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Home My WebLink About0195 LONG BEACH ROAD - Health (2) his G�m� f ,C�B� avS/ o z� �; �- r i Fims...... T 1'® APPROVAL WA A THE COMMONWEALTH OF MASSACHUSET;LS,�av�-�"�E CONSERPlA7➢�9�] .S QZ� B®A R® OF I-�l EA L.T H co mmis51® OF....:...................... ................................................. Appliration for Uhip sal Morkii Tomitrurtton Pamit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: Ifi- -•-- ---- .._. Locatio Address •-or. Lot No.-• ................................... .- _............_ ----•-�r/•r f a!i� ---- ---------- lq ......4�nz...:$ :.' rt . W Oy ner Addres Installer Address UType of Building U Size Lot............................Sq. feet a Dwelling—No. of Bedrooms__ /...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures . -- -----------------------------------------------------------------------------------------•-------------------••-------- W Design Flow___.__^______... __..gallons per person per day. Total daily flow------:...�yo.....................gallons. WSeptic Tank—Liquid capacity.XSPgallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench ia—No . .... _ Width..._. ..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter_......____.__..... Depth e ow inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by--------------- .......................................................... Date........................................ a �4 Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--_._.__________-.-____. fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------------------------------------------- •---------- •--------------------------------- ---•------------ -------- •-------•----•------------------- x Description of Soil................... -----•----=•------•••---•----•----------•--•••••-•-------••••---------•-•--•-------•••-•--••-••--•-•-•-•••---••••--•-••-••••----•-•-----•---••----- U ....._..•••-•-••••-•----•--•••--..... ....---•...........................................................................................................----------------- ----------- ..... ...../.. ...... U Nature f Repai or Alter An e wh ica ........ .. ---- = -- -- Agreement: The undersigned agrees to nstall 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 has b n issued by the boa f 1 lth. f' Signed..... ••••----------•-•-•-----------••--•-...........•----- / D to Application Approved By.. -------- .� `... Date Application Disapproved for the following reasons:...........................=..............................................--................................ ---------••---•------------------•-----•--....------------------....---------•--------•-•--•--------------••----•----•---•--•---••-•---•--•-••-•-•----•--••-••-......--•--•......----•-••••------------ Date Permit No. 7 ..." Issued....................................................... ..--------•--•-•-.._....._•---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ........................0F.......................................................................................... ApplirFation for Dispoii al Works Tomitrarction Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ocation'T Address............•••................. ..•-....................................or Lot No.- .................................................. y� .........../. ................�� E..• srjy-�!6 t/ 1r� f./d.'F,.r� ;I�1::. �' /.....:'i1/✓"-'', {...../C-t,'d -- ...................... ................................................. .................--............._ ........_.. Oyyner Address,. Installer Address QType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms___. ...... ........ .....Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building _.... No. of persons...............: (' ) ( )_____________________�_ ....._....._ Showers — Cafeteria A4 Other-fixtures ---------........................................................................ Design Flow...... :.......Q........gallons per person per day. Total daily flow..............................................gallons. P q • p �.y /6-p Length-•--- ---••---- Width_............... Diameter................. Depth................ R; Septic Tank—Liquid acit _. .._. allons Disposal Trench—No. _..�...-_-.� �lth..�'�1 r�;��T,.gttalt,Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (3( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..........___-__-...__-. GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth.to ground water......................... �. Description of -----. --•---•-------------•---••--•••-•-•---•--••••-•---------------•.............__.......------------•---.....-•--------.....---------...._...........-- 4 P -----------•---••------------••-•------------•-----•----------------------------------------------------------------•-----------•------------- x .f �r,.t W = ;- ....................................---...... --- 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,iIT1Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued by the boa&d-of 1 ealth. Signed.........tfl/"�,.. / Date Application Approved By..... Date Application Disapproved for the following reasons---------------••-------•------------•-----------------------•-------------------------......................... ........--•---•.......................••-----_----�----•••••-•----------------...........-----......---..__....._........-•-•-------------•••-----••-----•---••---------------•--•--••----•-•-......... Date PermitNo.-�%�.--.- --------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH ✓ �� .................................... sOF...........46"'".z.fT•'�c..�c........................................ Tntifiratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) c,! by......r.......'............................................!r' -•-e_x, "by 7 G C� G14r7 Yistaller -.. at'------------------/ .-----• ....A .................................... .._.._�................................................` has been installed in accord nce,witli the provisions; of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No................. __...i w".. dated----------`�_: THE ISSUA. CEO THIS CERTIFICATE SHALL NOT BE COIdST AS GUARANTEE THAT THE SYSTEM WIL F NC Id�S.FACTORY. l / DATE----/•1....L..... ..:_ .............................. Inspector.......__I-•--- . ------.................................................. THE COMMONWEALTH OF MASSACHU ETTS BOARD OF HEALTH ....................................... .......................................................................... < No....� .✓`........ FEE..--..:f..`.I Disposal 1vorkii Tonotrnrtion rrmit Permission is hereby granted....._-.._.'"'��:!�'`�``'..._._ �•�'�� e ------------------------------------•-------•-----•-•-••----------....----................ to Construct (X) or Repair ( ) an Individual Swage Risposa System at No........''j.2�1...------�1---r`1 .' /6'--ke Asj/v�f << •--........--•••••--.-------•-••-----•-------•-••--.------ R: ---------------------------••--•----•-•-•- Street s� 7� as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ' ' c� /-Board of Health f DATE ------------f ..3 - .............. ....... ` FORM 1255 HOBBS & WARREN, INC., PUBLISHERS