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Home My WebLink About0140 OAK NECK ROAD - Health 3a1- /'/7 a . — !! ji, .� i F - r �. t:a .7 $` !! a % i , i I 1 t s f f I a 1, ti. I� a g P 11 ',�— L--,—J-� 1, P . e d . LOCATION EWAGE PERMIT NO. VILLAGE iff 1 I N S Tr L ' ER'S NA/�E i ADDRES_4 S � d UILDE R O 70NER - DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r °�1 ! �� Cam. �V F.R$......e .QD... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ................ ......0 F....... ............................... Applirativaa for Eli4puual Works Toustrurtivaa ramit Application is hereby made for a Permit to Construct ( ) or Repair (L_�^an Individual Sewage Disposal System at: ---------- ----------- ---------------------------------- Lo tion-Ad r or Lot o. Y� ...................•--------------- ............... wner Addre s ID ,a ----....... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) aOther—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 ( ) '-; Percolation Test Results Performed by------------------------------------------------------------------------- Date........................................ 4� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--___-_--____--__.---._. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------- -------- - ------ -- ---------------------**----------- 0 Description of Soil----------------------- ( °tea} ---- - ..............................................................-----------"---------- ------....__.. U ---------.---------------------------------------------------------------------------------------------•---••--------•------•-=-----------------------------------------•------- VW I------- Nature of Repairs or Alterations—Answer when applicable._-______--_-----I-'---1: 00 .._�.GU..._._..1�L�________________ ----------------------------------•..-----------------------------------------------........---------------------------------------------------------------------......----------------••-----.......__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'lPIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the bo d of health. ------ ----------- Application Approved By----.------ • -------------•--------------------------•--•--- ... Date Application Disapproved f o he ollowing reasons----------------------------------------------------------------------------------------------------------------- ..............•----....------------------.._..----•-------------.....-----•--•------•----------------------------------•------------------------•---- PermitNo......................................................... NIA-I&..... FIZZ .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................... ..........OF.....................:.................. ...................................... Aplifiratijan for Uh4poal Works Tunstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................................................................................................. .................................................................................................. Location-Address or Lot No. ................................................................................................. ..........7---------------------- ------------------------------------------------*.......... Owner Address Installer Address Type of Building Size Lot-------_------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) PL4 Other—Type of Building ............................ No. of persons...._....................... Showers Cafeteria ( ) Otherfixtures ---------------------------------------0.............................................................................0................................ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width..............._ Diameter__.............. Depth_._..___._..._.. Disposal Trench—No..................... Width.................... Total Length___.............._.. Total leaching area....................sq. ft. Seepage Pit No----------_-------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. 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_-___-_-_____-__-__-_--. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.__....._........... Depth to ground water._.........._......._... . ..................................*-------*........ ------------------*.................... --------------------------------------*------- 0 Description of Soil........................................................................................................................................................................ W U ...................................................................................................................................................................................................... -----------------------------------------------------......................................-----------0.............................................................................................. U Nature 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 T IT LZ 5 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. ............... ------------------------------------------------- -------------- ....... . ............................................................Application Approved By............... . ....... Application Disapproved fo "tXhZollowing reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo.........................0............................... Issued------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... Tatifiratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by------------------------------------0-----------------------------------------------------------I-------------------------------------------------------------------------------------------------- Installer at...................................................................................0----------------------------------------------------------------------------------------------------------------- 40' has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod eis.Asieribed in the application for Disposal Works Construction Permit Noo'—.2------- ........... dated --------_---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTMD AS A GUARANTEE THAT THE SYSTEM ONCTION SATISFACTORY. DATE ? .......................................................... Inspector.................................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH ...........................................OF.. ..... ..... N . ................... FEE........................ Permissionis hereby granted............................................................................................................................................ to Construct or Repair an Individual Sewage Disposal.System atNo.............................................................................................................................0.................................... .................. Street as shown on the applicatio for Disposal Works Construction Permit No............ !�_-.-A-_15�ate XK Z--- ----------------- ---------------------------------------------- ............. cB—rd Health 4' DATE:.;7/;?J.. ... .... FORM 1255 HOBB'S & WARREN. INC.. PUBLISHERS