HomeMy WebLinkAbout0097 OAK NECK ROAD - Health (2) 7
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......----.---OF.......... .. .. ..
Appliratiun -fur Uiiipuiittl orlon Tut 4rurti n Vrruift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System
:._ . ..� --------- XZ
.4--------- ....... .............................
rl�a cation-Addre or Lot No.
. ..............
( Owner Address
�W..� ....... 1-----•-------- ------ - --- --- ----------------------------------
------------•-•----•---_..__.._..__.._......._____^"•'•••-------••--..._-•---------•-•---•------
'..............Ex Expansion Attic Garba e Grinder feet
It Address
UType of Build* Size Lot______________ _ q.
Dwelling �/ No. of Bedrooms............._ p ( ) g ( )
p, Other—Type of Building ____________________________ No. of persons.-_____-----_-__._-.._-----_ Showers ( ) — Cafeteria ( )
a4 Other fixtures -•-----.-------------•--•------
W Design Flow......................... _0._._...gallons per person per day. Total daily flow.__.__....._� `v____�_.._._..gallons.
WSeptic Tattk V-Liquid capacity/y_ allons Length-------------_- Width................ Diameter------.--------- Depth.-.._-__-------
x Disposal Trench—No............--------- Widt i....__.____._ ._. of 1 n th.... ,,/Total leaching area.--.._-._-_..__-_.-_sq. ft.
.
Seepage Pit No.......�___--_- Diameter... __ pt o t e ________ Total leachin area._---.-_-.-_-__-.sc ft.
z Other Distribution box ( ) Dosing tank ( ) j�
~' Test Results Performed by--------_-_------- ---------------------------------- Date------ --- ---
PercolationY
,tea Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground wa e ...... ..........
(� Test Pit No. 2________________minutes per inch D th of Test Pit........------------- Depth to ground water......-----..-._-._-----
a ----------------------- --
0 Description of Soil_________ _________________________ ,
x
U
w -- ------- ------------------ -------------------------- ...................................... ------------------------------- ------------------------- ------------------------------------
V 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 be ssued by the board of ealth.
22-e
Sign ...... . .......... --• ------------ ------------------- --------------------------------
. Date
Application Approved By------- . `�e D.e
Application Disapproved for the following reasons:---•-•-•----------------•-------••-•----•-••--•--------•------•-•---------.....................................
...............................................................----•-----••----•--------_..--•---------•....._•----------.............----------------------------•=------•------------.----------------
Date
Permit No.
'-",�------••••-----•-•------------------------------------ Issued--- 1 l=
a,
--- ------------------------------- - --
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No.. .... `I ♦ Fimic......r. ....`............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O,F HE L H
/ . . .. OF......... .. ......
App, iratinn for Ditipuittl Worko Ton,strnrtion Vrruift
�Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal
SystSem
'�' '+
`. cation-Addre or Lot No.
♦ 'W Owner Address
------- . ..... ................................ ----•-•-----------------------•--•-
1 Address
d Type of Buildir Size Lot________________ q. feet
Dwelling No. of Bedrooms............._
... .............. Attic (, ) Garbage Grinder ( )
pa-, Other—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( )
Q' Other-fixtures ------------------1___-•-••_.___-__--------------------------------------------------------------------•=----
d lions per person per day. Total Bail flow.............. gallons.� '� _. .....--
W Septic TankVLiquid capacityr� tllons Length---------------- Width..-_-_.._.._`:'Diameter----------.._-- Depth................
x Disposal Trench No,,,.___________________ Width___ of nth __ Total leaching area--------------------sq. ft.
_..
Seepage Pit No.____: .- �_.. Diameter___ _. pt �/i ...___ .__ To 1 leachin trea----- ----------sq ft.
Z Other Distribution box (. ) Dosing tank
Percolation Test Results Performed by--- _.. :_ ____ ______________ Date_______ ._:___ ,.
�a Test Pit No. 1................minutes per inch Depth of Test Pit-.-_._--_________ - Depth to ground wa . .:.:.._ ._..__._.-.--
L=, Test Pit No. 2....._..........minutes per inch D th of Test Pit.................... Depth to ground water.-._.-.-__-_------.--.-.
-•-•-------------------------•----._-- -- --••----------- =
D Description of Soil """' .
-------------------------------------------------------------------
U ---•---------------------------------------------•------------=---------------------------------------------------------=-----------------------------------------_---------------------------------
W
VNature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------------------------------------
---.-•-------------•--•-••-----.._....... ----•---•-----------------•- --•--..__.....--•----•--•------------•---------- --------•-------------------- -----------..-_...-------------------------------
Agreement: f. ,
The undersigned agrees to install the -afore described 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 beVI52ssued by the board of ealth.
—Sign ------------------ --------------------------------
Date
Application Approved B
PP PP y------- 1 :. <D. -
Application Disapproved for thef ollowing reasons::-------------------•.•.-•--•----•---•-•-•--•--._......._-•-•--'--------------•-•-=--------•-----•-•--•--------
-- -- 4
Date
PermitNo......................................................... Issued................--•---------•••. ==
Date
r° e
x
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...O F........ rG
pTV f trade,-of T vtianrr
T I IS O CER- Y, That the Individual Sewage Disposal System constructed ( or Repaired ( )
b ----------------- ---------------------------- ---
y... '
at_.. -- --
ller _r
has been installed in accordance with the provisions of Article o Th tate Sanitary Code as escri ed in the
application for Disposal Works Construction Permit No........... �t'�_. ___..__. dated.._.__ . f.�7-__�___.__.
THE ISSLIANCE OF THIS CERTIFICATE SHALL NO BE CONST D AS A GUARANTEE THAT THE
SYSTEM ),NML FUNCTION SATISFACTORY.
Jr
_ DATE:..�•-•-••-•------------------•---••-•••••-------------•-•-•-•-•••••••-••--•-•• Inspector._.__`._ -.
r THE COMMONWEALTH.OF MASSACHUSETTS
t BOARD Qff HEALTH
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Na__._. #-_ FEE-' ..............
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Ditivar,
1arkq nitrnrtivti Vamit
Permission •s ereby granted:_.... ---____-- --- -- _ -- x.______.._•-•--_---
-•--•------ ............................................
to Constr or Repair ( an I' di ual wage D• os ste
at No. , ' ` x ----------
as shown on the application for Disposal Works Construction P rn t No--- _--_------__ ted----- .1*_ Vi. _..:.
....... ..../— --------- . /�� .......
rr Board of Hea h w.
DATE 1- `-/----- f
7 I
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS