The URL can be used to link to this page

Home My WebLink About0095 WINDSWEPT WAY - Health (2) -E D� U)1 1 CRS�, (i LOC4TIOKI ' 5EW64E PERMIT UO. VILLAGE — — — — — — — w5TQLLER'S U&PAE ADDRESS �=,, 5UILDER 5 1.1 b MF— LIDDRE 55 DATE PERMIT 155UED D NTE C-9 UED lc z r�'� O I ® Q i is To..Q_.3....... ....... ` FEB.../V._.�....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I� --------- ..............O F.........................................---...----.--.......------..................... Appliration for Mipwial Workii Tonotrnrtion Prrmit Application is hereby made for a Permit to Construct (or Repair ( ) an Individual Sewage Disposal System at. 914—J, 2..... . - .-..�a-. ---------------- --------------------------------------------�. ..------------•----•------------------• I ortion dd. ss o N� ............... ... ---.. ...---...r'...I. ..........-- --. ....-•---•---........... .... � lD................................ .�?� ....... -..._..-- y ..... W 7 O er Address Installer Address Type of Building Size Lot. d/d_......Sq. feet Dwelling—No. of Bedrooms_....._.......__ :___. .......Expansion Attic ( ) Garbager Grinder ( ) Other—Type of Building ............................ No. of %sons............................ Showers � YP g ---...---•------------•P-�-•---------- ( ) — Cafeteria ( ) QOther fixtures ..................•---..:. .-------••-......._._.....--.._...........---....--•-•.......--•----•••-••....... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/40...gallons 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........................................ Test Pit No. 1................minutes 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........................ --------------------•.. ........... O �f Descriptionof Soil.............�:-�^'.`.��__.._................ . ...........--•----------------------------•.....�.-------------------...---••--••-----...----- x U •••• --••-•.... ... •-•-........... ...................................................... ............................................ ......... ......� __.......... __.... T, ... U Nature of e a s or Alteratio s— e. e ap cable........ . .. .........J ._......_._--. ............_..__..... l-. = .1� •--. f ��-----------•------------------------------------------- --- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Co The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is ed by the bow igned ..................` Date Application Approved BY-•-•• •.... . -•---- ........................... Date Application Disapprove or a following reasons�.. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct ( _1_'0_r Repair an Individual Sewage Disposal System at* -- \\ z�*o� Address Type ~ Size feet Dwelling—No. of Bedrooms--_..3............................Expansion Attic ( ) Garl5age Grinder ( \ Other--Type of Building ----------- No ofpecu000----_-_---- Showers ( ) -- Cafeteria ( ) � Other fixtures ^� . --.............................................................................................................................................. Design Flow.............................................gallons per person per day. Total daily flow----------- 14 Septic Tank--Liquid 'gUloma Width................ Diameter................ Depth................ Disposal Trench--No. ---.----- Total Total ft. Seepage Pit Nu----'.. --_---- Depth below inlet ur��--'-__�g �. t. Z Other Distribution box ( 10) Dosing tank ( ) '- Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. l................miuutcyperinch Depth of Test Pit--..----- Depth to ground water-_--__._.. Test Pit No. 3-.----'.minutes per inch Depth of Test IiL-_------- Depth tu ground water........................ w Description of ____________ o f era ---------------- The ~^^e^~^o^~~ agrees~ ~ ^^~~^^ the °^~e"es` '"^, Individual" Sewage Disposal System in accvcvuocn with the provisions o6TIT LZ 5of the State Sanitary Co place the system in operation until a Certificate of Compliance has beenfi�.sued by the bozrrd-;f healfg. ----...................... ................................ \ Dat e Approved ---------'�1------------------- -------------_----- u*" � Application Disapprove dv�/r �& fo Rowing reasons:.............................................................................................................. _ � / --- ............................................................................................................................................................................ � Date � Permit � Date � THE ooMwomvvsAcrH OF mmasAonussrrg � BOARD OF HEALTH ..........................................OF..........................................:........................................'' T �� o^o�uo�� 4u Toutplitturr . THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( \ bc'--------_..--------------.-__________________________________ ____________.__ ____ _____________ - Installer ot-_-------_.-----..-----------'-'_'__________________________________________________________._____ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit DJo'—.---------------- date6------.-----.--.---_ THE ISSUAN9E OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE SYSTEM RY. DATE.........1 lr ............................................... ____________________________________ THE coMwc»mvvsALr* OF mAssAc*ussrrs | BOARD OF HEALTH V4w� �* ��F I��—��^~� � --------------. ------------------------ /�{� —.----- ,=�/---_-___- to Cons uct'6,� or Repair anjndividlldr. ewag"isposal System / - ~- ��g�= ��--'---'-''-----'-----'------- � as m6shown on the Yisposal at N7171 ' -� �