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HomeMy WebLinkAbout0123 COTTONWOOD LANE - Health I Z 3 CoIT ot)wo 0 /-A/ CtA`t e ry i t t-e. 261 - 193 /// S M E A D No.2-153LY UPC 12934 smead.com • Made in USA s 1 0 F'U' NNA INITIATIVE Cl"ftd Fbor SowcN WMKW DMWULNI t __._/ LOCATION ``` ( SEWAGE PERMIT NO. VILLAGE e de- J404-J, NSTA LLER'S NAME i ADDRESS "$G,pG c.& QR U I L D E R OR OWNER 1DAT'E PERMIT ISSUED �_ �3 DAT E COMPLIANCE ISSUED 005 �mz, SrC,kw Cot., ?05 ��,a No!'.... ...... Fps....., ..................... '17 6_7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........OF......... .......................... Appfirafiou for Dhiposal Works Tomitrurtion Prrutit Application is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal System at: e f-4 ................................................................................................. ......L.6+.JT&.......CC&O.rm Lu ............. ............. ....................... L cation-Address or Lot No. r............... r..... ------------­-------------------- ................*'"*................................­------*­-­---------------------­--­--............................./W I_- ler, ........................ ............................................Address ...................................................... i.staller Address V -11 Type of Building Size Lot../X dXA..=...Sq. feet U Dwelling—No. of Bedrooms................J........................Expansion Attic i�;arage Grinder (X) P4 Other—Type of Building ............................ No. of persons..........._........._______ Showers Cafeteria Other'fixtures ...................................................................................................................................................... Design Flow.............­r�5....................gallons per person per day. Total daily flow_.._....$Zp.....................gallons. 1:4 Septic Tank—Liquid capacity,/X.d6gallons Length./A.!!A.. Width.!__.0_.. Diameter................ Depth...+!!-4.... Disposal Trench—No. .................... Width...... .._.._.___.. Total Length..............0...... Total leaching area....................sq. ft. Seepage Pit No......_/---------- Diameter._,06........ Depth below inlet..._14_........ Total leaching area,$0d_d:.:YW. . ft. Z Other Distribution box (kllf Dosing tank Percolation Test Results Performed by-_.__ ...-IW.Date-----6 /j_ ............. Test Pit No. I.......!;4!t_.minutes per inch Depth of Test Pit-----1..�._...... Depth to ground water......Awlof Test Pit No. 2......a2....niinutes per inch Depth of Test Pit.....Zol..... Depth to ground water-----446A/ ............................................................................................................................................................ 1V ...................... 0 Description of Soil.... W .,1. 1 A :-;.1"- ..................................................44M.ft U ................... ...................................................................................... ---------------------------------------- ............"'Ae-Anor......4.p....#0.V.__4,_/............................................................................. 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 prow' . rti of TI��4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in p at,, a er ficate.of Compliance has been issued by the board-cdhealth. Signed-."--... ... .......................... ...................... ....I........................... Date plication Approved By.......4�_ /C--------------------------------------------------------------------------------- ---------------------Dat-e-------------- V -7,4�_ --- ----- ------ lication A plication Disapproved for the following reasons:............................................................................................................... ........................................................................................................................................................................................................ Date PermitNo..... ............................ Issued....................................................... Date No.'....._a-•-- -�j q� , FEs............................. J " THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7ea..c..e�i ------..........OF...-.-...1. ' 1e . ,1I��.................................... ApptiratiTu for Disposal Works Tonstrurtion Prrmit catiorT"is hereby made for a Penm�o Construct (YC) or Repair ( ) an Individual Sewage Disposal Systems at: ................