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HomeMy WebLinkAbout0006 BELDAN LANE - Health 6 �e� l�rn LAnQ 18q —03 � -40� c P 7 S ICI E A D® KEEPING YOU ORGANIZED No. 12534 n 2-153LOR FOCRESW IIAM MIN.RECYC 1 IN1111WE CONTE iLEDma %,"' RherSaweinp POST-CONSUMER wuuw.sfiDroBramwp SR0129D M W USA GET ORGANIZED AT SMEADZU I G uq LOCATION SEWAGE PERMIT NO. VIIIAGE gq r--, A Pr"-- INSTA -& LLER'S NAME i ADDRESS ell S U I L D E R OR OWNER V Aa ol� DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i l � � „ .� �� - �� Y _ _ _ � �, _� � . � _� M t � LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS IUILDEIII OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �-d �� � I � + \ �. � y�, � *� .� �- �s( . V `r-, No.. ....... YzBl; ._............... THE COMMONWEALTH OF MASSACHUSETTS . BOAR® OF HEALTH � ire -------------oF....... �,��1 :.�..�A.... ............................................. Appliration for Disposal Works Tanstrur#tun 1hrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System _t� leP � C -. '. -_..___... ./ i� _. .... .---•-- %� ter/.. ..................................................... Location•Add t ss if......... ------ ......... ....... ................................ jP pOwner �^ Address Installer Address Type of Building Size Lot_./�. G©------ Sq. feet Dwelling—No. of Bedrooms.......... ..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ...._.....•••.....--•--••------•----•--••••••------••-.-••--------•--••---•---------------- W Design Flow...........3- 4...................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..................... Diameter.................... Depth below inlet.................... Total leaching area. l __sq. ft. Z Other Distribution box ( ) Dosing tank p '-' Percolation Test Results Performed b ._ � � ........ � i /��r/F® a �'1? ✓�� Y '� ''e�._. Date 1, �•-•®-•. le Test Pit No. 1................minutes per inch Depth of Test Pit___,`.3........ Depth to ground water.A!'me-(...._.__. f=, Test Pit No. 2_.-.....minutes per inch Depth of Test Pit.................... Depth to ground water_.OIACll_ Description of Soil.....Q.`_l_-- •. ---- •-• ��� U l • ----Cz-7,01dL' .! K �l�+ - x c.� ---------------------------�-":-il..'.__�a�rt e:..�`�..... ......... --....�'��----rah--- .......................................... 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 TITILi 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'sued by the and health. pp Signed.... ..-- --• ----- ............................................ � Q.. _.._ Dt Application Approved By..... C= ......................................................... ,/ Q....... Vate Application Disapproved for the following reasons:............................................................................................................... .......-•--------------------•------------------•....-------••---..........----------•-----------•----•------------•--------------•---------------------------...........-------------•--•.._.._.._..-- Date Permit No......................................................... Issued..-' -v _ -- to �s .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............0F.......,�.ji----- } A' 'pliration for Disposal Works Tonutratrta'oat rnmit Application is hereby made for a Permit to Construct (' ) or Repair ( ) an Individual Sewage Disposal System - �"�1,,�,�i,'1,! .... _... -..... -------- ................................. .. 19 Location Address j�3 ......................................... • •••-- ......................�tC'�..... E .[. --• }-Ott' ... 4 j`,l ��1s�` ..'>,�U 'Nr�-i(�!'Lr/ }�--........ •-•...... _ ....._. - 1 Owner ddreessss�'A� j Address Installer Ad W � - ----------• ------------- -- -- --A '---------------------------•-------------- ;.,r ,/� UType of Building Size Lot..1'-.-%'-��------Sq. feet Dwelling—No. of Bedrooms.......... ............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building a —Type g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . WDesign Flow...........3 .4-.-------------•-__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..................... Diameter.............. Depth below inlet.................... Total leaching areas!..�.A----sq. ft. Z Other Distribution box ( ) Dosing tank (/') � e �/L J"/" ` t Ea t {j/ Percolation Test Results Performed by............................ r....... ..__ Date.... Test Pit No. ................ per Inch Depth of Test Pit___ :` ......._ Depth to ground water. !�.t -_..._.__. 44 Test Pit No. 2...K'.."'"..._._minutes per inch Depth of Test Pit.................... Depth to ground water___<_'c'�'`(Lf 04 ............ ..............................................:....... --• n-----_ O Description of Soil _`. .�r �a,*o '1 ? ''�' �""�rlf r ?�..t` .�rJ w -•-•----.-... .P.vt..1 .... ...<3n---------------rf...... ........r_ -•----• --•-------------•---•--•------•--•-•------------•-•--•-•------------------•------•-•---------------•-•-------_-.----.-.-------•--------•---------------•-•---------.----------------•----------------- 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 TITLL 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 b-and of health. / ,10 / y Signed,`" =:.....--- " Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:-----•--------•----------------------------------------•------------------------•-............................. ................................•----•••--•------------••---•-•----•......------•.....--•--•-••----•---•--------•----••--••••---••-•----•-------------•---•-•--•--•---•------•---•••---•-••--••---•--- j' -. Date PermitNo......................................................... Issued.........................................................�. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p 1< %' '` ! %r ..... . : ,� ...........oF.....:.. ..�. '�. .. %antifiratr of TompliFaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed O or Repaired ( ) by---------•------.e l/-/ ; r r'll<'t:r_ ------...--- ----- -•--------•-•---------- Installer 1 at.-----•--------••-- ... ' .! cr~/>� has been installed in accordance with the provisions of T It, of The State Sanitary Code as dens ibb�d in the application for Disposal Works Construction Per �'0. 7_,;�.f................... dated. -.-�^_fl--- -/' :!.__............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM NAIL!,,FUNCTIQN SATISFACTORY. DATE..............._---•--5-••-........--••••---------------------- --......... Inspector---.......ye- -...._......•-•-- -••--...................................... THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH / cc�) ff... ........................OF.... G........ ....._........e... No........./............. FEE.. ............... Disposal Works T.uatu ur#ioat Upautit r Permission is hereby granted.......-�-.�`�i�--�!.... -'-----....... ........ ..................................................................... to Construct.(A' ) or Repair ,�, ) am Individual Sewage Disposal System at No---------------••- --• ---✓.'�_�F''`,c .° !t�_._ _1 1q�'-_"e, (1/ } •. . Street as shown on the application.for Disposal Works Construction,.-.Per No...... ... ..:. ated.. '"� d DATE ....... g1) •---.--. -----•-- -- ---------• Board of Health � FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ,. 7y k; .� if, N. t �,; .s 3i s 34' /0.00 GALy T,C. -rA v EXP.4NSr a DF nM a = g ' RO BERT s r - x cr y 'sa,�?�a �y..: '� •,� r. - ,, '- - - - v BUNIKIS' ,' �n yta: s ,rk pNo.22162�OrQ� SS'0NA1=� LEGEND ::r~XiSTIN�, SPOT ELEVATION 0..0 CERTIFIED PLQT :. PLAN E.XiSTIt+(t3 CONTOIiR` .0 ; - FINISH_F&- SPOT . ELEVAT,ION :0. L-0T .C� EL- - /V le-4Aele .... : }FiffiSHED :CONTOUR 0 � A'RPR�OVED; BOARD OF HEAITM IN S L ATE k' AGENT ' _ # _ SCALE ` (�� DATE 6�Z S4 ; CLIENT : r' EGISTERE I` CERTIFY THAT "'."THE PROPOSED *� `." : REGtSTERED� ? �Og.N.O �y� BUILDING SHOWN ON THIS PLAN &. . �f C1V.Il -LAND.. CONFORMS TO THE ZON.IN6 .LAWS kg': } E VGINEER4, SURVEYOR DR BY . A A,, ..�, >' r � — -.. OF BARNST SLE, ASS • M t' k 712 MAIN ST CH. a � '� a M:.S tiYANN..:, '-1,tA.. ., SHEET �.� OF ._Z. %0 TE REG LAND" SURVEYOR~ - W. T­ 2 J=r M//V. tq, F 4AI 'w' P4 .01AW AF 7WR CO.-YCR Z 7.C- COS-'ArAw $WA 710 4SMAJDAF (AW 7tRA EA 1­4 &,F',9AP,0&oS.V7 ISX C 0 _TA1,44 4- '49.46 41-S Z:�jD VY C-4�5;7 .14 �AIIM- AITCH /,V '.OR/VAEWA p 2 g.MlAe Covc&z&7 Aer - 1. 1 cc) CLEAAI. SANG z ,L:AYER 4"CAS IRON /OOC A P AIN. P17CW C . WASH-=O 5701YZ- D157. 0 AOW Vq Rem Jar. SEPTIC 7A # Or 1> • WA5N-=P 570NE AER7-.44 ' A Fo 0 6 a a 0 • soft V �L, 4-7.0 INVERT AT 6411L.D~6 S4,4 Fr 0.1V 10 C,(5--E Aeal_A7 INLET6;rP-r1C 7.-4AO'K S-3.9 FT 0 0 TLH 7- SEPTIC 7-A/VK S3.-7 F7- 1Aa,rr4o157-R14aa7,1o1v aox S3 9 o=7 S4FCT`10A1 O)C- aR0u1v,0 Pv,4 rf T TABLE .53.3 r SEWAGE AVIS,40045A 4 SYSTEM/W INLET LEACHING /�/T 3.D 7A46411-AT140AI i-EACH11V6 01T 01MEIV-510A, A 3 SCALE 0 DES16N CH17E-,A?IA OIAI_N510" 45 407% NV)b'f8-=R OF BEDROOMS 3 4>11,1,61V510N C, Iz:;;- FT.•41 A/. GARCA6,C p 15,4970SAl— 41N I r L, SO/Z- Z-O& S011 TEST - TOTAL. ES71,-WA7--ED FLOW _33 0 G,4i_.1,9Ay SOIL 7,55T 01 SOIL 7-4=S7-02 NUMBER OF -',5ACHI'va A>17-Z - IdFr ,DATE 0jX"'SO1L TZ.5 Al L4Fj1_ 51Z>ZL_-ACHPV6 ,R.-AC �P17- SQ. FT. -H54/1_75 GOA//Ae, 4L90T'r0AlLAq4CH1^lCrP�=_Rp1r so. &r -,dF/V C 04 A 770.1V RATE At ^71 tV,11N C H z_,u A -� & 7-07AL I_e,4CH11Y& AREA 2- SO. F77 �-Jlty, 14- )=L-JeCOLA 771.0.1V RA7'A-Ak 2 �15,_117 A71 A1.1 I N c L_ " (t 5Q. F;7r. R BERT. co 4,e iS�/<,V1 Z-4-t� P. , 0 BUNIKIS V" No.22162 pf Z>R,ED Cy,E ENCrl A t")?ING C 4;_ 47� 4 nx ' 33-NO. 7/Z I IA//V .9 4iPMdLTN MASS e3 . ISIST 'el- r7 'Aily;4AM11J., Y, 40 F IVNIA 42,10 , It joa N z,_