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Home My WebLink About0032 HINCKLEY CIRCLE - Health r i LOCATION : SE\NaC�E PERMIT MO. VILLAGE ® ��1� 11�1 TQLLERS I�a�ME � AD®RESS BUILDER 5 Al ll�xVAF- DDRESS L � I DATE PER"VT DATE COMPLM aCE ISSUED : 7-J 9=76 Rarv� d f NOOSE ,I Y E .1;7 No. ... Q� FH$.-/.d..` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " d ...............OF..... .f .� .r #�` ................................ Appliration -fur R,ipoiittl Works Towitrurtiutt Vrrntit Application is hereby made for a Permit to Construct t)() or Repair ( ) an Individual Sewage Disposal System at: _ Location.Address or Lot No. L. ---.1.1 ►4x........................................................ .._7 �---------��----1 l .i✓tl��! { `l s `f Owner (�,� ...................•-------•--•--.._._......Address ---&-4..C> r�-. ..................................... ........................................... Installer Address U Type of Building Size LotA.>�..S' _ __Sq. f�et Dwelling—No. of Bedrooms-+------------------- ..-_----_-Expansion Attic ( ) Garbage Grinder (kfo Other—Type '� . a of Building _6�y.h.3`�.�_......_.. No. of persons-----6................... Showers (� ) — Cafeteria ( ) QOther fixt res ---------------------•-•----.----- ---------.---•---•------------•----- ------------- -- W Design Flow........... . ...... . . .............gallons per person per day. Total daily flow.__.._.....-.......� gallons. WSeptic Tctttk—Liquid capaci��gallons Length------------_-- Width................ Diameter---------....... Deptli---..-.--..----- x Disposal Trench—No- -------------------- Width.................... Total Length-------------------- Total leaching area.6.0.0-=_-_-sq. ft. Seepage Pit No...Xk............. Diameter...(�x.e..... Depth belo let,.......... otal leaching area_�.��_...sq. ft. Other Distribution box ) Dosing tank . '-' Percolation Test Results r Performed by ----------------------------------------------------------------- Date-------------------------------------- Test Pit No. 14_....Z--minutes per inch Depth of Pest Pit...-1Z�.._.._. Depth to ground water..e !§_:Z-_fZ. f� Test Pit No. Z __ .....minutes per inch Depth of Test Pit---J.2c....._.... Depth to ground waterg.UL9 ,I0_-.-. O yt ---------------------------------------------------------------•-------------------------------------•---------•----•------------------------------------ Description of Soil_- .-..mod 4� �._ _ : - �_12> t____. .. 1 _._._ .A_0 !'f ...................................... W x ------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ -------------------------- U Nature of Repairs cr Alterations—Answer when applicable------------------------------------------------------------------------------------------------ -----------------------------------------------.....----.......••--••----••-••-----•-------------•--....-------•----------------------------•-----•---------•------------•--.-------------------- Agreement: k The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The un sign d further agrees not to place the system in operation until a Certificate of Compliance has been issued by V-,, d of health. LAW Sig -- . ••---•--- . .•-••--•. 6---- Date Application Approved BY-=Application Disapproved for the following reasons:................................................................................................................ ............................................................------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo.......................................................... Issued........................................................ Date ............................................................................... ........................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH .............0F..., ............ .... ... .......................... Tntif irate of TIMPhatta Tyj,.5 IS TO CERTIF That ividual Sewage Disposal System constructed (Z,)-o'r Repaired ( ) by.... ------------------ In�iatlerW--- ----------------*------------ `XW has been installed in accordance with the rovisions of A e of The State Sanitary qod4as described in the application for Disposal Works Construction Permit No. .__ _..._.__ / . �--------------- datekU - --- � _ l .l 4 THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS ANTES THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... No. oE.l�li r Fic:../d... ../...