HomeMy WebLinkAbout0029 WINDSHORE DRIVE - Health wfndShort fir., grt"3
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ZBA - 02-24-16
0 universal.
www.myuniversalop.com
phone: 1-800-756-4676
UNV12110
MADE IN USA
ILO•CATION SEWAGE PERMIT NO.
VILLAGE
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INSTALLER'S NAME & ADDRESS
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BUILDER OR OWNER
L DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED 7
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
G;I CJ.0...........OF..... 0.,--------------------------------------............
Apli iration -for Uhipoiitti Works CnoYt� r rtiott rro�i
Application is hereby made for a Permit to Construct ( � or Repair ( ) an Individual Sewage Disposal
System at:
,.
D f - � � _ � . A. ----------------------------------------------
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Locat' Address or Lot No.
Owner Address
W
Installer Address
d Type of Building Size Lot... ..47 C'__Sq. feet
U Dwelling—No. of Bedrooms---_--_--.�------------------------------Expansion Attic ( ) Garbage Grinder
aOther—Type of Building _-./........................ No. of persons............................ Showers ( ) — Cafeteria ( )
Pa Other fixtures ...../" 0A.f------------------------------
W Design Flow----------- �-'---------------------ff llons per person per day. Total daily flow.........�_�:�_____.._.._.........gallons.
WSeptic TctnkLiquid capacity�,��2--gallons Length---------------- Width................ lliarneter---------------- Depth-------------...
x Disposal Trench—No--------------------- Wi�drtth+__-.--_.._---._____ Total Length.................... Total leaching area..............------sq. ft.
Seepage Pit No./�..�.A`/DiameterOAA<_.��th below inlet.................... Total leaching area..11.27___sq. ft.
z Other Distribution box (1Jf Dosing tank4,of
4 ,
~" Percolation Test Results Performed by...___--. ---------------�L. _-*��.1-:._.. Date_-_--__--_---_--__- .-_-_--_-__._...
Test Pit No. 1__ ------minutes per inch Depest Pit____________________ Depth to ground water-..-_--..-.---..-_._..--
rXq Test Pit No. 2................minutes per inch Depth of Test Pit--_--_---_-______- Depth to ground water............------.--.--
----------------
--- ------. -
O ` z I 1
----- ----- - --- /
Description o Soil---------�.-•--_2..- � '�-t V. cam`' y�....�� P.
U -- ------ ` ----Gvw ------ -------------------------`----------------------------------------
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VNature 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 \I 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.
+ oe� r
}� _ Date
Application Approved B
PP PP Y------ .fir---------- ----�------ ----L�-� --- -=---------------------------- --1�---Z-�"-.7-+�----.._...
Date
Application Disapproved for the following reasons:.................................................................................................................
...............••-••--._........._••--------•-----------------•-••........••-•-••-•----------••••-•-----.•-------------------------•---------------•-----------•----------•--........--•-•-------------.
Permit No.............----........................................ Issued.......
'
R/ Date '
3� .
..�- 4Z..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........OF.........:... , !, /..�...... -
Application -for Mapoottl Workii Towarnrtion Vrrniit
k=, Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at ' J.
r
- p . . --------------------------------..........
Locat/i -Address( or Lot Pio.
�e!_�° '_.. = r /`'✓fftC l�..................•------•-----------•---•--------
Owner Address
W
Installer Address
U Type of„�$uilding " .. r Size Lot-.-.�, __�? _Sq. feet
., Dwelling—No. of Bedrooms _-_- . �:_-u________________ ____ At Expansion tic Garbage Grinder (,14
`4 O.t1.e! T e'of Building No. of ersons x a °' �-- ` Showers — Cafeteria
dOther fixtures °�T'tf+._'t`'................................... ..........---- .................................... ----------- ------------------
W Design Flow------------ _______________________gillons per person per day. Total daily flow.._.._.-_.�_.�-_.�-_---_-._-.I.._....gallons.
W Septic Tank Liquid capacity ITaallons Len-th_____________ r'_� `'
a bVidth---------------- lliameter.----�=-'-'--.. De nth-----.----.--
x Disposal Trench—No. , r a .----- t g g t •..�._. q
Seepage Pit No./ �_. iameter ----- h below inlet................... Total leaching area sc. it.
i tl __ ota Length
� --•---•__-- Total leaching •irca._.••-------.-._._.s t. i
z Other Distribution box ( L�' Dosing tank ( �,�1 /:4" o '
Percolation Test Resin Performed b Depth toio nd water...._.__.__ .__ ..
y--•......aD y'r' f. Date
Test Pit No. 1__ ______.minutes per inch Depth of Pest Prt.. _....____ p a
(s, Test Pit No. 2................minutes per inch Depth of Test Pit_....._...__--.._.._ Depth to ground water------------------------
---
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O Description Soil r � - --
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-------------�1--�, 1 - - •. ---------- -------- -- ----- -
------------------------------------
fV :1�1 Nature of Repairs or Alterations—Answer when applicable......................__--.-__----.-.-_., .:_.___.._:-_:__..-_-__.--.---.-.._.._--.--..-.-._-.
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Agreement
} The undersigned''agrees to install the aforedescrib'ed Individual Sewage Disposat,System, n'accordance with
the provisions of Article YI 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.
Si ed 01
... ,_. . �
Date
Application Approved BY...... #/•-•---- ---- 1-2:n2.;P_l-77------•-
�/ Date
Application Disapproved for the f ollowing redsons: 5______ __________
--....--•-----....--•------------------------•--....... ---------------...__. _ b' .................. '
Permit No----------------- Issued.. ....... ......... ...........................
Date
THE COMMONWEALTH,OF`--MASSACHUSETTS
BOARD OF HEALTH .
r
�prti�ir�t �f f��rtt��li�nr.r
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (4 -ror Repaired ( )
' by ------------------------- ---- ------------------ --- ---- --- ---------------------------------------------------------------------------
$pR:-------.�`f-tr--------- �j`���f�------------------------------------------------------------------------------
has been installed in accordance with the provisions 0f' 5i J 1I of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. ___________________ dated..... T--�.:"w'._�_--'��
THE. ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM"tWILL FUNCTION SATISFACTORY.
DATE--=, - a�- --- C F,, Inspector..............
- -•----------••------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7� .
aoAw.A............... OF----- ''��..f i�''.r. . ................................._
No.......................... FEE---- mac- ---------
Dinpoiitt1 ork-q 01onitrnrtion . rrmit
Permission is hereby granted--------------------------------------------- ---`
to Const uct ('-or Repair ) an Individual wage Disposal System
at No.-
Street
as shown on the application for Disposal Works Construction Permit No ______________ Dated .........
----------------------------------
,. � Boardaof ealth. ' '
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DATE_
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