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Home My WebLink About0016 SEA STREET - Health ri� 3�0 No.._�. -------------- Fxs.., .. .................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® ® H T j�..............O F........ . Apli ira#inn for Uhipusal Wo rkT.unstr�tion rrnti# Application is hereby made for a Permit to Construct ( Repair ( ) an Individual Sewage Disposal Nte,,nt ...... .... ... ....... *ati.on, dress " ...... ........ Loto.A. .. .......... ............................................Address.......................................... QU TypBuildin Size Lot./J..f'�.�........Sq. feet Dwelling No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ..... -------------------------•-------------------•••---------------------------- ............................. W Design Flow......................... .....____gallons per person per day. Total daily flow..----_-----. .... Design WSeptic Tank—Liquid capacity/gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width .._._.... .�Total Length.................... Total leaching area................. .sq. ft. x Seepage Pit No.,;............ Diameter__=�A_�..Depth below inlet......-C30-------- Total leaching area... .° .sq. ft. z Other Distribution box (K Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1-__--minutes per inch Depth of Test Pit.................... Depth to ground water---_...__-_____---__---. fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... p' ---------------•---------• --------••-•-•-•------------•--..--------------------------------------------------------- O Description of Soil r--•-•---------------••--••----------------•--------•••••••-•-••••••----•••----•-----•-••-- U -•---------------------------------------------------•--------------------------L............••-•-•......•--•-••----•......--------•-•-••-•--•----•--•---------•-•-•-•---•--•--...----••-•---••-•----- w ---------------------------------------------------------------------------------------------------------------------------------------•---------------------.....---•--------------------------.....••- 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 furthe agrees not to place the system in operation until a Certificate of Compliance has beenjigged.by, o of health. b Siged-_- ..... . . .. .- - - - ---------•-- ---------- - -- ----.......---- ate Application Approved By. • ................. . •. e f .�... ate Application Disapproved for the following reasons- ------- ...................................................................................................... .................................•--•-----------------------••--•----•-----•------.......-•----..........-•----•-•-•-----•--•--•-••---••----...----•••-•-•-•---•--••--•••-•-----•---•-•---•-•••......... Date PermitNo......................................................... Issued........................................................ L ____ ---- ----------I------------Date -=------------------------- }�'� No. . "° Flare. :............. .�.... THE COMMONWEALTH OF MASSACHUSETTS BOARD O , H .OF........ �IT , Appliraflun for 43tapaiial 10orkii TIonstrurthilt rantit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal S tern at• Y®r, '.'oeation-Address I.ot N e . "� ...... s it owne � .7 ........... �rels. ' g , a .............................. ....................:........................................... ...... ...._................ •-............................................. Installer Address U Type of Buildm Size Lot. : j t : ......Sq. feet Dwelling• o. of Bedrooms........... .....................Expansion Attic ( ) Garbage Grinder ( ) "04 4 Other—Type of Building ........... No. of persons......................... Showers — Cafeteria A Q. Other fixtures ---•-•--•........ ....... W Design Flow.................... .166 ..gallons per person per day. Total daily flow-_____..._ ...........gallons. USeptic Tank—Liquid capacity ,1.gallons Length............... Width.....` ........ Diameter................ Depth................ xDisposal Trench No ..................... Width . .�. Total Length Total leaching area....................sq. ft. Seepage Pit No.. f:... .... Diameter. .. . .`f epth below inlet ..�`r,-....... Total leaching area... ,d.A/-sq. ft. k17z Other Distribution box ( �osing 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........................ •.. ... r ............................................................................. Descriptionof Soil • -- r................................ •------------------------••---------------------------••---- x U = W Nature of Repairs or Alterations—Answer when applicable.......................... ••• .............:. -------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witL- 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 issVed by boayd of health. Signed .� ate Application Approved Bk ;- Application Disapproved for the following reasons:.-- .:_-7 .......................................................••---•..............----.........-='----------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued..-------------•----------------------•---.............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAD.. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .... ..... ....................-................. ---.. _....., •... -------••-------•--------•--••......-••.........................•-- �t t<i . r a '.- at... b s� has been installed in accordance with the provisions of Article XI0o£ The State Sanitary Code as described in the application for Disposal Works Construction Permit No........................... ...4,2 dated �+_.�_7-2................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector...........:..........................^ ...................................•...--... THE COMMONWEALTH OF MASSACHUSETTS ; BOARD OF HEALT.K • A .. OF......... r ......:.......... ° No :._: _.... FEE.. " ............... Permission'is.hereby granted.............. ......................`...................:................................................................................. to Consct ( ) or Rear ( ) an rrdrvidud .Se,vageDrsosal l:' stem atNo.. ``` ,t + � ................ .. .....-•--•........ ..... Sire as shown on the application for Disposal-Works Construction�e mit 906 � . Dated /7-2 .......... '- .............................. 'Board of a44 DATE-•-•••-••...............................•- -- .................... FORM 1255 HOBBS & WARREN. INC.. PUBL.ISHERS .