HomeMy WebLinkAbout0079 OCEAN AVENUE - Health )719 Ocean Avenue
Centerville
A= 226—080
S M E A D
No.2.153LOR
UPC 12534
smead.com • Made In USA
4p 0yke
NV-5. 5 .. Fps , ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... -- ..OF......... ���............................
XVV'firation -for liipootti Works Towitrudion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
---- •- --------------------•------- -----•----------------------••------••••--••----•--•••-----------------____............
�4ocad e�� � or Lot No.
•.... . ............... ---. ........................ ...•-•-•-....................... •• ----------............-•--•-------•-...--------
Owner Address
.........................•----•--••-----••--
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
daOther fixtures ------------------------------------------------------------------------------
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 ( )
aPercolation Test Results Performed by------- ----------------•-----•--•••••----•-•-•••-......-••••-.....-•---- Date----.-------------------------------....
a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...------.--.------_-.
f=, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
(� •-•----------- ------ - --------•-----
O Description of Soil_------- � �
U --••-••••--•-------------------•....--•••••----•-•----••---••-•--•--•••••------•-•---••••••---•••••---•••---------•-------•-•--•--•-••-•-•-•••-••-----------------------
U Na o epair r Alter ----------� ........................Anser n = �c w _-._ _ b . ._.. ......... .......
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 has4bbeeissued by he bQWdfhealthSi e °-... 1---
Dat
Application Approved By.-s;e r l' . . ._ ___... -y`--�,--
------------------------------
Application Disapproved for the following reasons:----------
-•------•------••---------------------•------•-•-•--•---------•----•----- Date .
---------------------••--...........••-•--------------------•----------•-•------..............................................................
.................-------------------------
--------------
-- � � - Date
Permit No.---•--......---•-•----•-•----•...•-•-------••--.....••• Issued._�.....�-,a'�� 7�
--- ---------------•----•---••--•---
Date
LOC.Q_T_1.0-IV SEW_�._C,E_P_E.RMV-T-U 0..
1-KI-TT --l_
l - -
r '.a
= -D-D-R-E-SS
D-b T-E-COM---P-l_IAt A CE-I_SS:U-ECG
C G
c
1
7
LOCATION : SEWo,C;E PERMIT UO.
VILLAGE
IPIS�TALLER 5 U.&tAF- ADDRESS
WuLl
BUILDE 5" &IC F- -P, ADDRESS
DATE PERNAI-T .ISSUED
DATE COMPLI AKICE ISSUED : _�' �
r
i
� ��
_�
_� � ��
�`
.'� ., �
- �J
� ,.
'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
���~° �
Applir��mou� w� ��pa�^ K� Works Towitrurtion Vamt
Application is hereby made for a Permit to Construct ( \ or &coa, ( ie'r an Individual 6r~agr Disposal
System at:
oca n or Lot No.
Owner Address
Installer Address
Other—Type of Building ---------------------------- No. of ycruous------'---.. Showers ( ) -- Cafeteria ( )
~� Other fixtures --------------------------------------------------------------------------------------------------------------------------- ..........................
Design Flow............................................gallons per person per day. Total daily flow.-----_.-��-t............gallons.
Septic Tank--Liquid capacity............gallons Length ----- Wicbb------ Diamcter-----. Depth................
Disposal Trench—No .................... Width-------------------- Total -----_- Total xnm--'---,.sq. 6.
Seepage Pit No_-_---' Diameter-------------------- Depth below inlet._--_--. Total leaching area...... ...........sq. 6.
Other Distribution box ( ) _ Dosing tank ( )
'- Percolation Test Results Performed by.-----------.-.--.----.-,.--.--' Dato----------.---'
Test P6 No. L-___minutes per inch Depth of Iom Pit-------------------- Depth to ground water., -------
44 Test Pit No per inch Depth of Test Pit.................... Depth to ground water-.-------
Ix
O
Drac,iptionnfSoil'--- --__--_----.-.--------------------
| -----''''---'----'.--'--'---'---'-------'---'-'------------'----'-------'---.
-''--------'--'--'--'-------------- --- |
�� Na ' �
-.~�^r�*_'c���^���-------------'
ugrrcmcor:
The undersigned agrees to install the uforcdeucri6cd Individual Sewage Disposal System in accordance with
He provisions of Article XI of He State Sanitary Code The undersigned further agrees not to place the in
Date—
operation until a Certificate of Compliance has be issued b7ithe,,bpar�d of health. I
Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_ystem constructed or Repaired
has been installed in accordance with the provisions of r.ibl� XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit Nlc� �i 2_?_j—-------------- dated'- ' -2- "/- 7-�_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
- 7(tr- f //-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
as shown on the application for Disposal Works Constr ction P M Nor a e ----------- .......................
ij
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS