HomeMy WebLinkAbout0005 PIN OAKS DRIVE - Health Pin .Oaks Drive
.Bdiiistable
A.=279 069
-
I.000T10.N_/ SEW4C,E PERMIT _UO,
_--BUIL-DER 5_ tJ F- _�n.-ADORE
DATE-.P.ERNA17-155UE 76�.- ----
D AT.E -CO.KAPLI-&MC'E 1--s5luF �; -. -_-
0
1,
I oro 9,A -rA►v)e
/dm, 9,qt pi
�S 1-10-771-9
No....... JT.. F��.... .............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Pf HE LTH "�
-..........OF.......,. . . . .. ...... ...............
Apphration -for Ui,ipoiitt1 Workii Tonfifturtion prrmit
Application is hereby made for a Permit to Construct (Kor Repair ( ) an Individual Sewage Dispo 1
System
. � Z- 1`........... .4...-A_!••• ...........1. ----.- --
Lo i or Lot'No.
-----`... -------------------••-•---•-----------•-------•-------•---•-----•----------�----9-------�--•--�-•!-�--1-.-
�
Address
--
� Insta ler Address
UType of Buildip� Size Lot............................Sq. feet
DwellingyNo. of Bedrooms..-_----- ............................Expansion Attic ( ) Garbage Grinder ( )
44 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ----------- ----------------
W Design Flow____________________J:70� ...._ ._gallons per person per day. Total daily flow........ __p--____-_--_--_gallons.
WSeptic Tank Liquid capacity.__. _gallons Length---------------- Width..........------- Diameter_............. Depth.............--.
xDisposal Trench— o. .................... Wi tli___---!!t.___. ._. Tot. gth.................... Total leaching area....................sq. ft.
Seepage Pit No. --------- Diameter./ ill'
ICI' e o `p'nlet/_�.... Total leaching area------------------sq. it.
z Other Distribution box ( ) Dosing tank ( ) f9®^ ®' � �� �` - /- 7 -L,,
aPercolation Test Results Performed by----------------------------------------------------------- --•- Date--------------------------------_------.
Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water.........................
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
-- ---------------
Descriptiojofoil.............. _._.__ --------------------------------------------- ------
....------ ----• ------- - -------- -- - --••-•-- - -----------
---••----
� r-�v 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 Article \I 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.
Sign d �4 � � ) ( tt4-
--------
Date
Application Approved By--..,._.-- Y -----74--------
fj`
Date
Application Disapproved for the following reasons:..
Permit No..................................... Issued �� ....
- ......
r Date
-- ------------ -------___..----------------------------------------�
10
..t 7
fV
No......................... Fic .........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ..r ... ...........OF........ � 1/!f 1.r/I, C .t l' ...............................
Appliration -for Bhipoiittl Works Tomitrurtion V.eroiit
Application is hereby made fora Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
�" Lo ation•Address or Lot'No. ,
Owe Address
Installer Address
dType of Buildin Size Lot............................Sq. feet
U DwellingrNo. of Bedrooms----------- ............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures -----------------------------------
W Design Flow......................�—.--4...._.�; .gallons per person per day. Total daily flow....... .._ v.__-_______..._-...gallons.
W Septic "funk;—Liquid capacity/d--------gallons Length................ Width................ Diameter---------------- Depth.-..------------
x
Disposal Trench—No. .................... Width-------------------- Tot Illength.................... Total leaching area....................sq. ft.
Seepage Pit No.__j_______________ Diameterz�11?—JAk t --belo`lw,,inlet.................... Total leaching area-------.----------sq. ft.
Z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed bY.......................................................................... Date--------------------------------------..
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water------------------------
(14 Test Pit No. 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water_-..-.-.---_-----.--....
a .......Z-------------f---•--•------ '--------------------
O Description of Soil.------------- rr.,.= r��fl. ti 1f , = ='--------- ----------------------------....--------------------------------------------
11
U `ate - i , -.. 1 ,
- - (/J./ru{ r' �• --------------------------------------------
UNature of Repairs or Alterations Z 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 health. 1
Date
Application Approved BY =`' -� �° i�f.lrl -,,.1,-' ' •--•--•----•------.- -�=- -7J) ••-----
Date
Application Disapproved for the following reasons:----••-----------------••--•--•-••-----•-----...............•-•--............._........_----•-••----•--------••-
-----•------------------------------------------------------------------------------------•--------------..
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
It,! rf�!%.'......................
IWITrrtifiratr of floutplionrr /—
by ffIS IS TO CERt IFY, That the Individual Sewage Disposal System constructed T' ) or Repaired ( )
------------- ---------------- -
.taller
at.' r•7 .� !/� t+ i--f l/r l/t'.__l`!-�_ %. ��„r.f lly %�f�s ! ..
X - -- - = ,.... :
has been installed in accordance with the provisions of Article 'I of The State Sanitary Code described in the
application for Disposal Works Construction Permit No - .. ��--------------- dated-.,=�_------------------------------------
THE
ISSUANCE OF THIS CERTIFICATE SHALL RIOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------- �.. --.. ----- ----------•------- Inspector
!d �.
THE COMMONWEALTH OF MASSACHUSETTS
r BOARD OF HEALTH
r; `�'
y..../1-. / +...............OF......c�.:?.�- �'...f�
0........ .... �" '"!
FEE. --
�i��o,�ttl oxk,�, o�c�trortiogt �rrutit
Permission !* hereby granted_, !+ ? ---� :__ _'"-------------------------------------------------------------------------------------
to Construct ( �2Qr Repair (/ ) n Individual Sewage Disposal Systemf
at N :�� = r-��# '6� --,-f------J•'t = �,L.!!_! 11�a 1 .-.--••�l'�•°'
y r ------------
Street
as shown on the application for Disposal Works Construction,Fermit o----.----.__�r��i( Dated__ ---7J.............
C..t .r v 1 �/r w { l
/ � Board of II`ealth
I.J---
DATE-•- ------------.....................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS