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Home My WebLink About0432 PRINCE HINCKLEY ROAD - Health (2) L43A PrL 'ia -� n�� 4:. i tis No��- FRs..... .......... .. •• ..----- THE COMMONWEALTH OF MASSACHUSETTS BOAR® ... . .F• HEALT IA r7o �� .-----......-f --...OF...... ........:.........................•---............................... Applirtation for Disposal Iforks Tonstrnr#iun ratnit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal N-SYS... at:. ..... .....--- --- �......••-•--•---- . .... .... -------•••--•-----•------------- ----- ---•-• cation-A ress or.j,,ot ........... .... .... ........ ..... .....•.............................. ............... ...... . ...................................................... O Address a ............... ...... ............•........ .................................... ................... ...ram....." = 7.._..__.........--••--•----.....-----•-••---•-• Installer Address �i- Q Type of Building Size Lot..f, f.. ---Sq. feet V Dwelling—No. of Bedrooms....._ ...--.....Expansion Attic ( Garbage Grinder ( 4" 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria (/7� a' Other xture W Design Flow......... ..................gallons per person per day. Total daily flow................. .---a r'-j6i.........gallons. WSeptic Tank—Liquid*capacityl� allons Length................ Width................ Diameter............_... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...1P-X-4d.).. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date............................. ---•••-----" aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.-.---------_-_------- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...-------------.------. .................•--••----.....----•--•---•------••----------------...................•-•--•......•......................................................... ODescription of Soil........................................................................................................................................................................ x c.� ----•--------------------------------------------------------------------------------------------------•------------------------------------------•-•----------•-------------------- W -----------•---------------•--------------•----------------------------•--------------------•-•••••----------•------------------•------••--•-•------••--•••-----•--•-•--••-•-•-••-...-•--•....-••--•-•-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the rovis'ons 1. �`IL 5 f the State Sanitary Code—The undersigne further agrees not to place the system in o atio t' a ifi of Compliance has been is ued by the bo health. igned.... -- -------------------------------------------------- f-- -----Date / � Ap ion Approved BY............. ...........eft ..................................... 79: 19 Date plication Disapproved for the following reasons---------------••-------•----•--•------------------------------•-----------------•-----------•-•--------------•-- ..............................................-------•-------------------....-•---------------•--•••-•---------------------•-------•-- --•--------•--------•---------------••--------•...------------ Date Permit No............. -� V9-' _ Issued........................................................ Date Nd.z> .......... HE COMMONWEALTH OF MASSACHUSETTS BOARD PF. HEALTH .. .. OF.. (,( ....... .. ........... -------........... Appliratiou for Disposal Works Tonstrurtiott, Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Systegi, at:, rr e, dm 4z",e"e-' .......Y�L ..................................................... .................................................................................................. Location-Address. - or.Lot No'. re .1-e e 4'! , ............4 -" .......................................... ............ .......................... Oasner Address ............... ........... Installer Address Type of Building Size Lot.-/c ._/.............Sq. feet U 't 'i Dwelling—No. of Bedrooms ..............................Expansion Attic Garbage Grinder P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria (1i)i'Ll' Other fixtures:. =, ................ Design Flow........ ....................gallons per person per day. Total daily flow................... ........'.gallons. 9 Septic Tank—Liquid*capacityZ:-------gallons Length________________ Width__.__..______... Diameter__.--_______.___ Depth:_______:__..... Disposal Trench No_.................... Width_____.._._.___._.___ Total Length.._._____._.._______ Total leaching area....................sq. ft. Seepage Pit No_2-�'___� n------ Diameter____________________ Depth below inlet____.__.__...._..._. Total lea'ching area...................sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Dke........................................ Test Pit No. I................minutes per inch Depth of Test Pit_.._._.___.__._..___ Depth to ground water_..._....__.__.__.._.... (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit._....___.__._______ Depth to ground water....___..-._____.._._... P1 .......................*......**-------------------*---------------*....-----------I'*"*---------------*.......*--------------------------------- 0 Description of Soil....................................................................................................................................................................... Ww...........................................................................................................................................................................1�...................... U ---------------------------------------------------------------------................................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... • ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with th provis*ons f T.'IlE f the State Sanitary Code— The undersigned further agrees not to place the system in 0 ati t* a tifi of Compliance has been issued by the board of health Signed.. ........... _;�d.................... ----------------------------------------------- D t 15 Ap ion Approved By-.- ----_------- --------------------------------------- ............... Date pplication Disapproved for the following reasons:............................................................ ................................................. ......................................................................................................................................................................................................... Permit No.......... _V9 I Date ............................. Issued....................................................... Date .21 THE COMMONWEALTH OF MASSACHUSETTS ✓ BOARD OF HEALTH ..........................................OF..................................................................................... Turdifirate of Toutplianu THIS-W TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by------...__.. .................. ..... 7-------------- ---------------------*------------------------------------------------------*------------ �__.. ...... Installer atc0 f ....... . . ....... .........................I......................................................... has been installed in accordance with the TrMhin"w@VTjTLE 5 of The State Sanitary Code as described in the application for Disposal Works.Construction Permit No.... ........ dated........... 1"" - _'d------__-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................I.......14::iE, ............................... Inspector......... ....... ----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................OF..................................................................................... .................. FEE-45EZ........ Disposal Nods %Txnstrurtiott Uptruth Permission is hereby granted........pl.,6(....� ................................................................................................. to Construct orAepair an ;ildividtial Sewage osal System at No.... - f i ................................ ... ...... ...*- ------------------------------------*------------------------------------------------------- Street as shown on the application for Disposal Vror Z-S-170-M ruction Permit NoIT5_7��Dated 4�1 ......... ........ ------------ . ....... .......................................... Board o oi Health DATE.................. ..... ..................... ....................... FORM 1255 A. M. SULKIN, INC., BOSTON r .'_. ..... ... .. OAMT :[� 'FLov�lty .rS x:S 330 ` GP!p 1 GO,cc , �C50%. { /LoT 306 _ / p+L_:.�i�"� TA7 dEfA 1�1�ZEP►: +`DSO 1 5. 1". .: {� PQaP qxa A pit Ttl�A S_c s'F 40 = 61 T 1 , C.P;a. 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