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Home My WebLink About0084 NEWPORT LANE - Health _ _ a ��/�� 879 in eet i O will A 03 Jill i ° NOp2 53L 4N �`�sr.co►�°�� HASTWOS.Uk = I y L0CAT10N /. ®�� SEWvG:ttPERMIT N0. VILLAGE f - C2 INSTA LLER'S ,NAME b ADD7�0 SS - JDZ M U I L D E III OR OWNER ® f CkLY DATE PERMIT ISSUED ems- DATE COMPLIANCE ISSUED • �L ICE w�o� ._.._... GOAal 9� i gist/o�� !7�O�• _ . No.: :.,,�.� Fxs... ��....®............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OjpF.�p�HEALTH .....-...................................."� 0F...........1�!.P�.!! �-----------•---•-----•-•---•----• Appliration for Uiipooal Works Tonstrurtion Vamit Application i ereb ade for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at: ation- ddress o• ...._ .._ ..----'- .. .... �-P&TLIii.At s ............. '-'-----'-'--'-...... .... --------------------- ......... �], r .......Owne -_ C Lvr> o-..Hk-•---- ........................•?gL, .....__._•----------•---.....------............................ ...... Installer Address g r Type of Buildi Size Lot...t �._C OW..S Dwelling—No. of Bedrooms___._._.______________________________Expansion Attic ( �C.> Garbage Grind (` S Other—T e of Building No. of persons............................ Showers — Cafet i Q' Other fixtures ------------------------------------------------•-------•••-•-----•--••-••••-•--------------•-•-•-•--•--••-•. ----�-------------- W Design Flow.........� ..........................gallons per person per flay. Total daply fipw____--_.._..._._��.�............... tons. WSeptic Tank—Liquid capacity...�).....gallons Length____---.-.... Width.&..'.... Diameter................ Depth...4....ef. x Disposal Trench—No...................... Width ....... Total Length...............a... Total leaching area....................sq. ft. Seepage Pit No......._d------------ Diameter_._. ...... Depth below inlet....... ....... Total leaching area.-Z0.9._.sq. ft. Z Other Distribution box (V) Dosing k ( A a Percolation Test Resu s Performed by-_...' �� -•-.�•�. -•-• Date.._.�`.��._.'__��__._._..-. A a Test Pit No. 1.!- ..;-minutes per inch Depth of Test Pit----__2_-...... Depth to ground water.._ ' Z Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... -.. -------•---•---------------- ----- - --------•----•--------- - Description of Soil. �� ... f�J /�.• ° . .- . '�_._> x �v Z M -----•-------------------------------•--- ----------------------------------------•--------------------------------------------------•---•-- x 1 'r -•--••-----•-------•---------•••---••-•••-•-•-•---•---••--••--------------•-•--•••••......-•-••-••--...-------•-••---•-----------••----•-•-•-•••---•--•--•-•--•-•-•-----•......•--•---•-•-.........-•-•- 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 iI'ILi:, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is ed,4by the b of h lth. Sign � ..................:..../.... ApplicationApproved By.... •-•-••........... ......................................................:---- .... Date Application Disapproved r t e following reasons---------------••-----------------•------•---------------------•----------------------------------------------'-' _...•-------------•-'---...----------......--•-•-------•-•---...-•••---•--------------......-•-----•.....•-•----------••-•---••---•--•••---••-----•----•-----•---------••-------------•••••------------- Date PermitNo......................................................... Issued....................................................... Date Fim$....,.Y... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �r .�a u---- .....oF............ �. .►�+ : .... Appliration for Diipos al Works Tomouatrtion Prrutit Application i ereb made for a Permit to Construct or Repair an Individual Sewage Disposal PP. Y ( P ( ) g P System at: ..... - a. ujE ...........I. ?.........:? .. ..... ................ .-----....--------- -� --------- -----------.......----------- ation• ddress t o. r ! �Ad re s -Owne a ..' ...... ......................... �-'�. ?.!'.__� -----•...................----- ��- Installer Address " Type of Buildi Size Lot... ��?..�(_ _S et aDwelling—No. of Bedrooms........... ............................Expansion Attic Garbage Grind (� p.I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteri ( ) 04 Other fixtures .........---•-•--------•--•---•• {---- --- W Design Flow.......... 7� .......................gallons per person per qay. Total daily flow__._......._._._.__....��..��_.._......... Ions. WSeptic Tank—Liquid capacity._..l`1 gallons Length___..�..�..... Width__.` .._ Diameter______________ Depth--- "_�. x Disposal Trench—No..................... Width ....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._.....;,�':..._..•... Diameter.__._�_�a�_..... Depth below inlet.............. Total leaching area. ? ...sq. ft. Z Other Distribution box ( �) Dosing ( - aPercolation Test Resul Performed by._..._�` I?•} zA _ _.:_`_ +° !s Date........................................� ` a Test Pit No. 1.. .7:_minutes per inch Depth of Test Pit... .. ........ Depth to ground water....O.Q.!n _... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._.__._____--__----_.__- O _ --- ....... ------ •.. ' U Description of Soil--...•..Q. ---= '�/ ?f.f c p a � ._... f' --�--• �� x --- U UW -•--...----•----------------••-••........-------•-•---•-------...--••--•-------------••-------......-----•------•-••••---••.....---•-•-•••----------•--•••-•---••-••--•--•..........__----•-----•-----•- 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 TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ss ed the bo f h lth. Igne Application Approved BY---•- --- Date -------•-•--- Application Disapproved f t following reasons:.•-•--••--------•--•---------------------------------------•-••••-----------------------••----•-.........._... ----------------•-••--.......----------•----------_...-•--•-•-----------......._.._-----..........------•._..._.._...._..__.........•----•-••---.............----•--•-••-------.........._...-----_----- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF41EALTH • ..:......OF............... ...!........ s............... ....::, Tnrtifiratr of ToutpliFanrr Isis, 0 CEI. Y, That the Individual Sewage Disposal,System constructed ( or Repaired ( ) ... b .--- -- .:... <E ._... ---• ............................................................ Installer • = � - ---------_--•---------------------------•--•--------•--------- ------------c---•-------•- has been installed in accordance wi the provisions of TIT, 5 of State Sanitary C�d e s •c�}bed in the application for Disposal Works Construction Permit No---- �_"_' _ �__...__. dated........ _._Sy............................. THE ISSUANCJ51 OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS GUARANTEE THAT THE SYSTEM WIL F CTION SATISFACTORY. DATE.....1� /.... 3...................................................... Inspector............ ------ ............................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No._.cr ...` 4k. ............... .........OF............... .:. ......................... FEE........................ io for lion rrutit Permission > hereby granted.---�--------------- ---�.�.::---...-�----------------•--------•-------•---------------------........------...................._.. to Construct ( or epair ) vldual Sew e Dis dsal System at No. •. .. ........-'t�-•--•------ �' ^ -------. - Street r��3 as shown on the application for Disposal Wo"Is'Construction Permit No..........._. _.__ -'ate �................................. ' Z oard of Health • DATE.............................. .nArr. tv•-•-....••--•=------. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS cult 1�4 6"Aeo-AL,lc 6An6jr T vta t��t` =1. ••v II I t o 5c-.�G TAy�•• �3v'�2.o0 "��o•: f�/nD GQ'� i � i� , � ' � ' : � .. . �°¢� •) Pas�,� Pt-r v��-c�icG`` 3's lL6 �.�c Prt I , AZaA TO r4 PEFcot..ATt©t.! PATC t I u 2 Ai W OZ LE*5�: . )`•±�,L-1_day t�(,�• ' L.� 17,;a`-wse`�,� � : ' � .; �,+(1; - .. � E .. �� 4 �4•�-`"� J. 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