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Home My WebLink About0079 BRETWOOD LANE - Health Q .f t w0d Ce ATCVvi;I It f68 — 127 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED jQINITIATIVE CONTENT10%If jai CertiBed Fiber Sourcing POST-CONSUMER wimadpropremmarp smolzo MADE IN USA GET ORGANIZED AT SMEAA.COU L Sewer Permit No. Name IQ Locatlon /i4levt/ �. lustalier's'Name.and-Address - w Builder's Name and Address Date Permit Issued: ' Date Compliance Issued:—�" v E-3 r f r i 6 r 3�' No.. .' Ye FEs..... ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...................... .. .............OF..........................................----------------.....-----..................._. Appliratiurt for Uiipuual Workii Tomitrurtiun rafttit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: QE�/T.yl®o.t7..... 1 s✓t_ �9---•------------•-•-•-------------------- ..:.............__- •-----•--••. •••----.....----.... ...-- Location-Address or Lot No. Owner Address W fYI�. Yn - _... 1�1.7 �-......... -•----------------------•--- ...................................... .............................. ... . Installer Address dType of Building Size Lot----------------------------Sq. feet U Dwelling No. of Bedrooms................ . _Ex anion Attic Garba Grinder Other—Type of Building _ k��.C-/___________ No. of persons...........a............. Showers Cafeteria ( ) a' Other fixtures P1j!�_1 .........Auixv/&&.inn- I ---------------------------------------------- W Design. Flow.......//'Q...............................gallons per person per day. Total daily flow----------!_3.k..............-_......gallons. WSeptic Tank—Liquid capacity./090..gallons Length...._.......... Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.___-_.1......._... 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----_-_.-_lam_. .. 1� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ------------------------------------------------------------------------------------•---•-••-------........................................................ 0 Description of Soil-------------------------------------------------------------------- --------------------------------------------------------------------------•-------..........••---- V W ---------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------- x 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 TL ITI.i. 5 of the State Sanitary Code—Th undersigned furtl: a es not to place the syste n operation until a Certificate of Compliance has bee i ed the boar healt . i -S3 " D ApplicationApproved By-----......:' ---------------------------•-••------------......-----------------------------• --- ...L® ..r.. Date Application Disapproved r t followin r 6 ----. ------ . - -----------------------------------------------------------••-•--- Date PermitNo......................................................... Issued....................................................... . Date 1/0 No.. . ..... .�. FEB..... ..........•. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................_OF............................................-----......-.................................. Appliration for Uiipnsal Workii Tonotxnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... , w7. �� ........ ............•••--••-•,..qb g.............. ...................•.................... Location-Address or Lot No. Owner Address W Z-VVA1P"-)! .........AAI-StX.4�......... .............................. 'ZIdu..17.kIKAY..................................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...."I.............k__---_--__-__--__--Expansion Attic ( ) Garba Grinder ( ) Other—Type of Building . JWC. _ _yp g ......... .......... No. of persons._...__._..4(;_......_.__.. Showers ( — Cafeteria ( ) Other fixtures ............�1LS;/_( Afls "p I•�l�! G. da_CN/.rv * W Design Flow.......1/Q.-----------------------------gallons per person per day. Total daily flow...........r�'..I d-........_............gallons. WSeptic Tank.,—Liquid capacity../400gallons 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................_...._...._ _.. W �.. minutes per inch Depth of _Test Pit Depth to ground water--___-_____ � Test Pit No. 1--------�----- ---- .. -- (Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •---•-------------------••--•-•--------•----•-----•••-•......•---•-----......_........_...-••.----•-............................... •......----••----------•- x 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 TITLE 5 of the State Sanitary Code—/Tinh undersigned furthe .agr yes not to place the,system n operation until a Certificate of Compliance has been s edhe board hea th! 13 Application Approved BIt1hollowingr ` Date Application Disapproved Ire o --------------------------------------------- Date PermitNo....................................................... Issued-------................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................1.........OF... ................................................................................. Trrtifiratr of TompliFanrr T S'IS CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by = •---------------- - ----• • -•---•-• ................ � � / nstaller ------------ has een installed in accordance with the provisions of TIT rg. 5 of��T//he State Sanitary od as de, ed,6m the application for Disposal Works Construction >xt No..___ .'`-„ .7-Q__.___.___. dated-.----- fl tr' e . -- ------ THE ISS E OF THIS CERMF`ICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE SYSTEM 1N L AUNCTION SATISFACTORY. DATE...` .L�. ._... Inspector...... .. :.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH k ...........................................OF..................................................................................... C� No.-•d ._.._.. FEE........................ Permission ' reby granted-•-- . = x to Construe orepair ( ) ndividual Sevc�age Disposal System atNo.. �._... ..-----•--•........................... ="= Street as shown on the application for Disposal Works Construction Permit No....... ....: ..... Da - .._:7_....'.._._..df......_........._.. `........... ..............%�.'---------------...--------------............. Board of Health....:...._.,,, DATE....................................�-�f. e�'�'..�-..---- ---..-. -. FORM 125S HOBBS & WARREN. INC.. PUBLISHERS • j�' S►�G►,.E FAM►LY � B�.ORooM �. ' IJC GARBAGE fJQ�IJAFsR. � I I o�a►�.Y F"ow : Ilox 3 = a3oG•gp - 2 �� _.. . Ir,l . f 15EPT1G TANG = 33o>K15�Y• =�95G.P. R f 1 ..,. USC %000 o►SPosA� PIT � - v6E } . f ., :. �a 4,; , 3, BOTTOM Atzf-A r Z 3 6-rf, YLI 'Td1'A1- D6•SIGN TOT A�- pA l l.�{ F�-oY�(. 3 O G•PR I + ` . V� � f �, i, M "` .i. arI GN PATE{TI''►tj ZNN o�LF 55► 9� , �t. WILUAM cyJ'� 2,41 C. No. 19334 }.'u J1oI G — L 13 o� 7- .-ALnN JONES l F , t r t i 4-t FG �Oo's TOP FWD 5%0 s ' • o►.ft' T �_;mot f a � !.� c r � i , et o' 4, g✓85avc... I •�- ' ' D INY' t�L •�; 9 ` ti r r Z 0-1 �W�! :94B.4 Th K IT , kkk INY. WTN � WASNGp t ' . I( :41 "``'j C�RTItrICsO PI- T A1•I � /I f ,�.2 k1T' PR.O F I LE. . • - �vPos�,KSaiµovYN PLAN RE D � •GEQ•T1FY 'THAT ?N1"c K6,R6aN .oMpL45 1nlITN'TN� S I o�L1N Es A SVT5►GK R.6RLa►R.EM�N'T� OF•YµE- ��c..r-�pC�tj �..1.1�. C3,&XA6-rA.15t.E. AN'D I lj Iw'T'- _r L.oGp►'T o •WtT IIJ PATE 21 BA*AT rsv-� IJYE M - . . REG 1'y'T 6.Q6'D 4.AN D•S u R.Y��oe"� -rwo PL&M 1�i Na1' BASS b AN- osTER-YILLFs' • p35... I= I INST•RuMENT -5V2VG--Y 4'TNE Or-0,6E"f5 suou►.'D No t3G- �V�C•f�'Cc+ C�C'Tt�.c•-MI►JC �.n'�..