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Home My WebLink About0049 BELDAN LANE - Health �{°I �2f dan l.o►�e C �Ale rv►1). /// S M E A D® KEEPING YOU ORGANIZED No. 12534 0FM"TWIVE 2-153LORMIN.RECY CONTENTIO°k® ce, ro�sa � POST-CONSUMER sko� MADE W USA GATORGANIZEDATSMEA ZM I � N SEWAGE PERMIT NO. VIIIAGI irk v l� I N S T A LLER'S NAME i A_DDRESS r I U I L D E R OR .o e kj0 /'ei, 1� DATE PERMIT ISSUED g _ac� _ df' 0 . DATE COMPLIANCE ISSUED �. � • i ti �� No.......... �. ��s. 0. ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HIE, TH 1..............OF..... .. .................................................. Appliration for 11ispos al Works Tianstrnrthin jJrrnfit Application is hereby made for a Permit to Construct fk) or Repair ( ) an Individual Sewage Disposal System at ��...- �./ ' . ---........ ✓:. .- ................. fir// ✓ .. ". -� ...... f.'�/ �� y..�..� . ............... - , _. ��....�e.,� �o. ��........................ �p Ownerp vv Address ....�'i'/ ............................................................... Installer Address � Type of Building Size Lot__��4 A ....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ) aOther—Type of Building ____________________________ No. of persons............................. Showers ( ) —Cafeteria ( ) Other fixtures --•- -- •----------------------------- .................................................. W Design Flow......... I./_).................. per person per day. Total daily flow....?�.,74_____._._.___ _. ___._gallons. WSeptic Tank—Liquid*capacity/kR.O..gallons Length"________________ Width................ Diameter.............. D pt _ ............ 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 ) a Percolation Test Results Performed by .. l ✓ 4! .$__.. Date......- Test-."Pit- No. 1_ °sf.____.minutes per inch Depth of Test Pit__. ____._ Depth to P P - --- p ground water_1VfA.'R_1_____ f� Test'P:.,it..No. 2A�'! '-_minutes per inch Depth of Test Pit____________________ Depth to ground water_4%✓C0l . Gr - O Description of Soil = ��• �JLR�1'1. _ �� •- f"._ Cl7Aa.r ..T..... . _J� x V ..............,,:_--------- --------••-•--------•------- ------ 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 TI'L U 5 of the State Sanitary Code— The undersi d further agrees not to place the system in operation until a Certificate of ComplianceSi n as bee issued by the o - l J P g ..................... . ........... Date Application Approved By.......... --. -;2 Date Application Disapproved for the following reasons___________________________________________________________________•---•- ..-__ .•____---_--__ ............................................•........................................................................................................................................................... Date -----• Issued— _-_- Permit No. ........................................... Date No..........L6' 4�Es .................... THE COMMONWEALTH OF MASSACHUSETTS r y BOARD OF HEALTH r..``.....w'.�±.................OF..... ................... �.' Appliration for Uiipoii al IVIlrkg Tonstrurtion ramit Application is hereby made for a Permit to Construct (4) or Repair ( ) an Individual Sewage Disposal System at: ................_........_.._.........---•- ---•-•.......----.... ...--•-•-•-----•--------••--------•----•---•-... •--------.......... Location-Address �i 0 ...... ff .............. 