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HomeMy WebLinkAbout0009 BREAKWATER SHORES DR - Health (2) q � ux�e2.6 hd'es"beivf- (aiLwd S�oreS Fus...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �l...f/oi/ ...................OF.......... ....................... �. Appliration for Uiipniitti Workii Tonstrnrtinn VarAft Application is hereby made for a Permit to Construct (pC) or Repair ( ) an Individual Sewage Disposal System at: Cs"ia. - _------------ ..•.- - =.......••••-�......•••---. ........ ................._. � ..........-••.................------...... cation- ess or Lot No. ....... -_. ...•.. • ............................... 7 ner Address W a . .......... .... .................. ......_^._• Installer Address Type of Building Size Lot....! -_4SV..Sq. feet Dwelling—No. of Bedrooms________________ ......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ........0................... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------••----------- ----------------------•-----•----•----•--•-•••----------•--•--•----------••-.........._.. W Design Flow................:!5� _..................gallons per person per day. Total daily flow.............. .3.®.___...........gallons. W Septic Tans Liquid capacity.'ee gallons Length................ Width......._._.`._ Diameter...... ........ Depth...'...... �/ x —No. .................... Width...../0........ Total Length_._ ......Total leaching area.:2�tB.4....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet..................... Total leaching area...........-......sq. ft. Z Other Distribution box (K) Dosing tank ( ) a Percolation Test Results Performed by....4 '. ..... ... ... Date.'- .-1_7__-'R Test Pit No. 1._C. _minutes per inch Depth of Test Pit/ _ ..��_- Depth to ground water...-�.!'___. fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .-----•---------------------------------•-•--------•---...------•--••--------------•••-•---.._...---.........................................................O Description of Soil------` E......--�-���� -•------�L '�-------- 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 TIT12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been s ed t b of hea�l�th.,�,�, Signed .. ..1=� :�-=-b...... . .... ........... ...._.. Dag Application Approved By.. '• --„, ----------------•- �-------- Date Application Disapproved for the following reasons:-------•-------•-------•-------------------------------•---•--------------------........._.........••--...._.._ ---------------------•------•------------.....----•---------•--.........-••--•--••------•....•---------••-----------......••--•-••-------------------------------------•-•------------------------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... a,c ""— Trrtifiratr of Tomplittnrr THIS IS TO CERTIFY, That the In ividual Sewage Disposal System constructed ( Pe/or Repaired ( ) •----•-•-----•------------------------•-----•-•-•-----------•------•----------------------.........••-•-._..........•... Installer at...................... --•--•--- a" = '- ----------•----------------•--•---•-----------...•..------•------------- 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 No.....61=y.g.5`............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............•-••----.......-_...--•---.......................•--•----•--...... Inspector.................................................................................... o Na:....... r.�....c/S S Fps...... THE COMMONWEALTH OF MASSACHUSETTS BOARD 'OF HEALTH ..................OF.......... ` ,2. ✓- T La. _ ...................... Applira#ion for Disp.aiial Works Tomitrurt,inn Vamit Application is hereby made for a Permit to Construct (,<) or Repair ( ) an Individual Sewage Disposal System at: '- G95rJOL/�-._S77. .................. .:" _._....... ........... -..:r.......2. _... . ................. Location-Address •, _,,:. or Lot No. ......................»........................................•...._..............—........... •-•••-.......................•••••••••......••••--............................................... Owner Address W ..........•..... •--•••-•-•.....................................•. ..-•-••-•-----------------......••.............•......... Installer Address Type of Building Size Lot...../..4S .Sq. feet . Dwelling—No. of Bedrooms..................erg' Expansion Attic ( ) Garbage Grinder......................... ( ) Other—Type of_,§yjlding ............................. No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures ........................•------- . W Design Flow............... ............................. per person per day. Total daily flow............... .3. ...............gallons. W ��Se is 3ank Liquid capacity...... !gallons Length._.....�'>...---- Width.....���.. Diameter................ Depth...`...... x —No..................... Width....../0......... Total Length....z.z......Total leaching area..; . 2. _..sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X) Dosing tank ( )__// '—' Percolation Test Results Performed by....4r��_..... Date..' Test Pit No.`l___- �-Z.minutes per inch Depth of Test PitY :.. Depth to ground water.../-..-3..z.......... Gz, Test Pit No. 2.,,..............minutes per inch Depth of Test Pit.................... Depth to ground water........................ x1 •--•-•------•---•----•--••--•-•-•••••--•-----•-•--•-••••--••-•••-...-----•-:_--•_---••••••-•--•-•-•...•---------•--•...-•-•••••----••--••.................•-- O Description of Soil.....`='' ��. /�1 Cf-} _ � L-!� j-----------------------------------•---•-----------•-••------------ U --------------- ----------- =- --------------------------------------------'_.`:,.--•-•-•-•••_....---•-----•-•---•--•--•---••.......•----•---••-------••--••-•••---•--•-•---------•--•-•----•-•-......•••--•------------...._.........•-- 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 TITIZ 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. F Signed.....................................--............................................... -•-•- -- •••......-••------ Date Application Approved By...............— �!�•-j✓t'.G� ® -x.................. ..- ,d" f.,...... ate Application Disapproved for the following reasons:----------------------------•--------------------------------------------------••--------------•-••......_.---•- ....................•------...-•-•----...............---........-•----------------------------------•--...__....---------•----------•------------...---................................................. Date PermitNo......................................................... Issued............. • Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.. .............................................................................. Tntif irair of Tuntpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( "Or Repaired ( ) by-•-••............... ... ....... �-, we,, :_�_.. , ...-----...------•......-------•••-•••••••.._......-••-•-•••.....-•---....._....•••-•-•-••...........••.....••••---•-- Installer at-••••................ ---------- `--- --" -------- ''.---•-------------•-----•------------------------............----------- . 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 � , , ------------ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector....................................................... ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH �' ! �� .....................1.'dfTr'........0F......... �,.. 4.4.........................,.............. FEE, Disposal rk� nno#r ion Errant Permission is hereby granted......... %....._.. ................................................................................. to Construct ( �'or'Repair ( ) an Individual Sewage Disposal System atNo............. _.. t!l........... 'off_ ...... -------<�s�'yg h ----•----------------------------•--•----•-------•-----•-------•-.... Streetf as shown on the application for Disposal Works Construction P it No..................... Dated.......................................... �:. . VKH e a I t ---------- ---------•--- - ao DATE ---..... V" '"AV------------------•----- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS „ 1 . , s i _ W y , 11 1. , , . , F y , i , iI-A t "'T r , 1 9 t , r f .. - G �av;:�b a p _o ! _...7 t a..,•r. e.. w ,. t Y ,.. } '.1 s. .. _ .:. _.. .. ., ..a,... .,n;: .v,.,-e, v ,a.. ,, ..... _». +.,bx n .r,. ,.a --8 wr, i,w) , t _ .._. .1 .. ,r.:.._. 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