Loading...
HomeMy WebLinkAbout0091 ELIJAH CHILDS LANE - Health 1 1 IEEE■EE■EEEE■�■■�■■■■■■■�■■■■■■■■■■■■■■■■■�■■■■ IEM■EEE■ME■ ■■■■■■■■■■■�■■■■�■�■■■■■■■■■■■■MEMO IEEEEE■EEE■■EEO■EE■EEEEEE■■EEEEEEE■■EEEMEEEEEEM MEMO MENEM MENNEN MEMO MEMO IEEEEEE■EEO■�■EEEEE■EEE■EEE�EEEEEEEE■EEMEEEEME■ IEEE■EEOEEO■EE■EE■■■EE■■E■■EEEEEEE■■EEEEEEEEME■ IEEE■EEO■E■■E■■E■EEEEEE■E■■E■E■■■■EEEEEE■EEE■■ I■E■■EEOEEO■EEEE■EEEEEEEEEEE■EEEEE■■EEEEEEE■E■ 1■E■EEE■■E■■E■■■■EE■EEE■■■■sEEEMEE■■OEM■■EEE■M■ IEEEE■M■■■■■EEO■EEME■■■■■ME■MEEMM■M�■EMM�MEMM■M IEEEE■■EEE■■EEO■■E■�E■■■■�■■■EEEEM�EEEEEM■■MME■ IEEE■■■E■EEEE■■■■EEM■■EEM■■EEE■E■■EEEM�E�■■EME■ �■■■■■■E■■EEE■■EEEM■■■EEM■■ME�EEE■MEVEMM■■■BEM■ IM■EEO■■■■MMMEEMEEEEEEEEME■■■■�■E■■■■EEMMMM�■■ IEEE■■EEEEEEEEEEE■■EE��W.��' ,�i�EE■EEEM■�MM■�EME�MOE■ 1■■EEO■■■EEEE■■EEO■!��l�������■■■EEEEEEE■■EEIIE■■■ .� a 1 ;� :� I 7 d d Y ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■'■■ IS ��■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Flcs.... ... ......... THE COMMONWEALTH OF MASSACHUSI Cev BOAR® O HEALTH ' ftaptVim'BE PtL CE AN_M,<_.V�.............OF......... N�} �TC 5 E 4ND Atip ir�a#ion for Di m al arks Tomarnrtiviv;WNs k-, I-7I-.2-7/ Application is hereby made. for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys - ----- .. � ... - w.. ..- -_. .... • ...... . . ...... ...._._.._" . ocation-Addr' ............................... ......... or Lot N ' .................................. � Own r .. -Address............................... ................................................ ..... ................................. a--------------- --ins r Address l5 dip UType of Building Size Lot........... ............Sq. feet ,., Dwelling—No. of Bedrooms.__...................................Expansion Attic ( ) Garbage 'Grinder ( ) '4 Other—Type of Building No. of persons............................ Showers — Cafeteria G4 Oth fixtures ---------------------------•-•-- . d -------------------- -�---- --------- Design Flow..... ___._7.5...................::...gallons per person per day. Total daily flow.__......_..__ .._. ...8...._..._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.Il Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water--______-____-._..-____. Test Pit No. 2................minutes per inch Depth of Test Pit..................... Deptli to'ground water........................ a •--••--•---•-•---------•-----••••-•...............................•-•-•..............._.......------......................................................... 0 Description of Soil........................................................................................................................................................................ W 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 TITL U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b�sudi a ofhealth.Sign `� �� " Application Approved By----------)-- ...:......--•-----•............................................ ....�- -----'--'� Date Application Disapproved for the following reasons:............................................................................................................... ..._....•----...--••.......--•••••-------•----•-••••-••--------•-••--•--•••••••••-----------••------•----......--•--------------••-•---•--•-----•--••------------•-•----•--•-•---.... ................ Date PermitNo._ .... ,1...---•--------------------------- Issued....................................................... Date t ' THE COMMONWEALTH OF MASSACHUSETTS ` ,,.�. BOAR® O HEA -H r App irFation for Disposal Works Tonstrn.rtinn Frrmit . Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Indivviidual Sewage Disposal" System 1 -// / ...... -•-• - •- r-• -•-•.. .............. --••-•• -............ _. ^�� � cation-Addr ��. '��'�` or Lot I}T OwnX'l Address a .........� T_t......� ..............................................•-. ......................... .................................. •, Installer Address M. UType of Building Size Lot..._.._. /_ Sq. feet Dwelling—No. of Bedrooms...... ¢....................._..........Expansion Attic ( ) Garbage Grinder ( ) pa-1 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) al Oth fixtures -----•-•--••--•------------------- �W Design Flow_____ ...._.7- -----------------------gallons per person per day. Total daily flow____.._...