HomeMy WebLinkAbout0030 BRETWOOD LANE - Health T _ i
(30 Bretwood Lane
Centerville
IS A= 168-132
S M EAD®
No.3-953LOR
UPC 12534
smead.com • Made In USA
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THECOMMONWEALTH F s
BOARD OF HEALTH
Tee�..4......................0F.. � � ic�� -�3a
. E1JT��U IL - T�1 ..
Appliratiun for Rupuial Works Tonutrudiun Prrutit
Application is hereby made for a Permit to Construct r Rrpair ( ) an Individual Sewage Disposal
System at: 6 �
.... Gc.. ��....:::
oration-Address Lot No.
-11.4,................... .! .. .A11.�.1 .�.N�J .__.........__..._.
Ad
-- d4
I taller Address
Type of Building Size Lot.../���e���Q.._Sq. feet-t
U Dwelling—No. of Bedrooms............. ...........____ _____Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of ersons............................ Showers —
a g p ( ) Cafeteria ( )
P4Other fixtures ------------------------•------•---•------------------•--------------------------------------------------._...----...........-----------.....------•.
W Design Flow...........G-55.......................gallons per person per day. Total dail flow..... ��?e..................__..._•.gallons.
le
WSeptic Tank—Liquid capacity.l���.gallons Length-.�..... Width' --1.O... Diameter______________ DepthS..cS.....
x Disposal Trench—No. .................... Width_.I �I Total Length.............T..... Total leaching area....................sq. ft.
Seepage Pit No........:[----------- Diameter._ .. T&XDepth below inlet..... ......... Total leaching area.Zlt ZIO)sq. ft'-
Z Other Distribution box ( i,< Dosing tank ( )
aPercolation Test Results Performed by_.:15-1-A ..._ :.t�k I7s4EV—.i_� ez. Date....4B4a6'- ............
Test Pit No. 14.��_.--_-____minutes per inch Depth of Test Pit_. _�`._ Depth to ground water---140.1��--_.
f14 Test Pit No. 2.�40.._.._.:....minutes per inch Depth of Test Pit----..r� ----- Depth to ground water._N*).4:>_,___.
a --------------------------------------------------------------------
O Description of Soil I. " /C>_►',__.' ' .... , -� ��(�-I,Lr ---0gV.M - t '-
w --------- = 1+� 7Jl�M.._. '� 1 l,lf�_...._�'JIN 5�1✓i' ..�C�!`1 ....� _ .
xT� = = ITPt ------------------------------------------------------------------•-•----•---.....----•-----------------------
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 iI'112 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu d by the board of health.
Signed..-... 1_ ........ _W�eP.-
w Date
Application Approved B ._..--� ------• -
Date
Application Disapproved for the following reasons-----------------------••----•-•--•--....-•--•----------------•-••-----------•--•-----------•---•-------••------
.. ........ ..........................................................................•------_----
Permit No------OD.--� -� Date
l -------•----------
Date
"=JL TOWN OF D3AR STA LA
LOCATION �- 9 �� SEWAGE #
VILLAGE! Q .! s i.L ASSESSOR'S MAP LOT
INSTALLER'S NAME & PHONE NO. r�,6- lg5-3
SEPTIC TANK CAPACITY^��� (9,
LEACHING FACILITY:(type)_ —5:�l(size)�
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER (?,JTZ-R-A J
DATE PERMIT ISSUED:
DATE COUPLIANCE ISSUED.
VARIANCE GRANTED: Yes No
14
l t�
�e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Tl�G - OF..(G;5, .lTEk?IVILLF_'
Appliration for Disposal Works Cfun.strnrtion runfit
Application is hereby made for a Permit to Construct (v<or Repair ( ) an Individual Sewage Disposal
System at:
L roT - i
................__.._..................................................atioAddress -------yam .-- ------•------------- •----------.------------ - .. ..... -
ocation-Address ( •� o Lot No.
--.------
_ff Owne ,,pp �^
,Wa sh. . ° -.... ._A'r .._ . ��Z[ --XPP Ao 2� 7 o A vs�e?tt �`�ot- �L Z`
Installer Address 15 U Q
....
Type of Building 2 Size Lot.._____...:.......... ...Sq. feet t
►, Dwelling—No. of Bedrooms...........✓...........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures
W Design Flow--_----____ _______________________gallons per person per day. Total daily flow......�.�.�'� ........................gallons.
WSeptic Tank—Liquid capacity.1��_gallons Length�p'}._ ?..... Width�_.� _._ Diameter................ Depth5.r 5.....
x Disposal Trench—`o..................... Width..'%)«...... Total Length............. Total leaching area..............._..sq. ft.
Seepage Pit No..................... Diameter•!_.Z--.��F-� !`'-Depth below inlet..... Total leachingarea.20!- q. ft.t
Z Other Distribution box ( f.-< Dosing tank
Percolation Test Results Performed b .. T_.. �=-`�_. �15 :!�s 1- 6//o 16
�' Date
Y . . f1
,a Test Pit No. 1G:._�'�_.......minutes per inch Depth of Test Pit.-,I' -....__ Depth to ground water-._�UN r__.
fq Test Pit No. 2�-.Z--__..minutes per inch Depth of Test Pit---- Depth to ground
a' ........•-----------------------------------------•------------•--------•..............................................;---•••----.._..
0 Description of Soil__.t.1.... ___._M f l-�t -ro-..._r/:P rr .�A ktrD._.OWDEP- 3Z .Tal t} CJIL-
-- -
-� �� � 1NF `!� <_,u�r�c 'oM C .nrr ► v...IDf
x -------------------------- -=�`. MD�' � _��������. ----------------------------------------------------------------------------
�� --•--
U Nature of Repairs or Alterations—Answer when applicable...................................................................................:..........
.• ----••......-•-----•----• ••----------------------•-----•---------•-•-•--•-•------••--...-••----------•-•---•------•--•------•--••-••--•-----•-.
S Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITU- 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 - - --- - :- 62/ - .
Date
Application Approved BY-------J_.. _ -*X -----•--.
l./ .'� � Date
Application Disapproved for the following reasons:-•------------•-------------•---•---------------.....--•-----•------------------•--------•------•-----••••------
...---------•----•-••---•---••--------------------•-----•••-•---........---•---•.._.........------------.-•-------........--•-••--•---••--••---•----•-•-----------•••------••--••-•--•-••...----.....---
Date
PermitNo...... ....... -------------•-•----- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r.......Lz.......�........OF...........L ' ..t°.:. .....'.. ..................................
Tatifiratr of Tomplinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ^or Repaired ( )
'f / U .�j/J Installer
at /_G_-1... ------------------ .............................................................
has been installed in accordance with the provisions of TITLE 5 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 WILL FUNCTION SAT! .A TORY.
DATE..........................
cam.............. Inspector..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH/
%..4: .. ..........OF..........�:� , � E c:�.�C'6K,.C............
6&a IL NO.._ ..._. FEE....... .........
Disposal Mork.5 Tonu#rnr#iu nmi#
Permission is hereby granted (�::t....::r...''-----•• ---- f'--- .....--•----------------------------•---.............---••---......
to Construct ( ) or Repair ( ) an Individual Sewage Disposal SPs'tem
Street
as shown on the application for Disposal Works Construction Permit No.y :>. �__ Dated- - -- -------------•--
"� ..................................
i
Board of Health
DATE.............=------------�_..--�•,-��.-----•---------••---
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
AEVISIONS By
�.�ELEVA rIONS OE:SI(3N CALCULATIONS
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