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Home My WebLink About0109 BARNICLE DRIVE - Health /0 cf Gafn c� - _. �I'S'f-0 LOCATION ' SEW/J,C;E PERMIT MO. VILLAGE IWSTQLLER'S 1 &NAE ADDRESS bU1LDER 5 ►J / V AF- ADDRESS y DI�,TE PERNA T 155UED =— .ill — — — — DATE COKAPLI wacE ISSUED : �= ` I p.4 No.Z�y !___4--___--_ Fss. THE COMMONWEALTH OF MASSACHUSETTS BOARDOF HE TH ....7. '1 OF...... ....................... App iration -fair Uhipoii al 10orkii Tomitraartioaa Prrulit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys at Locatio Add � or Lot No. ar l6'L ---�---oca, ----•------•---•-•--•-- ------------------ Wr -0----c•. ---•- _ - Addre Installe Address Type of Building! Size Lot.- t_?�-/......Sq. feet U Dwelling- o. of Bedrooms-------- ----------- -------------------Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ____________________________ No. of persons-.._____________-___________ Showers ( ) — Cafeteria ( ) Q, Other fixtures ----------------------------------------------------------------------------------------------•-------------------- ------------------------- W Design Flow............ ____________________gallons per person per day. Total daily flow---------3_�__..___-__-_-__-___gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter................ Deptli--------------- x Disposal Trench—No. ____________________ Width.................... Total Length------------_----- Total leaching area--------------------sq. ft. z ( ) ( ) d�f �C: '1y �- •t1 7i Seepage Pit No____ _____ ________ Diameter............ ........ Depth inlet e ow ______.___ Totalc unrea__________________sc1 it. Other Distribution box Dosing tank � it Percolation Test Results Performed by__________________________________________________________________________ Date--------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-._-_-______-__--_-__--- �14 Test Pit No. 2................minutes per inch Depth of Test Pit......-............. Depth to ground water------------------------ P1 t - --•� p ------ O Description of Soil-------------------© ' L� --• --- J --�77---tx ---------------------- -- _ ------ - x -------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Article NI 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 alth. Signed •--• -- - ----- ----- --4- E 7V4D Y------ Application Approved By---- - � •--- ....... �i ----- - --- - -- --- --f ---- /te -------- Application Disapproved for the following reasons: ---------------- ------- ........................................................... --------•-------•--•-------------•--•----------------- -------•-----------••••-------•-•••-------•-•--------•-------------•-----•--•-----••--•--------------•------------•-----..._.------------------- Date Permit No______________________ ••---------------••••• Issued...- Date No.':;.FA........ ............... THE COMMONWEALTH OF MASSACHUSETTS `7 BOARD F HE TH . _OF. Appliratiuu -fur Uiiipuuttl Works Tuuitrurtiun Vrrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys at: ��? f.. ------ -- A ? !?._ ....... Locatio . ddress or Lot No. V t................... .........�. ...................... ................... ............................................ Addre w - ...................... .---------------------- - ---•- ..................--------- ----------------------------------------- ................................................... p Installe Address U Type of Building Size Lot-- ...... feet Dwellingo. of Bedrooms_. ------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) aOther fixtures ...................................................... WDesign Flow...............61___....................gallons per person per day. Total daily flow..........,o!A.................._._gallons. USeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter........__..... Depth................ xDisposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--__._-__--_.-.---__sq. ft. 3 Seepage Pit No..................... Diameter•.._•___--____---__; Depth below inlet .... Total 1 Ching area...._._._-_______-sq. it. z Other Distribution box ( ) Dosing tank ( ) Q� + CF/�! � W Percolation Test Results Performed by,,..... --------------------------------------------------•-----•-------- Date---------------------------------------- Test Pit No. I________________minutes per inch Depth of Test Pit.........._...__.._. Depth to round water...--.--___-__.-.__...-- a P P P g (X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..................... - ------- ------- - - ------------- D Description of Soil------------------- ` l t ---- �---- �' '4 U ------------------- --- A------ - - --- •-----. .. .......y t- --s------- -- -- ---- W 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 Article XI 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 alth. , ....... .� - -- ..Sign ed... ---- - - ----- •- l---- - - ,. . Application Approved By --. ............. Application Disapproved for the following reasons:...........................................X ---•---•--••----------•-----------•---•--------------------------•-•---....---•-•-------•--------•-----•----••••----------....----------------•----..............-----------•----•-................--... Date �A PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD V EALTHOF............ Trrtifira#r of f�uutlitturr THIS IS TO CERT Y, Tjaat the I di 'dual Sewa Disposal System constructed ( ) or Repaired ( ) by at._... - ------- �. ' Installer � f �� .......V.. .. �- 2 .....- .... .... .................. has been installed in accordance with the provisions of Article XI ot The State Sanitary Code a des ribed in the application for Disposal Works Construction Permit No------- ----------------- dated.._... , '- _a :............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------/-L)-- / _ ................... Inspector----------�................... ....................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH I` 7d. �r��..�� b! .........OF �+ TJ No.........••-•......--.... FEE....................... %s:puiittl arks- 01uufi#rurtiuu Pr r 't Permission ereby granted----•--•-•-•-•-----•--------------•-•------------••----•......------�----- = /`. ••-• •-• . !�F.. , .. ' to Const ct ( or kep ' ( ) aft Ind' idual a age 'spVsal System ` at Now "" ✓� ' '� ..................lr = ' = ... - reef - as shown on the application for Disposal Works Construction e it No.--_ __ ___ . d ... ...:......... -------- ---- .lam. oard of Health DATE---•---------------------------------------- ---------------------------------- ; . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - L__ Cr S�v�� Q I �1 ^ 0 0 ay x 3� i ^' ISx a2 o . -o% lvG� OcD jPasr D ►N6- �� .