HomeMy WebLinkAbout0208 HUCKINS NECK ROAD - Health (2) aoB' Nucl��i�s Ala R,el , Genf,
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THE COMMONWEALTH`OF`—MASSACHUSETTS
BOARD OF HEALTH''-
I ....................
Appliratinn -for Uiipnoal Marko Tomitrnrtinn Vrrniit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal i
System at: is
Location-Address ' or Lot No.
. � e..........Ze. -------• •--•---•-- --•-LU � ' ��s��e�..... /LJouw-
e Owner Address
W
. --------- ...... ------------------------------ ....
Installer Address
Q Type of Building Size Lot....1'_ 59 --------Sq. feet
V Dwelling—No. of Bedrooms....._......-F________________________Expansion Attic Garbage Grinder. ( )
aOther—Type of Building ---------------------------- No. of persons------------4------------ Showers ( )' — Cafeteria ( )
Pa Other- fixtures ------------------------------
I, W Design Flow..........._s '1� .....�0----gallons per person per day. Total daily flow..............
WSeptic Tank - Liquid capacity_Os Mgalions Length/'Q_°'_ _.. Width__57 .4._,'Diameter----------!......Depth., . . ..:
x
Disposal Trench—No..................... Width-------------------- Total Length---------------------Total leaching area.... sq: ft.
ro Seepage Pit No............ ------- Diameter..._.6—..0... Depth.beloWnle Total leacl 'ng irea__. ..._.....s 1. ft.
Z Other Distribution box ( ) Dosing tank
~' Percolation Test Results Performed by.-AWWW.....QA?XW_4..................... Date_._--_:--_:::__.
Test Pit No. 1____ 2 -.-minutes per inch Depth of Test Pit...___`_ . Depth'to ground water h
(� Test Pit No. Z----------------minutes per inch Depth of Test Pit.---._-_---`._-__ - Depth to ground water °
N .o - - ---'---- .. ayi rl .................. ... .................................. ...._.____....................._....__.......................__.____.________..� --'y v. , .
Description of Soil--------------- -----It j6FA4f.W_,E.............._----------`--------------- ..
U ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------
W
VNature 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 \I 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 oj health.
Signe -----
•- •-------
- • Dar '
Application Approved By----- ------ ---• - " -------
Date
Application Disapproved for the following reasons:.................................. -•--•-----•-•-----•-----------------------------------• -•----------------.
--••........................•.. •---.---------------...---...-----------------_--
Date -
PermitNo......................................................... Issued........................................................
Date
y�-- ---------------------- ------------------ - --- ----
No:._._.._.... .. a ' 1 Fps .." ".....
P. THE COMMONWEALTH OF MASSACHUSETTS
C,71
BOARD OF HEALTH
... . ........0 F................... ...... .........................................................
ApyfirWion -fur .Bigv* imf
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
Location-Address or Lot No.
L/Owner Address
------•--�._'----- . ------
Installer Address
U Type
of Building
of Bedrooms Size Lot..--y= --.Sq. feet
Dwelling— ooms._._ _--_ ________ ___ ___ _____Expansion Attic ( Garbage Grinder ( )
Other—Type of Building ____________________________ No. of per n :�tR_r sos..-__-_---_ -__.___---_ Showers ( ) — Cafeteria ( )
Q' Other fixtures ...�'
W Design Flow.--- a$**_..gallons per person per day. Total drily flow...._.. ._.v� ------- --------g111onti.
WSeptic Tank—Liquid capacity e� allons LengthlQ1!t4.. Widtli-.r*"+�- Diameter................ Depth._�•� .
x Disposal Trench—No.---------------- Width-------------------- Total Length.................... Total leaching area_._- .-.___-_sq. ft.
Seepage Pit No-____-______-I.._._. Diam'eter_.__.i;r!'!4_! _. Depth bel(�w�inlet- �' Tota",leach' ig trea. ..sq. ft.
z Other Distribution box ( ) Dosing tank ( "
Percolation Test Results Pg-formed by ,17!! __. Date- -----
aTest Pit No. I..-_., .._m nutes per inch Depth of Test Pit-----_10-r--- Depth to ground water________________.....
g .
rXq Test Pit No. 2________________minutes per..-inch .,.Depth of Test Pit..__._--____._._____ Depth to ground water------------------------
----------------
O Description of Soil J' _ i ------------------------------------
V -------------------------------------------------------------------------I ......................... ------------------------------------------------------
W
VNature of Repairs or Alte-�Ntions—Answer when applicable..__.._. ----------------------------------------------------------------------------- .........
-•---•--------------------------•----------------------------•----------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage DtsposaQSy stem in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not,Jo place the system in
operation until a Certificate of Compliance has been issued by the board c health. !a
Signed ..-* - --- - '. '�
Owl
Application Approved B «_ 1.
D
PP PP y---� -- u � .Dat a ,
Application Disapproved for thefollowing reasons________________________ �.
r.., .
__________________•------------------•-------•------------------•---•--_._-•-•----•------_______-----•------------------------------•-•=--••--•-----•---•••-----------------------------•---------------
n, Date
PermitNo. - Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS'
4
* ' " BOARD OF, HEALTH K
r
OF. '
............ ......... ... ..............................
W.Irx#ifiratr Of (911tttvil-anrr
THIS;IS TO CERTIFY, Th t the Individual Sewage Disposal System constructed ( r Repaired ( )
Installer
at-•-------•.............. ----- -��---- .------ ► c •"-- y"'�" i ' ----------- t'
has.been installed in accordance with the provisions of A icle XI of The'Stay. Sanitary Code as described in the
application for Dis osal Works Construction Permit Nod._ ` dated _
P f
THi ISSUANCE OF THIS CERT4F'CATE SHALL'NO,i�BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUN TI N SATIS ACTORY.
DATE 6 -------------------•-- Inspector------�..... .. l� " : ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ",JOF HEALTH
.OF_.....A W. .jr ......................... �w �'� W
�. No.........................
Permission is hereby granted .......... - -------- ----- ---------------------
to Construct (901 or Repair ( ) an Individual Sewage Dispo al;Syem
at No.--.... ..__.. .------..&w �!�G�f,r.....A! . - ....__ ✓/. ............................
Street as shown on the application for Disposal Works Construction Permit No Hated s ,' ...
,� ✓ d oar of
DATE :�,
Health
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