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HomeMy WebLinkAbout0022 CENTERBROOK LANE - Health 22 Centerbrook Lane Centerville A= 172 - 248 - - / 6,1do No 2C-�R �#,� w� No. .............®.. FIMs.... ........ THE COMMONWEALTH OF MASSACHU SETTS _----BOARD PF HE L ----//.0( )........--.OF..... ...: ..:. �,��-�..��1_ . 7c............................ Appliration for Disposal Works Tonstrnr#iun ramit Application is hereby made for a Permit to Construct (LII/or Repair ( ) an Individual Sewage Disposal ystem t r Location- d ess i-+ Lo N . •-/ ------•�C/7.. ....C-��--- .. ... .............................. s�.. 5�..--•-•-....�/Z_...��.._(dlf•-�l—f Owner yy%Address � Installer Ad ss• 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-__---_-__. gallons. 1 : - - WSeptic Tank—Liquid capacitZhQCOgallons Length................ 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_._ ft. Z Other Distribution box ( ) Dosing a Percolation Test Results Performed by V-�Iest /!Cj e 1(_f Dat? e_..9 o�--/- ---�...... Test Pit No. �e-sj.....minutes per inch Depth Pit----- .------ Dep`it to ground water.-_ fs, Test Pit No�,�d--- minutes per inch Depth of Test Pit... �...... Depth to ground water................. O Description of Soil... 7 ............................................................................................. . ../__... ._ ..... .................�_._ .-•------------------------------- X..T � /� - U r 1, _._ _ ........ ------=-------------------- " �l�irr ---• . -- - ---............................................- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system 'n 1170 operation until a Certificate of Compliance has been issued by the �ofal ---------- Signed. z.. j Application Approved B `-�.._ !:...G =.n� �_1._. �....._.. PP PP Y Date Application Disapproved for the following reasons----------------•-•----------•---------------------------------------- .................................... ------------ ------------ ------------------------------------ .---------- ._--.----•------•-------•----------------------------------------•---------------•------.------- 2 � Date Permit No............. J - ----------- Issued-..........'V"n ... -�"�- No.—`.ram. �r Fini .a............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HE L ....... ...........OF.... --.....-•.................-- Appliration for Dinponagl Works Tontrurtion Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at , ell Eo ation- d ess +- Lot Owner Address �O Installera --- ------------------------ ....... . �....._....... A ess Type of Building Size Lot_ .Q.. '....Sq. feet Dwelling—No. of Bedrooms___ ................................Expansion Attic ( ) Garbage Grinder (7jb Other—Type e of Building ............... No. of ersons___-----____•__-___.-__--___ Showers — Cafeteria a YP g ------------• P ( ) ( ) p' Other fixtu W Design Flow................!,__ ..............gallons per person per day. 'Total daily flow........ : ..........................gallons. WSeptic Tank—Liquid capacit}. gallons Length................ 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.._......._._.._. q. ft. Z Other Distribution box ( ) Dosin �+ �!~" Percolation Test Results Performed by _.__ ._ ___-••--�'�Z Date:_._ __ ....... Test Pit No. .._._minutes per inch Depth Test Pit. ..__ _...... Deto ground water.. . f3l Test Pit No _ " minutes per inch Depth of Test Pit--- _------ Depth to ground water __. j .......... O Description of Soil r ! l ____..__ PIP ;4 :.ti,4,37 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place th syste n operation until a Certificate of Compliance has been issued by�ard of heal Signed _ .. . D '` �`.•.. -----•................................. •••. -�--- ..........Application Approved By"________��'_.__�_:"""�_______________ __ � ate Application Disapproved for the following reasons:.............................................................................................................. --------------------------•--•----•-------------------------•-------------------------........-•----•------------------------------------------•-•----------------------- ............................ Date- Permit No..._•--•-�5--------------�--------------- Issued------------�,J. .1aE............ ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH A ........................... Tnrtif iraft, of TontpliFanrr IS TO 0ft TIFY T System constructed Individual Sewage Disposal Syste constructed (" or Repaired ( ) -- -- --- - --- ------------- -------- �P✓ Install has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code des ribed in the application for Disposal Works Construction Permit No....... ..... dated......... __t.. ._� .......... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONS RUE® AS A GUA ANT E THAT THE SYSTEM WILL FUNC ION ATISFACTORY. DATE...................�----.I./L ._�6.............----•-•...._. Inspector ...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HELTIH �- --/U(7 OF.......: ....I... .. ....---... No. FEE........................ l or (gon union rrntit Permission is reby granted_.._ •-- - --•---------------------------------------------------•------•--.......... ..----- to Constr ( or, pair ) an n vir3ua1 , ewag Dispo +System Street as shown on the application for Disposal Works Construction Permit o._!_�........... Dated.....Q1_1 ..................... ........................ ---of---H--ea--lt-------------------------------------- DATE........... ..._ h ........................................... FORM 1255 A. M. SULKIN, INC., BOSTON �3 r(U 076 s /hfF ui--c7 7r ark: f+D� c.�nrr ter 1z h Lo ­/ ok n It RS � t i yip �Ov /'(0 7p,(j� ,CY DID x o A 6 Ln r 9 T tt 3Xv ORSENo 1095L to i 4 ,o c i L S n C-.l S ' <E FSS F<1 s Yr a�"�: if VIM W, �ONAI. 7r !ry rd a5 ?a�a fr,It LEGEND e �'r�1 ss Rif ' k A EXISTING SPOT ELEVATION� Ox0 !�s M r aEX-EX 1-CbNTOUR °'---- 0 tl CERTIFIED PLOT -PLAN yc N r `IIdIS.HED 'OOT� ,ELEVATION irI�I�HEDA CONTOUR QrpL" '�14 �f3 f/�Cj �' /✓T '/</�fcc�,{� l��06+r.a 4, MOTE The location of any;`exzsting underground sewerage� wellS� Urathcr utili,tkes" shown;.on this jrlan is "aPrrox-' �I N mate on�yf;as 4det_ ermined from records ;i id/or verbal' 13, ;7 1/1 S 7 Yxn ormatxon The;contr actor is' responsib.lea'.fo'r•`the REV(.FEP / 7�S ;? y ,xi£x'cation of the 'existing locations �n'sthe "field.' SCALES _,/"� 40: -DATE , 1.