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C(eVN.. ...............OF ..... -�.............................. Appliration -fur Uiopuoal Works Cnunotrurtion Permit Applicationl`is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: _ ------------ 1_t �- ��...C.I--IZC-L 0 .------- ------•-•--------•------ .......................... .... .= ............................................... Location_Address or Lot No. Owner Address Installer Address Q Type of Building Size Lot_.�..(,p_. ...Sq. fe t V Dwelling—No. of Bedrooms._ ._._Expansion Attic ( ) Garbage Grinder ( C� 114 a Other—Type of Building .t�1 Lam__-_-..-._- No. of persons_._.�.._.............. Showers ( � ) Cafeteria ( ) � Other fiatr�res -------------------------------------------------------------•---------------•------•-----••--•-----._._... w Design Flow-----------S.V----------------------gallons per person per day. Total daily flow______-___t-------�_-_ .-----.....gallons. WSeptic Tank—Liquid capacit1046;0-gallons Length---------------- Width................ Diameter---------------- Depth...---.-__..._.. x Disposal Trench—No. .................... Width-------------------- Total Length-----------_____--.. Total leaching area...60'v-----sq. ft. Seepage Pit Nc...-.j --- Diameter___. _ s--_ Depth below inlet_______________ ___ Total leaching area.-_ Q_a__sq. ft. z Other Distribution box i€,(X) Dosing tank ( ) d'� Q` ,,�� a Percolation Test Results Performed by------- ---------------------------•----.._..._..--------•-----•••-...14 Ye.-_------ 0-� Test Pit No. Le. per inch Depth of "Pest Pit....../_z--------- Depth to ground water....d'.`�C (14 Test Pit No. 2_-_,--.Z....minutes per inch • Depth of Test Pit-----/2_1._.__. Depth to ground Oi1 -----------------------------------------------------------�--------------------------------•--------------------------------------------------------------- Description of Soil---(9------k1 Q•QO.-A!JoAlex...-------� F1.-IZVh------G.O.A.,4I`= !Q12 w 5 � w ----------------------------------------------------------------------- --------1... ------- - 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 NI of the State Sanitary Code—The and g d further agrees not to place the system in operation until a Certificate of Compliance has een issued by th oard of health.Si ?-t L_, f Date / Application Approved By_--- - - - r- -- ---- �� G L� Date Application Disapproved for the following reasons----------- ---------------------•---•--•-------•------.------••-•-•------------._-•-----------------•-•-•------- -•-------•-•---••--•------------•----•------------------•-----------•--•-- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH . ............OF...... ....................................................................... Trrtifirat.e of 01.141ntpliatta TJr t IS TO CERTIF hat t ividual Sewage Disposal System constructed ( or Repaired ( ) by------ -� :!> ---�----- ------ -f"!-'ae -------•--------•--------•---- at v } nsltller ---- ------ has been installed in accordance with the ovisions of Artic1h NI of The State Sanitary C de s described in the application for Disposal Works Construction Permit No--- ;2_9��.............. dated.,_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS UA AINTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................................................----------------- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS 7G BOARD OF HEALTH OF.......... . .... ...... .. . .. _ .. ..... . FEE---• --•--•--•-•---._.. io ork,i QTun urti am Permit Permission is hereby granted L i ------`-- -- --- I--------------.----------------------'-_l......................... to Constru ( or Repair ) an n vidua ewag is p Sys em at No. � r tr as shown on the application or Disposa orks Construction Pe i N ._ Dated--- / }- -- =�c Boar o a DATE ............. / ----------------- FORM 55 H BS & WARRENINC.. PUBLISHERS G•� N! F OLF . KROSVK CIA 10 i t `9 L 0 T 3 2- ' Bo R '� �� Dr�rQrgvr�oN f x l I 20 a LOT 31 ALLN4 ' c: KINGSBURY STO C E RTI F ILD � CERTIFY THAT THE PLOT PLAN or LAND FOUNDATION SHOWN HEREON N. IS ACTUALLY LOCATED ON THE QARNSTABL� (05TERVILLE)� MASS. GROUN D MEETS A LL S CALE :I"=zo' DATE : 7/ 7/ 76 . AND . TOWN OF BARN5TA8LE 1 ZONING U IRI= I� IT KINGS BURS' SURVEYING Co, INC. 11 121 R OU.T E 6A SANDINIC H SASS. l