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Home My WebLink About0110 ENSIGN ROAD - Health IID Erssi3A �d CeAftfvi iie 07 -061 SMEAD No.245KY UPC 12934 smaad.com • Made In USA SUSTAINW FORESTRY INITIATIVE Crdfi.d Fiber so*-M w �n r i LOCATION w S E W A E PERMIT NO. VILLAGE J 49 I 1 �ST lER'S NA & ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED= DATE COMPLIANCE ISSUED _ �� - Lo No.a.a..7_7... FEs.... ..... ._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF !-ZEAL H ......(? -------5..... App iratinn for Uftip sal Works Tomitxnrtinn 11amit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System at -1? T � ..... ... 1—.I .......................r -fiz yr l 1 e l�/ � ...... ..... ._... -•- ---- j Location-Address or Lot No. .,.� Owner ddress (� r � Installer Address 14 U Type of DwellindingNo. of Size Lot..` .Y.;.. K.Sq. feet g— Bedrooms........•�---------------------------Expansion Attic V� Garbage Grinder (Aj() �`4 Other—Type T e of Building No. of persons............................ Showers YP g ------------------•------•-- P ( ) Cafeteria Otherfixtures ---------------------------------------••-------•----......---------------•---•--------- .............................................................. w Design Flow...........................55..........gallons per person per day. Total daily flow......................- ..T.(j._....._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..... ........sq. ft. Z Other Distribution box (� Dosing tank ( ) Percolation Test Results Performed by__________________�..1 A.c_4 - .... Date.......... ...t�4e1_.... Test Pit No. 1.��j..__minutes per inch Depth of Test Pit------- _De th to ground water-___�644-1 (.i., Test Pit No. 2._.....��_.,minutes per inch Depth of Test Pit.................... Depth to ground water..... a 0 Description of Soil.....................0 . ---"'= j S. -......----••-------- ----•----------------- ....... U — !Z .......------. �'If-��-,------5,+1� )------------------------------------------- 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 r2IT1 , 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 boa of healt . Signed :!..... ... D t Application Approved By._...._ �'2..._.. Date Application Disapproved for the following reasons-------------------------------------•-------•---------------......------------....----------------•------.....-- -------------------------------------------------------------------------•-••-----------.....-------••-•-..------------------------------------------------------------------------------------------•--- Date PermitNo......................................................... Issued....................................................... Date Nod._-2=77..... Fss..3 ............... THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH .J.-(, ?GL• tE:.rl..........OF................> 1 `.jf i.-...f'....:..!........._•...�.. � � L Appliration for Uhipanl Works Tonitrurtion ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: f /� •yam �/ry // �sf V 1l `✓ l�..r/ Y t J Location-Address. /�� } -or Lot No. �` ............................... . ..�a�� .... �� !. �!ti .• 4�✓ .............1t_�.n. .._...�..`.. ...... Owner Owner / r Address r I l 5 C c,/ ,..-9 .-�, ..c, a 7*'�`�:.. . ................•+`"__......... ..•-----•---•-------._....--••----•-----_`� ............--••--..................-- Installer Address Type of Building - Size Lot."` _`�.. _: '__Sq. feet �--� ooms-__________-Dwelling—No. of Bedr _______________________________Expansion Attic F6'/)J Garbage Grinder (4'')'` aOther—Type of Building ____________________________ No. of persons............................ Showers,C'. ) — Cafeteria ( ) Otherfixtures :s---------•----•-•---••------•---•-------------------••----------------•------- ------------•---•-._'r__ ____ _ _ __ ______ �.._.______-gallons per person per day. Total daily flow_.__.:. W Design Flow g P P P Y Y ----•------- '.........