HomeMy WebLinkAbout0056 OAK NECK ROAD - Health NO
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LO,.CATION SEWAGE PERMIT NO.
VILLAGE
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1 STA LLER'S NAME & DDRE S
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B UItDE R OWNER
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................O F.............................................----•.......................................
Allp iration for Digvniitt1 Workii Tnntrnrtinn runfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
• ....................... ............................................................:........................•--
Location-Address or Lot No.
�...
........................... ..................................................•-------•-•----•---•-------.........---.........
caner Address
Installer Address
dType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ............................ .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity.i_&.r,0._gallons Length... o..__.._._ Width... ......... Diameter________________ Depth__'sa...........
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. 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........................
R+ -------------------------------------------------------------------------------••.......-=------••••-----•.....--•-••---•-•........._._._......_.._..........................................................
0 Description of Soil........................................................................................................................................................................
x •-••-------•------ --•-------•-•-•--------••-••--••••--•••-•---------•-----•••-•••••••---•--------•---•-•----------•----••-------•••----••••--•--- - ...............
U Nature of Re airs or Alterations—Answer when
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of 1ITLE 5 of the State Sanitary Code— he un igned further agrees not to place the system in
operation until a Certificate of Compliance has bee s band of Health.
ned .t-s�,-......----•-----------•............. ��- - 5�•----...
ApplicationApproved By---•-- -•---- ...........•7.............................................................. ----f� ...........
Date
Application Disapproved f the ollowing reasons-------------------------------------------------------•-----.....------------------------=----------......._._
.................. ......................................•-••...........-••---•-•--.. _..._. ........_...._......_....._.__.....••--••••-•••-••--•-•---- ----••••- • -•--•••-•-----
Date
PermitNo....................................................... Issued.........................................................
Date
�wo..... 7__l......... Fxs..l.. _...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................OF...........-...............-..-..................................................
Appliratiun for Bi,ipuiitt1 Marks Tutwuurtiun firrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...................... .......'-•-----.............-•----•--•---•---'---...___._....-----._......-----................_..
f�t Location Aid ress_ or Lot No.
..............................
caner Address
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`4
p-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
R; Septic Tank—Liquid capacity._1500_.galIons Length---w......... Width.__U......... Diameter................ Depth_..(o_..........
W Disposal Trench—No_ ____________________ Width.............:...... Total Length...._............... Total leaching area....................sq. ft.
x
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...................
0-4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•-------•------------------------•-•----.._._.__.....--------------........_.....---'----=-------•-•'-----••-----••-._...--'-----......._.........--••_-•----
0 Description of Soil........................................................................................................................................................................
x
U •-----•-•••--••-•-••------••-----------•-•••••-•-••-•-•••••••--•-..._..----•-'•-•-••----••---•------....--•--•••-•-•-•---•-•----....-•--•---••••-•-••---•-••---•-•-•-•-•...--••--•........-•---'-----••-
x •---••-•--------------------------------------••--------------------••-•---.._-...•--•-••-------••---••-•-•----•--------•------------•••--•-•----•-
-
V Nature of Re airs or Alterations—Answer Qwhen applicable_ �C0_A_Q_-.�t���4x _
ls'_s�o---�f�,���A'T�.�� F to 0--------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The and (signed further agrees not to place the system in
operation until a Certificate of Compliance h s bee nf's b 'bdard of Health.
/ to
Application Approved By_______ ______
----•-•....--•--------- ----------------
Date
Application Disapproved f the oflowing reasons_______________________________________________________________•_________•_•_____-_._.___-_:_.__........._.......
.........-•---•------------------•----------•---------------••---------------------..._..•-•••••••••--•--
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
/ BOARD OF HEALTH
(/ ......................................... OF.....................................................................................
Trrtifiratr of ToutpliattaIT
d.
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IS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
'
Installer
at.....- =-e...•-A Z�G ---------•-------------------•-----•------- - ............
has been installed in accordance with t e provisions of TII � e State Sanitary Cod as (esc bed in the
application for Disposal Works Construction Permit No---- '_.___..__yl ________________ dated-. . ............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUARANTEE THAT THE
SYSTEM WN UNCTION SATISFACTORY.
DATE._r�... .. Inspector . ...... --------------------------•---•-----------___-----•-_-•---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
? t ...........................................OF.....................................................................................
/O
No. ....... r•.1..-c•• FEE........................
Diupuual Vorkii Tonutratiun Vanfit
Permissionis hereby grante�-------_. -_-------------••--••-------••-----••-•----------------------------•-----•--•••---••-----•-••------•-----•--••__----_---••--_--
to Construct/ oAepair i ) dividual Sewage Disposal System
at No �-_4..--��fil�-� � ...
----- ---- ----
Street
as shown on the a plic ion for Disposal Works Construction Permit No.............. _____ ed..........................................
DATE••-•f� ---......................................................... .,.
Bdard of Health
J'
FORM 1255 A. M. SULKIN, INC., BOSTON