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Home My WebLink About0358 SEA STREET - Health 358 SEA STREET, �N R A=306 109.002 1 tE w i 'L - 9 H o - I,*-*................... Yn ... 6.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR LT OF.... H EA7 .......... SiPVfirafion -for Uhipwial Workii Tonstrurtion Vantit Application is hereby'made for a Permit to Construct or Repair an Individual Sewage Disposal V System at: L-o0o) 1-e_� ............... i-�------e.. ...................... ............. .// ...................................................................... n-Address or Lot No. Sk.................. ................... .................................................................................................. 00!7 Owner Address .... ....... .. .... ............................. ................................................................................................. Inst er Address Type of Building Size Lot_-------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ------------------- No. of persons---------------------------- Showers Cafeteria ( ) P4Other fixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- Design Flow--------------------------------------------gallons per person per day. Total daily flow------------------------------------------.-gallons. 01 Septic Tank—Liquid capacity------------gallons Length________________ Width.----.._.--___ Diameter._.-._.-_...___ Depth..____._....... Disposal Trench—No. .................... Width______--_- _----_-- Total Length_.._..__.....___._.. Total leaching area--------------------sq. f t. Seepage Pit No...................... Diameter-___-___--_----_.--- Depth below inlet........_........... Total leaching area...... -----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date..------------.------------.--------._.. Test Pit No. I----------------minutesperinch Depth of Test Pit-___________-.____-- Depth to ground water........--------------- rX., Test Pit No. 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water--...._-.____----___-. - a -----------•.............................................•-••---•••••------•--------••......---•-•••......................................................... 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U ......................................................................................................................------------- ------------------------------------------------------------ ------------------------------I------- --------------------------------------------------------------- ---------- ----- 't �0-/ ---/ ------------ U Natu�@ ofRepairs or Alterations—Ans en applicable_ ---------------- A- ---------------- ------------------------------------------------------------------- ------- -------------- -------- -As _ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article X1 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben ssued by the 'board of heAth. SigSig d. -- ------ --- -----ex-t------------ ate 7. Application Approved By------ .....jo. ........ ...... ................ --------------- Date 17----- ----------- Application Disapproved for the following reasons:................................. ----------------------------------------------------------------------------- ...................................................................................................................................................... -------------------------------------------------7 Date PermitNo......................................................... Issued..... 47----------------------------------- Date ------------ —------------------------ 1-------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD F! HEALTH..,, ............... Appliratinn -for IM-4p iial Works Towitrurtinn Vamit Application is hereby'made for a Permit to Construct ( ) or Repair { ` ' an Individual Sewage Disposal System at: 0-0 ""' �+ �j !' -•� ..----, --.------ �-,�..,-- ""-"--------•-------"-"----"-----------"._.....--"-•"............. fAeve6ion-Address �h _ or Lot No. •:�} Owner Address W -- . Ins ler Address Q Type of Building :- Size Lot----------------------------Sq. feet U •i Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building --------------------------- No. of persons;,.._--__-_..____------------ Showers ( ` ;)- — Cafeteria ( ) Q' Other fixtures ------------ ... 4 �. Q •.-. ------------------ W Design Flow...........................................gallons per person per day. Total daily flow._.... .___..... k.................. gallons. 04 W x Septic n Iqut capacity gallons Length t tIt ltameterin 1 Depth----------- Disposal Trench—No.....................,Width._. Total Length Tcl re1 _. ..-__.. .._.._sq. It.g Seepage Pit No..................... Diameter........L�----_-.-:_'_ Depth below inlet--.................. Total leaching area°---------------sq. ft. Z Other Distribution box ( ) ,Dosing tank (" ) a Percolation Test Results Performed by 'r Date-_ -------------- _--_---.-._. -- Test Pit No. 1................minutes per inch Depth'of "rest Pit_................: Depth to ground waiter.___....-..--.----..... Test Pit No. 2................minutes per inch, Depth Qt,Test'-Pit- ........... Depth to ground water__.-_.----_-----___----- a' ------------ -- --- = ---- ` .-••--......................................................... Description of Soil------------------------------------------------------------------------------- -----------------------___ A� ---- I.LI _.''II! U .-------------------------------_--------------------------------------------------------------------------------------- ,_ .,- �. W ------------ ----------------------------------------------------"._.--__-______-__•-_.-_•__--___----_--_____ --_ _._. _..... ____--___--.. V Natu off,Re airs or Alterations—Ans en applicable ., --_ Q_}�_ x 4 ' 1{I' --- -d A reement 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 t n 'ssued by the board of he th. 4 ate Application Approved BY------ - - -- ---- A - fed_4 -- --- .------- ------------- " ...... i!'^f` .. Date Application Disapproved for the following reasons:......................................................................... -------------- _.F0 ...................................................................................:................ •-_-_.-__________________---_-__--__-_____-______----_.____--._ •• ate � PermitNo................................................... Issued--•------1 ..................................?7 Date = THE COMMONWEALTH' OFMASSACHUSETTS. l BOARD j HEALTH00 ... y R Tntifirate of Tofttplianrr n '� y r' z.HIS-IS ToefERaY, That the I ividual Sewage Disposal System constructed (t ) or Repaired''( ..................................................... - - /�! i Insta Er -- -" - --- VC , at..`' ,� '.' ----------•---•--•------------ has been installed in accordance with the provisions of _ � XI of The Stat Sanita�Cocdies described in the application for Disposal Works Construction Permit No. _fj' 1-----------------: dated........Y--J'"_�'�'. ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION _SATISFACTORY. fl DATE ( ✓--7 ------ .........JA ------- ................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � I�d�!��.....of........... .�_ "' . ----�................... No....... , FEE-- ✓ Dig n�tt�11/ nrk �nnitrnrtiou Vrrmit Permission is hereby grante " ' .. to Con ct ) or Repair ( an Indiv al Sewa e ispo. stem .............................................. St r , as shown on the application for Disposal Works Construction r it N':_... _ Dated--- -1 �-•-- " ---- ------------------------- :... 0..,C� Health4/� • ==� -------------------------------------------------------------- , FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ,�' _