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HomeMy WebLinkAbout0300 SEA STREET - Health (2) t��r��s - 3oc�� a�� � � _366 — all `P Fps ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H .�✓ sl ...-------OF............. .ApplirFativaa -fur Miuuual Works Tonfitraa�u Vamit Application is hereby made for,a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: _ ......--"--r= '..........L�_E ,e '--'-'-.. •. •-- • •••.._.._..... ---•-'--•--•----'----•...............•--•--••••-'•-•-•-•-•'•--•••'--••-- oe Addres or Lot No. Own 7 Address W / -' f --- •------- .�fi.......... ` �. '-------------•--....----.................----•-•-----. Installer Address Q Type of Building ` Size Lot----------------------------Sq. feet U Dwelling o. 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, 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--------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit...---------..------ Depth to ground water....-.--..--.--.-------- (.z, Test Pit No. 2----•--.-_.-----minutes per inch Depth of Test Pit.................... Depth to ground water.-_---..-.._----- .--- a •---•......•--- il Descr ton o So -------------------------------------- 1, x ------ ---- - - ------- --- --- ----- - -------- ----------------- --- -< ------- U Nature of Repairs or Alterations—Answer w e appli -:-- - -_------ --- - . --------------------------------------------------- -- .......................... .......... ---------------------------------- 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 b9en issued by the , and f hea h. Sign e ................ _ Date/ Application Approved By..... ` � :'`. Date Application Disapproved for the following reasons:--•----•-------•-----------------------=------•-------•--------•-----...-....-..----------------............... '-.......•---•-••-•-•......-•----•---••••-------------------•-............. ------'------••-••-----.......-•---...--------•-----•---....•--.........•----------------•---......--------...--------•.-•-•- Date_-- PermitNo......................................................... Issued..----�-- ---�- ------ --- Hate t! ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H =r _......OF.............. ,. .. Appliratiou -for 43itipmat Workii Tutuitrurtiou Pumil Application is hereby made for a Permit to Construct ( ) or Repair ( ' ) an Individual Sewage Disposah Z4System at it ) Loc Addres t ✓ v o Lot No. 444 it W r w M �`''h@r Address '••---••-------- ---•'--/ � 7r' Er' --- ---•---------------•-•------••-•-----•-----•- I � Installer Address Q Type of Building/ Size Lot...........__---------------Sq. feet U Dwelling o. of Bedrooms_____________ _____________________________Expansion Attic ( ) Garbage Grinder ( `1 Other—Type of Building __________ No. of persons____________________________ Showers — Cafeteria G4 Other 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 ( ) aPercolation Test Results Performed by----------------------------------------------------------- -• Date_..................................... Test Pit No. 1----------------minutes per inch Depth of "Pest Pit._________.___...... Depth to ground water....____._____.______... (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ -------- --- - - -------------- `0 Description of Soil--------- ------ -------------- ------_------_ L______ __ _______•--__ s.......:wP--•-••-•-•--'--...�_._...---•-------'...._...---...... ----- (� '--•-----------•-•-•----•-•-----•------._____..............•---•' .asps-.._'_._ _.. ••-----•-•--- — ----I------- ------ ---------------- •- .-,' .Qd.� ' r d� - ` - rl U Nature of Repairs or Alterations—Answer w appli ble-._ { ,� $ :.: __. . :_ _- __ ` ------•--------------------------------------------- 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 ©f health 0 s ` Dat Application Approved By.. ... r �t d Date Application Disapproved for the following reasons----------------------------------------Z ---------------------------•---•--------••--------- •--•---•-•--•--------_-••----------------------------------------•--•------------------------------------.. f Date PermitNo......................................................... Issued...... ------------- e THE COMMONWEALTH, OF MASSACHUSETTS BOARD M1OF HEALTH ts'" st.............OF. ... (Urtif rate of Totttphaurr THIS TO CE TIFY, l�a�the Individual Sep ai ee lDisposal Sys constructed ( ) or Repaired y - at_--•• y ..._.. � °•--.:. ----•-------- ---• -----= ---- •----•---•-••----•------'•------•------------------------= has been installed in accordance with the rovisions of Article X"lte Sanitary.............................................. as described in the application for Disposal Works Construction Permit No---------___....� _ __; datedy._._..__............__..._____.._._._.___.__._ ® ' THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------------------------------------------- Inspector---------------------------------------------------------------------•-------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD O� EALTH f fr . .. ............ ..OF:....... ..,. � ' No,- ----'=•'• FEE DinVofitt1 ark , Clonjtrurti Mi ,.•." Permission is hereby grante ,___ ._ __._.__ f�-.•........ :..... -.... --------------------------------------•---•-...------•-•'---_--_.. to Construct, ( or e it ( ,*" ndividualfSewage Disp L stem -- - . - � � .., Street as shown on the application for Disposal•Works . onstruction Pe No_ ___ _________ : Dated___.>�._ ___'� .