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HomeMy WebLinkAbout0106 BRIGANTINE AVENUE - Health y�-f cas s r o LOCATION SEWAGE PERMIT NO. 20- q 6 9 l6 IN 7-01F, VILLAGE 09k-- 03p INSTAL ER'S NAME i ADDRESS 0 - r1-1&® ( 0 I V41� WQ617-11 e U I L D E It OR OWN ER \DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 6 ._ �,YPJI�► fI olf 73 P1 T i ® j At h phi WAY No......6L.-6.3a F�$ .....:......_ STHE COMMONWEALTH OF MASSACHUSETTS BOAR® PF HEALTH ..................OF.:. ............................... Appliration for BiopooFal Marks Tonutrnrfion rjernfit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Loc on-Addres°s o t No. Owner's ..._ 1-, ••------------------Address Installer Address UType of Building Size Lot�41.4.q......Sq. feet U Dwelling—No. of Bedrooms ... ............................Expansion Attic ( ) Garbage Grinder ( ) per4 Other—Type of Building����. No. of persons._.._ ______________ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------•--_-----_--. --_ w Design Flow_.VO.� ........................gallons per person per day. Total daily flow....... .......................gallon4.� WSeptic Tank—Liquid capacity?!� .gallons Length.---....... Width/4..�....... Diameter____-___.._. Depth.7.•-.3.-_. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area......!g.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.... f._w ...6C...Y. ctil................ Date__. �,�.9� _1............... Test Pit No. 1....x4.......minutes per inch Depth of Test Pit...A?........... Depth to ground water__1V4a!__e....... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •- --------------------------------------- ........ .-..... --•-•... •---------------------...-----••------ --------------------------------------- •-•......... - ODescription of Soil.vvy,..... ��76. 1 sl9k-&............................................................................................................. x w -------------------- .................................................................................................................................................................................... VNature 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 iITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued by tht board of health. ®°1 D e Application Approved By............... = ..... . G /!? ...... ...........Date Application Disapproved for the following reasons----------------------------••-------•---------------•---------------------------------------•---••-•------_..._ .......--•--•-••----------------------•--•------...----------------------•---------•--------------------------•---------------•------••-••-••---...---•-•-•-•-••--••-••••-----•--------•----•----....... Date PermitNo--------------------------------------------------------- Issued....................................................... Date No......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � �✓ ...................OF. . 1/ '/'/ E-7SG ApplirFatiun for Dispoii al Vorkii Tonitrurtion Prrutit Application is hereby made for a Permit to Construct or Repair { ) an Individual Sewage Disposal System at: , rr✓P /vP_ cam;• Location-Address or Lbt No J �ZA -- _ - ./ Address Installer Address U Type of Building Size Lot:z�4a!5? ......Sq. feet Dwelling—No. of Bedrooms.— ..:............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building � ............... No. of persons_•-.�?j.....•..._...... Showers ( ) — Cafeteria ( ) dOther fixtures --------•---------------•-------------••-----------------------...••-• .. W Design Flow.-�e�..........................gallons per person peg' day. Total daily„flow..........__......._.........................gallons. WSeptic Tank—Liquid capacity `� a.gallons Length.................. WidthC?._�........ Diameter__Z.......... Depth_7.._ .... 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 ( ) aPercolation Test Results Performed by....�/.1%-/ ... ................ Date...... '?Oh !. Test Pit No. 1...... .......minutes per inch Depth of'Test Pit-__-a---------------------- Depth to ground water... ........... 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............... -•------••• -•---•.....-•--•-•----••-•...........................••-•---•-•----•-••---..._........._..._....•-----..._............-•--- O Description of Soil.<r% cw.......65G---fz�,y.... � '�-�•----•-•---------••----- V ............................................................ 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 TIT E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued by tYie board of health. j 1 Signed.y •••-• .....................I...................... �y ............... ................................ Application Approved B -- / _• _ PP PP Y - ............ . . .......•--•--_.... ....._....A........ .................. Date Application Disapproved for the following reasons:.............................................................................................................. ---------------------------------------•----------...--------.....------.......--------------------------•------•-•--••••---•••---•----••--•---•••-••----•-••--••--•-••-------•••---•-•......---•••-•-- Date PermitNo.................••-................---•-----•----••--.. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS cam- BOARD OF HEALTH V ' ........................OF..*52 S> `J�/_ C ............................................••... �rrtifirFatr of ToutpliFanrr THIS IS TQ CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by- ✓!Q.... ``,r---eyl . ......................................................................................................................................... Instal - at... q ........9.........X -i�l,._-.��!��' ��!!P rf/........6iys ........, has been installed in accordance with the provisions of TITLr; 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......... fi".-��-_3 ._...__.. dat --- ----- ............................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® GUARANTEE THAT THE SYSTEM WIL FU TION SATISFACTORY. DATE......fl / ' �---------------------••----------.-----•--- Inspector_.... , THE COMMONWEALTH OF MASSACHU TTS BOARD OF HEALTH No...... / - FEE........................ Diapoti al urk r n t/rttr#iun rranit Permission is h eby granted..s_>!5_",�I.-'h-?-.....(.�_._'_�.. �7��' .G/S-•-------------------------- ............................... to Construct ( or Repair-( ) an Individual Sewage Disposal System at /' ....... ........ /._��1�'7../,I.e ;/v /�f�/ fT G' s e�`< Street as shown on the a' lication for Disposal Works Construction Pe No..................... Dated' -._......__....___......... �`' ' ( . ...... •. '•- Y'.....11.. ......... ........................_ Board�oefl alth DATE................ fix' - FORM 1255 HOBBS & WARREN, INC., PUBLISHERS i elm GEXJEV-AL- N OT E'S --A.r,..L ELzv. S"OA,,/Jj AR.E McAll l SEA Esose 1D p-..J U 3.E C-.5 PL.A ,,j E y '"" ___--�-1 � PiTG LI �it� t..F�,IES A i`'t►�.l i M t}M � ��"��,� .* �•1, °M� I� � _ . � � ,---� l..)N ASS C�T'1-�EE�)t5� �P'G,rGi F��. Q - ,w O (� 000 AFL 'SEPTFC TA"V-S, O STfZ%!SLITk0iJ i lh , A"D Q.EWo7-/9 AUK.. 1)�,JbojirAaL� MATrLim%A. - vw—oeAn-1 ® V rl-t€ t��/E2'r' E�.�t,/ATIo•JS of L*-Ax-��►.* PRS fke- �►'� f 1! f 1 i Ilj ----r•- �, _ A, E.AL>US of 10 A430 t LA- lTN C LA. --ilT `�a `R n \� \/J fi I G)-- T� T+ � ©f .TV4 I�`W i x ,,�, � - i � t-�^l Ft�p W111E�J T►•+�. S�IS'T'�►� tS N LAt. j! M O 4 ® C�E�+"�Pt_ETA r..l ,�.i t� P�toQ- TO d►+e.�Gl�'r t.�,�1.r1 i'w O 00 � co) o 0 coy--1Pb�..1 E�� 3H�+.L,_._ 3E ►�,.►srA,t.�v �� f j o h CSC C V-DAA--lC*, \A/17�4 -T't T L.E. TN*w. 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