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Home My WebLink About0019 WINDSHORE DRIVE - Health 07 ZBA - 02-10-1 s 0 Laversal. www.myuniversalop.com phone: 1-800-75&4676 UNV12110 MADE IN USA 4 LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLEIt S NAME & ADDRESS �r- ®r,/� Co BUILDER OR OWNER DATE PERMIl ISSUED �� o 77 DAT E COMPLIANCE ISSUED -2 -7 v � , '�� . .��_ _�� r � � .� e `�. . � �y � � �' c ��" j .. i` V • i ... // No....... ,_ .r `f FRS..: 7.--------------- THE COMMONWEALTH OF MASSACHUSETTS e. BOARD O,F HEALTH ...... TCXIU/,/.-- .OF...... . ,�11 1�. ................................ Apphratinn -fur Bhip iial Workii Tonotrnrtion VrrntW Application is hereby made for a Permit to Construct (6,4-or Repair ( ) an Individual Sewage Disposal System at: ^ f---------------- .................. l oyatQn- dress �i or t No. a /A Owner Address--------- ... (O""t ........................... ��..777 Installer Address � Type of Building Size Lot... li_l--____Sq. feet V Dwelling—No. of Bedrooms---------- ............................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ---------------------------- No. of persons------------- ( ) — ( )_______________ Showers Cafeteria P4 Other fixtures -------------------------------- w Design Flow......... .... _••-_-__-- Mons per person.per er day. Total daily flow-__--_______ _c��_._ g ----------------- g< P P P Y• Y ��_.--- - --------------gallons. WSeptic Tank—Liquid capacity/CX-1 gallons Length._'............. Width................ Diameter---------- Depth.--.-_--_---_--. x Disposal Trench—No..................... Width-------------------- Total Length-------------------- -Total leaching area--------------------sq. ft. Seepage Pit No„lB-VV DiameteaiA%-eA Depth below inlet .. ........... Total leaching 91-�area q. ft. . z Other Distribution box ( ) Dosing tank ( ) d� l aPercolation Test Results Performed by------ L(... V........... Date.__/49._-�_-_7_---_-_-.--. Test Pit No. 1................minutes per inch Deptff of Test Pit.................... Depth to ground water...----------.._--__--.- LT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ----------------------------------- ----------------- -- -- _. . ----------------y Description of Soil. Q-" 2 ` ------ �' --- ------- 4 j x 4/ ----- w UNature 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 further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. f 7�77 Sig ( /f Date Application Approved BY----,� ----- --- ..... .-. Date oved for the following reasons:-------•.................................................................---------- Application Disap�_ ------------------------------------------------------------------------------------•-------•----•--•-•-------•---•--•---•------••--•--------•---------------------------•--------.-----.----------------•-------- `� Date / r Permit No. Issued...... ................................... Date No.............. Fizs..........4....... THE COMMONWEALTH OF MASSACH-6PETTS N BOARD 0 HEALTH ................................... ........... ..e&......OF...... ........... ......!P� Appliration -for ER-4polial Workii Tomitrurtion Prrmil Application�is,hereby made for a Permit to Construct (4,)-06r-Repair an Individual Sewage Disposal System t 71 ... . . ............ ................ ................... . . .. . ............................................................. or t No. .............. ..... P.. ............. ............ ........... . . ... .......... ................................................... Owner Address ............. ................................. .................................................................................................. Installer Address Type of Building Size Lot ------Sq. feet U Dwe fi —No. of Bedrooms.___.___. ..:2— I Ing _________________________Expansion Attic Garbage Grinder VK� Other—Type of Building ------_--------------_---- No. of persons---------------_----------- $howers ( ) — Cafeteria ( ) Other ,fixtures ...... ----------------------------------------------------------------------------------------------------------------------------------------------- Design Flow___-. -- ......................gallons per person per day. Total daily flow---____---1gP_;4-_0--------_-------gallons. 9 Septic Tank—Liquid capacityAW-k --gallons Length--------------- Width--.--.. .