__. r, Board of alth ° DATE..... -------------=--•"'--'-•-'---•• FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - - 2qYO Fs�.., ............... THE COMMONWEALTH OF MASSACHUSETTS EOARD . OF HEA - OF...........�� il . ...... ................ Appliration -for Uiopoottt Works Tonfitrurfinn, Vamit r _ Application is hereby made for a Permit to Construct ) or Re air ( ) an Individual Sewage .Disposal Sytema..: � __. e ..._...._...._ ._...........___...._.....................__............._.. t on. A or Lot No:er Address "---Cy --r.--•------------•--------------------------•------------- � = Installer Address QType of Buildi Size Lot............................Sq. feet U 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. 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....................... ------------------- ---------------------- --------- . Description of Soil s� ` ---------------------_--_----------------------------------- V - -- --•---s -------------------------------------------------------------------------------------------------------- -- _ W -------------- ------------ ---------- . ... = !� 4---f-4--�' ---- --- --- - UNature of Repairs or Alterations—Answer' hen applicable � � ir _._.. __.. -: /.-- --------------------------------------------------------------------------�= �d.�- . .. ------------------------- ------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue4bye bo:, ,_Z�td h. 3 Signed.�i •-- ---------- ---- --------------------- Date Application Approved By....... ill ate- Application Disapproved for the following reasons:................ . ------•----------------------------------------------------•-•------------'•--. --------------------------------•----------------------------------------------------'--'-------------....-----------------------------------------------------------------------------------------•-•--- Date Permit No......................................................... Issued---a�/.`¢� � Da N0.2!! ..1_.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . } r9 Apli iratiun -fur Mfipuutt1 Works Cnunitrurfi n Prrmit O Application is hereby made for a Permit to Construct •or Repair ( ) an Individual Sewage Disposal System at f _ x }/ L on,Ads or Lot No. � ((ff O er Address q Installer Address Q Type of Buildi Size Lot.................... ......Sq. feet U 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. 9 Septic Tank—Liquid capacity_.........gallons Length................ Width................ Diameter-----............ Depth................ T Disposal Trench—No_ _______________--_- Width-------------------- Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No--------------------- Diameter.................... Depth .below inlet-------------------- Total leaching area.__-.--.-------._-sq._ft. z Other Distribution bo*,(- .. ) Dosing tank ( ) aPercolation Test Results Performed by....... ...............•-••-----••••-••••....--•-----•------••-••----.... Date.................................... Test Pit No. 1................minutes per inch Depth .of Test Pit.................... Depth to ground water..-.---..___-.-.-__----- (ri// Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water__-__.-..-_--_--___----- P4 --------------------____________--------- ___y --- _ O Description of Soil- ----------------_ ..."".�---�.-�;��� "=. r Vt --- -- W '----------- ------ --------- -•- ;-_ �° U Nature of Repairs or Alterations—Answe hen applicabl _ � 4' ----y1;-6 /,---- i C -414 --------------------------------------------- --------------------------------- � ----------------------- 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./ /115 Signed .. � <, �� -----•-- ---- = r ¢ Date Application Approved BY---•-• Jl `� .... � &444.. �X ....... Date Application Disapproved for the following reasons:-- ------------- ----- -------------------------------------------------------- ------------------- ........................ ------------------------------------------------------------------•.----------------------------------------------------------• --------- ----------------- ----- --------- Date Permit No......................................................... Issued.., Ie .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OEHEALTH . ..... " OF............ - ................................ _. T'y- Trrtifirufr of Tompliunrr T[�r[ ' S TO ERTIFY, TtlAi�t he Indiv.isivah Sewage Disposal System constructed ( ) or Repaired - nstaller .:. ..::. PD -------- " ---­-------------------- at � '°°�� has been installed in accordance with the provisions of Article X, of he St to Sanitary Code a describ d i the application for Disposal Works Construction Permit No------------- _ ... _. dated. _ -- . .�....•.. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSYRUE® AS A Gv RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------------------------------------------------------------- Inspector.................................................................................... ! THE COMMONWEALTH OF MASSACHUSETTS e BOARD `"F . HEALTH �.........:.....OF................�........ ------.....---.......------.................. ' No........ FEE. �tn u4 � nrt� rrl�ti„,� _ Permission is hereby gra ___------ - ------ '"�''------- -----t-1A------------ -- - - ---...._..........----------------------------------••------- to. C tr ) or epair ) an I �i al Sewage Disposal System atN .•--••- ------------------ --- ---------- - ---- -- Street ' ed` as shown on the application for Disposal Works Constructio r it No � at --. . Board of Health DATE '. ---- FORM 1255 HOBBS &WARREN. INC.. PUBLISHERS