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Home My WebLink About0062 LONG BEACH ROAD - Health (2) aov/ oiu All ... ................ ......................... THE COMMONWEALTH OF MASSACHUSETTS F C� BOARD" 'OF HEALTH SUBJECT TO APPROVAL OF' ..............OF�.. . LE CONSERVATION W. . ................BARNSTAB.................. COMMISSION .. pfirtttt c for Dis a_1:;.,Warks Tvustru* rtiou'ram 4. Application hereby made for a Permit to Construct or Repair an Individual Sewage Disposal l tion is her X System,at: ................................................ .......... ................................A.0................................ ter Location 4ddress or .............<Lkw;..... .............................. ... .... A Qamar :�9 Address .................................................................................................. .................................................................................................. Installer Address Type of Building Size Lot.../91_Z06.....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (X_4 Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers Cafeteria Other fixtures -----------------------------------------------**-------------------------------------- -.gallons per person per day. Total dii.- _-3j��.O.............gallons. Design Flow.................... . daily flow---- --------- P4 Septic_);" uid*capacity.../Pe6gallons LFngth---9=4... Width..!l.._iU.... Diameter................ Depth.__.____........ Disposal No.....Z............ Width.../..Z......... Total Length...,/..F.......... Total leaching area .6,..sq. ft. Seepage Pit No..................... Diameter...z................ Depth below inlet........._.......... Total leaching area.................sq. f t. Z Other Distribution box ( 1-j'_ Dosing tank ( ) aPercolation Test Resul Performed by.__.... ............. Date..._ ._ '.. .... 4 Test Pit No. 1--- minutes per inch Depth of est Pit-----4-6f.... Depth to ground water_._lid............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.....4X........ Depth to ground water...... ...... 9 0 -----------------1_11*1*_1*--------*1----------- .................................................................................... Description of Soil.........0:n/.........40.1 sug 0 - ------- ----------------------------------------------------------------*-------------------------- ......................................../=.4......... ....................................................7--------------*....... -------------- U .............................................................................................................. ...................................................................... U Nature of Repairs or Alterations—Answer when apppcable.... . ... 49............... Agreement: 7 The undersigned agrees to, install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITITE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu y the board f health. Si .. .........70_w� ................ ......... ............ ... .... .....A......... ... ....... fDat Application Approved By------ ......... .. . . . .. ...................... ------ ........ Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARDF HEA TH i...&t-M................0F.......1. . ... . ................................ Tntifirate of Tautpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Z111*,0,r Repaired ..........by.............................................. .......... .............. ............... ....... at...... ....... . .......................... has been installed in accordance with t provisions of T 5 of The State Sanitary Code s described in the application for Disposal Works Construction Permit No.&Z Z.J.................. dated....%�:7:1,7_7�................... 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 F HE T .2— ?3 A ;. ..�-I. ......0 F....... .......... .. .................................. No......................... Dispasal Works Tonstration "pantic Perrmssiotjjshereby granted.......................................................................................................................... ............. to Const W!, ep�air 1�idividual SeAa Isposal tern Aeodle la .... .... .......... an. Street as shown on the application for Disposal Works Construction PSp5R No....... ........1. Dated.._._5 ......7.............. ---------------------------- 04 DATE................................................................................ B..rff Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �J ... ..... :: ^ .^ i Figs I ... THE COMMONWEALTH OF MASSACHUSETTS �.. BOAR® OF HEALTH d....,. OF t A. ........................ ', ppiiration for Di4pnsFal Works Tonstrnrtban Prrmit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage°Disposal--^- System at ..........•-•.................. Location ddress or Lo No 4 .. .. ...... ...�. �".................-•-- ----•------•----•-- ------- ¢ W -owner„`{MVE it`'r� Address Installer Address Type of Building d "'_'` `' Size Lot---=----------•---------....Sq. feet .t, Dwelling—No. of Bedrooms...............1_............._...___.__.Expansion Attic ( '>) Garbage Grinder (*'C) p, Other—Type e of Building ............................ No. of ersons....................._...... Showers p.l yp g p ( ) — Cafeteria ( ) y a Other fixtures .........-----------------------------------------------------------•---------------------------.......---mom--�-.....-----.....--•-----•--.... .,, W Design Flow.................... 5' ............gallons per person per day. Total daily flow................. ...............' .............gallons. WSeptjTan�h �Jiquid capacity 'f 'gallons Length. ! ._"Width_' f''} ,`- Diameter............... Depth............... x Disposal Ali—No....Z............. Width..Vie.......... Total Length...,A,?" .._...... Total leaching area...22.�d ..sq. ft. Seepage Pit No-_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box O' Dosing tank ( ) '-' Percolation Test Results Performed by...._.IA.� '� :�:: '.�.��,�i��'---........ Date. `��f' 7 I ! p^� .. ._..ti..._. er. .............. Test Pit No. L._ _...._._minutes per inch Depth of/Test Pit...A_.._.'_--- Depth to ground water...................... rs, Test Pit No. 2................minutes per inch Depth of Test Pit.__...�._?........ Depth to ground water--------- _ ...... a --.......... ---- ........................................................ x Description of Soil........ .,_. V --......-•-......•-••-•-••-••.........:......•--= �-• ", r - -� . ..--- �`' 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 TIT`.`: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iissu- y the board of health. ^�.. .. Dat Application Approved BY --"- �...... . Date Application Disapproved for the following reasons:----•------------•-•--•-_i..... -•--....----•---------------••--------------•-------•--•--...--•-----••------- ....................................-.•--•-----•--...-•-----•-- Ile Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS --- BOARD F HEA Tvie rkm-...............O F....... . . ............................ *. C�rrtlf irttt�e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( r Repaired ( ) bY----------------- ------------ -- -••--•---•.A ••. --------------- nst er f at � C ,- "-.tom- " '�' has been installed in accordance with throvisions of T 5 of The State Sanitary Codes esc ibed in the ¢ application for Disposal Woks Construction Permit No. ........:......... dated-.... '" _ Z---------_------ THE;.,ISSUANCE OF THIS CERTIFICATE SHALL' NOT. BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION' SATISFACTORY. DATE.. ... Inspector..............-..................................................................... THE -COMMONWEALTH OF MASSACHUSETTS BOARD �HEA T 1 ......OF........ .: No....'.... ............. ',s' i FEE... ,`�~............. i9ispnsai World Tomitf Lion rrmit Permission''s hereby granted_........................................... ----------------------------------- --•-----------• -...... .....f�. to Construe o 11 ir ( ) an ivldualewa s o,�al VS em J f. Street as shown on the application for Disposal Works Construction Pe No 17, Dated...... ." "'*.er'.............. B�f Health DATE...................................................... ; �r FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - ,rF J )igj!„J�'-'� I � -. •4+ ' � • r i l�:. ~ it - r ,�,,....M,,,,,,si .ram k' ac. - 'V a. 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