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HomeMy WebLinkAbout0062 COTTONWOOD LANE - Health 62 Cottonwood Lane Centerville A=252-168 / E M EI®1®� No. UPC 12M sn ed mm • M.d.In UM It.W. L No............... 't'.. Fms....`��............. N THE COMMONWEALTH OF MASSACHUSETTS ��� BOARD OF HEALTH . .......................OF....... 4r ........................................................... 'a 4- Applirtation for Disposal Warks Tongtrn.rtiun ramit Application is hereby made for a Permit to Construct (—) or Repair ( ) an Individual Sewage Disposal System at: ...... �1 Ted +sari G ,�,9•v ----------------------------• . >�..---•-•------.........------• Location-Address or It No. ....................... Qwner Address Installer Address Type of Building Size Lot_'! _oa_r}.___._Sq. feet U DwellingNo. of Bedrooms....... ................................Ex ansion Attic— p Garbage Grinder Other—Type e of Building ....... _.... No. of persons a............... Showers p., yp Yg --•------ p •• ( ) — Cafeteria ( ) Pa Other fixtures -------------------------------• Design Flow........................... .................gallons per person per day. Total daily flow-------_..__.........._ (.......... W W Septic Tank—Liquid capacity/ cj_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..................sq. ft. Z Other Distribution box ( ) Dosintank ( ) Percolation Test Results Performed by._ _1C _. ^'4' '.............................. Date----- Test Pit No. 1.... .......minutes per inch Depth of Test Pit.........ram.... Depth to ground water.AI'?'`'.._____. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•••-•••-•••--••------•••---••-•••••••••--••••-•••--•••-••-•-••--•---•......-•.............•••_.............................................................. O Description of Soil------q... ............ -----6--�?U cii ......................................................................................... .---------.••.............................•-•--••-•--••••••••-•-•------....-•---••••-•--•.•...•. ------------------- --- `'a---------- .te a-- . 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 in operation until a Certificate of Compliance h n issued by.the boa`a.J ealth. d ..._ - ��� ... ....... ... ........ ApplicationApproved By.....i.; .----•-----------------------------------•--••-•--------•------.........•...-- .. ...©---- -- ............. Date Application Disapproved for the oll ing reasons----------------------•-•----•-------•------------------•----------------------------------..........--•----_..._ Date PermitNo......................................................... Issued--•-----------..._..---------------•---••-----•---..... Date r N ......�................ Fins.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1. '..._-------------------OF..... ��!"o�r5T�9 .6 -.. .................................................. App iratiun for Disposal Works Tongtrnrtiun erutif Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Location Address /� or Lot No. .... ------^• - ---..... _..------•-------•-- ------._....•••••-•--- Owner Address Installer Address of TypeDwelhnNo. of Bedrooms...... .................................Ex Expansion Attic Size Lot..._/- • r9QO Sq. feet Building .....----•------------- a g— p #vv) Garbage Grinder (yg aOther—Type of Building ..__.'4 i9 � ' ...... No. of persons.......�................ Showers ( ) — Cafeteria ( ) t„ Other fixtures -------------------------------••---•-••-------------......------------------•--------------------------.......------...._..----•-•-•--..........----• WDesign Flow__________________________!!�__._.•____gallons per person per day. Total daily flow...................................._.......gallons. WSeptic Tank—Liquid capacity/.�ro.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..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed .. ti✓tiU._"P__ _______________ Date....✓'��! _' ............. ..a Test Pit No. 1....�___....minutes per inch Depth of Test Pit_..__... _____ Depth to ground water'�'''".P_.._.