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Home My WebLink About0023 CLAMSHELL COVE ROAD - Health � i'� 1�c��- d5j � i e� No..1�.OU- ----� Fim....... Q... .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® J F HEALQTH. - `"'` --------------0F............... .....x�,�.� ......_.._........_... ------ Appliration for Mipwial Workii Toamtru�anIndividual ' rrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( Sewage Disposal Systemat.� ��M S� ...........--------------o---.......... - -- ........---...... Lo ti Add` ` �� tNt ...................... ............... �............ -A--•------------------•.... ........:..- ....................................................1 ...................... wner Address ----------•- t Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___.......3_____________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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..................sq. 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________--_-___.-______- •----------------------•--••------•••--••----•••-••••--•-•----•------•------•---------------------........................................................... 0 Description of Soil..........< ....--------------------------•---------------------------------------------------------------------------------------- -------------------------- - --- -- --•-•- U Nature of Repairs or Alterations—Answer when applicable....___. _ vim. S 1, ......................................: ---------------------------------------------------------------------------------------•--......--------• --•---------------------------------------------------------------------------•-------•---•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL% 5 of the State Sanitar Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha b n A1sjuFd by the b and heallSigned----- '! �----- -------------------•----•••-••-•••... ................................ Date Application Approved B ..._ ..__T_.._ -------------------- ._ Date Application Disapproved for the following reasons-----------------•--•-----------•---•---------------------------------------------- -•-----••---•--•------------- --•-••-••-•----••---•--•------•-•-----•-••••-------•-----------•---•---•---•-----------------••••---•-•---•-•-•-••-------•--•------------•---------•--•----..._•-••-----------------------•••-••-------- �,T Date Permit No.------..-T1•-�� r l ---------------------- Issued.------------------ Date TH OF MASSACF No................--....... Fps. ........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD _ F HEA TH :�...-----------OF............ .. -: .�.a. . --.............. Appliration for Dispog al Varkii Towitrnr i n amit Application is hereby made fora,,Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System,at Gcl � t �! ^�. Lo atii Addr ss or hot No. .... ...------. --. .... _ ----•-------.•.... ... ... ........ ...•--... . . -. ....................................... wnei' ''""`� Address ............. 11 -------------- Installer Address Type of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) `_ Other—T e of Building No. of persons............................ Showers — Cafeteria a YP g P ( ) ( ) d Other fixtures WDesign 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..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_..................... rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .................................................................------..............--•---.......--.................................•----------------------- O Description of Soil......... --------------•---•-•------------- x U .........................................................................................................................................................•---.......................................... = w UNature of Repairs or Alterations—Answer when applicable.--____:M .....`'_.. ................... ....... ............................ ------------------------------•--....----------------------------------------------•-----•-------•................................---------------------------------------------------•••-•-•--.----- 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 place the system in operation until a Certificate of Compliance has'b� n is ued by the b and of heal rh. ey l u c, Signed. '•l� \Q',e.�, J__ 4 � ! ......................................................... ..........................--.... Date Application Approved By.,............ --------------------• ------ Date Application Disapproved for the following reasons-------------------------------------------------------•--------------------------------------------------•••--- ........................................................................................................................................................................................................ 1 Date PermitNo..........v..off--=----y ------------------------ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _a r 40 �e, ..........................................OF........... :?..... ............................................. TrrtifirFatr of Tompliatta CHI„d IS TO CERTIFY; Th t the Indiviqual Sewage Disposal System constructed ( ) or Repaired t b .......`'- b . = '- �t`. S' I . ------..... - ' ( Instal er at ------•--- -- ----------------------------------------- w ---•---------- has been installed in accordance with the provisions of TITL_ -5 of The State Sanitary Codelas described in the - .application for Disposal Works Construction Permit No-----------?'� /. '...... dated___..c ______________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................Q.-....�7:.� -----•------••-••-----•-----•---- Inspector.....---.......---- --1- ............................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD,—OF HEALTH .... ........ ..". ..............O F..........:... ...Gx `... ...�. c_. U 2' hy. _. FEE....;)—.C... Diapaq�a1 Work �nndr io rrmit Permissionis hereby .granted......- ` -�.....................•-------�----------------------••---------------------.._....----------....................---- to Construct ( ) or Repair (' ) an�I dividual Sewa Disposal System p at No Gi l�, _ OA �, c � . . ._.... - .._... .�.�.................. - --------- . .................... t................................... Street p as shown on the application for Disposal Works Construction Permit No.?2J.V.8'._ Dated..-3__: '2�......... ----------------••--••----------.�"P.ad_ `"} ,,. � of-Health- -----•-•-------•------- _-•-•_-••••-•--_— DATE----- -- -------•--�j----•---...... ................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS Lc Sewer Permit No. I Name ✓ �., yl t.ocation 3 bam !�v)el\ Lge Rom' Installer's Namc and Address \-1 c 0 zS` Builder's Nome and Address Date Permit low d: — A — a 9 9 7 Date Compliance Issued: �,,,e cen.._...". .:.:'. 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