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Home My WebLink About0034 BEACH PLUM LANE - Health 3 b¢,ck&\ V I u m �No.1. .-... Fss....... ..�...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CO w4 ApplirFation for Disposal arks Towitrnrtinn Vantit Application is hereby made for a Permit to Construct ( K1 or Repair ( ) an Individual Sewage Disposal System at I' -- - •••Locat -A.d ..ess ,\ ..... 1. l�or Lot No Owner Address W !✓Y .. ✓ ................................................................................ Installer Address Type of Building Size Lot'... a.�M........Sq. f t U Dwelling—No. of Bedrooms._...5.................................Expansion Attic M4) Garbage Grinder (2k) a'4 Other—Type of Building No. of persons............................ Showers . YP g --------------•------------- P ( ) — Cafeteria ( ) Otherfixtures -----•----------------------------------------------------•-••••-••-------------------••--•----•----•---_....._ W Design Flow..........�5..........................gallons per person per day. Total daily�flow..............5 ...................gallons. WSeptic Tank—Liquid capacity.l allons Length Ad..—.(A?... Width._S_.�._. Diameter________________ Depth._.d5. 8.... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No. ......Z---------- Diameter......_.A........ Depth below inlet.....C2........... Total leaching ft. Z Other Distribution box NOS Dosi tank (►s 0-4 Percolation Test Results Performed by_ �-1-!_l1P�F�I. AX.T 4KIIIELK. Date_._. _`".. a �...-...__.�.... a Test Pit No. 1..L :......minutes per inch Depth of Test Pit----- o_ _._. Depth to ground water_ � �.. (i, Test Pit No. 2--- ....minutes per inch Depth of Test Pit.....ll_o.._.. Depth to ground water:!waterJ! b ,C—N4AU1,iT Ra O Description of Soil... . i'N'. � .. ._.._._ -'...... Lo ..5�€ ?l -`-` ._'.`"Z...`lv1�p tt� Q Ic�l� c, ...................................:.-_z-....c`_g.--�„ _ �..t ...._ . 1 -' ,� ._Ca ...� w ----------------------------------------------------------------------------------------------------------------------------------------------------•---------------------...-•---------••••....._..--- 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 iITLU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ssued by boar f health. Signed----- -- -- ------------------•-•-------•--------•----•- - D t Application Approved By..... x i1 ... ---•---------------------------•---....... , ........................ Date Application Disapproved for the following sons: .................................•••--•-...--------------•---------------•...----------••------....-----•--••------------------•---•---------------•---------------•-------------•----------•--•-----••- cc Date PermitNo..........!?...7-. 3.7•--•................ 'Issued-....................................................... Date No..Sj.1-••-_ � � Fims...........,1. Sv THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l..dv`t.f ..................OF. /............4 Appliration for Dispas al 10orkg Cnomitratrtion Frrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at . 3.!=:a.c ;t_ i�v c t�_L...►.►... �:ct2�� ------ -----------moo. �.�- ............... ....--•••--•--- .Location-A drjess 1 �j�� / _ or Lot No.}�n i I C , Owner 7 (—)Address a ..................... ....._.... � :'. ---. ...---- ...-- Installer Address Type of Building 4 ' Size Lot.�_��A2. ......Sq. f t Dwelling—No. of Bedrooms...........................................Expansion Attic (IV o Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ......................................................................................... W Design Flow......... . ..........................gallons per person per day. Total daily flow..... ......................... ..._.. 5 ._......__........ aJlon�s; WSeptic Tank—Liquid capacity_t':?_. allons Length.��. �.. Width..J`~: .._ Diameter__.- — --- Depth..5`�.__. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--_----.�._.....sq. ft. Seepage Pit No.--____2.__.____-- Diameter......!A....... Depth below inlet_.............. Total leaching area.%776?sq. ft. z Other Distribution box (YO-S Dosin tank `" Percolation Test Results Performed by._2.... _��41 -Date....4 �.e_L'. .......... a Test Pit No. 1---1-z.....minutes per inch Depth of Test Pit..... ... Depth to ground water.. � �..� 7 fX Test Pit No. 2...:°3n...minutes per inch Depth of Test Pit...... ..... Depth to ground water-. P _ ---.................................................- .........---.......------...------...----•........................... 0 Description of Soil--•--t:kA.. ........�.'.?, C�r w� `. �v�SO.�.._.---�� '`� \� ti:"1� y,iZ�(_Czt�,�S� i�`� d--Z c�a' .�ti�_ ..._SuC?�` JtCs ?. ll M� CUA`_`Z rJAN� Cxj --------------------------- T' --_-•-.._ ........_ ....---------------- -----•----------•-••. 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 place the system in operation until a Certificate of Compliance has bee .ssued by boar f health. Signed...... 'u . D tq Application Approved By . ...----��.-----•--•----------------------------------- .......................1 Date Application Disapproved for the following ons: ..--------•---•••---......-•--•-•-----••••-----------•-•----•-----------•--------•---------------------•.--------------......-•-----------------•--------•----------------•-----•---------••------...•-- Date PermitNo.......................................................... Issued-...................................................... Date i 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF . HEALTH ` ..............OF................ '!] ................................................ Trdifiratr of ToutpliFaatrr THIS 14 TO CERTIFY, T at t :vidual Sewage Disposal System constructed ( ) or Repaired ( ) by .-- \J 0 �,�►,Gvn . � - --- -------------------------------- ------------------------------------------------ _ j Instal _ ------------------•-------------•-----. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...__-_ ..... dated........ - y.._:".................. THE ISSUANCE.OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ ?,�r .r 8 7......................... Inspector------J ( ��/ f rr G�� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �_ 3 Ala. `................................. ... NO .............. .... .... FEE........................ i gas l orkii Timm112P, rrutit Permission is hereby granted /YY1.�1%1r1.... ----------------------------------------------------------•--•----- to Construct ( ) or Repair (,, ), an Individual Individual j ewage DisposaXystem at No..... =t.......� _ '........ Street 1 �'' � /''� =' I as shown on the application for Disposal Works Construction Permit No.....................Date .--.---_-_------.-_-_--.------.---.---.--- ................•--....._ ]: /. ��------...----------•------......: 1 and of Health DATE------------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _' a3 / \ Z/7 y/ w 1 I N �f 97 . 7 1 9v./ OFto l � 7 6 8_ SULLIVAN ,�"t 9 •�' No. 2�733 � zj I s i ��`�y�C�JA 1.E�� y7 •.7_. _. .. _ . .,. `- � _. R r / Q'3 � 5+k � .". . __ _... .. _ ___. _._ . _ . _ -. -•�--zv �s�a�� -._u�=arms: "_ . Ae4-7E,�l,4L_X�7e-4 ALL gls, i%T' _ -IA E T;,lZo + F'Cxa HA 3�)N-7-k C?i-'s 5 t�ow.� ..+��ral� Cz51�r�-'`C�a �tT�'��-E!�• s 1 ---USE. 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