___. (r Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-------------------------------------------------------------------•-•------------------------------------------------------------ --.----------- •........... D Description of Soil....0 ........'C�9.'�!_....' 4� Sc^ri ------------------------------------------ x �- S�9a �V ...-•--------- %7."_.b---- ....! .....----• _--- --------------------------------------•----•-•-•--•-----.....--- � ���- - ---------------------- -' .......... - ••----`�'ry�.'` c'� .................................................................................... 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 TITIE4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hZs- n issued by the boa ealth. t d ••._.. . ...........G�.� + "-•••----...--- '. . ApplicationApproved B ............... . . .......... ........ .....•---•----------••-•--- _Z..... ------------ Date I Application Disapproved for th oll easons-------------•-----------------------------------------------••------------------•---------.........---•••....... ---------------------------------------------.......... ---.............................................. ............................................................................................... , Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.............................................................................. uwrtifiratr of umplianrr THI CE. IFY, That th In ividual Sewa'` Disposal System constructed ( or Repaired ( ) by.........L!instilled ----• -- .. ---- staller ' at.................. •..... ---- •••'� .7 -•--z--- .............. ----- ............. ------------------------------------------------------------------------- has been - accordance with the provisions of TIt I� j of he State Sanitary Code as described in the application for Disposal Works Construction Permit No._ °.,�_.'_ __.f..................... dated----------...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................................�................... Inspector----- ''..� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................OF.................................................................................... ta , No. ...`jj.�.........--- .., FEE`.�......---•--......---- �tu�rus , '`� u ' �unuiriun rruti� Permission is y gra d.................5 to Construct or a' ( ) an id Sewage Di osal System atNo.............. ••• ........-•-•--•..ZZ?...'............ _ --. ---------------------------••--- -....-----------•--....------------------.................. Street e as shown on the application for Disposal Works Construction Permit,N,._`.. ............... Dated.......................................... -----------------------------------------------••---------- ----- DATE.._ �%'. Board of Health r" FORM 1255 A. M. SULKIN, INC., BOSTON LOCATION V ` A G E PERMIT NO. VILLAGE I N S T A LLER'S NAM%E A AbDRESS w y d U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1 f �,�►NG1.L- 4FAMtt-Y - � BGORooM , :.; ` 1.10 �GaRgAGE �jWNDE2 •j. :�-�',2 `. O/�►L�( F►-;aw - Ito x 3 = z g O G.p c). SEPTIC, TA►►jK U5E- l 000 GAL. :,`f: . ; 5P 5 v5E Ioo GAL. o1 D AL PIT v Z % , 1�,pTTOM ARZEA: . l�0 S,F, 0�/7•� k ' 5a S.F• x ►. o -ToTA�- " -TOTAL pAI►-Y FLov.! _ 33oG,Po. � � ,,�•. .� /07 Z AV, PE2C.0I.-AT►ON 'RATEs I IN 2MIN ot`1.E55 tN OTC. ��>`� H OF MRx1r. $ 1 I ,S.T. c' I I a C RICHARO �n$�f C' LA THUCIN A. a BARTER• �' .o p�yl,��� �o �I . I ,5XJ V I Na2'4fl ?� "IST4t at �� /v3 7-9 i J l Top FNDt /090 INV. i 5 ti • p1ST. INS. e,EPTIC- Z , 6vX /ps.9 ,TANK GA►.. ds3 LE A. INV. INV. .S.¢ND I�3/9•I�i WA D 6TvNG 9" - 993 • GE2TtPtG0 PLOT PI..AN • .SANS + P R-U F I L t= 1.o C A ►o N ��i✓y �I//GL�- j Wwxp- o SCALE SCALE ?f EIZEN GE � GE Q'f IFY THAT 'Tl+��cs� F�a. SNovYN . V{ER.EoW GOMPL` !S WtTN-THE 7— A.W P 5E'C5.GK 9-ExQ019-eM6N C)V-- pGL .47r,- • -To W N O F�3A2�45T�.-.� A NU 1 S til�� Y I,. LOCATED •W ITNIIJ TIA'S F//L�•OoD PL`t�' 1 t4C- DAT E_3, 3 � ► J ���� BAxTE Q e `M INC. R.EG I SZ V- tZSrD'tA1•!D 5 u V-V E�(oes -TIa15 PLAN 1�5 KlOT 4n5c D oId A OST1c2.VILLE • �S6- ilJ5-1-RuM6NT � V9-Ve ( -TNF- 0 11r6e TS Suou►� / NoT DE 'vSE�To Cat='1ERl^i►�4 L.c-r k-1 APPLIC-A, H