____ ........�..........gallons. WSeptic Tank—Liquid capacity gallons Length................ Width................ Diameter............:... Depth................ x Disposal Trench—No. ................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._Z, Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' ------••--•-•---•-......•-•---•----------•---•-------•------•--------•...................•-••--•._..........---••------•--....------•--...........••••.....-- 0 Description of Soil........................................................................................................................................................................ x c, 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 TIT1 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be�id• e . a of health. Signe -• ~..:- ------------------------•---------•-------•-- ........ .. . .�.�...../ gD Application Approved B ---•------------------•----------•-••----•••-•------------------•---------- i Date Application Disapproved for the following reasons----------------------------------------•----------------------------------------------------------._....-•-••- ..............•--------•--------••-••-------••--•----•-••---------•------------•--------••-•--•----•-•--•------•--------------••----•----•---------•-----------------. p / Date PermitNo...4.�� ��/.---•-------•-------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n4 ..........................................O F..................................................................................... Tntifiratr of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( -<Or Repaired ( ) bY---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at........................................................------_____--------------•-------------------- has been installed in accordance with the provisions of TIT F ` of he State SanitaryCo e des ' d in the application for Disposal Works Construction Permit No.__.r�j" ............. dated ... _..._'?`':..._..................... THE ISSUANCE OF THIS CERTIFICATE,SHALL NOT BE CONSTRUE® AS A G ARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................V. 2_ I�....----........:,--•----..... Inspector.... j .l THE COMMONWEALTH OF MASSACHUSETTS BOAReOF HE T �j ............. OF.......... ..!.......V. .............. ••' ••� No.. ?.1...° ....�.... FEE.._.................... �a .. nrk T' ns inn rru it Permission is ereby nted..------. ............................ ......... -----• ........... ..._._.. to Constr t,(� oee air ( an d gage D posal em `7t `]� at No..--•............. - i _ .,G...1 .-- f . ••- Street �,.�. '1 f y` as shown on the applicati or Disposal Works Construction Permit No....._...'.`....ram... Dated............ ...� .... ...... DATE------`'••. ...... . FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ' ► :a C�Ai�'2:Alrf rs-rtl f.rGsc `� / r:ls t t._Y �Lcaw _ 1 l b x ��j = 3�b G.F'•t�. � �,: � �V .r t=f Tl G TAE i t� z Sso-d tr70 70 - •A_9 4.P.Lam. s ! U,E-- t o0o GA.t_... - - .I`.Po�et. PiT usE 1 ac�co / -':5Ur--WAt_.1._ ACFA = 15O S.P. Icy. ,c 2.S = :�77r-, G.P.LD. Ja Bcrr-rO,fA AO CIA r t=;O '8TZ-. pIT 1 .d TOTAL -C�V--Sl6W = �.25 G.P.D. �E1 / r"aA[AP_L }r 'TGTA L ID41 Lam( frdGULQT1UtJ tZI�T : "ttJ �LMIl.1 02 11SS. �� =�• "-`'' - I F4 D ffL il gyp. har F f; l •+1© 1 3 57 Tor Poo 4rfJp n - '� 6AL. Z -Box SSG Seqnc f�Iv. I Daa S •• IWV. IfJV- ikA L L�K � Fl T W 1 rr_i a wasu�.a � �� /•o� � _ G,O' ,_,,,,f (,,,LSD ___..•.... ,_.......�_.....___.._ I. V-Ttt=1G� IL Cr-lZTIPlq Ti4AT T14C Fpi/�..t4TIOW 5140vi J P4 A1.1. Rt�t= 6ZCI.iGC j t-t[.QU cm-1 WIT" Tl-1i:_ ( P AWC> `;C't'17,AC1� 1'CQUIr:EMc��T Or- !-! � E� PA't'G .d � ' 8D) n , P,AY,TCIz- tr 1 G- R GIS'1 -.T> t..Ai.10 5U?%vJayo1Z4 T t-t l� C�t_A ti-I 1 ,� �-t G>T UA ,C'C3 v t...i /�,,►„� , t`..Ic:iT• 4�',t'. CJ-ita['� Tc� t�f-.�.C1�Mt��t.�^ LC7''C' _ t_t WL_`.a r ����� � �n�di.c... i�� ppp— (1 ti.., -�lt..��/,Gclt'o,��: ��-�• � Ott-� ' ,e re s t t�+ L OT* y c � E Lk)n i INt i I G F 11oUS - a° A ✓`� �