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..................sq. ft. Z Other Distribution box (-') Dosing tank ( ) ... l /I ~' Percolation Test Re ults Performed b ............... °'"_ r ' Pt.v¢� ..__.%"l �% _.__ Date � f Y . ! _..........•------•_.. Test Pit No. l _._minutes per inch Depth of Test Pit...... .,�_. Depth to ground water...; 4 Test Pit No. 2...... per inch Depth of Test Pit____________________ Depth to ground water.. O Description of Soil.................... � . - - ... - �. ------. •--••........_ .•- U .--------------------•-----------------.._..._--•-•--�d'-,�1..._-.'.":'.. .W..-----:,:.:.:._.._...._._.✓-xj.= !1'R_: ............................................ 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:T ''s1 S p 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 board of•heal% Signed._ ' - t D to Application Approved By...... x ....................... .......... Date Application Disapproved for the,f ollowing reasons:-•-----------------------------•------------------------------•------ ...................................... -•--•-...-..--••----••--••--------•••---•-•-----••----••-----•••----•---------•--•-....----•-•--•••-•-•------------ •--•--•••-•.............••----•--••--------------•--......---••-••-••------•• .. Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,-- ................................ .... ..OF........................ ..... . .�..............::............................. Trrtifiratr of Tong hattrr THIS IS TO CERJFY, That the Individual Sewage Disposal System constructed -(,-�,;) or Repaired ( ) by.._--•.................................�_:'`� tt s............. .................I.................. ....... .._ ._.. _. ! Installer at........................................ f ----- - I j '' r= - has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No... , _-_.q_..`r______________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................................... ....................... Inspector............. -- ...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t <.. . . � ::...-....13 6.. ..... FEE... ............ Diopooal Worb Tonotrurtion Vamit Permission is hereby granted--••• .`• t-? . -ac 3.f. q r ---------•..................................... r .7 •. t r to Construct( ) or2epalr ( ) an Ii�dIVI�3u�1 Sewage Disposal st g 7 .._, Street as shown on the application for Disposal Works Construction Permit No.......... Dated.......................................... . ' 3 _ Boar ealth DATE................................. --••-------- ••-!-/---`J=--•�-•--•--------4.... �. , FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ti , v \Av. a o RDAD' . I '839••28 9 E: 44 7 .• 4} ,s.' ''' y .5 tit L ToP oA OUNDRTI'ON a ? FND.EI. 97.5 9. . . Fl¢v' J~ ` LoT 3 f �.SEPTlC rgayK'i' m a i� y oho"' roo/ 9 10 EiLSE`AA�N F ` `0 � n �ZB ,348 x L. VA OFMAI 74 ,0 Q 12.Ln f Ogg gK UQ` � . NO SUR�� 60CD s.F WIDSN IOO LEGEND EXISTING SPOT ELEVATION Ox0 '��` , :" CERTIFIED PLOT PLAN `EXISTING CONTOUR PNLP k FINISHED SPOT ELEVATION WEINMG ;i FINISHED. CONTOUR 0 No. 3�6 j. LOT a ENSIGN ROAD VILLE ;. I N u1ST(hl �y I APPROVED BOARD OF HEALTH a f �. 1 € DATE AGENT %' -SCALE: L° =60' DATE I Ffs L DREDGE ENG/NEER/NG CO. IN Cl. ENTGreabrie•- I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOb NO. $/023 BUILDING SHOWN ON THIS PLAN CIVIL LAND -. CONFORMS TO THE ZONING LAWS , ENGINEER SURVEY DR.BY� JDP OF BAR.NSTA E� SS. � } 712 MAIN STREET CH. BY= • HYANN I S,, MASS. SHEET-L-OF DATE ,R LAND SURVEYOR 4 M 9 N077e 7A.,V,(<. OR c.,w/."v G�-;om/r IZ,1,8 -3 7 El-0 a, SNA 4 L 8E co a AP044SH 7VC P/PL ,TO 4.TA o.=_ (�4,v EXTRA --A V Y CA S 7- /,VO" CO Vid—Ar z- Z/S =,o 9.1 EL co /,V.- ovm/VE WA Y,-,. 2 CLEAN -TANAO VOW LEVEL" 4F Z'LAYER -0-eAS 1,ky HED' 5727NC, aay.,, 4F (EFFECT/VC. -3//40 A, I WASIYACD 57ON416' 401 -PRECAST P17 .OR ZVVIV 7 RVAr 54- D IN&E 7' SEPTIC: 74MK' PIA C(51Z7A -A ri sep Ooalr .3 , FTi- 77 rl c rA v A • � lic- 90: OROUNO '�PvA7-ZR7A- Ae.Z-- ox' 69:5 FT. 0 -TeC7/Olorq. 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