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Home My WebLink About0240 SEA STREET - Health co� 'Tea �-. , )411G, 0 r) s I NYV 'S`JNI1SbH ° • t�£LL l 3dn 0 II` I i I IV AS L2,O,C A j ION j SEWAGE PERMIT NO. VILLAGE 10 I N S T A LIE R'S SAME & ADDRESS B U It D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ._ . � �• �. � � ,� � r �� _. � �� = .�--- Wr YmB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o� l -- ---. .....-.OF......; .....:.. . .: � ..---_----------- Appliration for Bi-qVniial Workii Tontitrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair X an Individual Sewage Disposal Systemat:...........:5.-j&A.....12 ......j��Ub................ ...... ................................... i Loc t' n-Add s r or Lot No. ��, ----•----------------- --------------$®-------.-------------•- .--------.------.---------...................._ e-V Owner ddr A ess Installer Address Type of Building Size Lot...................•-_-•--..Sq. feet U Dwelling 7 No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures __________________________________ ------------- - ----------------------------------- •......... •------------- •-------------- W Design Flow............................................gallons per person per day. Total daily flow.....----.--.-•••.--..-_••--_-.-----••-----•gallons. WSeptic Tank—Liquid capacity/WA4� gallons ,Length................ Width................ Diameter------.......... Depth................ 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 X Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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------------------------ Ri ................................................................................ O Description of Soil------��-��----�--6-�------�-�--��--'- �-�---------------------------------------------•-------------------------------------•------------- U ------------------------------ •--------------------------------- --------------- -------------------- ----------------------------------------------------- •--------- •------------- ------------- ---------------------------------------------------------------------------------------------•----------------------------------------•-----------------------------•-•-•-••-- --- U Nature of Repairs or Alterations—Answer when applicable..--0�; __-_ '.�'� __. � ��_. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT _.: 5 of the State Sanitary Code he undersigned fu r agrees not to lace the system in operation until a Certificate of Compliance has en.i d by ,he bgar•d-If h gi ne . •. -• ---••-••... • •--• = Date Application Approved By............ -• • • •......• •-•--•-- -- • . Date Application Disapproved for the following reasons:................................ ..•--•---••-•••--•--------•-•-•-----•-•-••••-••-•----•....Da .............. •-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•.............._ _,Date OE.P� 5 t.y '. Permit No.. - ' ` -- ; 'r�:. Issued..... �/ .. Date No--------------- . FE$...... ... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD E HEALTH s� . ......OF..... -------------------------- Appliratiou for Ui_gpm al Works Tonotrurtion Pprutit Application is hereby made for a Permit to Construct ( ) or Repair Y an Individual Sewage Disposal System at ........ , .... ................. ------ ............................................ Lo ton-Addr s �" or Lot No. ...................... ......_..------------ ................. -..........._.......................�..... Owner Address W , .......................................................... . i i ....... ' ,.. . Installer Address Type of Building Size Lot............................Sq. feet U Dwelling N.o. of Bedrooms....•..•....................................Expansion Attic ( ) Garbage Grinder ( ) pal Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P.4 Other fixtures ------------------------- ------ . W Design Flow........:................................,..gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liqui&capacit 10Agallons Length................ Width................ Diameter_............. Depth................ x Disposal Trench—No...................:. Width.................... Total Length...............,.... Total leaching area....................sq. ft. Seepage Pit No/40_40_4!__- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box A0) Dosing tank ( ) Percolation Test Results Performed by-----------------------••-------------------=---------••-•----•--••--_._. Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to, ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water......_................. O Description of Soil.....4a „ ---------- ---------------------------------------------------------------------------------------- x rJ -----------•-------------------------------------------------------------------- -----------•-- -----•---•-........................................ ••--•••............................................................ U Nature of Repairs or Alter tions—Answe when applicable ___ + ._; _a Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.^. 5 of the State Sanitary Code he undersigned fu r agrees not t lace the system in operation until a Certificate of Compliance has en • d by he b h �� igne Date Application Approved By•--.---••- = .................... ---.••................................ Date Application Disapproved for the following reasons____________________________________________________________--------------------------------------------------- _- --------------------------------------------•--------- ...........................................................................................................---------------------------•-••- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS OARD.40F HEALTH V ....0 I................OF 4.0. ..:... ......................... Tntifiratr of Tompliaurr THIS IS TO CE Y That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY -as;�.' ..��/1!. ...................•.....--------------------------------....------•-------..........------......-----------------------......------------------ nstaller a �00 ._P5 . has been installed in accordance with the provisions of T 5 of The State Sanitary Code as describ d in the application for Disposal Works Construction Permit No.7 "_ �_. a '' ---- -:----•----... dated 4 `/ " �-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM! WILL FUNCTION SATISPACTARY. DATE.............. . .. <-... ---------------------- Inspector---`- 11L ----- ••---------------------------•-------- lky THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...Al ...... . .OF... �ery� w�`•••: rr .................... No....................:.... FEE.-I$ ............... Rupoual rki oat t ttrtion rruttt ": ��r . Permissionis here ed----- ----- ----------•d ! --�------•-•-•----------=--------••--------------------------------------•--._._............. to Construct ( ) or a air, ) n.Individ Swage Disposal System atNo....... ...... .. ....._ ! 1 .--- --- Street as shown on the application for Disposal Works Construction Per ' No_ __________________ Dated_-___ ____�__/____._........._......_.... •............... .--- •-.. •. - -- .................................... DATE. -_-•--•----------•--•••-•........:..: Board of Health/ �4#1 _47-C lth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS