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HomeMy WebLinkAbout0037 BRIGANTINE AVENUE - Health �� I(��C'C�,v�h,e �v ear,ue; _ C � LOCAT3�ION 8PICPI/ 5EWAGE PEftVIT P0. �, '2 3 & c�� v g/— U.I VILLAGE I H S T A LIEU'S NAME A ADDRESS ID U1LD-ER OR OWNER �O DATE PERMIT IS UED ? DAT E COMPLIANCE ISSUED,- V 14 0 u 115 �v THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .�/..................o FW�Jr '< G ---------------------------- Appliration for Uispwi al Works Tongtriirtion ramit Application is hereby de for a Permit to Construct (Al or Repair ( ) an Individual Sewage Disposal System at: ..l .__. c3......... -- --------------------�------ --- s -� ...... .L��...:.:. : Location-Address r Lot o. �5,, .._.J.�!�'Q..... Ur.?1L? -----•---- e s es �`�"�✓ ........ s L�eY ow Address ...._.' -- --------- ------- -' --------..__.^_......-----... ------- -._......._ .-•--'---^........^-'-- Installer Address Type of Building Size Lotx>-_YX"!7....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building pe6.............. No. of persons...... Showers — Cafeteria Q' Other fixtures -------------------•----------._. W Design Flow............ ......................gallons per person per day. Total daily flow._._.......a a_....................gallons. WSeptic Tank—Liquid'capacity.14w-w-.gallons Length.__._'..-__- Widthz©..'-�-........ Diameter_O�_,F.'.__ Depth...?_ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area-____y _7__--sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. 1 Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by._- 'T N_...._ �C .!!t,C9 .............. Date....6/��. . .......•....--.... ,aa Test Pit No. 1.... ......minutes per inch Depth of Test Pit----1.9.. Depth to ground water.tieA'.�...___.. (Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 ----------------------------------- -----•-----------------------•-----.--.-.----• ........--•----•---•--------------••--------•---..---- Description of Soil `� ...Q G-t......cDjLS:E------�f,�t'h.......... b t1dv-----6'e9�'' ------------------- x 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 iITI,E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee 'ssued by t o of alth. "o Sin D -----------------•- ���--...- e Application Approved By........... •--- . --- --�...... /z0��1-----•------ Date Application Disapproved for the following reasons:......................................................................................... ---•----._.._ ..----•--•'--------------------•---------------•-------------•-----------•---•---.....--'-'-'-------••--•--•---•---------------------------------•--------•-----•-----------------------•----------'_--- Date PermitNo------------------------------------------------------- Issued....................................................... . Date + Fizz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF. /�11�/'�.��>..':`,.b�L--(-.-------•----.....----........... Appliratinn for Uiipnsal Workfi Tnntitrnrtivit ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: 000 Location-Address or Lot o ��lf�i� < fir✓!r�r (J 7 f>,.. . a/-�'/%T` V Owner Address ?}�:5. ��Instal er Addreess s s-- ........................................... � . d Type of Building Size Loto_JY!4E�.l.....Sq. feet Dwelling—No. of Bedrooms......... ............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building -------------- No. of persons.....?_............._... Showers ( ) — Cafeteria ( ) Q' Other fixtures --•••-•----•... ••----•---•--••-••............... ... W Design Flow............ ........................gallons per person per day. Total daily flow............._. 0................._---gallons. WSeptic Tank—Liquid capacityZC!a_.gallons Length---.- ........... Width! -'�..._._ Diameter.�_I..... Depth... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.... .7......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._ l/MFtti!._....G��ossr?.................. Date....L� �?. .:................ a Test Pit No. I.... .......minutes per inch Depth of Test Pit----L.2........... Depth to ground water.'° r%4 Test Pit No. 2................minutes per inch., Depth of Test Pit.................... Depth to ground water........................ P4 --------•-------------------------------••-•---..... ---------------- ----------•-------------•------------- Description of Soil...L. ._`o"4.....__..Cap&!aF .....-� ---------------/����!�5 SfIw�.. x •--•-•••... U --•--•---•-•-•-•----•-•••••--•---••••-•••-••-•••...•---•--•••.....:.................••••••-•-•-••--•-••-•-••-•-••------.....--•-----•---•-•...-•--•••--•.._...................-•--•.........•------•-•-- UW -••--•---•--•---•------------•-•---••-••---••--•-••-•-••------•-•••--•-•---••-•••••-•--•-•-----•----••----•--•-•-•----------•••••--.-•-••-••••••--•---•-•••...............•---••-••............••------- 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 TIT+,^_. y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has bee issued by t e bo d olth. Si ned. Y,.tl�� --._._. ...: �! ........./ N�' Date Application Approved BY •• :.X: .�.. ._. � ... Date Application Disapproved for the following reasons----------------•-------•---••-------•---------------•---------•--•-------------------•--•-••---••-•-•••......••. -•----........_.........•••-----•-•--•-.....•-•--••--••---------•-•-•..................•--•-••.......•••-••-•-------........-•-••-•------•------•--•-•-•-•---•-•--------•---•••---- --••....--•-•- Date PermitNo......................................................._ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................OF.. '/V ... f .......... . .................................... %rrfif iratr of Tuntplitanrr THIS IS TO CERTIFY, That the Individual Sewage Di posal System constructed ( ) or Repaired ( ) TGIN W/`..yA llJ�ri S �l` ��/� ` a���%F. D'V Installer at -•---•--•- ----------•--------- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit .......... dated-.............................................. THE ISSUA CE F THIS CERTIFICATE SHALL NOT XCO/NSTU ® AS A GUARANTEE THAT THE SYSTEMWILL U TIONSATISFACTORY. DATE---••---�..:Z....� ----•--•-----•--•--•-•---•-•----------•----•---- Inspect ..............................................•.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH do d!it/........................ ........................... ..................................... No r t° . ... FEE........................ Mapasal Worka Cannotr ti.on rrnti# Permission is hereby granted_ ®! '..__ . ,r.> __�� !!-..................... to Con ruct (>! ) or Repair ( ) an Individual Sewage Disposal System at ......... Street as shown on the application for Disposal Works Construction it No..................... Datead.......................................... B�xt� of Health DATE --------- � .... s FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - --- ��� . ... 1,a�.n,c t 1. : .- A♦ '; / _ i S e- v ;A -s Y. 'f'-a It 9.. ..:. - , , � C,.�.I.I,)�.I�J-.'.II 0-:Ir�,1 I�H�", � � .. - - _ .:-.. - , v -��...,,,,"�i-,.Z,�2���,II.-,.-��-,I��-".'.-��,,��...,:,":-��`,..I�--,,��-,��:II-',-`T,-.��.I-�;.-�I,�.-,,�1I.,�.".,�-�,1,- I.I-..-z.-11-I.1 I--.I I��I I.�.,.11�II&.-r0.I I._1\I1 i1I -I,I.I I-.I-I "-�I-I"1,11I- I./,IT- l.�.I I.1,.1�LII.-.I.iH.I1.j I�4II I��0I-�-I"I�I-I I I��I..�.e.I I- -I I:.I�z-II�,.j-�I 1 1 lI lL I ...I..I-1.�..I� -�-I,G(0CI. .�)*L I-(0 1 I0 ��-I � � I cI .I II� I�..I�I�I%9�2--, Y , ,.4,}�"' _ W _ 5 ,, $ , . „ / c .. .y:., y f'A - < , S' Ce;, ♦ ._ *[�� • <, - " ..v , r , _ . . � Z. t�tT aL:c>.T- A I. 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