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Home My WebLink About0405 HUCKINS NECK ROAD - Health 405 Huckins Neck Road 233-046 Centerville CLFO I/ 0 11/l •� ti UPC 12543 4 No.53LOR o�`�SI•CONS�� HASTINGS, MN No.. �7Z_' �� 3 _ Fizz........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH - -.O F.......................... 33 0 �� Appliration for Mipm al Workii Toes union thrutit OApplication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ' Sys t at: , ... 1� ... ----•----- - ---------------------------------------------- e c on-Address,`��J%� � or Lot No. ff% .. owne Address ................... ..... .... ...-•--- .- ------•-- ..._......--•-• ....................•---•-----......----•----••••-•----•--•---......-•--•••. Installer Address Sq. feet Type of Buil n :: Size Lot.............•.._._.____.__ Dwelling—No. of Bedrooms._........_ ...................Expansion Attic'°!..( ) Garbage Grinder ( ) Other—T e of Building '� Showers — a YP g ... of persons. = ---•--_ ( ) Cafeteria ( ) Otherfixtures ----•-••--•••-•-•--.............................................................................................................. W Design Flow....................'_'_ __ ___ga ons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( Percolation Test Results Performed by------Z_kA44_)_ • ------------------------------------------ Date..............................._........ 14 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...................._.. r1L4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .......... - r .... O Description of Soil•-- ............... 3..�. LJ.'.- _.... ..:. p�� — a � _ __-----.�..---------•------___--•-- �� --------- ------- -- ----- w �- -r-- , ------ �--��--�Jy� U Nature of Repairs or Alterations—A wer n applicable__--_.. 'tom- D` '® G; �1 ---- --------- d -1� ------ - -�-------------------_____-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 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. Sign d -•--- - .L7 / D to Application Approved By•-•_ L ----..... ---••` `' •- Date Application Disapproved for the following reasons-------------------• --------•---------------------------------------------------------......................... ---------------------•----------------------•----------------------------.....------------...------....--••-••-•---•-.....••-•--•••-••-•••••••-•••-•-----•--•••-•-•------•-•--•-----••......•-----•••--- i.Permit No......._......................-.......................... Issued_.:}a_...V.1...........--Date------ THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH ......................................OF........................................ Appliratfilu for Disposal Works Tomtrurtion ramit Application is hereby,Made for a Permit to Construct or Repair an Individual Sewage Disposal S. st at . ......... .... . ........ ...... or Lot No............................................ c ion-Address ........... .... ... . . .. ....... ............... ....... Owne Address ... ...........6..... 4.............. --------------------------------------------------------------------------------------------------- Installer Address U Type of Buil m Size Lot............................Sq. feet Dwelling—No, of Bedrooms. ..._..... ............................Expansion Garbage Grinder Other—Type of Buildingx�y .... ) 4.WrON6. of persons_..__...__:" ......... Showers Cafeteria ,.Other fixtures ............. ............................................................................................................................... Design Flow.................... -----------ga Ions per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid 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. ft. 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.......____._........... PLO Test Pit No. 2................minutes per inch Depth of Test Pit.__.............._.. Depth to ground water._.___..............__.. --------------------- ..................................... ....... --------------- -----------&........ 0 , 'S..........?.. A......... Description of Soil..... - ----------- 6- .4 �4 ------------------- ........ ere -------I . ------------------ ............................................................ ............................11----- --------------I--------------------------------------- Nature of Repairs or Alterations—Aygyver &h applical 1p, ------------ jt U ble. ..................... ........... . ........../.,41W Agreement: Ile, The undersigned agrees to install the aforedescribed Individual:.Sewage Disposal System in accordance with the provisions of TITAIE, 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. Si �,d... ........................................................... ................................ Date Application Approved By...... ...... . . ........ ............... .... .............."................. op, Date Application Disapproved for the following reasons:.............................to...........-1............................:.............7------------------------ .....................................................................................................................................................................;.................................... Date Permit,No.-.,,--. ................................................... Issued........................ -----------------------------Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ....... OF..........4.. ............................................ . Tntifiratr of Tompliatta THI 0 CEfT171Y, T a e Individual Sewage Di�vosal,,Systeni constructed )'or Repaired y....b� ..... Z�..... ................................... ............A^_�e....... at...... .... ..... --- ................. ....... ....... .....147 Jiy has been installed in accordance with the provisions of TZ*T,ff, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit NQ(7f .... ---------------- dated-------/dnxo-.7,f.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. K ........DATE Inspector................................................................................... P r "44( THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ""0 .............................................................. -1/ 7 ... ................ ........... FEE... .......... Permission is hereby grante '2�'n....C,el �, ... ............... ............ --------- --- -- ------ o Ire 'an Ind iwa e DispV-.S,31' Sys 4 to Construct air ..p at No..'"... ......... V....................... lilo/11 ..... -Y-- - - ------- Street as§Jhown on the application for Disposal Works Construction Poffp—t No.- Dated../P_n ......... K47"',ez"-e4gr�. ----------- Boaid of Health ..................... DATE....... ...................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS �90/ Cf)q --7 -7 C4 LOCATION SEWAGE ERMIT NO. fl&4lAQ VILLAGE INSTA LLER'S NAME i ADDRESS Rol d Z- A S U I L D E R OR OWNER Jay DATE PERMIT ISSUED DATE COMPLIANCE ISSUED rlli)-7.1 -7 LOCATION SEWAGE ERMIT NO. vC4 VILLAGE INSTALLER'S NAME . i ADDRESS BUILDER on OWNER '00OLl D�As DATE PERMIT ISSUED 1,79 DAT E COMPLIANC-E ISSUED 7 _ bu- 6117� ii S AP -ozrj i A_'OVA &L rO .4 Ie,4 v y CA S;7- Ile O/V C 0 "/)Vl PIT C14 J) /,,v r: Z-)R1 4v-Q EL Sz COVERS 0 C01V Ce--E�7 A'- 1*f I M. CC) c z :A ,v &A CJe) r LAP4114) LEVEL 0 LAYER 4 IRONCAS r ...... 00 0 WA 5 HF0 5701V r1c TA lvx D) pem v .41 . S WASHED S p �,j 'T TOiY I> o-A C of IF�: p A -F/7 R 7;;7 DNS'' S, Y_ 6 F-r. 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