0 nef �.. A" �. � Address •-•-••-••-----. ..�-•-•---••..._•-•-•-•.......................r............ ...... .......... ......... ...._......._........ . Installer Address .- Type of Building r, Size Lot.--_-_e Wins..........Sq. feet Dwelling—No. of Bedrooms..........................................Expansion Attic ( ) Garbage Grinder (4)) Other—Type of Building Z' a g --•• --•--- --- .;--. No of persons............................ Showers ( ) — Cafeteria ( ) dOther,-fixtures ---•--......••. •••--------•-------------------------------------------------------------------•-.- - W Design Flow..........:�. .t.....................gallons per person per day. Total daily flow... .�` ...........................gallons. WSeptic Tank—Liquid capacity/uPs?..gallons Length................ Width................ Diameter...._._......... D pth :___._..._._.. x Disposal Trench—No. .................... Width.................._. Total Length.................... Total leaching area.. �l ....sq. ft. Seepage Pit No..................... Diameter........... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( I) Dosing tank ( f '-' Percolation Test Results Performed b ..... j- .... Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit /3........ Depth to ground water ��y ti Test Pit No. 2!�'..)...minutes per inch Depth of Test PitJ4 ............. Depth to ground water._4.� /'' O Description of Soil-•- ................ {r S ,�+�r ..... r f ......._... rA x / ' ........................ t1/Jt'_. P�t+l F' l'�<'t°it' ""`" V ........................................................... ----.......-------------••----------------------------------------•••-....--••-•••---- -- 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: 5 of the State Sanitary Code— The undersiaed further agrees not to place the system in operation until a Certificate of Compliance has been,issued by hoard of health. Sig - it A- Application Approved By......... ...... . ..... /'�__ .................. - ..ate tCC/ .............. Date Application Disapproved for the following reasons_______ ___________ .:_.=.•..__..._.______.._____...__..___.___......_...___•_--------------------••......•---•- --•---•......•••-•-•..........•-•--•--•...............••-•-•---...•••-•••---•-••-------......-•---••.......---•-•----................................................... ............................. Date PermitNo......................................................... Issued-...................................................... Date t' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAI,TH "dr; OF. </ . ./ -' Trrtifiratr of TontpliFanrr THIS IS TO CERTIFY, That tl�e Individual Sewage Disposal System constructed (.�;) or Repaired ( ) by ?! '� '�' //ti' ' ' ....................................... '`---------------------------------------- ------------------ _ - ----insc�ii-- � has been installed in accordance with the provisions of T 5 o The State Sanitary QQde esc ' ed in the application for';Disposal Works Construction Permit No.' 'a'.___--------- dated.... . .....7-".. <V_.......... ,.x THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GU44RANTEE THAT THE SYSAM WILL FUNCTION SATISFACTORY. y DATE.•--•-••....-- .. Ll•�/I - ---------------------------•-- Inspector..... -• -• .....-•--•- --I-•- . