HomeMy WebLinkAbout0995 SEA VIEW AVENUE - Health Q�O- o
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THE FOLLOWING
IS/ARE THEBEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
IMAC
DATA
102,
L' TIOKI : SEWaCaE PERMIT UO,
�/ILL/�GE � �c-c� (..Jr �.v 1�v ► — — —
IMSTLaLLER*5 W&ME ADDRESS
NT � L4G `j — — — — — — — —
bUILDER 5 ►J &MF— ADDRESS
DIJ►TE PERMIT ISSUED
D A.TE COKAPLI W-ACE ISSUED ;
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No..•-••'-•r•---..... F
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THE COMMONWEALTH OF MASSACHUSETTS
BOARQ�OF HEALTH
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G .........OF.......Q�' J^ t!►...� .. ...........
Appliratioo -for DWV oal Works Towitrurfion Vrrotft
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
S stem at* •�
i. � L Cif � � l_L�r2 C� t f '-----------------------•-
��•. ation-Address or Lot No.
-�=-f-� �`---...---------- I... =-----------------------------------------------------
.......
C Owner •- ----------•------•----•---._-.----Address._.
Install Address
Q 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 ( )
Pa 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 ( )
aPercolation Test Results Performed by........................................................... ... Date................---------------.----_--
,� Test Pit No. 1................minutes per inch Depth of "lest Pit-------._._________- Depth to ground water...._---.--..--.--.-_.-.
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-.._-.___--.--_-_-.-.
tx -
O
Description of Soil.---- Q-etc(_.....- s ;--- ., -
---------------- _
V Nature of Repai s or Alt rations—Answer when appl ble.._ N�_ �- � ....�4� °
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance will,
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
foperation until a Certificate of Compliance has n iss/edy the board'of health.
Sign t ._ �------
F.. Date
Application Approved By---- .- f --•• -•... ... ---- .......o!Y:! —.7--Y':--
Date
Application Disapproved for the following reasons:-------•------••---•---•--------••------•--•--•--------•----------------•-------------------•-------------------
-•-------------------------•-•-•----•---------------------------------------•---•--•------•--•----------------•--.-----•--.-_-.---•--•-------------•----------------------------------------------------
Date
PermitNo........................................................ -Issued...................... --------------------------------
' Date
No. '...�.z.3.. <_�p...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........C'�-tJ .........OF........� _C✓`�,.vt. ..G.�C..':"... . .............................
ApplirFa#iuu -for Bi. voiiFal Morkii Tuus#rur#ivaa Punift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at• _ It
C� i(l''Cc ) �✓C1 S
f'( � IL,.tion-Address,� j�, _ /� or I of No.!�'
Owner Address
•-----•--•---•-•......................................................•-------
talle Ins Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ---- ------------------------------------------------------------••-•-------•---------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
P4 Septic "funk—Liquid capacity------------gallons Length................ Width.__........-.. Diameter_..-_-.._---_ Depth---------------
xDisposal Trench—Nc•..................... 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----.......-- ----------------------...
,a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
P4 ----------------------------------- -•---•-----.....................................-----•------------.-------•---•----•--------------
O Description of Soil .d .�'` /
x --
V --•-----•---------------------------------•--------•------.------•--- ---- t ----------------------
•--•---
(/
U Nature of Repairs or Alterations—Answer when ap�pliqable.-._- w----r._Cc._--r-----._167-o-zJ-----`' / ........----_.----_-----..-
--------------------------
T /
Agre ment:
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 been issued y the board of health.
S* n -'��-�� � ' ':a...............•---------..._..........._..-- •-- //t!•-���
c'i6 � Date
Application Approved BY f /� , ��__J 7--(..
Date
Application Disapproved for the following reasons:.-.-•--•-------•--•-----•--------------•----------•----•----•--••-----------.--.----------- --------------•----
•................•--......---•-.--••-----•--•-----------------------------------------•---•--•------------------------------------•------------------------•--•---••-----_---•--------------•_---------
Date
PermitNo...................................... .................. Issued....................... ................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH/
..�. �-c ;r�-•..............OF.....��,�t'c.{ y� 5..t... e tt .........................
�rr#ifiratr of f.1,uutpliaurr
THISnIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( C).
/; �ns�;alle J
at---------- Cc /._.(.` .i4j----- ,--` !,- 1 5 -C(--U-f- - -----------------------------------••-•-•----.................----------
has been installed in accordance with the provisions of :article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No__________________------------------------------------------ dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM Vr/I LL FUN N SATISFACTORY.
DATE � -------------------------- Inspector-- . .. `•----- ---�-
i
THE COMMONWEALTH OF MASSACHU
BOARD—OF HEALTH
. /t,T' `-......._.OF.- ...�`....;.C(�1/s�.. ....1.... �� "....�.�:.................. �C3
No........................ FEE........................
Riripuiittl urk C.nruat #rur#i>�at rraui#
Permission is hereby granted----------__ __%' ___'______' __ t~e__c ..__.. .
to Construct ( ) or Repair ( 44-an Individual Sewage Disposal yste
atNo. - G f1:. _4- :&).:.----..-.-------- - �1 ------------------------------------------------------------
as 1
rect
shown on the application for Disposal Works Construction it N ._. ...__. ..____ Dated-------:Y/K/7�_.........
DATE.---.�-<--
/-7-� -�.� h
r- ---------------------------------------------• Board of HealtJ/
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS