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HomeMy WebLinkAbout0231 SEA STREET - Health �'` �. '1 �.'�- .-...,-. ,�f_� _. �.- _.�. - - �-�-�,.{ - - -� -��_� _ ..r - - s _ � _ __ ��C"/ ��G� �� �—r ( 0�3 r s '�� `, �, µ — �. 5 3 trawb 1 od A = 24 013 No. 4350 1/3 RED 0 1000 © 0 0 Q v _ _ LOCL,TION : 5EWa(► E PERMIT MO. 1tJST'l�l.LF-R5 U&IAA F- &bDRESS bUILOER5 Q &VAE ADDRESS DN.-TE PER IT ISSUED e�11LL DATE CONAPLI 1,t,4CE ISSUED ; J ` I .'"° � � A - - _„ 'F; ��. 6`t . �.L CJ'� `�. { � � �i � �� �� P� S � t� � ~ i F i � �� � '"it`s �A_ ,. � _ __ _. -___. ram` `os No. S 'r...... FRIM.Q...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF....6.. �A ............................. pliIiration for Biapviiai Evrks Tonotrurtivu Vrrufit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal ZSySa�-�' r_ � x'._a;..�1. , -----•----- ... �`'..�'�s zf........................................................ Location-address Lot No. ----------- ------------- ------ O ......................................•--•--Address nstaller Address S feet Type of Building Size Lot............................ q. aDwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) p� 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....................sq. ft. Seepage Pit No..................... Diameter..--.--.--.-.------- Depth below inlet.................... Total leaching area................... 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..............--...----. Test Pit No. 2................minutes per inch Depth of Test Pit--.................. Depth to ground water..............--..----.. a' ---------••-----•--•----••--•-•--•-•-------••--••-•--•-------•---------------•----------------........----•----•-•----------...-•••--.........------•-_.•-•-- ODescription of Soil........................................................................................................................................................................ W U ---------------•-•-•----•-•------------------....--•-•-------------..........--•----••----------•---------------------------------------••-•----•---------------------------------.....----•------•••••. -------------------------•--•-•-••--------------------------------------•-•---------------------- j ------------------------------...................................--•--•-.....•-- U Na re o€ Repairs or Alterations— wer when appli ble..r-------hvp.... - .--t-- /.. ................. =- --. ... ... -- - ------------------------------------- greement: 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 be issued by the board of health Sign(d_ / ?i? ��-� .. .. f � .' Application Approved By...... =-/ Date ................••.......--•----------------------•-•••......-----------•• --•-•-------.----- --------••---- Date Application Disapproved for a following reasons:................................................................................................................ Date ••-•-•--•-- -----------------•- ----- ---------•-- -- -.-• Permit No. .... .....�.............•--•-•-•-•----.... Issued._. .` .... •......Date -- - - ----•_-- '----------------------------------------------------------------- ---------- -- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........0F.... e.a. .''-V. 4............................... Appliration for Dislimal Works Tomitrur#ion Prrmit ,,-A�iplication is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Syst at ... Location•Address or Lot No. ..... ^^ . .............. ...................................... ........:••--•--•---•----------•--._...-••---•---•--••-•--------•-••-------------•.........•-----. O er Address W s F nstaller ;•,` Address Type of�Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers"'(-, Cafeteria ( ) Other fixtures <: .J. a W Design Flow.................................. ° ___.gallons per'.person per day. Total daily flow__:,............................... ___gallons. P4 Septic Tank—Liquid capacity x gallons, Length" .._.. Width _____________ Diameter...._-,._...... Depth ___________._- Disposal Trench—No_____________ ___ _yt>>dth „ __..__..__ Total Length .______.___._.____ Total leaching area._.__.__._...___....sq. ft. �. >,. Seepage Pit No..................... Diameter ' Depth below inlet ................. Total leaching'area:.: sq. ft. Other Distribution box ( ) t, : Dosing tank ( ? ) , Percolation Test Results Performed by ..... ........ ............................... Date......•................................. aTest Pit No. 1................minutes per inch Depth 'of Test Pit..................... Depth to ground water._...................... (i Test Pit No. 2................minutes per inch.: Depth"of.Test Pit..................... Depth to ground water........................ ---•------------------------•--•-------------------•-----. ..................................................................................... 0 Description of Soil........................................................................................................................................................................ U -----------------------------------•---------------------------------------------------------------- . _._.. U Na re of Repairs or Alterations wer when appli ble �'"` `W......_ s ._�_. '" e 1. ..... -------------- ------------•------•- greement:_ 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 be issued by the board of health - �irho .r, Signed � ` X, ;✓+/� Date Application Approved By......... . '<..._ ._ _..��______________________________________________y__.. 4 ....... ............ ................. l Date Application Disapproved for.11 e f of 07,Vi tea ons.... ---•-• -- v Date - � Permit No.......,� ---.....�..................................... �. Issued...---8..�-�---- -.. - .-, Date r THE COMMONWEALTH OF MASSACHUSETTS A'. y. BOARD OF HEALTH70 �!f .........OF..... / d..................................... THIS IS TO CERTIFY, That the Individual Sewage Disposal System.constructed ( ) or Repaired Gz3 ...' by-----------.f9 X......CZ-.�-.� . .. r }•-t Y-.. Installer ` at................. - ............ I-KA114✓ has been installed in accordance avith..the prov>-ores Yof Article 1I of The State'Sanitary Cod a d cribed e application for Disposal Works Construction Permit'No.....� . _ �__`'� -----­-------­--- THE � ��� ----------------------- dated ---- -- ISSUANCE:OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS ,— IJARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....... .� ,.j.. !�.I. Inspector__ -_. :. ------ •................ Lµ ti �^{• . h THE COMMONWEALT `'bF"MASSACHUSETTS •� i..s ri t BOARD OF HEALTH �.. NO. FEE.... ....._. -....... Ftg >asal Mars Tomitrurtion ramit Permission is,hereby granted....... --------------•-••----..................._......•...---............ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo. _ .£. ' = 1 .....`......---•••----.....---••---------•--•----------•--------•------------------------------------------•••.......•... as shown On'the application for Dtsgc3sa1 Works Constiruct>bn Permit No_ .3 ...... Dated.....3�"' "; ....... DATE_ /• _ c - ,Jq/ - � and of Health � FORM 1255 HOBBS & WARREN, Lj_gC., PUBLISHERS -