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Home My WebLink About0323 LINCOLN ROAD - Health .... �- i s# O ' e 0 II� 0 ASSESSOR'S MAP NO. r- PARCEL LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NA.M�E ',A ADDRESS I! U I L D E R OR O:WNER DATE PERMIT ISSUED � B a DAT E COMPLIA. NCE ISSUED 6 h 1` cu i �'{Xb P�-cP�PtT jd4, ASSESSORS MAP NO: , =Z L - —to � PARCEL NO.: __ r� - f No.... _.... 1 Fps ....................... THE COMMONWEALTH OF MASSACHUSETTS EO, FRD OF HEALTH -- ......OF........................................................................ .............. Appliration for Utgpusal Works Toniarurtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: rr tt --�1. —...;�......LZ. !. s?_Xz� _.... .......................................... __ Loc t' -Address /// j� f�f� o Lot No. c -- - a-------------1]- - S•. ..---.---------•.... .......................................... N0- r _ . Address - ..� Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._.____ ___________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of lersons............................ Showers ( ) — Cafeteria ( ) Ga1 Other fixtures ................ .............. .. W Design Flow........? ....................gallons per person per day. Total daily flow...... ................gallons. P4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter.-._.----___--_- Depth................ Disposal Trench—No..................... Widfh.................... 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 s----------------------- ---------- ---------------- Date........................................ Test Pit No. I................minutes per in ) epth of Test Pit.................... Depth to ground water----------_............. Test Pit No. 2................minutes per inch hepth of Test' Rit.................... Depth to ground water...--._____-,__--•_____- r„ P ....-----•-•----•---------------------------•-•---••----•--•----••------....................---•--------------------•--.....--------------------------...... 0 Description of Soil.........................................................-...................................................................... .................................. U --•-------------------•----•••----------------.......-----------------------------•----------•-------....-----•---------`-------•----•------•------...--------•-------------•-•-----•-------•-------- - -------------------•-------------------------------------•----....... U Nature of Repairs or Alterations—Answer when applicable-----`_____ .{�--._______ .. .. . .. �.i�_.___-__- � - ....... - --------------------------- ----------'fie------...<! c47 r --------� "`--'X'.� N' ' . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI tI ',I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has .een-miss and of SignP `.... ........ ........ .. ...... ......... --`7.7Z--... Date ApplicationApproved BY------------------------------------= ---= ....................... -------•----............. ..2-_........ Date Application Disapproved for the following rea o s-.............................................................................................................. ..............••----•------....----•-----•------••-•-----------------------••-•----------.........--....... Date PermitNo...............................:.......•---•-------...... Issued Date tl hh � -7 f TT 1 No......................... FE$............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -.............. --- ...........OF............................................. ApVtiratinn for Bispuial Works Tonstrnrtion Prrnti# Application is hereby made-for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: c~ ......��. .C .c�.1 r�.v� -0-- ---••••---........_ ` ......................................... Loc Add ress / or.,Lot No. ........ - �. S--- ------------------- ............................................... Ow er . ` .�-= Address �. ...................---•._^•---------- --•---------=w-----------------9.------._............. --'--- ................................................................ Installer Address UType of Building Size Lot....................--------Sq. feet �., Dwelling—No. of Bedrooms.......�............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ..............................................................--------------•-------------------- --------------------•-------------••----------- W Design Flow....... .....................gallons per person per day. Total daily flow_--_�_..�_C2.................gallons. WSeptic Tank—Liquid capacity.._.._......gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—NTo. ................... 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ M •••-••-•••-----------------•--•---•-•---••••--•-•••-•••--•...._..----•-•....._....-----••-----_....•................................... -------------------- 0 Description of Soil..................................................................................................................................................•..................... x U ..........................•••---••-•-•---••••--••••--•-•-•••--•••---••--••--•••-•-••----•------•-•••-••-•-••---••--•-•••----••-•-••••••-••--••-•••-•---••••---•-•••-•-•••---••-••...................•••. w x ----------------------------------------------------------------------------------------------------------------------------------------------------•••••••••------•-•••-------••-•......-••------•-••` U Nature of Repairs or Alterations—Answer when applicable._____0I.D.0........... 1.1----_--_- V... ._ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of �TY� .5 of the State Sanitary Code—The undersigned further a ree not to place the system in operation until a Certificate of Compliance has e-e,�� and of Signd:-- . ........ -- . --• -- ------- -----•--- •--- •.. Date ApplicationApproved By.................-•---•••••••...I..................... ....... -- -------- ---- ............*-........ -_ I Date Application Disapproved for the following re ns:......................... ---------•----•-•------••----•..........................•------- -----........ ---------------•-----------------------------------••---------------.......------.....-•-------.....----.._.....--•------------------------------••---•----------------- ............................... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..�..V.V_AiV........OF....... .... A.e................................... Tntifiratr of f omplianr THIS IS T T- attthe I.n�ividual Sewage Disposal System constructed ( ) or Repaired (` f' by c . -� ` Installer has been installed in accordance with the provisions of TiTiE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit N o.�4...�,.-_ - ._I........______ dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL-FUNCT ON SATISFACTORY. �� -/-. • _.-_- DATE....................... ----------------•------.--------. Inspector..............................................................................•..... -- Z -1 1 - C�7�2 _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . UkJ �~ ao ' NO. FEE.....Ll............... ►i �a (9nns#.r - -wit rrnti# Permissionis hereby granted...........t......;----------�.......... ----------------------•--.....-------.._.....------................._._.. to Construct ( ) or Repair (L-j an Individual Sewage D�spo System at T sheet as shown on the application for Disposal Works Construction Permit NoS G=C..a L Da ed.-------- _'._. ..-.` .... -•--------------------- n= ......................................... Bay of lth DATE . 3 _�---------------••-•---.••--- 1 FORM 1255 HOBBS & WARRE . INC., PUBLISHERS t J