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Home My WebLink About0065 SEA STREET EXT - Health (2) COS cS-e-a 5icee+ U 7 No.------ --•Z....... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH ..........OF..... ..... .. ............................. �� A lira#ivit for Dis otia1 Works C�onstrur#iutt Frrutit Application is hereby made for a Permit to Construct (e') or Repair ( ) an Individual Sewage Disposal Systat, .......................... �aa e�ahon .-dress J/ or Lot�I o. .... '�v ,. a /fL/.e�yu .............. .Addr ........................................... Owner ess i. Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedroo _Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building Atersons_.__.._ ............... Showers ( ) — Cafeteria ( ) Otherfixtures ..... -----------------------•-------------------------------------•--------------------------------- --------....... Design Flow..................... ._-e� .,.........gallons per person per day. Total daily flow....................�._7..�____gallons. Septic Tank—Liquid capacitygallons Length................ Width_.............. Diameter.............._. Depth............. Disposal Trench—No..................... Width...._.__.. __. oW Length____.:__._._/`:__..- Total leaching area..._.___-.. ?„s . ft. Seepage Pit No.__l................ Diameter "`� Depth below inlet._-----ie•....... Total leaching area_ 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-__._____._•__.---___-_. Test Pit No. 2................minutes per inch Depth of Test Pit............_.. ... Depth to ground water_____-_______-.-_.-.._.- O Description of Soil----------•---• _. .. = --------------------------••--------------------------------------....----------------••---••-•-------•-----------------------------------------------------------------------------._.._...----------- V 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 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 by the board of health. Sig D/e ,Application Approved By...---. •. ------. . V �1 I� .2 D Application Disapproved for the following reasons:---------------------------•-----------------•-•-•-•---....---------------------------------------------........ .................•--------........-------------------•-------.......----.....................---•---•----.._._..------..........----------------•--•....----•-----._......._......---------------....... Date PermitNo......................................................... Issued........................................................ Date �= T ---._. .. - - -- -. ------------------------------ F$$ THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH o. yR........._..Cr�..... y`. .. ;..�.' P" .................. Appliration for is oiia1 Workg Toustrurtion Vamit Application is hereby made for a Permit to Construct ( + ) or Repair ( ) an Individual Sewage Disposal Syst at j r .. iP£..: �r-t1....... ...... t w ,c.. -..................,...._. ;; a*ionddress t; d � ""or Lot No .............. ............................ ._ .......•......-....,......... �.. -Owner �d; Address � .................. .,..........,......Installer ;..._.....,..............,......,,., .. ........_ -......._....... .Address:..._._......_.._._......._......_....._... UType of Building Size Lot...............:............Sq. feet a Dwelling—No. of Bedroom � .Expansion Attic ( ) Garbage Grinder ( ) ,� aOther—Type of Building/�j� persons... . ............ ShowersCafeteria dOther fixtures ..........................--------•••-•---•---•••-•-•---------•----••--•••----••--••----•-------•----•--•-•••---• _ •• -...•-•..__._... W Design Flow................... „ " gallons per person per day. Total daily flow_..__-.._________._ .f' ._._gallons. WSeptic Tank—Liquid capacity gallons Length _______________ Width................ Diameter................ Depth.............. Disposal Trench—No Width _ Total Length.._.__._._. Total leaching area __._ sc. ft. Seepage Pit No__ _______________ Diameter ;�.: .._._ epth below inlet_._.._.._..:_.. Total leaching area)pA _.....sq. ft. 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_________-______-._-__. Test Pit No. 2................minutes per inch Depth of Test Pit............ ._: Depth to ground water........................ n; O Description of Soil............... a� �, t g r-�" �. :._ V ...............•--------•----------._._._.._---•--•--------•----•----•--...._._.._..-------------------------._.....----------------------------•-----•---•---------.-.----------------------------•-•-- 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 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 by the board of health: Sig d Application Approved BYE' � ° .SFr ' -- ate � Application Disapproved for the following reasons________________ _________ �____ __________________._.____,__. _...._....__...____._._..____.... ...................................•--------------------------•---------..-----------------------------......------••----------•-•---------•---•---••-••-•------------=-••---•---=--•-•------•-----•--•-- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL * ..._....... THIS IS TO CERTIFY, That the Individual, Sewage Disposal System constructed ( "or Repaired ( ) by __-- -- -•-••- ...... -} yr G .�- . has been installed in accordance with the 1-0 lsions of Art of, The State Sanitary Code as.descrbed in the Jl �' y application for Disposal `Yorks Construction Permit No----------------- ,_ _____.:_ dated �; �� ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W L FUNCTION SATISFACTORY. _�'_.?DATE._._:._........ -..... -••----•--------------------•-•--•--•--•• .. Inspector----•-- ...�:. _ .. .._......._ THE'COMMONWEALTH OF MASSACHUSETTS BARD F HEALTH, r ........OF ._;a. ................. ✓$df NO.... .:: .:... FEE. ...... ......... Permission Is reby granted ...... ............................... to Construct ( . or Repair ( an, liidivi(4)al Sew g,Disposal System , .4 treet as shown on the application for Disposal.._' orks Construction p iit No; r bated . ' _ ./>:.. ....... �" f _,t_` Buai,d'of He' DATE............................................................. .._ . .:.,_._ ' h : FORPA 12.55 HO88S WARREN, INC.. PUBLISHERS