HomeMy WebLinkAbout0108 WESTBURY WAY - Health l08 WW�s- buf-�-GWo-kA-
Caq - bits
C
LOCAT-0 N � SEWAG E PERMIT NQ.
Lo l` 8 5---
MILLAGE _f
(n f f
INSTALLER'S NA H.E 8 ADDRESS
D U I L D E R OR OWNER (
s DA T E P ERMIT ISSUE D
DATE COMPLIANCE ISSUED ��„ t1�-
e c
f�
.r A�
r,
No 0"� 4 Fua...... X .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HE
/ V'vG y v Y
1
l . . ............ O F........:.............................---------------------------------._..............-_
Appliration for Disposal lark Can �trnr#tnn rrnnit
Application is hereby made for a Permit to Cons ruct ( or Repair ( } an dividual Sewage Disposal
System at: � - ------ - -------- ---- -------�=�-
........��-- (J - .... .....
1:�•••ion' ess r t•No.rr ;
. _. '�: 1---------- ---------------�'h..°�'� -f--------••--••--•-----........_....------.....
.... L l s
�Y......_.n1. � d't
r -
Installer Add ress
Type of Building Size Loto�.. _ ____.._Sq. feet
Dwelling—No. of Bedrooms__.___ Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons____________________________ Showers — Cafeteria
P4 Other fixtu
W Design Flow................... _.......____gallons per person per day. Total daily flow____._3 �__.__..____.____.._gallons.
WSeptic Tank—Liquid capacit�Mallons Length................ Width---------------- Diameter................ Depth................
x Disposal Trench—No_____________________ Width __.__._.._______ Total Length_.__._.___ ._ Total.leaching area------------ __ sq. ft.
Seepage Pit No---------Z-------- Diameter......�S.-____.__ 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_-____-___________-_.-.
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-____.-_______________-
O Description of Soil---------- _.. ._. -6^��f
•-------------------------•-- r .. ---------•-
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 iITLL 5 of the State Sanitary Cod — Th dersigned further agrees not to plac/the stemoperation until a Certificate of Compliance has been i sued a board of health.
S ed- - .. ...... ..................•---------•-----•-----•----•--------Application Approved By-•-----•-_ ..:_._... ---•---•..........................•-- --•----------�
Application Disapproved for the following reasons----------------------------••-------•------------------•---...-------........................................
........................................ -- - - •..._._._.._._.._--------•--•---------._...-------•--•- ........................................................
ate
� r i
Permit No......' ........................ Issued----------- .......19,5..........
Date -
' t r
No ... Fxs .......
f; ___ THE COMMONWEALTH OF MASSACHUSETTS
zz , BOARD Qfir H EA
Appliraiinn for Disposal parks T trurtion ramit
Application hereby made for a Permit o•Construct (:' - or Repair ( ) an Individual Sewage Disposal
System at: /171
.................. .. ll:. .... ........ -- -- .
.. ... .- - --.. ............. ..............
o ion �d/ss Lot No.
..................... if+c-a= �,. .... ............. ............ -t ........ -• ----------------------_------•-_---• - .t•
Ownerddr s
w .l G .. ............. �I`
a .. .. ....
-
Installer Address - -
Type of Building Size Lot_. -...!!,_ feet
Dwelling No. of Bedrooms....fi.
,... No. of persons
Attic- ( ) Garbage Grinder ( )
" a Other—'Type of Building . _.- p Showers ( ) — Cafeteria, )
Otherfixtures ---- -----------•---•-••-----•----------------------------------- --.- -•-•-
fzl
Design Flow gallons per person per day. Total daily flow____.__ gallons.
t $'r'ptic"Tank. I'_>qud capacrtgallons Length....:.......... Width................ Diameter j_: Depth ....
Disposal Trench—'Vo .................... Width................... Total Length............. _.... Total leaching area sq. ft.
See a e Pit No.... D>ameter._.... . __._p g J _...._ Depth below inlet.__...._ ,__.:_. Total leaching ar sq :ft.
tip:z Other Distribution box ( ) ' Dosing tank ( )
Percolation Test Results Performed by........................... ate.._. .:___.........................
