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HomeMy WebLinkAbout0288 OCEAN STREET - Health (3) s S � � r � 2ir Z O f 1 l I• _ No......................... i Fimiic..... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ri HEA ..........OF.. ..... .. -V. ............................. .. ........ .... Appliration -for UWVofial 19arks Tatuitrurtion Vanift Application is hereby'made for a Permit to Construct or Repair an Individual Sewage Disposal System at, 0 ..... ........... .. .........7--­--------------------­---- Locatio -Addcess or Lot No. ............................... ........a f .... ....CA...... 7' :�........................................ t owner Address ,Wj .A-1 (2 t�i n ........ ... ..... . ......... ............................................... Ins taller Address Type of Building Size Lot..- ...........Sq. feet Dwelling—No. of Bedrooms._________"___________________ _ -Expansion Attic Garbage Grinder P4 Other—Type of Building -------No. of persons......f 7------------------ Showers Cafeteria Otherfixtures ........................................................... ....... Design Flow .........10M----50-----------gallons per person per day. Total ...galloV 9 Septic Funk�(Liquid capacity-tOW.-gallons Length......J7 .1 Width­R/­'�'--- Diameter--'-......... Depth------'i..o'- Dispumt-Ttern+ No- -------------------- Width---.-------------.-- Total Length----.--------_.----- Total leachii1g-area---------------------sq.-ft.,r Seepage Pit No.________1---------- Diameter......... ........ Depth below inlet ....-,_Total leaching area.-"-:--._._:_ -sq. ft Dosing tank 7-, Other*Distribution box ( /) I . Co;-Co;-y�.... ..4A................................. Percolation Test Results Performed by ........ --------t--------- Test Pit No. 1�sI---------numites per inch Depth of Test Pit.................... Depth to ground water..-..._._------.--.-__.: rJ, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to grouhd water--------------------- . ..................................................................... ------- ---­-------/--------10.... 0 Description ob Soil Pun ----t----- - -------- ----- -------- t .......... ....... .... ... 7-r -- ----— .4- - - -- - --- ------------ 7 ---- ----------------­----- - - -- ��--- ---- --C-- ­------ ---------------------------------------------------------------------------- .... U Nature of Repairs or Alterations—Answer when ap icable------------------------------------------------------------- -­---------------------- ----------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------- - ---------------- Agreement: The under-signed agrees' icoinZall the aforedescribed Individual Sewage Disposal System in accordance with the provisions oPArticle-XI-8f the State Sanitary Chide— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i 51r, t bard of health. S S�igne igne>1 ------------- .................................................... ../...... -------- ----------- Date 74­ Application Approved BY------ ...................... ---­- L/,7 Date Application Disapproved for the following reasons:................................................................................................................ .................................................................................................................---------------------------------------------------------------------------------------- Date PermitNo........................................................ Issued...................... .................................. Date ---------------- J—--------- ------------------------------------1--------- I, t . ZZ No THE"COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --- .-.. n. A lira#iuu -fur M u� l gar u (n r r #r�trt uYt rrutit Application is Hereby made for a Permit to Constriic ( ^or:Repa> `an -Individual Sewage Disposal System at /` L Cabo Address / or Lot No: ________ _ t Owner Address W � , Installer Address V Type of Buildinglei Oo0 x'.