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Home My WebLink About0057 WINDSHORE DRIVE - Health 5 W ndshoce, be$, F ZBA - 03-23-16 j I F t O Z z � W t ` � W W � A a W ,w� � ti W � W 1 c e\ z y V 3 z 3 h Z IIQII is oc O' Z 4c °� o THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7/P..................OF......., .. ,r r Jr..................... ......_... Appliration for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct (vj or Repair ( ) an Individual Sewage Disposal System at: ' ..... !, Z......` � ..� C_+? °e-....Pe ....••--•.......... ...................• � ." . �� ............. cation-Ad s or No. ...... �. ' . ............. ------------ - ' -------------•----•-.._._.... ---•-••--- ----- .r ..L. -.----------------•---•---------------------- -� Owner Address W Installer Address Type of Building Size Lot... 1 2 .................Sq. feet aDwelling—No. of Bedrooms............,...........................Expansion Attic ( ) Garbage Grinder aOther—Type of Building .................. No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------ ---------- ---------------------------------------------------•-••--------- 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..................... Widt ji.........._.._..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.. 4?L DiametezM below inlet... Total leachingarea---V 2 s ft. Z Other Distribution box ( ) Dosing tank )ID� "40xi /D -7- 77 '~ Percolation Test Results Performed by............. t----. Date..../a-n._7..:7. ............ aTest Pit No. 1................minutes per inch Depth o Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............................ ........................... P ' / -. ----. -'�"�""'""l-� .---------.--------_. ODescriptign of Soil -- - ....... .�........... ..... ............ •..._- .... ---S ------------------------------............. x ...................... -- = 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 iITI,i� 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 Ilealth. Sig - _� � ``----• ... �02.7Date Application Approved BY ,&! ✓l._.._ p.................•--........-- •-•---.1' ' 7 7 Date Application Disapproved for the following reasons---------------••----•--•------•-------=-----------------------•----------------•-----------•---••-•••----.....-- --------------------•---......--------------------------------••--....--••--......------------.......--------------------•-••-••--•----••-••----••--•--•-••-----•-----------••------••--••••------------ �' ^ —7 Date o[ Permit No......................................................... Issued._. . Date ; No................_....... Fps...... ................._ THE;COMMONWEALTH OF MASSACHUSETTS �. BOARD OF HEALTH I '. yr` .................OF...... ,tv/. ........................................ Appiiration for Bisvnntt1 Work.5 Tomitrnrtion rnmit Application is hereby made for a Permit to Construct ( ), or Repair ( ) an Individual Sewage Disposal System S ` cation-AdAefts orb, No. - .... -.: .. .......................... ....................... -- Owner Address W a =. .................................................... Installer., , Address Q Type of'.Building ;: EM yT 1 Size Lot... �!`}a-----__-Sq. feet V Dwelhn —No. f Bedrooms Expansion Attic d g _...__ p ( ). Garbage Grinder y ther�f I e of'13uiIdin p.-I� yp g No. of persons_ `_ Showers ( ) — Cafeteria Otherfixtures f �..............................t......................................................... Ions Septic Tank—Liquid'capacity............gallons P Length................ Width................ Diameter.................r Depth._._....... Design Flow.............:... .........•....•..____gallons per person per day. Total daily flow.......... W Disposal Trench No Wid T.. otal Length.................... Total leaching area...... sq. ft. x � _ Seepage Pit Nod - Diametet� _ ! pth below inlet•.. .............. Total leaching area_ " _._._sq. ft. z Other Distribution box ( ) Dosing tank /0 7 77 '-' Percolation Test Results P&formed b �ITe .._ /►. ......... Date__ . _ _Test Pit No. 1________________minutes per incepth Pit.................... Depth to ground water........................ ; Test Pit No. 2„..............minutes perX inchter Depth of Test Pit.................... Depth to ground water....................... r0 Descri tipn off Soil " Q ,.!°ee ------------------------- x ---------------------I-------_I........... f.... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................... -•----. --• •••-• -• •-- -• ----• ............................. Agreement The.,undersigned agrees to.it4iall the afore'described Individual-Sewage Disposal System in accordance with the provisions of TITI - 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 bealth t 20V/.. ..... Date ... Application Approved BY......- .. t 11s4?!� ..................--•------- .. Date Application Disapproved f or. the f ollozvang.reasons: •----:--- ------------------------------------•---------------------•-••-•--- . t. J ____________________________________________„_._____....____........._...._ - .........a _ ..... .................. ...................... } ,4.. Date PermitNo................................•--------••-•-•-•----... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ,g BOARD OF .HEALTH .............::O F.... ...... f�� rr�ifirtttr oaf ��ant�Iittnr� THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (1417 or Repaired ( ) atc ra '. __F_*Tf�` �i i�!_ _ A�!......... r Install. --• � y------------------------------------------------------------------------- has been installed in accordance with the provisions o *j The State Sanitary Code as described in the application for-Disposal Works Construction Permit No-----------------------------_............. t' .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G87ARANTEE THAT THE SYSTEM `WILL FUNCTION SATISFACTORY. DATE................................................................•...----._..... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS 7 BOARD QF HEALTH ...............OF..../�.� .. f ....................... �... No......................... F ................... latilmial Workii TIFAInlitrn.rttiart rrndt Permission is hereby granted.-•-••---•--•••---...-•••---•--••...... " ......:= to Con r t ) or:R a ( ) n Individual S . age Dispos , System e� , at N r Street as shown on the application for Disposal Works Construction Perrp4 No ___ ___________ Dated.�/°yt_^_� z7 ----- k�. •_._••-•____ , _ .................................„ Board of ea h DATE.............................................................................. .: FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS sso 6.pV. L )3 ��1^�1-I c Tl�.t IC _ �30,� !So �,lo • 4�1 g 6.1?�� use o0o CAL.. lo �ISPoSAt PIT - usa✓ logo Gam. 1 i;_ _; ; �•�G y2` �•�'� SMGWAL.L MEA = l'So s P. 5 F sic 2.S BOrr AA A1ZeA e 000 � A CBD sue-. ► .o _ 0 s.RD. TCrr,&L 'DSGI&W = 42S G.P.D. 330 6.PD to Pmcotp"I' mj K e l e C t0 L-M t N' ,DK. 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