�/61� L:jrL?R GIC.Ii E'IYWNSE'RINO; C0. lM Grccc-�gr►e=2 CLIENT-, I CERTIFY" THAT THE PROPOSED A&t !STARE - REGISTE tED L JO® NO �`FO� GU6LDIPdG SHOWN ON THIS P L,Afd; , VCIVI;L LAN® ; CONFORMS TO THE ZONING LAWS: ENGINEER 3 RVEY R OR.BY, A - --- OF B RIV- rA-/3z.G MASS.' y� key £€?12 MAI N STRE ET CH:hBYs ' { AI N I , MASS 0R ~ SHEET_ OP' ATE RE(�. L�(ND -SUR9lEYOR /1lO7'E /F EI7'e°fER TI,I.E SFPTl G TA/V/rC ®R ; 20 FT M%%V_ L CNtivG P/T '4A, • MORE. rAfAN 1zp'jZ'L f: /o /�/ 24'DI.4MET.Ee CONCR�7►'� ---------------- SNA4L &A ' T'® Gl�A®R.�.4N EXTi�A G�NCI��"TE PYC P/PL' t/EAVY CAS'7'/RO/5/.COP'.E/W -TW,4LL 1�eE 41S —.0 MlN: P/TCi! /F/N CAR/V�'y4/A Y -.7 0.0 C®b�E�✓r Iva wOFQ Fr Cc) 1�4C1&r . CLEAN .SAJYO � 4'"C•4s°'T 2�LAY,-R N �TCN i lG GAL. ° f eQ Tao a • • • • s + b o4o yyAspt'P!!J SANE S,EPT/C T.4/VK /ST, O • / a ® ° • • • 6 a ® O a 4 ®�X p � fl 0 ® � • f ff6i alp ° t EF�ECTI✓.� ♦ i V ♦ • e a e D�PTt/ • o e , O WASXED STONE 470 O� s ♦QQ e e s s • • • 0 , p P o Fl x s,o = �-- r v. e , • . • s e e o a p ,• PRECA5/' 7 .SEEPAGE �t� s a f • 0 ** too e D P!T OR o® DUI% - /N!/4-A° eAEVA7-1,0,VS P,, r C,,4-per u7 y ��S l � p „ � cL s7 0 /Mye.R6T AT dui DI'vvG 6 s-" FP t . r�vcE 7 . -Pr'!c r.�/v/� �¢s Fr,. / o PIAl+-l. cCs��r.�uLaT/oev� : OU'r1-ET'SEP77C TANX —3.I=r •, IIVLET I»5tR/���fT/®hl BOX E'T • S�Cri®/v o�' GROvND WATER TALE. TA8z4-A7'/D L CHIlVG: AV T ;S eA LrE .. %4 A a ! p~ DIMENSION . DRS16 CRI TE IA Dl.•lE/a* 1®/�I - F�'. `/ NU1�9EEi� OF�EARD<D0+9S ' '3 OIMEMS/AN G 4' FT 1`'er of GA.g6A6. P/5P®5-4Z.u/v1r E'' SOIL, LOG 4 r07A ' ri e,0 ./=LO y, SQ 1 L TEST A/ S014 TESTS 2 S®�•� ?�S'� e{NUM OE/1 OF 4rACXlNO Pir.S l �^FLe�Y. &1.7 �L Y, l�A T aF SOJL TEST SIOZ Z.,--AC'H1MG PER P/T ,Sv" FT. ��SUtTS A1IIT f "ZS�'r'EEa BY=i DP Gl�ooe}% ®07'TOM LErAGHING PAR P/T 7 U._ Z: ; $Q; RT. s '+ERC®.CATION I�s�7'E / M/IKNCM I/ TOTAL L:�CHING AREA 2..b 6 SQ. f'T �e SC /3 S vvr� PENCOI-A77ioN RA7R j*e� .@E��Rb�E LEACH/NG AREA 26$ SQ: ) MJE OF MAss,, L 0 T ROaERT '�' o ALB L a ELDRED v ORSE f �` • No:10951'40 � .r o caV! 1 x A ei, ' 9. "G .pc4't +y r+; 7 'v.. +�..5'41 �' tI.J"4.« _ I g'r O� GIST �� n e: w. ar �. I nl /DNAI - :,�'"._r--� ., '�'•.�. '. 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''�,` : �� '�'... •�•.. �..r� e.s. a,�n w �:�..a. ... �. ,-,✓.w:.-+, x�..+.+..Xr"r-Y.+.:.....%" a';�"k ..p ,-J p..., �. f� ....r:- .�-S ��. .� �.r . ��a .,4Cr + .'=7;,:;. _ `...r. �' a'�+?.,, -.see ,.; a e ..,.. ,.,,�..- ..,�:.. .. .:�. .. .F., .�e. ..'��.. .... ,...5r ';'.mot vp..-„>•. .� �f ,r,: a,�`Y.. i^^,v. :.t, ._�. ,5:.. �.._ u� sA" ''+ .F^��".H..a� v. ��<y�'..{f.c-:_;t'�.�r. ��x9 fin:.-^(,w. .r_ L 0 CAT ION G" SEWAGE PERMIT NO. /yt ly nt��13/©al� =160 / VILLAGE C� e lh I N S T A LLER'S NAME A ADDRESS jJ 1)r," e--o/14 0 h S UILDER elt OWNER enAksgr DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED r Isej . , t