D
.� Test,Pit No 1 minutes per inch Depth of Test Pit.................... Depth to ground water ...____.
44 Test. Pit No 2 _____________minutes per inch Depth of Test Pit...__........•.._.._ Depth to ground.water.
Description of -----• -------- =-- ••• w
O
••-:--
Soil �.._..._ �� .....................................
Ur r -----•------------------------ -------------------_........._
1 ---
W ............................. '. ` ............................... ............................. ...................................................................... }4
Nature of Repairs or Alterations-Answer when applicable................................................................................................
.............................. -••-••• ......--•--_..... -------------•-----•----•--•.........•--
............. .
"Agreement
VThe undersigned agrees :to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of.TITLi�' k,5 of the State Sanitary Code`—The undersi' d further agrees not to place the stem '
;,operation until a Certificateof Compliance.has.been stied e bo` of health.
fined•. .................... ........� /........
> `� �
Application Approved BY--- -`-'-- 5....f :...:.:... ............ ............
Dat
Application'Disapproved for the following reasons:-------•---------------------------------------..........................................
5 a 4 .... Date .....
Permit N ------ ........................ Issued.__
a . Date b
THE COMMONWEALTH OF .MASSACHUSETTS
BOAR OF HEAL
�rdifiratr of Tompliaurr
THIS IS TO CERTI hat the In ividu wa pos 1 System constructed ( or Repaired ( )
by ................ �� _ .1 = ".. ... ..._.....
at......................... : .._..__ -_-- -. •-•_•-. ...•... �-- .
has been installed in accordance with the provisions of T 5 of e State Sanitary odead > 2 e
application for Disposal Works Construction Permit No.....:. ___._ ,,..,_. dated ... ..... .......... ........ . ...•...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAQtANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
DATE ram.► , ; "°` :... Inspector." ------•--•-
THE COMMONWEALTH pF MASSACHUSETTS
BQA�R �F HEA T
,�L
eo"'](4 ®F..................... ... .....................
...... b....
. ...... ..... ....
.z
FEE.''...........:.
Permission is reby granted - ............ ....... ................ --.. .........................................
to Construct r;R air n In 'v' S -
at No.................... . ... (. Y ...
S eet• O�
as shown on the application for Disposal Works Construction Per O Dated_j . ................:..:..
✓.
............--..................---- ----------------------•-----------....-----••-•-••-•--••_.....
Board of Health
DATE........................................................................
..
FORM J255 A. M. SULKIN, INC., BOSTON -
f '11
0A7`-4
S//V6L E FA1/y/L Y ~ 3 BE0.2aom
/t/O G4.2B.4GE G�/iC/�E.2
OA/L Y A40 141
AN
USE /4:51,510 <5'44 .
,S/OEW.4LG A e2 .4
BoTTotif,4,e� 3v /,V.,
To7T•4,C 172�GPo.
v6 OF
f ` (
RICHARD r \\ l ��`ti:, �J T,,�1.
A.
r.�v'. 2913 u" s BAXTER u `' 7.
J `
7 3� °r--
!�
80X /rV✓. GAL.
� l�ACL/P/T.��•G /�.G .S.EPT7G
y. I'✓AX,9E 7 '
/-1-0,` /`'�''�` G'E.GT/F/ECG PG OT PL.4�t/
G /
,�/E�Eo�c/ GOMPGY�S W/T//7,yE S/OEl�/�E B�XT�,2 /t/rE IAOL-.
A�v�,S�"T6/aG� ,eEQIJ/eE�IENT_S �� Th14 .2EGisr�ec�.�i✓o.Slie�Eya,�S
A.vJ7 /.S NOT
74/ aL.Qiv /.f /t/OT- Lj4SE0 GSA/ AN 1,YVJ7T,e-
-�/.iJEyT.svel/�Yfl�t/O
/J/i/�T A69E USEp
Ta EST�ddG/S,S/ LaT G/NHS