- x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet _ _---_..__--_-__ otal le chin area------------_.__sq. ft. z Other Distribution box ( ) Dosing tank ( ) .e �/� /d• e� aPercolation Test Results Performed bY.......................................................................... Date----.-.-_-•------------- ------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water._-.---..----.--__.--_-- GL Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...____..____--_-_------ P4 -------------------- ------ • ...__... ------- ---- ODescription of Soil--------- ------------------ °I�- '----------------------------------------------------------------------- x W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has*i1by the board o th.Signe --- ------ - ----- -----------------------•------Application Approved BY �' -•--- V� Date Application Disapproved for the following reasons: 17---------------- •--•-•-•-----•--------•----•-•--------------------------------•----------•--------------- .................-----------•-------••-----....----•----•---- ------------- ---------------------------_-- Date Permit No......................................................... Issued---_�---! 3 ------- ------------ Da e ,w No......Z.�. FER 2..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD�,PF HEk t=TH -25 2, -1,31 ..........OF.... ............................. ................. ............................... Appliration -for Bhipaoal Workii 'Tomitrurtion Vrrmft Application is hereby made for a Permit to Construct (6 ) or Repair an Individual Sewage Disposal System at* ......... JR --- ............................................................. ...... ............... ,f- j Wation- 8r3s or Lot No. ------- .... ------ .................; �---- --------------------------------------- --- V 7--- - ------ 'wner d .......................... --- --- - .......................... ....... ... ........................................ Installer Address Type of Building,: Size Lot-�. Z S "feet q Dwelling __________________________Expansion Attic Garbage Grinder-&'No. of Bedroom s----------�/- Other—Type of Building ---------------------------- No. of persons-____________-__._....___-__ Showers Cafeteria Other fixtures .........................................................................................Design Flow__Flow ..................—S..... ........gallons per person per day. Total daily flo I w ...: .................................gallons. P4 Septic Tank4liquid capacity/4- gallons Length________________ Width______-.-..--_.. Diameter__-__---_--_____ Del)tli..-:------------ Disposal Trench—No. .................... Width_____________,_______ Total Length___-______________-_ Total leaching area..... ..............sq. f t. Seepage Pit No------------------ Diameter___...__._..____..._ Depth below inlet ----------------- Aotal le chin area_____--_-_-___ --sq. ft. Other Distribution box Dosing tank Percolation Test Results Performed by-------------- --------------=.......................................... Date____-_._.._..__....._._..-_______._.._.. Test Pit No. L,--------------minutes per inch Depth of Test Pit_-_________________- Depth to ground water-.------------------- f� Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water-.._-__________--_-_._.. 1:4 --------------- ------ .................................................................... 0 --- --------------------------------------------------------------------Description of Soil_____________________________ U ----------------------------------------------------------------------------------- ..................................................................................................................... ---------------------I---------------------------------------------------------------------------------------------------------- ------------------------------------------------------ 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 i by'the board Sig o h I th. 17�,oe-V—Ze VK, ------ -------------------------------- 'to -4 Application Approved By.2�� .. ...... Date -------------------- Application Disapproved for the following reasons:........................... ................................................................................ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEAL H ..........OF.... %ice. ... 14P................ Tufffirate of (11kontpliatta THIS IS Tia CE TljItl,,)That the Individual Sewage Disposal System constructed (4<0r Repaired by......................... . .........;. ............. ........ ......... .................................... ---------------------------------------------------- I instalvr a --- --# -/---- - - ----------- K has been installed in accordance with the provisions of Article_.XI of he State Sanitary Code as descrked in the -it application for Disposal Works Construction Permit No----------- ed'..-.. ......... -------------- dated_-. .. .::_.____. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------------------------------------....................... Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS- BOARD Q)-F HE�AL�T ..........11 OF. . ...... ............ N ......... FEE., .9................ Dispofial 0111rho To fitrurtioll Vrrmil Permission is hereby granted____._____. 7-e---::�,Z- �Ir:......... ------I ...... ........................... R stem to Const Qst/,( er or., epair ( ).ap Indivi I Sea,age atNo. , ...... -------------------------------------------- ................. Street as shown on the a ru application for Disposal Works Congt"' ction Permit*No--------------------- Dated--- ........ -------------------------------------------------------- ----------- .......................... Board of Health— DATE---..__._.,_..._._....'----------------- ..... ....................................... 2 �� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS