Loading...
HomeMy WebLinkAbout0037 ANSEL HOWLAND ROAD - Health 37 ANSEL HOWLAND RD, CENTERVILLE [A= 172-218 �I I No. 42101/3 ORA ESSELTE 1 o% O O O O >-�.�.i'.::s .: ... .�s �.:::.- PARCE00 .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J M.16...........OF... .-/W.!�77 .............. ........6.A ........................ Appliration for Diiipoiial ivorkii (famitrurtion ramit Application is hereby made for a Permit to Construct (��or Repair an Individual Sewage Disposal System a 0 .......................1".0r. .........1..................................... 6ye .6ept�ek� l ® I%V40-tS IYIZZf -:PbPAj -441 Ph?avel� ,Wp ............................. ......................... ............................................ --------------------------------...............r _7 �Tdress .. .... .......................... ...................................................... Installer Address Type of Building Size Lot_._._I I feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons........_.____...._.._______ Showers Cafeteria P4Other fixturp�....................................................................................................................................................... < Design Flow...................5A _gallons per person per day. Total daily flow............................. ....gallons. Wcapacity. Length................ Width__.- -_ Diameter____..._......_. Depth Septic Tank—Liquid '!y C�_gallons ?i........ ;14Z....... —No. ...... ........ .... al Length......... .... Total leaching area...................sq. ft. Disposal Trench Width.... length Tot i Seepage Pit No--------------------- meter.._................. Depth below inlet................_... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank 41-- 4 Per-formed by Percolation Test Results ......BA-Mr,1._C�. ..t �-_ 14x.. 44e.................. Date.......//--- ------- ------- A, Test Pit No. I----7-—-----minutes per inch Depth of Test Pit..........2...... Depth to ground water_rn-----.......... �-4 44 Test Pit No. 2................minutes per inch Depth of Test Pit__._.__............. Depth to ground water__........_.___......_.. 1:4 ..................... -- ---------- ......... ......... ... ....................................................................................... 0 Description of Soil...................... " 4;)8 . - Z Yj ------------------------------- - ---- ------------------- -------- -- -- .................................... ...... ...... ................................................................................ U ............... --- --------------------------------------------------- ................................................................................. U Nature of Repairs or Alteratio s—Answer when applicable-------................. -------------------------------------.............................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to p;ace,the system in operation until a Certificate of Corn nce a e issu y the r f al -,/ Signe -- - . ..................... ................... .................... ........ 7------------------ ........................................... ........ Applicatibn Approved By -----------------­---------------- -- -------- ........... .....*............................ ............................... 13a te Application Disapproved for the followi g reasons: .................................................................................................................................... .................................................. ---- - ----------------- .............................................................------------------------_- .. ........... ........ .. ------- ........ Permit No. ... . ... Issued ......7 i5ne---------------------------------------- No.-----::f...�/�� THE COMMONWEALTH OF MASSACHUSETTS -, BOARD OF HEALTH ApplirFatilan for Dhiposal Works Tomitru.rtinn JIrrmit Application is hereby made for a Permit to Construct (�') or Repair ( ) an Individual Sewage Disposal System at: i t / i)Uri) t r-ref -t f �1 ................_........-•-•--•-•-•-••-•--------------------------------------------••-••••-• ..•---•-•-••---------•--•.......-•------•-•-----------•-...................----..... Location-Address or Lot No. ---•.................._.....---•-------•---•------....-----....---•-•............................ ..........--...................................................................................... Owner Address W Installer Address Type of Building Size Lot...................... ....Sq. feet Dwelling—No. of Bedrooms............... .......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures,__--------------------------- . W Design Flow.................. ................ ......__gallons per person per day. Total daily flow....................................P----gallons. W Septic Tank—Liquid capacity,?. _ ?__gallons Length................ Width................ Diameter__.............. Depth................ x Disposal Trench—No. .......��-....._.. Width..........47------ Total Length......... a.._. Total leaching area.......^ .sq. ft. Seepage Pit No___________________-----------------------Diameter Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( f)� Dosing tank ( ) Percolation Test Results Performed by----------------l I r _?, •_._...._ t Date......_ _.._ ..__ ....._.. a Test Pit No. 1____- "____minutes per inch Depth of Test Pit-__-_.j_Z------- Depth to ground water---_—-— Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth"to ground water........................ ----------------------------------------------------------;......--..........--•-----------•---......................................................... ODescription of Soil -..r==-•-'--•-..rf:.�:...---1-•-•--.:................................................................................................ -_r �,_ --------------------------------•----------------------.................... U Nature of Repairs or Alteration—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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 -----------------�---------... .......................------......-------- -- .-----......---..... ........................................ 1-7 Application Approved BY - 2.�. = = - j .......- e Application Disapproved for the following reasons ............................................... r�-.................. ..................................................-------....................................................... ...... Permit No. ....`---- ...... ..�.f Issued .............................. ./.. Date THE COMMONWEALTH OF MASSACHUSETTS ! BOARD HEALTH ..............................................rGt OF ... -- . ., h�/ E_L---.................._..............--- Cler#ifiratE of C omplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) Rpaired ( ) by .......... ........................................................... ...... ....................... ............................... ........................ �sauer , - at . " � , 1/ .: d �---- 1 Ll�.. �. `'.'..r' ---... cam-------�'.-- '1-..�' .........- -s c -G-!'.......-... has been installed in accordance with the provisions of TITLE of The State Environmental Code as de cribld in the application for Disposal Works Construction Permit NO. ����` -..-- dated --- =°-.: ."..P- ,�� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....... ....... .....�.-........16'......1ki....------....---------- ------------------------- Inspector ...................... . ........................................................ � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /'2 , No......`.'................. FEE...-._...__......:��� Uispaaa al Workv T41notrurtinn 00pamit Permissionis`hereby granted.............................................................................................................................................. to Construct (;✓)� or�.epair ) an Individual Sewage Disposal Sys em at No f..... ---��". ...... d1�,.!; �� ------.:M: -------------•------------- -- - Street" . as shown on the application for Disposal Works Construction PermiT .___ °_ Dated.._ "..s ... '� ----------------------------------------------.............................................................. Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS t 7 a TOWN JJOF BARNST // LE s/ LOCATION � f �1 �' /lU��a� SEWAGE# r'l `7 VILLAGE Ge��c�y�� ASS1ESSSOR'S MAP&LOTL1���� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �✓���� LEACHING FACILITY: (type) Z y©�7� ��G (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: - - 3 - ? -COMPLIANCE DATE: I �% Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by L 4 • �4IlEE'Z' I o� Z sl VATA 51 1,IG-E FAM IL`{ 9 58>2 awl E PL A 11 oN BAGK. u GAP 3A r.,Q 6 _ 'PAI Ly FWW = 3 x 1 I a = 33o 6 LDT l Q,�JSi�L 1 t AtJt7 �, GG v t�1 SEPTIG TAML ` 6,530 X 700%=640 4PD USF- 1500 "L. D•B�( N uSE 2 - ix 72 Tuay-Am-va 40• Im. ATIPL1 CATION A2SaA 2W'D. N SW GPD s o�¢ �- 4Q�SF APFU"T►ON AIZBb D251&14 Srs;t---WALL Atzr,-4=Av X 2X2x2= 7nSF tSTAI L OF LE"IkV-- T W14E5 SOTTOM AMA = 46 X 2 X I= 160SF -Tapv- AsrA s 49�0 sF . OIL 1:br- pMZ4o4ATWW (?d?E L 5't't���il l A4. rOUi 3/4-1�� stows PM vSAXM a M No.29733 ACTION o1a "1 . "(w gar.E GL I o11� �(o=t qR, T�-i d3 loAw� �SI�Soir, ?i i� i 9q•o ��t3 9g.Z 9 4 48.4 M 8 g e r� T /r . _ I 9� h(En� � tJc �catr� w wad Loe-A ow ChiLL&. P 54ALIc 1'L dc� J 21,1995 . �aflposEn I cs=r-`f T'KAT -rNE PLAID M=EzENC- 4aZbvh4 COAPI-`IS V rM TV-- SIMLI9 AMD iBAGtG taE ul2sIn6�rT DF T Is 'mK/N aF Cm-ur�vlL� i�lcauns "�AY.lJg A� . _l�_•--�df'LLIG,A'L�D . W 1 T'I�IN .A MAP Pam- 'Z1$ 5?6,::JAL FLxvp 41PAV MONt:. IbAtr=- it, RYE 1114 oST�zvtus ow-:5� MOM BV IiLDI t%" 490 XP NOT ®I:; LAM Ttb liSTA15tK4- :PRO?ESZTy l tWL24. /�pPUGA,NT: t :. n SN7PET. J0,4W • -Z-D�JE VL 20 /id /iD MAP 1'717_ I?CL 2.18 . I�-�i5zYj2 Q�t N log , �,� . I ��.• � � �i $ o PRopns� II c/ e6 a a,. Amid 7. ANS�L �o a t i RILE • YULLlVA "CKAPPA. No. 29133 MxiE11 r w p am rsT�`6 At Ems` T,DE4r(&-1 VATA �woET t o� Z 'Sli�l(.Ls FAMIL`{ 3 RmRr»K -E PL-A" OW B,A44 USZEAF VAMLy ,FWW = 3 x to = 33b6 Lor tQ Qj,15FrL. f�Cl•eXAIJb WD, C,�til'iFZV'LLZ SWne- TANL 3� RICO°�►: �Pb _ _ uSF- 1=;oo 6AL• AT-ru cATtoN AMA 114'D. -' N 330 GPD 4 0.-)4. W= 4-4&sF APP LIeA Vi.4 AM 1>2516 N IMEwA.i. At A=4b x 2xix2=�7osF 'bST'AI L of LEA691IJ4 TZucA1=5 torr'oM A9&4 = 40 X 2 X 2= 160 sF 7OrAL. Ate s 48o 5 D�¢CoL�T sF . OIL 6.• /I� 3. W�J (?d'TE L Miv Ad AA 194Z SOIL ClAjr., r 4` � _ 2 ��-I�� sTc►la 4Ri1Mfo P�1>ERR vb SSW ~ No.29733 'F(,= ioi•S 92 ,. T9-103 10 Wau 2 j7984 � +w � 94•0 Ls T ��18 9g•Z q9a (SWO g.= 9& r� t htm. �.hb �ir.Aiiar CE"RGD R.CT IJv wad 1r�G�T1dF.1 CC�/l U..� P i l 14-81 SEALS— I" �rzapoSEn I cs=1-`/ TPAT .rAE Dw Sl�otiuN PLt�J ENC� AW5"IG QECiV1E6M!wr D= ivra 'mWN OF ChiVTE7zVltrl,� 1FI6bkAWflS . � l�z PAPc-L. 219 "13 A I STA9Cg A►m :_L��:. LzxATiD . W t T'4 t N :A _... _.._. -$V.::aAL FLWP 4A►Z.AV- MOHlb. ; -ImkTw2- "It. Nym It%4 -r),.Iq-7 1 �-b� 11�� L S11RVI3C/t>ZS ; W6I�ttl i OS�ILlar ��i• Owls ''s Mom Bu iuD►O" SE�.NoT' I Fs APPU[',A,NT: tt 058D Tb l.twei. J Dr-{t� l=Dt�l Ems_ 5NEt:--T 'Z- z:1i- PET• JO�+N `F�,r�NE�. S,,t9gS ZD JE MRP l`l2 �GL 218 a400 I 151 S3 ° 4D•sox 15C1 Z Qn too. ��. . ti ►d ID 20 N PRo�sen �� I! l`Z �a� �w .i�J(m �pIV Y IT _ J 3.1 e6 I- �o uo-L-A Q ' ANS �D.4�D 'D o SULLIVAN No. 29733 AL wnM ° *am ISTBA6 '�� QA'Al Ei►G i i G