_........-...................................................................... ............t'---1 fJZ� ..... Location-Address „, or Lot N7 N- o. ....... ,--_ ._..-••-•-•--.._._..._....................•-_..... Owner 105Address -------•••----•--•--•-••-•------ � Installer Address U Type of Buildin Size Lot_ � `� _'___Sq. feet �-, Dwelling—No. of Bedrooms................................._..........Expansion Attic ( ) Garbage Grinder ( ) Other—Typepf 1 Buildin ____ No. of ersons____________________________ Showers — Cafeteria dOther 'fixtures •----•-••••--•-•-------•-•••-•-- ••-----•---------------•••---•-•-•-- W Design Flow............... _ ....................gallons per person per day. Total daily flow------ .DO___________._______.___gallons. WSeptic Tank—Liquid'capacity`5A0gallons Length_%(2:77'&__ Width__)__-Q. Diameter_______________ DepthA'_=6m_-- x Disposal Trench—No_ ____________________ Width...................... Total Length.................... Total,leaching area....................sq. ft. Seepage Pit No______ ___________ Diameter.....%'.[)._._.... Depth below inlet....6___......... Total leaching ar�a_E� _ _ q. ft. Z Other Distribution box (P) Dosingtank ( ) .1AS `'" 753 Percolation Test Results Performed by.... ODOR-1.1!y.._.._.�:-�_51 r1'�t�_ ___ `5 a Date ------------------ -- Test Pit No. I....a.......minutes per inch Depth of Test Pit.....�q_________ Depth to ground water____ __ _____ GL, Test Pit No. 2.._..o�______minutes per inch Depth of Test Pit.___-/.._.______ Depth to ground water...___..._��! a •---------------•--------------•--:•.----_--------•----......._... ---.....• ? .. _. ..--- --`-•-x � �nDescription of Soil_._.-�p•- AD4_ �- 5") > - - --------•-•--- wrC.--q ------ 4------ ------------•--------•--•------•----••-•--•-••-•---------------- 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 TI T�L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in t6perati /until a er'ficatof Compliance has been issued by the board of health. • Signed 1 / Date 2p1lication lication Approved By--••-----••------••--•- . fr 7--r-Y-•--------•...._... -•-'-"-----•--------•----------•-------•- -----•--•-••---•----Date -••-•--------- Disapproved for Me following reasons---=--------------•---------•---------------------------------------------------•---------------------------•---- --------------------•-•-----------•--•----•--•--•--•----------------------••----•----------•--.._..----...---•-•-----•--.._..--.-..-.------•------------------------------------------------------------- Date rc Permit No....... Issued....................................................... Date I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l.0 ice. ..............OF*........DafV.\-af"- )��_-`-............---................. -._ - Trrtifiratr of Tomplittnrr THIS IS TO CERTIFY, at the=Individual Sewage Disposal System constructed (V) or Repaired ( ) r by1�:.�. �'. - -----------------------------•• _______ nstaller at............................v ?'`-=------�-- -------• - ......... e.41Z ....................................................... has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No _ _-__ dated................................................ THE ISSUANCE OF THIS CERTIFICATE, SHALL NOT BE CONSTR ED AS A GUARANTEE THAT THE SYSTEM WILL FUN ION. ATISFACTORY.'% DATE..............•••-• �� .............. Inspector.::.............. - THE COMMONWEALTH OF MASSACHUSETTS t, BOARD OF HEALTH V3� �l . .............................OF......- �1a- � h: .................. No. _... S./. :... FEE.._. Disposal Yorks Tonstrt ion rruti# Permission is ereby -granted................., P' _ �a _:____________________________ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No........... •-•---i- T?----- � C?_hi_Xo ��l..... l�� � ------------•------------------------------------------------•--------...-•-- Street as shown on the application for Disposal Works Construction Permit No_____________________ Dated.......................................... -------------------------------------------------- -7 -•----•--•----•----------•----•--•--..... Board of Health DATE.........-------�.--/-=--�-��- FORM 1255 A. M. SULKIN, INC., BOSTON f lam D a,..t.. . .�� sue,,J ,Ae.E Ma SSA tVC� r . , a � =.- • .r.+ 17N ptTr-w /LLA. t:"a U ES M W (ki o pA OF VC,"/fir a A U... 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