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HomeMy WebLinkAbout0072 FARM HILL ROAD - Health (2) r7 off. Tbj--rn 09 S M E A D KEEPING YOU ORGANIZED No.10334 2453L MADE IN USA GET ORGANIZED AT SMEAD,COM e{ ` a ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH T.1. �/..........0 F.... ? %U '� <s.................................. Appliration for R-4pogal Workg Tonotrnr#iun ramit or Repair an Individual Sewage Disposal osalAPPlication is hereby made f12Permit to Construct (& System at: o /1 t P�' ✓1 L P LocA on Ad ress a�� or Lot No. C 6Ve � .SD 72-1 •--- ...L..Ll ? l. D-i_...- .:. . !Y ......................................... aOwner Address Installer Address Type of Building Size Lot__r__ ®_-----Sq. feet Dwelling—No. of Bedrooms__________ _____________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No, of persons____________________________ Showers — Cafeteria Q' Other fixtures _________________________________ _ WDesign Flow.......................5 ...............gallons per person per day. Total daily flow.........._"7_�d._.__..______.........gallons. WSeptic Tank—Liquid capacity.!_ev©__.gallons Length--- _�G_�`_._ Width__��`��.��_ Diameter................ Depth_: / ".. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........l---------- Diameter......../a...... Depth below inlet-_.__.G_......... Total leaching area....�7....sq. ft. z Other Distribution box ( ) Dosing tank ( ) _ Percolation Test Results Performed b .___�L✓ ___�L__.__ -� ............ Date._ _.../5 y H }________________. ,aa Test Pit No. 1... ___.minutes per inch Depth of Test Pit....e ...... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit............ _....... Depth to ground water........................ •-----•-•--------------•-----------•-----------•---------------•---.._...-••-••--•--•----•--•--•----......................................................... 0 Description of Soil_....__.l1_ir-L ..._wa'e _P.46-2.....�___ Y,',6-•---562-• . ......................" ti1 !�!y✓G- V -Sip.__..._-.._.P "-/ �� LSD a s '�Aiv-D ?N-.,-- _�o�y s !��Jy W •••-•••-•-•-------•---•--•-•-------•---••---•--•-------•------•-•---•••-•----•--•- •-••-----•--•-•-----•-•-•-•••----••---=--•-•------------•---•--...----•-•-•---••---•---•-•---••-•••-•-........_-•-•-- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation til a Certificate of Compliance has been issued by the board of health. Signed_._ �� /_.... PPl ation Approved By.._... �Q ................... `�_.__ . _ _.... Date Application Disapproved for the following reasons_______________________•____-_____________________________._....____________________._____________............._ --•-------------------•--•------------....._.._...---•------•-------------...---•-------------------...--•------••---------••-••-•--•-- ......................•......................................... Date Permit No.-----.. :_•-/C��..__._...... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. JIVA,/.........OF.....�a a1.! S T!' 'G: ................................... App iratiun for Uiopustt1'3lurks Tonstrurtiun Frrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ..................... •--• .....4�.7. .- '.................................... •- -- Location•Address -or Lot No......................................-- Owner Address W Installer Address Type of Building Size Lot.....-4..`..... 0..---.Sq. feet Dwelling—No. of Bedrooms...........:...............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria G4Other fixtures ............ --------------•----- ----...---•-----•--•--.---•• .....................................•--•••.......----•- W Design Flow.......................•: .............gallons per person per day. Total daily flow_..........����........... ............gallons. WSeptic Tank—Liquid capacity..Zeeg..gallons Length....�.�6. Width..... .�� Diameter................ Depth_.:5�.``.... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area......-............sq. ft. Seepage Pit No..........L......... Diameter........./e..... Depth below inlet.......6.......... Total leaching area.....L...7.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..... 7??!✓ ��-.- :..--;�i4 G v........... Date.... ---------------- Test Pit No. I....j5�.?...minutes per inch Depth of Test Pit-----e� .`.... Depth to ground water,......-............... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ......................•---. o --------.---.---------•---•-------•-•-•----•------•-- .. ..-......-.,-�--•--•-----------------•---•---......----.-•---- O Description of Soil.........o.."-Z 4 i6- ........ ......... ......-.......G:.Ir... o •`5- - --.SAr✓_D 1r✓.�i� .S�M'� ....2:4./.... . 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 TAI TiS 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation uptil a Certificate of Compliance has been issued by the board of health. Signed............ ------------------------- ------------ •.................. ...... ---....... /ppliftion Appro ed By------- _R---12 .... ........................................ ....... ........ Date Application Disapproved for the following reasons:..........................................................................................................--- .......--•---.......--•-•----•--•--------------•---.....----....-----.....--•--•--------.....................----•-------------.........----•---------•------..................---...._.....•--•--....-- Date Permit No...-----. ""'�...a` ----- _..._.._ Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............Z ljAIA ......OF........ c:/VST ._e ...................... ........................ At— Trrtifirate of woutpliatta THIS. IS TO CERTIFY, T he I dividual Sewage Disposal System constructed (�`or Repaired ( ) by........... .--- -----....... =---- ---•---- Installer at --;:�....0.�:. _��..�------.. .--:��d n_y- ��=+( : - -' ��-f -�n at...�� . .................... - .. .......... . has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code 2asesc abed in the application for Disposal Works Construction Permit 1V'o.___. _._� ? ....... dated.__........�. .. ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAREE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. j DATE..---- ���f ..er............................................ Inspector.... ' ` _..............•----•--•--------................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ~� f ca T�h� �.....OF........��riv �AB Disposal, Vvr8s Tunutrttrtiutt f rrutit Permission is hereby granted............. U . to Construct ( 64 or Repair ( _ ,_an Individual Sewage Disposal System at NO......... _.. ../+: ........ ::ca��- - = '- --._. ��-s -••_-'�`--� "+v+�: ,?1r Street as shown on the application for Disposal Works Construction P•e, knit No.. f!' Dated.... ...........11 DATE.............. ... ..' _ Board of Health FORM 1255 A. KIN, INC.. BOSTON - 1 i Z-o7- FT...t i till W14 Par go•� 7ANe 3 , i / o 3aP � G . d GL,Z8.S Si ram- PL�}s•� /Vo7E- L`L /A77a.vs B/;3 LOCATION WG"ST qy�n//.s o2T SCALE . . . . DATE .ocr 2B iy85; PLAN REFERENCE /33 . . E10�� ELLEY N 90 No. 26100 � 1p.GIST[ ¢ ICERTIFY THAT THE s�oMAL�ppS SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND,THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE . . . . . . C. -=PVC - /e77T/O.Vc�� REGISTERED LAND SURVEYOR a � TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 4 CAST IRON II2"MAX. r OR SCHEDULE40 12"MAX. P.V.C. PIPE 4"SCHEDULE 40 PV.C.(ONLY) • ' PITCH I/4"PER. PIPE- MIN. LEACH PITCH I/4'•PER.FT. PIT PRECAST o e NVERT e Q :: LEACHING a EL..?:9. . 8.. INVERT INVERT p . ;' PIT OR INVERT SEPTIC TANK EL..7-RI/.. BOXDI • ELA944. >= EQUIV. /nno ,., GAL. I N V E T •, `' F.F- :•• e; EL.z :e .. INVERT W w p: :�. 3/4 TO I l/2' ;.� EL.?..:.5 ELy�. u-G �: WASHED w .r'• STONE i • /3 6 DIA. ivoke wc—A /o' DIA. �,T+c�uuYBX6'O PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE , SOIL LOG WITNESSED BY : DATE .!? !��y2S TI ME.ei , • A?9 , �e�NLa N , , , BOARD OF HEALTH TEST HOLE 1 TEST HOLE 2 ENGINEER ELEV. .5P.•;-R: . . ELEV. .. .. . . . . . . Wo 44" DESIGN DATA : NUMBER OF BEDROOMS A, TOTAL ESTIMATED FLOW . . .zZU. . GALLONS/DAY 5A-14o BOTTOM LEACHING AREA 78•S. . S0.FT. /PIT/,-./?D. 6Z. Z3.zv SIDE LEACHING AREA . . . SQ.FT./ PIT/47/CAP. GARBAGE DISPOSAL (50% AREA INCREASE). SAS o we_- TOTAL LEACHING AREA . .Z6 7: . . .. SQ.FT Cl?.9V� PERCOLATION RATE LG55 ?;V-lw rW9. MIN/INCH M4" lfL_/f3,ZoI LEACHING AREA PER PERCOLATION RATE . SQ.FT./C,p,D .No• .WATER ENCOUNTERED NUMBER OF LEACHING PITS . APPROVED . . . . . . . . . . . . BOARD OF HEALTH •77No F�G�T. 6/= ST�nrL� G N �JZG, s/Zj�s DATE. . . AGENT OR INSPECTOR �= nr EL ELLEY No. 26100 IsTFa�`� f�•IST� c SANIiP0.�P� PETITIONER G', C, Z7^/C,• ~�ava