`' 3 -`Size Lot Sq. feet aDwelling—, :Io. of Bedrooms----------------------------------------: Expansion Attic (. ) Garbag e Grinder ( p aOther—Type oil Building .._ No. of persons-------S------_.......,_,._: Sowers Cafeteria ( ) d Other fixtures ` l W ,Design Flow_``,-_ -__.. fca_---=:-_gallons .per person pe� day.. Totalpdily flow....._. r1p �\ �' :g3klollls. WSeptic Tankr Liquid capacity__((_`gallons Length___.) _____ Width_-1_.......- _-. Diameter_-__ x Di osa Tench—No_ ____________________ Width,,, __,______ -___ Total Length_.___..�I -_ Tolleaclvfrl 14 --sq. ft. Seepage Pit-No.___._. Diameter______ ______ ____ Depth below inlet________________x_ Total leachi tredr-__ � ' sc fr-. Z d ✓) ,� Dosing` P ` ,g \; 1 , \ Other Distribution box or cpk i( ) S _ � 1 a Percolation Test Results Performed by-__-' P----_____----UJ--------.----------------------------- Date';.V Nw- J Test Pit No. L________- niiinutesperinch Deptli of lest Pit_':`_____________ Depth to ground water-.-:_''.__' !14 Test Pit No. 2_(jz5E--------minutes per inch Depth of Test Pit____________________ Depth to ground water:_--_-_-__:___;_-__-.'... a -------- ------ Description Soil `-- �( r„---�--..0 -e •2 jd �� -------------- w .� .� 76 V ••,� Nature of Repairs or ' Iterations—Answer when a licable:________ ! ____-__ ------ ----- ---- - -: - Agreement: rd, 1 ' The'undersigned agrees�to install the aforedescribed Individual Sewage Disposal.System in accordance'witI the provisions of Article-XI of the State Sanitary Code—The undersigned further'agrees`pot to place the system in �peration until a Certificate of Compliance has been issued by the board of health. I ( Slgrie � ti ?9 1 Application Approved BY -:- ,: ,F,t f1�¢ ....................... V y` yDate Application Disapproved for the f ollwzng reasons:_ ,__,:_ c. ' : ._.__ ------------ ----------------------------- Date d .. j \ Permit No. - Issued _ 11 ,F• Date THE. COMMONWEALTH OF_MASSACHUSETTS \ srk BOARD HEALTH ��+ ! w\\ ........ .-. ..OF �t ` Terfifr #r of f� ntlittrr � r g p 'y .)for Repaired. ( 'Y ` 4T IS TO TIF , Tl�at the Individual Sewage Dis osal§ stem constructed" by - ? f \ r �/ I t11b at 4- r a lias be exl installed• m <zccordance with the provisions of ICf f State-Sanitlrv'Cod gg,'as le�cr.il7d n•the application for DIsposal'Uvorks ConstructiomRl rmit N __ __ dlted �( � ______ ` _. " -- ,:T-H.E ISSUANCE .OF THIS GERTIF:CATE SHALL NOT BE CONSTRUED AS A G,UARAN*' TFI�/rT 7HE SYSTEM WILL FUNCTION SATISFACT®RY DATL = ----- Inspector (� ., _.._ sty V ' THE COMMONWEALTH z0F MASSACHUSETTS F` .:.., BOARD; � ` HE,dLT� O F , r No..........S 7��_ ^, - >=, y FEE , t utt ryur' t' �r rruti ►4' Permission i ,reby granted:.._.. - -- � ,--•-- --- - �5, - ------ to Construct �Or Repa �) I 1r pual ag �a y , � t' d�F } y.t� Q at No.. :._._..�___...------• � _ a " \ p j ., • lt• `jr- eet Irf ;as-shownonthe application for Disposal Works Const`r`uetion it N \\. `KKK ,' ;�ted1 _� t+._: __ _:. '_______________ ...... -• ll• �- ' -i}I f - n y b $oard o`'HeaIR ' _ ---------------------- ` / \ f d 41 FORM• 1255 1HGBBS & WARREN. INC.- PUBLISHERS a "k Odd A o6 vs P I GD 1` ✓ n ��Q� por Al 47 n�A O r Arv,o .9 ,offo YF� Pl'io f' To \ eo P �� /G I ;t/J J,rL-' .�� .T"" �3A C:/'S• Ii���.>4�7T.3 .� ! ,- ` �� _ /aG'� / [r� .c t--mac?r�M. .�J7 9 ,.{•� o 7- .4 : /✓�.c� A/o ,4 � - .___� —___ _ .�_ d.E, �'QTi G T�%',�f__ ;A`' GG'a�E•P s lJ.r- i=i.e>f 5 h/,C- ,tom G fr 14 ,0 N, ee, ,,C-7/7-6e - s= 14,E'y 807 o.✓f I GU./9-5Wol-F Z? �N Cl G+i9 l r''.£�RG.fir <~.%I ft'/rc..7 c�>�r+!"',,� J� �� ! i � � ,/�" � L•G CIO 0 1 i 10 f9 if G/.4 .�6,9>r A--7 6 T",'9 r(3 4 .t- G o.J � 5 r Ir' i/R T"/©.� ) �,E r�T"/G T`h��/�� J.� T/►�/ c� V T'/0,0 0Af ,C+ J9' 4-; / . A- G. fV O T 7-,.F '3OC7 f / 'W/A,? 0, ,,W i 0 vi OF 5 � � ,� .�= . .�...�' ,tl� T�=,� O G � "" 2 G, / 9 ?G � ,C7J�i v� ��,✓ .v n i ,r3� .c. G� �h'Tr� cy JOSEPH M. CRAG �9�y MONAHAN,JR. T C T �C7 A E 7 "O .Q r /O/ —/t�i°= RAYM SHORT RT 13660 c .� /9 No. 27483 0/STE� �c`" �y� sill s10NAL