--- Diameter-----------I.... Depth---------------- Disposal Trench No ------------- Width___ -,-�r-------_- Total Length.................... Total leaching area.._..------_-------sq. ft. Seepage Pit NoM. ._.0Qj__' DiameteJA94II& RRIepth below inlet.................... Total leaching area.___W- K.$—sq. ft. Z Other Distribution,box ( ) Dosing tank ( ) Percolation Test Results Performed by--------- ---------------------------------------------------------------- Date---------------I-------------------------- Test Pit No,.-L�--------------nunutes 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-- ..----_---.--------. i�, ., ---•-------- ----------- - ------------ - ---------------- - - ------------------------I------ .......k ---------- Description of Soil------ ------------------------------ - ----- -----------------------------_ 'D - .1. ... -- -----------;("--2 3 U ------------------------------------- • ------------------- - ---- /_,S__!...... —-----------------------------------------:------------------------------------------- ------------------_----- --------------------------------------------------------------------------------------------------------------------------------------------------_----------------------- 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 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. Sig . .. .. ........ r-,' -7 D U !Application Approved By------- --- -- ---- ......... 4e-* 6P ate 7 Date Application Disapproved for the following reasons:-----------------------------------------------------------------------------------------------------i........... ..........................................................................................................---------------------------------------------- ------------------------------------------- Date PermitNo........................................... .............. Issued. ..................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH of "'7.......................................... (9rdif iratr of 0.11ontlifiatta THI T0,VT)RT1,,F'R,,, That the Individual Sewage Disposal System constructed tZo)-or Repaired by..--..----- .p...... .. ....(A.-I ....................................................................... ........................................................................ ....................................................................... at...d"l—r/T ..................... has been installed in accordance with the provisions of ofi XI of The State Sanitary Code as described in the application"fo,r,Disposal,�NVorks Construction Permit No. .0 ;1, --------------------- dated..... 7;......... THE ISSUANCE OF.THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector............................... ....................... ....................... THE 'ebM,MONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0)777� 0 ................................................... No. j. FEE.... .............. Permisision is hereby granted... ...... _4_ ------------------------- ---------------------------------------------------------------------------- to Constriluc; or Repair.. an Indio dual Sewage Disposal, System Z .......... at No..... . ..... ........2.......... --- --- --------------- street as shown on the application.for Disposa4',W 77 orks Construction Per5a*�;,No---Z---------------- Dated-4-- ;27- -7................................ Al TOO-- Board of He.1ti7__ DATE ......................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS co r.1 L 3 ov ISc F?D. U S4 O C>Ca 6 A L. �$ ��tr��•'l�.L PIT - IJSE lOcx, ��. L--� C1 V.t3ox uc/ALL AEA. = tSo s.t-. irk -Sp 2.S = S77S G.P.0 . P� Y PROP D'LLJ, d rr}j/I TOTAL 'F->ES16,K] = 42S G.P.D. o�✓D� P t---izGDLQTk0Q CZIITE CIQ ZMIIJ` 02 LES1,. txP. 00 �f1 t � Z �z�e soi� 4'ppF 1W. 6&L. ,r -Box Yc.4 SEQric t o A iDOO �iNv. �►N. 9G:Z R'. . AY25 GAL• LEAa N �a PIT e• Cow RsC W(ro .� WASHED d <.,nraDY ,TONE= 89. ] artAve� /o� �•o• � �. CCZT pt._b'T' PQo>✓t L_ L oGAT l a" N Y N IV t S L!o SCnI_ I V 4 0' bA.TC 1 0/7 /7 7 w v'Y A,-c R Q4'G po6 6' 4 C t.1Z-r t t--1 T�-!A T' T 1-d 1Z F c, �.1 u< t,tr�� cc�ti�nL�s �� tT�t T►�� St vr.t_t►�� L o T 1 S h.ti.!to •>L"C�A C 4! �'C-C,�U t�E M�.t,.lT; D� T N �hw►� cY= �i?,�12�JSTA�( �` WEST fit+/ O L-12pAyrl' LG ��•�AT C 1Z_ <' �• Tt-d 1�, n c�na.t t t...IOT 11&131-0 0" %W ;t.lyt'r'J;nr_►.lT f,Uc_.�� ti 'Y►tc cal-c_ ��=r�, �Il�wts� A�arTt_tCAo-..1T' CA.Pe Wsc�. E T'G t�r.ri_C�Mtl�lt 1 >T t_li�ta