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Home My WebLink About0251 NYES NECK ROAD - Health (2) `�� I"'��S 1v-�GI�� 1 +� ,. r 0-20 E PERM IT c�&.TIOKI 5EWO, ki0. n l ilowVILLAGE — — — — II`ISTQLLER*S UWE ADD.RESS BUILDER 5 tJ / MF— ADDRESS DATE PERMIT ISSUED DATE COMPLI &MCE ISSUED : —7' 2c1, _7fC G ® IIA^f t -s , 4 No. Fua...1 . ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ._.. ----OF........ is r07 7 .�.ilo. . ...................... Appliratiun -fur Uiipuoal Works unwtrnrtiun Vaniit Application i�hereby made for a Permit to Construct (° ) or Repair ( ) an Individual Sewage Disposal Synste�my at: V rim �� / ^ ...704., aaa�e�ss! /d-.-. ,1 t?-,l .........---•--•---•----------•---•--•----.....-- ,�f� Po atio .-Address / or.Lot No. ............... ..---...,r��.�er?t?!"s�r:��?-. .... O ner /� A d ess a ....�1 .�.-...................................... ...................................... 14 Installer Address UType of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms.�-?.Q.....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------------------- W Design Flow__-__-__-__-•__.. ___:-__-_--.gallons per person per day. Total daily flow--------------- ...............gallons. WSeptic Tuck—Liquid capacity_1.c gallons Length---------------- Width................ Diameter-----...-------- Depth---------------- xDisposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------......sq. ft. Seepage Pit No . �rDiameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. z Other,Distribution box ) Dosing tank ( ) aPercolation Test Results Performed b ------------------------------------------------------- Date____ 1. ^-..7 r........ Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water.-.----..----.-..-.--._. �14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.--.-.--_--_--.--_.... 0 ---- ------------------------------------------------- - J.. ... O Description of fSoil_-�e_e.. . �_ I .._�_... �G. �t-t, ..... - ---------- --- - 7 7 .......r.. ........... -- -------/ ----------------------- --- - - ----- U Nature of Repairs or Alter s—An er when applica le..---------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beSa4ssued by the board of health. Signed._ r. t'_. . 1,4�`e .--7 7� Date Application Approved By.........................:...... �r ------...7---- Date Application Disapproved for the following reasons-.................................................... 7------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo........................................................ Issued........................................................ Date .1 No.-------•-•••----..._._.. Fps...../ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH e:r> _....---------OF......... 1 r.-. /1M_1......................... Applirtttion -for Uiiipoiitt1 lVarks Tonstrurtion Vrrutit Application ishereby made for a Permit to Construct ( Zor Repair ( ) an Individual Sewage Disposal System at: /--C 1;F�3-��r /�tJ =.:: .. .. �Lo at'?•Address 4 or Lot No. „a' '-•r-' - _`t•..f.:'.,._�i_-'..,..d.J.�wwer.............. ......... ......................................................... W // (r^ / Owner Address/ .....�C r...... :.{..---. •_ _�t.......-•-•............................. ........0 r.G�.E?.� .�!,r�..... ��{-s------•----•-----•--•----------•-•-•- a Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling o. of Bedrooms.- .,cv Q---------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons..-_____---_______--------_- Showers ( ) — Cafeteria ( ) dOther fixtures r=-------------------•---------•---------•---------------------•------••--•- ......................... -----------------------------•----------•--- W Design Flow.......................�._(-._.........gallons per person per day. Total daily flow................,,2�..............gallons. WSeptic Tank—Liquid capacitv__ ,�-gallons Length................ Width................ Diameter..........------ Depth---------------- x Disposal Trench—No_ ____________________ Width-------------------- Total Length.................... Total leaching area......--------------sq. ft. Seepage Pit No__L-rjrg��,,.tDiameter-------------------- Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box (/ ) Dosing tank ( ) a Percolation Test Results Performed b ......................................................... Date___. ..r_.!_G�.-.._ _ __..... Y r Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--._--__-.--.---_-._. /�,� - di-------- Descrtption of Soil " ¢ ` �. _.�_t•/ter r- :r• t;/ i�t�---- - -- U -------- ------•--•--O-----'•/•--1 ' .1_ / Ir. /�/1ni - �4�......J........ �- �E °�e G•f�1�/ x -------------- � !- U Nature of Repairs or Alteratiofts—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 issued by the board of health. Signed - -----• 1� �t� P .Application Approved BY-------------------------------- ------------�-----f� -- --r�s,.c�-!- ......... -------- Date - ---------�� Application Disapproved for the following reasons-------------------------------------------------------c'�.----------------------------------------------- --------•-•--•-------•------------••••••---••-----------------•-----•-----•------•---------•-•-•----•-•--....--•-----------••-------...------------..--------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT ......... , .........OF....... . . .. .�n .... .. ....... ........................ (frrtifirtttr of f�outphatirr THIS IS rg CE TIFY That the Individual Sewage Disposal System constructed Repaired g P Y ( ) or ( ) . _. > 1 by . -- r---Ydier --- .. ---------- at vf'X------ = �� T•�'`?�f ._ ..�,,E has been installed in accordance with the provisions of A fi9l XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ 7_.__... ............. dated-...... ..':... ............ THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... ------ --------.... Inspector -----.-..... `'.............................. THE COMMONWEALTH OF MASSACHU TS f` BOARD F HEALTH �G �.��I!1..........OF........ .. .... �s/ ....................---.... /' a-f� No:-••----3a2 U' FEE-- ............. u :` at �rrutit Permission • hereby granted......... � ... - ----------------------•-•-----------•----•--._......_...•••---.--... to Const&�' o R jai ( ) an ndividuaY, ri g Di al S m / oV at No ------------V. .- 1 = ''1 d l�' Street as shown on the application for Disposal Works 7 Constructionr e ........... Dated-_-_7 .�-a. ............ it N L�S ------••-------•----•••-•------ DATE.... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS / // L f i 1 r a, • n r r E cti n 74 f Y � C 3 50 t _- /C-cto -- z A 15,42oS� � 00 j RICHARD Nr7, A. a g EAXTER ap T-I i—=i Ew a r P"a,1 Na 24048 su 1—A 4J ►c C-F E2eN C.e. 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