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0051 BRIGANTINE AVENUE - Health
51 Brigantine Avenue A = 098—045 Marstons Mills - - - -- - �— - -- LO AT ON SEWAGE PERMIT NO. . � VILLAGE I f INSTAL , ER'S NAME i ADDRESS Via 8 U I L D E R OR O NER,J �> � ✓g -[�� J DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �, O Q o rj Poo` k y gRIV6 WAY -7 9 ' No. Z F�$.....3.5............. THE COMMONWEALTH OF MASSACHUSETTS u BOAR® OF HEALTH ./� OF..._...� ... ..�. .............................................. - W10 Appltration for Dtspuml lVorkii Cnunstrurttun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at � r' fe ,Z ............. .L?-Ly4.......;..... --•--------.---_--------.---------.--------------- . 0 ..... cation n L - c�iess ^• ..............------..............-.................... -•� •------ ---- -•---- ........................................................r ... ................_....... - WOwn r � dd s a n... . Installer � Address UType of Building Size Lot.................... ......Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Buildin !�/ •.7 // a g ----- No. of persons__---__-•._. _..._f�_._... Showers ( ) — Cafeteria ( ) � Other fixtures ---------------------------•---•-•-•------------------•-•-••-••---•---••-•--•---•-•-•---•••••-•-•-•--•••-•-•---•--•---•--•-••••....•-•---....--••-••• W Design Flow.......... ........................gallons per person per day. Total daily flow............... .3 J.,3.0................. WSeptic Tank—Liquid'capacity/4MP.gallons Length_/13-... _... Width__. ........ Diameter-----L-`_/. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ) '~ Percolation Test Results Performed by��G.!? ... -----•--•••- Date l Test Pit No. 1................minutes per inch Depth of Test Pit---l2 ..... Depth to ground water-__-- .. 44 Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil...... ----- -...... ...--• - �1 ...................... x T� r4 -•••-•-•••••• -•-••••••-•-••••-••--._...-•-•-••-•--.......••-•••-•-•--•-7......-------............................................................................................................... w 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 iIT 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 iss d by the bo of health. Signed; - �f' Date Application Approved By. f _- --------------------------------- � -----------•--. G����i- Date Application Disapproved for the following reasons----------------••-----------------------...-------=-----------------------------•-----•--•-••-•-•••••......... ---•................••-----•----------------•---••-•--------••-------------------•---•-----•-•-------•---••••-••••-••.-•••••••••-•-••----•----•-•-•-------••-•--...-••••••-••••......--•-•-•--•-••-•--- Date PermitNo......................................................... Issued....................................................... Date r � No................_....... FEz5 s� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............'..--' •ri� OF. —J...'.'!.lirr.l '.rc,rj ................. ..... ...�----.------........_._........................_._ ,Apure#ion for Bhipasal Works Tonitrnrtion rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 0 dSa Ltion• ddress/ or LotsNo. Offer ... A ddrels� ._��J............? {J..*�1'.� :n �/t-ia.G.-!,/C+Q/ \/Z.F♦/i. '7''C i!�' . � �f�� (i Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........................................Expansion Attic/( ) Garbage Grinder ( ) aOther—Type of Building �r.� v-�L ... No. of persons......... ._ ?...... Showers ( ) — Cafeteria ( ) 04 Other fixtures --•-•--••--•--------••------•----•-•--------------•------•--....--------- W Design Flow........: : .......................gallons per person per day. Total daily flow.......-.....__130__.__..__________gallons. WSeptic Tank—Liquid capacity......`...gallons Length.—"/Z��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 by1 _ '?? ... Date... b - %�/_. Test Pit No. 1................minutes per inch Depth of Test Pit--- ..... Depth to ground water--__- �'-O-Ids___. (i Test Pit No. 2................minutes per inch Depth of Test Pit.._....._._.._...... Depth to ground water-_-___............_..... 04 ..--•---•-•---•--------•-;•---•---------•-------••-----•.......................•-------•----•---•--.....--•---........------•-------•--------...........----- O Description of Soil------.... �i-��-�-�- ------------1-1-4�-��..........................................er J ,��� f �� / j, ---•-•---•----------..........._......-------- W V 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 p 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 health. Signed...................................................................................... .......................... _. Date Application Approved By----.... ..... •" L-------------- Date Application Disapproved for the following reasons__________________________________________________ --•---•.................................. ----•••-•----- Date PermitNo......................................................... Issued...................................... ............... Date THE COMMONWEALTH OF MASSACHUSETTS -� BOARD OF HEALTH ................. r.-tJ....O F.....` .....c... ....:r-.`..�.......... N ...................... (Irrfifiratp of Tamplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........... Installer —;_—� J j t at_ , `r C. .. Ji... -- ..................................................................................................................... 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 No.... ..... -"�7............... da.ted___.._____..._._._.___._.__-_................... THE ISS AN OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEIN/ W L NCTION SATISFACTORY. L�-X.."............................................................. Inspector...------.-_..11----- ............................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA_LTTHNo. �r .... FEE.... ............... Disposal Workii Tlinstrdion r utit Permission is hereby granted...... :-- 1'' ...1?-r?_.._1 l :P _. ..-'!J-!-* ................................................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System / at No r�� ,/V I ��r1 .r �_ _ �� ?7��1ziz = �� =?,: . _.. --=--•-- j---------•-------------�-• J Street as shown on the application for Disposal Works Construction Permit No...___._--__'_ _ Dated...........:.:........:......... 21 Board of Health DATE......................... :;.................................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS t T _ T �" "4 - ,� y n.v:x aunsM1r 3 •Y'. , T.. .. ,e .t , ry. ,.w r.• ..:._.., . x ,. 8 R-i., .:.. a .. �• ! r 11 ...: „ 'y ,} ,. 5 ...r h.. x r __..: ,� ... v .: ,. , ... .< ... .,t ..sue - ri:.. ....: : ":y ". ,.` .. n .. .,v., , r .. •{.'w .. . • - - .^4 * . - e 11 . 4 fJ -t. 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