HomeMy WebLinkAbout0040 SEABROOK ROAD - Health (2) Ro SeabruoV. Road , y�u�ri�s
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ASSESSORS MAP NO:
PARCEL NO.:
No..96 FEB..... ...
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
UC 'i't. ..............OF...81r#,75, a..p.'Q? ...-..
ApplirFation for �i-spooFal Works Tonitrarrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (44, an Individual Sewage Disposal
System at:
..... 4!�._y.._.�. t:«�.....
-�A..d.dress a ................... ....................-.•--------....----...--o•r-•-L•-o-t-------- ---
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Location 'cat ----------•------------•.................................. ....�.........:.1 ......... ..............................
a Ada c Owner so /1� Ad
-
"
------. X1 �o. --•-•----
Installer Address
Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.....................--..... Showers ( ) — Cafeteria ( )
dOther 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 Test Pit--.................. Depth to ground water---------..............
.
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit---................. Depth to ground water------..................
P4 --•-•-•---•--------------•••------•••------••--•------......----•--•--------•-........_..............•---------•-.............•-----•--•••..........---.•-•--
0 Description of Soil..,,.....................................................................................................................................................................
x
W ------------------------------------------------ -----------------------------•---•----------•-••--•---
-�xj Nat re of Repairs or Alter ions—Answer when applicable n.s ---lrz.00 Ld
re c� �° ------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of is T "of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issue4 by the board of health.
Signed-
------------------------------------ •.--?-Z�' 6
te
-
D j
Application Approved By--••---•-�-.�-- - ........-/
Date
Application Disapproved for the following reasons---------------•---------------------•--•------------•---------•-.............................................
•••----•-•--•-•--•................•••---...-----------•--•---------------••••--•-----...••................---•----•------------•---•--•----•--------.:....•-------------•--•-•-•--------••-------------
Date
PermitNo......................................................... Issued.....................................
Date
Fint.... ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD AOF HEALTH
................... ... ........................................................
Appfiration for Uhipasal Works Tomitrurtiott ramit
Application is hereby made for a Permit to Construct or Repair ,(V,) an Individual Sewage Disposal
System at:
....qnL yMlo...................... ..................................................................................................
Location-Addres 410 ...............�K h.......................................................... ........... . ....... -Lo ...............................
Ow.er yy J rAddr,;,,j...................
........ .........
Installer Address �7
Type of Building Size Lot............................Sq. feet
U
Dwelling.—No. of Bedrooms..................................... ...Expansion Attic Garbage Grinder
a
,Other Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfixtures ------------------------------------------------------------------------------------------------------------------------------------------------------
W
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1
04 Septic Tank—Liquid capacity............gallons Length................ Width..._._.._._.___. Diameter---------------- Depth................
Disposal Trench—NTo----_-------------- Width.................... Total Length.................... Total leaching area___ sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet................_... Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by......................................................................... Date-----------------------------------.....
Test Pit No. I................minutes per inch Depth of Test Pit.._.._.............. Depth to ground water--_______-____.___-----.
G%, Test Pit No. 2................minutes per inch Depth of Test Pit..._......_......... Depth to ground water...................._...
.............................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
W
U .......................................................................................................................................................................................................
............... ............................................................................................................................................1:11--------------- .. . ...............
U Nature of Repairs or Alterations—Answer when applicable. ........i.................
.....................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of -5 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.
Signed,,,f_—k--2-',.... ..Ott ..................................... ...
Date/
Application Approved By.............. ........... --------------------------------- ......
a Date
Application Disapproved for the following reasons:..............................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....... .........OF... ..................................................
fit
Qwwrtifiratr of Tompliaurr
THIS IS fXE�RTIFY, That the Individual Sewage Disposal System constructed or Repairedby....................4 ...... ...................................................................................................................................................
at..........................9.J_.... —---------------------------------------------------------------------------------------------------
has been instilled in accordance with the provisions of TILT-LE. Of The State Sanitary Code qs descriWd in the
application for Disposal Works Construction Permit No_ =Tlz—------ dated-.---_-- ............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT YHE
SYSTEM WILL AUNCTION ATISFACTORY.
DATE... ....................... Inspector.....-7-Te-k
..............................................................................
V'A' 6 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H ALTH
OF...8-6o."DP4..................................................
.................
No. FEE.. 26...............
Permission is hereby ranted. ............. .....04.. .......................................................................................
to Construct or Repair X an Individual Sewage Disposal System
atNo..................(0.........I'S A ...............................................
et
as shown on the application for Disposal Works Construction Pre it No.-__-_-_-_----_ Dated..........................................
`7 Boar of e
...I.T . .....................................
DATE.................. ........................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS