The URL can be used to link to this page

Home My WebLink About0498 SKUNKNET ROAD - Health (2) y98' SllunKnef QsO� land, lip I&q - 6q3 cOS � -- - - C1 C) Ct FmcA4:,& THE COMMONWEALTH� MHONNWEALTHOFUMASS/ACHUSETTS f�� TH ------ ....J0.1_Y.)...........OF..... --------------------------------- Appliration for Diopooal Works Tonstrnrtion Vernfif Application is hereby made for a Permit to Construct ( ) or Repair (/---)—an Individual Sewage Disposal System at: .......... ---Rua e.............. ............ ------- ,-------------------------- L c Address r Lot No. - ..:� .t c: ....... .> ----------- ---------- _ r �1.�. ..-.---------.........-:--------------......... Own dress Installer Address UType of Building Size Lot............................Sq. feet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------•--- - W Design Flow.............................................gallons 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----------------_----.-. Test Pit No. 2.............___minutes per inch Depth of Test Pit.................... Depth to ground water-------................. a --------------------••-•-•••-------------------------------..__....---------............-•-••-------......................................................... 0 Description of Soil.......................................................................................................................................................................... W V .._..-••-•-••--------------•------------•--•--•-•---•-------------•------•----------..........------•--.....•--------•------•-•----••--•------••-••------•--------------•---------•-••....-•------------- -------------------------------------------------------------------------------------------------------------------------------------- --- U Nature of Repairs or Alterations—Answer when applicable.---:------. — .. ! ___ , ..-__ ...----•----------------•---�=-� y.- •----•_Ca ................................. Agreement: . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT?2 5 of the State Sanitary Code— The undersi"eer agre s not to place the system in operation until a Certificate of Compliance hasIbDn issued by the bboo,�r� ed Application Approved By-•-----•- -------------•• '-----------.....•--••------------....-•------•---•--._..._--_---- �T*_0 -------- ate Application Disapproved f o e ollowing reasons-----------------------------------------------------------------------------•--•----------------------•------_.. ....................•------...---...----...--•--•-----------....-•--------------......-----._...--------•--------•------------•-------------------•-•--•----•-••------------•------------•----•---•--•-- Date PermitNo......................................................... Issued_....................................................... I Date s No....P.........:....... r I? Fsa.. THE COMMONWEALTH OF MASSACHUSETTS J BOAR® OF HEAYTH ......... o r' %............OF.... �"f zf fI r e ter I . Appliration for Disposal Works Tonstrnrtinn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (.l 4-an Individual Sewage Disposal System at: l� fii { a f x _ Location Address y l� pr Lot No. r. Y { f /MI . �y 1} 5/� 1 G x "VY`Y .. Y i - ................................................ Owner c n p�x f Address '••'•-•`TM•`'.t...k,....k.. .�.J,3..ta r........r a.: .:. .:::!f.. .�...3. } # �•� .. ._...l.-- •1t•-•..#..4. ........................................................ .. .. Installer Address Type of Building Size Lot............................Sq. feet .—I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder PL4Other—Type of Building No. of persons............................ Showers — Cafeteria 04 d Other fixtures --------=----------------------•-•-•••-..••••. W Design Flow............................................gallons 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.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water................:------- f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. f� O. Description of Soil....................................................................................................................................................................... x U ......-••-•-•••--••••--•••-••-••---••••....-••-•-•-••-•-•-••••••••-••••-•--•-•....•-•----•••...----••-•••.............••--•-•••••••-••-•--•--------•••-•-•••--•-----•............._...--•-••......------. MW ----------------------------------------------------------------------------------- ----------------------------------------•--- -•-•••-------•-•-•••------ . UU Nature of Repairs or Alterations—Answer when applicable______--•-. :� ..: g . j ;!_ li . ; ' -�'` 1 P = -1 =� .......... .....••... •----------•--••-•••-•----••-••--••••••-•-•-•-•.............•-•--..._..--.-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by the board of health . .. . .::.. . Application Approved B . Date Application Disapproved for t.e f of owing reasons-----------------------•-------------------------------------••------------------..._...-----•--••-•-••••-----•-. --.....••---•---•••••-••••-•••---•-•--•-••--•••••-•••-------•----•••--••----•----•-•...............••••---•••-••••-•--••-•---•••---•••-•••-••---•••.................................................... Date PermitNo...................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y..,..a.! �'' ....OF....f tea:.... ��..,.1...°.�.. .. ,f ............................... Trrtifiratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (Z }�a by at.....tltf i .._ .f+_.J -.f cC ` .#.. .tr 3 ref} s� Ins�allet�l �I �f r ,l ( o . E ---•---_------------ - has been installed in accordance with the provisions of TITIf45yota4state Sanitary Coc r in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUA CE OP THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UN ION SATISFACTORY. DATE....l �...+ Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH W..n.........OF.... J� No......................... FE A6.�l�!.(.l.. ks Ton Wn Prrmit Permission is hereby granted----- .. .........ill r � �` C= �l �- ........... to Constr or epair- ��j"an I divi ev�Ta08 ..d........g > pos ystem l / - at N ff Street r � . as shown on the application for Disposal Works Con4tction Permit . ................ Dated........ �...._._.._......._._........ .................... •................ ...•--............----••......---• -- Board of Health DATE27 -- -------------- ---••--------------•- FORM 1255 A. M. SULKIN• INC., BOSTON