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HomeMy WebLinkAbout0306 OAK NECK ROAD - Health . o6 oW\ nVFCk D �os•o86°00� t _ _ LOT NO. : —ADDRESS :_ OWNERS NAME :— &ou—tF SEWAGE PERMIT NO. NEW: REPAIR: DATE ISSUED:_ DATE INSTALLED: INSTALLERS NAME := r S INSTALLATION OF : ©cx�> WATER TABLE : -, FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE : oex N'�ctC RD Ll.ve od 5• '�` iocotvat� � `0 GM C&SSFOD6 �$Y RNk J No.--. 3.........9 Fes$.... ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ..................................OF..........................................------------------........._--•-------•---...... Appliratiun fur' Uiupusal Works Ton,strnr#iun rnmit Application is hereby made for a'Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..............•.....0_4....1 A. -----------......----------...... ®. ° ... --------2- - r Location- ess or Lot N . Owner Address ' W9f`Q .........:................. Installer Address UType of Building Size Lot........../d 33 L Sq. feet Dwelling P ( ) g ( ) 6 " o. of Bedrooms......... ...............................Ex Expansion Attic Garba e Grinder aOther—Type of Building wmo� � of persons...................... Showers ( — Cafeteria ( ) Otherfixtures ... .7 .... 3.&.,��•----•-----•----•------------------------•----------------•----..............------...------------......------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter____-___.-___ - Depth................ 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 ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ a --•-•------••---•-•-••••••--•-•---•...............•--•-......-••-••-•---••-----.............•......•......................................................... xDescription of Soil----.....---•...................................•.......---••-•--------....------------------------------------------•------------------------•-•-•...--•------------•-- x ....... --- _ ---_ .••-- :.. •--•••-•------ -------•---••----•-•••••-•--••••-•--•-••-•••-------- ---•--- ...-•-----•-- . .... --- •• - ......-- --- . ------- -•U Nature of ReP fs r erations er when applicable- •••- -••--..... ...... --- A.......... / Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIE4 5 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 Health. ned. -----....-••-••--•----------•--•-•---•----•...................................•••. ApplicationApproved By:.... •---• ..............•-•---••----•..............•••--•-•---•--.................---.•••--- -•-- � ..._.... Date Application Disapprove or a following reasons:-•-----------------------------•----•-------------.........------------•--------........._...--••-----......_. ------...-•---•--------------•-•...........--•--•-•-_...•----..........••••••••----..._..._................--•----•------•-----------•-•-------•••-•---•----••---•---------•.•-•••---•••................ Date PermitNo......................................................... Issued....--.........----------------------......._..._.....: Date _ _------------ --------------------------•---------- ------ - Ahk No-------3 � I-- Fms.....2.'�.................. THE COMMONWEALTH OF MASSACHUSETTS g BOARD OF HEALTH ....................O F............................................ Appliration for U44puiittl Marko Tonarnrtiun t1jernfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systexn at: .....-------•..............................................••----------.._..._..............--.... -----•--•--•-----•-•..._._..•----•---•....-•-••-.......•--•••••-•--•--....................-----••- Location-Address or Lot No. ......................^.......................................................................... ..._............ --•-•------•-•---------•------.....•---........•--•-............................ Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ________________________-- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -•--•------------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ 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 ( ) 1.4 Percolation Test Results Performed by......................................................_................... Date.................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:4 •---•--•-----•--------------------•-••--•--•-•-•-•-----•••----•-----......----------•-......----•---......................................................... ODescription of Soil........................................................................................................................................................................ x •-----•----•----- ---- ---�---• �Zw W ...................................................................................................................................VNature of Repa7r9'or A erations er when applicable.. l "`__ ... �^ �1 -- - ..u . ---------------- 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance thas been issued by the board of Health. ed. ------•--•-••--•------•..................................•....--------•--•--•--•. .......... ............. Application Approved By----- -•-•••..�l,�t'`-- -----------------•------------•-- /'l Date ........... Application Disapproved r t e following reasons:................................................................................................I................. ................•------------------------------------...-•---------------.....-----------....-------•-•-------•------.............----•------•......................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntifiratr of Tnntplianrr T< S/iS T. CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired by .; p`-7♦ ='l. ................•- --------------..........----.....--------------...........--------..........---- Installer has been installed in accordance with the provisions of TI F ` of The State Sanitary Code s �,;relin he P > yt application for Disposal Works Construction Permit No._ _. ._.`.............. dated_. .. ....... .... t THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A UARANTEE THAT THE SYSTEM WILL FUNCTION SATII, FACTORY. DATE.............................................k_leli!..--•-....--.. Inspector...........) ........................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH % OF..................................................................................... N0 ...... - I FEF. ................ �i��r�a�ttl Ji�r �un�#rnr�inn rrntit Permissionis hereby granted--------- . ........................-------------------------------------------------••--------------..................... to Construct ) R air and d Sewage Disposal System Street y as shown on the application for Disposal Works Construction Permit_N _. _ dated. c ... ............. ........................ .. .�r................... ........................................ Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON