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Home My WebLink About0164 PRINCE HINCKLEY ROAD - Health (2) /l��l Prince Nt'ncK , U6, No. Ficiz ...!Z .. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA TH ------O F..... ... ...... ...................... Appli.ratiun -for 43itipusttl Wurk,6 Totui#rnrtion Pruld Application is hereby'made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal gSystem at: �- r � !-- / ------ - -------- oc ion.Address _ or Lot N ................... .... •• •.•. ............................... - Owner - Address Installer Address -�/ d Type of wilding Size Lot. Y,;JSq. feet U Dwelling No. of .Bedrooms.............................. _._._Ex Expansion Attic �-, g— .-----•-- p (1(,)'O Garbage Grinder (16�O aOther—Type of Building ............................ No. of persons_-______---________--__-.-- Showers ( } — Cafeteria ( ) aOther fixtures .....------------------------------------------------- W Design Flow.......... _�.d....................gallons per person per day. Total daily flow__________��_______..........gallom. WSeptic Tattk—Liquid capacity_ gallons rI efigth________________ Width.-----------._. Diameter-------.-------- Depth..__--__.-.---- x Disposal Trench—,' N/oo_ ____________________ Width...;tr:_---.-..... Total Length-------------------- Total leaching area--------------.-----sq. ft. Seepage Pit NO.._d—._-..._..._ Diametero _�__ Depth below ' let______ _____ ___ Total leaching area------------------sq. f;. Z Other Distribution box ( ) ,,y Dosing nk aPercolation Test Results Performed by____ --___-____-__-'4.... _.... Date--- _____________ Test Pit No. 1----------______minutes per inch Depth of Test Pit...--__--_-_--____-- Depth to ground water....-----.-__.---.-. -. L14 Test Pit No. 2... ^'...._..minutes per inch Depth of Test Pit.................... Depth to ground water.-.--._.-__.__--.-_.._-. W •. -------------••------ --- _ O Description of Soil..... -.0-" --- . ......... ....-®----------- - � U -------------- m Y _....-•-•----•-------- ... W U Nature of Repairs or Alterations—Answer when applicable..---------------------------------------------------------------------------------------------- •-------------------••-•---..._......---•-------....-----...._•.. .......................................---•-------------------------------------------------------•--- -•----------------•--- Agreement: The undersigned agrees to •install the aforedescribed Individual Sewage Disposal System in ac rdance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place he system in operation until a Certificate of Compliance 4beened by the b health. Si ....... - -- - ------------------------ ------------- -----• ------ -------------- Application Approved BY----••'�j - ----- �-- --. ...•-•--•-••-•--•-•----•--- Date Application Disapproved for the following reasons-------------------- --------------------------------------------------------------------------------•------- ..-•-•••---•-•......................•-•---.------.--•---•-----------------•--•-----••-••----•-----------.•--•-••....----•---------------------------------.....-•----------------..........----------•-. Date PermitNo......................................................... Issued....................................................... Date (7); XNo..__...••- d F$iic...............'s..."- THE COMMONWEALTH OF MASSACHUSETTS 7BOARD�,OF HE.....ALTH -- ......1� r7 ✓�-lr� / j r ( .... --..OF ...��fY ............................. Applirtttinn -for Uiipniittl Works Tow5trnrtinn Pprinit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at , /, f .1 ,,,c /:;_e /jt' f I�`!r/// ,I(I f/ . _Y� /•-�'� .................................................._ ? - -•------ - -.•------------------------ Location-Add/ress / or L No: _.__.___-`,f .11 / iot _ ______________________________________ ____________________________________ ____________.___ ______________________________________________________________________________ Owner � — Address �.!i' t_�_-•---._.._..-•---------•------- ------•--•---�-.��---..._�/�/.------------.._....-•------------•---- - ----- Installer Address Q Type of`Building -i Size Lot..:!