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF- HEALTH ...................................... No.......4...?. FEE........................ Bisp�.a1 ors Tomitrttrtion rrntit Permission is hereby granted =. .��_:---- ....... ..•-•- l to Construct ,01 or Repair ( ) an,Individual Sewage D�pgsal-System , at No f ...r P '�D O, ;") ,,i AA/ C ti Street as shown on the application for Disposal Works Construction Pernpi ated..... .: _lI' _ ..!__ Board of Health DATE........... -Y -------------------------------------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS M „ .A s �� .��`e4��'��.•�, } ¢ � Fa J� � ... °�r h. w - a� t T ✓ r S}�d'X�� 'e'f Ji if ��. .-f• ��t,z` 3 �,�,�t'�.;.Y,�' "fit r, -. :'t - . . r.: 1 .s 1 ` c 'ffi .°�}' .s,y1't �F, r"# / J�r ` ✓ V 2'- I ✓0j / - ��..,r 1!la ,tia Co as 36 1 3 '4 #sy, '�'} ,,:s Je 0 rvA l_r Fi tk yyv �d< N '.SEP71C Pp ,� Q `r +1i z4 [mac%+.. tfli in r� xgRr P(.T ot! :•InIlk e �' ✓x 1 ' l y yr " A ti j � •334 s/F, ,.Y. l$�' tad. aj p, �.& iv .:l a Y 1 / * �.r4 Fta tea$:- �•!4+ 4'w ,rx 05 M^° II : is }yz C S �rjgtr� r rr a rn G_ 3 OJ U. *pry U 9UtJ!'fIS ' VlJ x � h r yQ rzk->v' t f } �Q �162j ,,�`,� £:.'r at'`is sr¢ }F d s e�•S f. �w , ,,�.>t ( o�, ,Q r•' �. k-/� � � tom_ ,,o \ g �(/�f�' :'ifs a Z � �•*��r gcS. w" F'�"� �`,�� r a SS��A��9�� d.'�4.�' tt� f.. E 3. SING SPOT ELEVATION 0,,0 CERTIFIED' PLAT' k PL`aN l; d3�.T�lNQ: CO'NTO.U,R, 0 - - a LOT. :�3�LD�4 Y afIMI15: IED `SPOT `,ELEVATION �FlNJiEO 4CONTOUR 0 --- R L >' Mi` v CN' /L 1N � b x BOARD OF HEALTH ' +��} �4{' a" °�;t�+a w,�'19� � ° _. .. , l - V a, r�� •, n / ik�; r �,� � � 9�� DI�TE A'6ENT, " SCALE rn- s I�CFrV BR 1 l �Pl � GE' ENGINEERING CQ ING�7 CLIENT _ k.` I CERTIFY THAT THE ±Pl�Op SCW ' EGISTERE REGI3TEREQ Jig J06 BUILDING SHOWN 0! THIS `PE :L "w C1VIL LAND CONFOR'Ms To 'THE� iONIN6 ' L S -'ENGI;NE,ER , ISURVEYORS� - OR.:.BY � ;.'�'�— OF BAN'5T `8'L `.$ - AW `` x "� TY•G` t -;,�,,Y .'z > "1 NO MAIN Sr. 712 MAIN ST. CH. 8Y= n i?._!3 . SHEET _ •, 'SQ YAAMOUT.H;'MASS._ NYANNIS, MASS 1. OF _ jDA E REG LAND,.;= SURVfl . !# o, J, �vo M/M. .......... A- MA FT _f'P;r4Fk .covcA4 re 6`.0 amotwavr r 4mA Dw. Iv q ' SHALL CA *Ae VIEJOVA Y" (00 2%!WPv... CRA CO/V 7 C Z AwA,V .SANGCC)PIA 11w &A CA,=1 L *LAYR 4-CAST:t. V49. IRON eo ::;, X-p"Remr-r. SEPTIC rAAI/< DIST' • • WA 5 HED 5 MVe A03OX ae w 314 WA5,q--,P STONE W7 8 Op 0 PRECA 5 r S,-ZRA 6 e a s a e 4o P170R ZVVIV m iveA-r eit.-ilArlioNs ff J' INXER'T AT ffZ11l_.D1tV& 577-4-�'Fr • I PIAM V 0,V 7A 8VI_A7 -1,V4ET WP77 F7 01,4 M. C CSEE IC 7,-41VK 57, 0 Fr 404/71-AET SEPTIC 7'AlvF< 5_�.a-Fr &ZE7-V,157RIA9417710H BOX 4=7 SECT/O/V OF GRO.UIVL7 W,47-E,'w TABLEOV7LE7-,D157-RA8iI-r1,0,V BOX =7--1 -17- ISEAVAGdE AWSROSAIL SYLS774=114 /-"4- --EACHIlVa �T& F7. 7A- 49411-ATIDV EA CHIIV45, R/7- -T SCAL-E DiMENsl ON AFT, � - D,=5161V CRITERIA FT. A14/Af8ER OF &,-_ZW0OVS- 3 FT. G,AR45AG_r-'.&15PO5A-L- Z/,V/r 501L Z_0 C7 6�0/1_ 7L=5r TOTAL e.T7l)WA-rez> j=7-ow a3 G,4 #/ SOIL 7_-4=S7-,*2 I/_.1,0A Y SOIL. 7,F57- NUMBER OF 40ACHINa 41>/TS_:_ 5LF.0, 01—-101--1-j-1 ,DATE OF SOIL TEST . . 6 S/DE LEACHING PER P/T SV. FT. Ir 4 RE54/j-rs W/rv&sszz> t"Alt I<, s 6 OT-rom 4E7I cAflvcr z;.,-,R p1r 7 FT. C) 7— r07.14/_ 2.e,4CH11Y& AREA 2b F77 S%//o s OIL, PEleCOLA'r10,VRArF 02 7-H-1- //,Vc RESERVE I—EACRI)Y&AREA SQ. .407. -z.-, ItA OF 40 T �rl zi C-72-7701 27-AIIE 4R, OBERT P, bl; o A, la, "_BUNIKIS NO.22162 "A, IV S7 #4 9. fsT NO c PRO! ,j :Z. Wv 4: zo apa % AL �-A t