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Home My WebLink About0140 SHORT BEACH ROAD - Health 140 Short Beach Road, Centerviile A 206 106 4 , Q 0.EC�"CIFDDD✓ "rri�fdCo = " T UPC 12543 Wo.53LOR HASTINGS, ION 1. CAIII ION SEWAGE PEPMIT NO. -i c V i L L A 9 E 57 .4 L L E R'S NAME ADDRESS 1 172 0 U I L 0 1 H 0 R 01V 4 E R 6-TATE PERMIT ISSUED DATI E C 0 M PL I A HCC i sSSUE0 � �"'► 11 ,a L� 6 a ►� A •� e FER....../5 .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD''�OF HEALTH 46� 206440 .......... ......'?1....................OF.....f�.C�!.Y.l.5 Appliratilan for Eli4putittl Workii Tnnitrurtion Vernfit Application is hereby made for a Permit to Construct ( ) or Repair (•)(� an Individual Sewage Disposal System at: l... y o .l�(.. a ----•----•----...-•----------------------------••-------------------•-------•-...------- Lo ti �Add:.r.e.s.s.... r t N,. _ .� .••- #.............•-------..... l.�................ owner Address Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............. ___..........._......_...Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons____________________________ Showers — Cafeteria a Other 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............,.. q.___..s ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.........................................................:................ Date........................................ aTest Pit No. 1________________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........................ •--•------•--•--- ----------------••-------•--.._...---...-----.....----•---•--...._._....--•---•-•--------•--------•-----------.....-•--------••------_...•- 0 Description of Soil........................................................................................................................................................................ W V --•.._..__.._..•-•-•---••-••-•-•..................••••-•-•-•--•-••-•--•--•••--•-•-••••-------._...._..._...----•--•----------••--•--••••---•••-.....•-•-•--•----•-._..._._.....------.....-•----...-•--- W : ............................................................. ------••--••-••---•--•-•••--•--••-••--• •-•--••-••••---------•-------•-• - ------- -••-- ...................................... UNature of Repairor Alterations—Answer when applicable...1*$Q��_-5 ® _:1�- .iC_L$71�____.___. A.S.- .54 �5_._ �_S pYI.�_ S_� [.eEFl --------------- f Agreement: 2t5' ' ` .A The -undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of iI'= 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. ............................... ....`1--z"5 ....._.... Date Application Approved By------------- ............ ....... .� 1.� _.... Date Application Disapproved for the following reasons---------------••---=------------•-••---••••--••.._..-•--._...----------------•----••---...-•••---•-••----•- ....................•---...__._.......__...._._.....-----•--•-------------------------....----------._....---....------------•------•-----...----•---------------••----•-----••••----- --- --- --- - Date Permit No..---.�.........- 'E? Issued_ .. Date No-- `- ---- L- N j•r? +�`� �fh`?!�}ivC L Fss......:s..............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF iHEALTH ........................................... OF.....3... #�.1e,...... . ppliration for Disposal Works Tonstrurtion rtruti# Application is hereby made for a Permit to Construct ( ) or Repair (*-) an Individual Sewage Disposal System at: !! �Lo anon,-Address ....... ............................ ...........�....^FLt ..`S.. G'C?�1� ............. - - 1 y� SI2,1 tb der, i �OQ[�t Ny.P37 )"of.t l -• ........... � Owner -.... ---.. .................._...-- L�ddress a Y.a C'wmc�? ••-•-----•------ �s o.�IcP��_:SI.,-.��..4...-e.,.................................................... Installer Address Type of Building Size Lot................ Sq. feet a Dwelling—No. of Bedrooms............... :........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures -•--------------.....---------•-•------•---•-•--------..... ...... •........... .-------------- ....... Design Flow............................................gallons per person per day. Total daily flow..........--..........._._......_...........gallons. Septic Tank—Liquid'capacity.._.........gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.. .................. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 0 Description of Soil..........................................................-----.....-•---.........-•-------.........----•-••--•-..........----•--•--••-----------•--•--................. --•---•--••-------•----•.......................................•-•---•--.......--••------.•..............-------•---•---...•-------•----------•-••-------•--•-•-•......--•.......-••••--•--•----•.._... W U Nature of Repairs or Alterations—Answer when applicabl _..�5. - -� -54'�7"C_ >f , : ncl ........... ....icsvae_CPs..�C�. sc �y-- .... ....................... -•--•- -----------•------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT IS 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. Signed.._.r-I I< �tuw. ► �' -8� --------•--•................... ..........................--•-- V* Date Application Approved BY.......... =........ - - • ...._� Application Disapproved for the following reasons:...................................•--.......----•------...-----.................-•-•--......--•-•-•........-- ••-----•••--•----------•-••-••-----------------------------•-••--•-----•-••--•--••-•-•-••--•••••-••-......--•••---•••-.....-•------••----•--•-••-----------....-•----......-----•...----..............._ Date Permit No....��- �.._ '-._-�- : .......... Issued........................................................ Date e �eI THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................oF....JJrpr±? {d (Irrtifutttr of Tomplutnrr THIS IS TO CERTIFY, TlXat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................................1�. 1N v4� .... .... ...........I...aii -•-•----.--------.----........- ................. ......... .. •--- -....... at.. �.qI....... ...�.�r,, cx....---- X. -•...... has been installed in accordance with the provisions of TITLE- 5 of The State Sanitary Coe as described in the application for Disposal Works Construction Permit No..... . ...-` Wiz-... dated... ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... ..... �. .�-•-••-••---•...................... Inspector ---.....��-.------..........------....•• --••--........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N .........................2 ?'�''s"rl.................oF.... .....------..................................... _.. Fn.../E..........-- Diop�h orko Tono#rurtion fermis Permission is herebyanted-------•----• ..... ln ......................................... to Construct )�.or�.Rep ' ✓�. );an Individual Sewage _isposal System at NO..J � � = sc2 c.: VA ........--••--••....... ...••..............••••-•----•--•-•--•--•-•••-•-•-•....---•--......-------•..._......Street ... ej................... as shown on the application for Disposal Works Construction Permit "No...................... Dated...r��_(..-................ ............«- d �-_- D Board of Health ATE...... --• .�.�Q h...--•-•-•-•--••...........•......... FORM 1255-A. M. SULKIN. INC.. BOSTON ;Septic S® Vices y rya PREPARED FOR: He + .. Pumping << r. Installation f Y i. LOCUS: LdT 2>-2- t2 r 13F1'hC:l�k'I�d R D t, A 350 MAIN STRdf �WEST;YARMOUTH,MA'02673 4 oF�, SANK i i APMOX -r � I-�ArIvN of Q& �LLEAlTl-1 VA.IZI ARIL_V-5 ' f To plsE ol% wiF ( -AN►? zoo I. . ... H o-r-I__ EACH.: __2_oa _ � i f 4 TEST CATE e` T.H. • 1 QEKN - BEDROOM HOUSE 1 x FLOW ROTE I U EMI sn�..�onv SEPTIC fiANK '14 0 /SIB �s �U 6J/ r12 REC'DSEPTIC TANK SIZE /S6 LEACH'.FACT LtTY t ">.MDE WALL o- 1b 2G—Rl� _ �_2 -- G D6Z(2, .t a BOTTOM `� o lc�_1T_-_3bD.�r 3Q6 0 G./D. T TOTAL - 45 imp o- ' Fri I, ` llSE: Sb F 11%WAT.ER EN90UNTfiAEp \C/`j Gi�oL IFs 3C�' F LE ?I f W 117r1-1 � — � ' � Jet -- — - � �`t'- s ✓ - -- -- .. _._ _J