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Home My WebLink About2220 FALMOUTH ROAD/RTE 28 - Health (2) .�, ola � C^c..��r� fig. �t��2 _ � �. Fxs............................_ THE COMMONWEALTH OF MASSACHUSETTS , n_ BOARD F` HEALTH a.."v..'.\................O F......-.. ••------------.--.---.-..----- i A liratinn for Diu uuttl Workii Tome rur#inn 1hrmit Application is hereby made&,oaPermit to Construct ( �or Repair ( ) an Individual Sewage Disposal System -ZON z ... ...... t _-.- .. 9; .). ---•-•.----... .... ..... /L...... . - o tion Ad or Lo O r Address W Installer Address d Type of Building Size Lot.__31_3 d.0...Sq. feet U ,--, Dwelling—No. of Bedrooms........._. ___..__.._._Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building __._.. No. of persons............................ Showers YP g ----------•-••------•- P ( ) — Cafeteria ( ) dOther fixtures .-_•------•-•-•-•--------•-•-•-•--•-•----••--------•---•------------------•-•--•------------------------••----•••--•-------•-----•------..-.--- W Design Flow...................��....._...•......gallons per person per day. Total daily flow..........._._.....$�y ............ga,1lons. �� WSeptic Tank—Liquid capacity/01 ..gallons Length_ _��_._ Width _.-/�__. Diameter________________ Depth_.b x Disposal Trench—No. ................... Width.................... Total Length.._.........-.__7i Total leaching area....................sq. ft. Seepage Pit No._-----__I_..._._.... Diameter..7...... Depth below inlet-/._.... Total leaching area.... _-,�_ :sq_ft. c1 Z Other Distribution box ( r/)Dosin tank Percolation Test Results Performed byaAlk ....... Date.-- �•7�_-�_�_.L� a Test Pit No. 1..... 2-.-..minutes per inch Depth of T st It.. ..._._� Depth to gro n water.. fTq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground Description of Soil s ----- .... - ... - - ........................ x t W x •---•-•--••••----•---------•------•-••-•----•...--•-------•---•-•••••-•-•-•--•--------••••••-•--•--------•----•-•-----•--••••----••----•------------••--•-•-----•-••--------------••--•-----•--••...---- 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 TITLE, 5 of the State Sanitary Code The undersigned further agrees not to pl e the system in operati until a Certi e of. ce has been issued by the bo rd�1, 1 II -- -..... i ned._�.1:-r � C 6 t /• - ............. 5°-_.... Application Approved By........................ j . --- --- . ................... --------fie- �------ Da e Application Disapproved for the follow n reasons-------------•---------•-------------•----._...------•----------•••-------------••------------•......---•••------ ........................••••....-•------•.....--•••--••••---•...----•.....----•----...---•----••--.....-----•-----•---•--••--•----•--••••----•-••-•------•••-••-•-------•••----•-••---_.._..----•----... Date PermitNo......................................................... Issued........................................................ Date No.......................- F$s................. ...__ THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH ........ -- ....... ....................OF....................................... ......-.........:.......-.................... Appliratiun for Disposal Works Toustrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ................__......»...................................................................... -----••------------•...----•-••-••••-•--...__.....-•---••--•-••...._..........»...........-----•- Location-Address or Lot No. ......................»..»._......_........... .......... - ...... ..._._.... . ...........-----•-----........................----..................................»....... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................. ....................Expansion Attic ( ) Garbage Grinder ( ) a aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .......... W Design Flow........................:...................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Dept h................ x 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 ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ 0 P14 - -•-•----••--•--------------•-•--•--••-•••••• --------••----•--••-•-••....----•....-----...------•--••---....•-•-----•-...---••------•-•-•-...._............ Description of Soil......................................................................................................................................................................... x w UNature 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 TITLE S. of the State Sanitary Code—.The undersigned further agrees not to pl a the system in operati n until a Certi• e of ce has been issued by the board ff health. �I,/CS"igned_._...._.. ............. Date = ,' Application Approv By........................ . Date Application Disapproved for the f ollowin- reasons:--••-------------------•---------.....------.........------...........--•------••---•--•----......_....•----- ....--•-•-•-----•--------•----•------•----.......•...................................•--•----------.................•....................-------------.-------•---•---------------•----•----•----.....» Date PermitNo...................................................---- Issued.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH �— ...........OF........ .............. ( ................. (Inrtif irab of (aoutphaurr THIS IS TO CF iFy_ That theC Individual Sewage Disposal System constructed ( ) or Repaired ( ) Installer at .......... -------............................................................•---_..... ---------------------- has been installed in accordance with the provisions of TITLE ]of The State Sanitary Code s 4escribed in the application for Disposal Works Construction Permit No.-75.:6_....M!............... dated.... /249C........_..._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUKCTION SATISFACTORY. DATE...............•---. ..... 2 ----------------------------------------- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS !� BOARD HEALTH rf =?••t.�' !�1 / ��!�1..................OF........... ...................................................... Disposal rku To trttrtio Vrrmit Permission is hereby granted.................. -•V=--5. ....... .........................................................---- to Construct ( � or Repai ( ) an Indivi Sewage isposal ystem , /`` at No..-. - ..!-....•.. _.. ?....... .....................•--.... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.____...... ----------------------------- l .......... oa d'd'�Health DATE ...2.. '.. ..f� .......................... FORM 1255 A. M. SULKIN, INC.. BOSTON _ _ .:., '._,_t jr _ a T , G/ T ( 1 3 4 J, A P/R455 e D,4fYP fN 7":4 a OC) � (D BE C'.467'• IRON OR SG R 2-E 40 PVC. - �_ �_ 0 ,6,4 1, BE .:. ... ...ate.;,.,,,._:::x....-_.:.._ ::: i• .`�: ! _ - � � p sfJir' f' 9f °C. , 71 - - C.--..tea?+:m.. j .. a..,.. .... ._.. C ,j ..,.,._.. 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