_��-_.::� '_:2Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder (�) Other—Type of Building ............................ No. of persons Showers a yp g 1 -' S ( ) — Cafeteria ( ) Q Other fixtures -------------------------- W Design Flow---------------------`___________________gallons per person per day. Total daily flow-__---_-__`-_(__.------ -----------...-.gallons. ly. Septic Tank—Liquid capacity?. :C?gallons Length________________ Width-----.---------- Diameter-----.---------- Depth.--.__.-------- xDisposal Trench—No..................... Width____--^_._---.----- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No----------___-_-_- DiameterZ�! Y=�_.'� _. Depth below plet----- Total Jeaching area------_----- Other ft. z Other Distribution box ( ) Dosing X�lk, !�f!" l )t X"77 ~" Percolation Test Results Performed byI!G-e ___-_--__-.-44.e _- �.__ Date___er- 3'-7�_--.__.---- W a Test Pit No. 1----------------minutes per inch Depth of Test P-It-------------------- Depth to ground water..-.-__----..---.----. !14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.-._._.-______ __. Depth to ground I t water--.-.-.--_-----.-------- - ------- --- Dx g--. ' J., --•--• -escr ---- Description of Soil._ Q UW---------- ------------------------------------------- ---------- - -_- ---------------- - 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 provisions of Article \I of the State Sanitary Code The undersigned further agrees not to placelihe system in operation until a Certificate of Compliance has been issued by the board of health. Sig ed.. ..--�.f'�t r' -��__�! -- r n � to Application Approved. BY �'� -1.�y-- "" -- �J -" ate Application Disapproved for the following reasons-----------------•-•------------------------------------------------------------ ............................... ---------------------------------------- ------------------------------------------------------•------------------------•-••----•••...--•-••----••-•---- ----------------------------------------------- Date Permit No.............................................. ----•--------------------- Issued-----a��d-----=��f--�--- - .......-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH • Trrtifirtttr of Tomphaurr �,.-- THI IS TO C FY at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--•-• a .._r.-•-• ......................................................... �al ------------ ------------------------------------------------------------- has been installed in accordance with the provisions of Arof T'e ate Sanitary C de as describ d in the application for Disposal Works Construction Permit No.-- _�. .............. dated-._--7......................................r� THE ISSUANCE OF THIS CERTIFICATE.SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM :WILL FUNCTION SATISFACTORY. DATE..... ........................................ Inspector------- ------- THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALT 7 ... ..OF............. No. •••• .......... FEE... ............ %xivn,ittl rk nrfinn rrmit Permission.is. herebyranted::_.___ g ,t.-- ---------- - -- -------------------------------------- --_--.-_ -_--__----------------- to Construe ( or Repair ( An Individual ewage�D• pols l System ) ... at No.- .- �7! ` -•-X '1 D 1 1' 41-------- -- 1 • - • --- treet F as shown on the application for Disposal Works Construction e o------ --____ ated-_-_ -' �.. 7. /e:.. f- 7� Board of Health DATEV.-..--w----------------- ----------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS { ' J I0C)U J NL:�.a- Fa�.�-GA — tGfU �F-. `•T ( r—� � ' �T� t \; 1=7 i v, tt rp r, SO G.PD. qjell 330 6w. PEfZGDL T�It O&TE t"�u 2hc�u' 0rz La e,<'. - t� I t _ 1 F Tar VW ..III d\.• , 'IT�.N t 000 tuv . 2 wv. SePr,C r -Sox �. T-AP4K _aa. r� loo0 95g tlwv. „rv. ,� GAL ��.� Cta Z. T , w I rr_[ I Ala/�-►'lz WAS►1ED STONE 4j CFZTtFlEzlD PLOT' t✓L Ati f LOCA.TIU" c Wo ScaL_� SCALD C �� L�p �'A.—rP-L ` C U tZ Tit-- -r T�A 1 T t1 r\ W iTt4 T"i2: -SIDE t_[t-►E: ' I AuC> ':ET0ACI_ WCQLJlQGMc.►lTl; oG 'rNfz cr I . -TOWL-t t Bl�XTF G_ V2 1S rLczaD 'LA ,uZ L) Tt-It5 C7t_A�•-•1 t� s_.loT LA�GC) Ul•-1 �t*J o5'TE�'�/1Lt_L'= � /IrCAS�i I•ki r CI t, U<",L C7) 1-0 i7 t 1'i_C'i1r(�t j t� 1_D"( Lill�.( E �_ OA LJ _