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HomeMy WebLinkAbout0009 HEATHER LANE - Health J 30 0 S M E A ID KEEPING YOU ORGANIZED No. 12534 2-153LOR N" MIN.RECYOfILED INITIATIVE CONTENO7 CutifiedfiberSouming POST-CONSUMER www.sApmoru wrg S-01m "E W USA GFT ORGANIZED AT$MEAD= 4-_. Non. -J-J--14V F�s..�� ... ........... THE COMMONWEALTH OF MASS-A.C.HUSETTS BOAR® OF HEALTH ...................................---.....OF............................._........---............................................... , pphration for Ui;pnaal Worbi Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct W or Repair ( ) an Individual Sewage Disposal System at: ................ Ir........... ® .._. a?��:4�.c� ✓®r..�'. .E.A EC�._,�:h.?. Lo ation ddressor Lot No. Igo . Owr Address (Sa .. ` .................... ,-� ••-•------------ ------------•-----•------•------------•--.......-----•-•-----._..._...._....... ..........----------------•---•-----...--••-•-•-•-•-----•---��.9�... S feet Installer Address d Type of Building Size Lot..____r_____ .k........ q. Dwelling—No. of Bedrooms....._.....................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T ype of Buildin g f� __.._..__._ No. of persons____________________________ Showers ( ) — Cafeteria ( ) dOther fixtures -----------•--•------------------------- --•-•-------•-•-----•---•------••---•-•---•----------------•-------------------........................ W Design Flow........5t2..............................gallons per person per day. Total daily flow..........�.3®__._.____._______......gallons. WSeptic Tank—Liquid capacityl.go.©.gallons Leength._7.6...... Width.A/A_Q._.. Diameter---------------- Depth... x Disposal Trench—No_____________________ Width ......_....___._._ Total Length__.._._..-------.. Total leaching area....................sq. ft. Seepage Pit No.........1.......... Diameter__._.. °......._. Depth below inlet....4............. Total leaching area.2c........sq. ft. Z Other Distribution box Dosing tank ( ) / ~' Percolation Test Results„ Performed b A1AN.....A...Tok.ESt.......................... Date.._-�.!_elkl............... Test Pit No. 1.......I... ..minutes per inch Depth of Test Pit.... Depth to ground water.V__e_l1t.F...AT.f 3-a fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .. Description of Soil---- ..... --•------ = Q .- ..... .................. X U --------•••-•••-•-----------•-------------•--------••-------•----•-•--.._...-----••---------------•-•-••--------------------------------•-------•----••---------------------------..............--••--•. W ----••••------------------------------------•-•--------------•-----•-------------------------------------•---•------------------------------•----•-•-------•-------------••---•---•--------------------- VNature 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'�ITL L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be d by the board of health. �,�,,, ned.... •-- --- . ---- . ----------•----•------------------ a�- e Ap cation Approved BY------ -- ---------••--- ........----•-......----•---....--•-•--•--------------......._..-- -• ...---....0-•---- ........ Date Application Disapproved . r e following reasons:-............................................................................................................... ..------•-•---•--.•........--•---•----•------------------------------------------------------•-•------•-.I-----------------•---•-----------------------•--•-••••----------------••-•-•-••--•--...._..---- Date PermitNo......................................................... Issued....................................................... Date — __ LOCATION SEWAGE PERMIT NO. VILLAGE m. M.I [ r INSTALLER'S NAME i ADDRESS BUILDER ' OR OWNER " PC,6 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED c �i� ��� � � i � �� �� �� ��� � i� .� �� � � r "No. . K`''f Fmc...fo.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................... .................OF.......................................................................................... App irFatiun for Dhip uaf liorkii Tunitrurtiun thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..............................................................•-•-----------.._................... --•-••-----•--•----••---..........--•-----------------------•------------•------------..-......._. Location-Address or Lot No. Or Address wrf Installer Address Type of Building Size Lot..................I........Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P I Other fixtures ............ ..._------ -------------------- W Design Flow......:.....................................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..................sq. ft. z Other Distribution box O Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1.................minutes per inch -Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water..........._............ ......,..,.., 0 Description of Soil.......................................................•-................................................................................................................ W U ----••......-•--------------------------•...............-----•.............--•................--••-•.....-----------•-------•-••----...•'---••--•------...........••---------------...--••-•-•--........ 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.'I F 1, 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 health. ......................-----•----...................-'------------------------ D A icataon A roved B . r.:..-. ......_.. ----• P PP Y---. / ..._ Date Application Disapproved r e following reasons:------- ...................................................................................................... Date PermitNo......................................................... Issued----------•----------................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... T.Lrrtif irFatr of TuntpfiFanrr T CERTIFY hatee Individual- Sewage Disposal System constructed (. or Repaired ( ) by ��re' -• .... . .. ........ t --- --------•--------------------•-•-------- --........-•-•-----•--•-----------. at..... � •---- 4-_ -- ... -!r✓Z.m.............•--------------------------------------- I - 5 of The State Sanitar Code . s cried in the has been installed in accordance with the provisions m r y application for Disposal Works Construction Permit ' `r-�`r_ ____________ dated_-- _ '�____ ______._______._.._...__.. t---- THE ISS ANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU S A GUARANTEE THAT THE SYSTEM�WN1 I.TFNCTION SATISFACTORY. DATE_J.......................................................................... Inspector......... ------------•--••-•--••------------•------------....-••-•-...........-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o......................... �©-)---.- ...........................................OF................................----......------..................................... N -- FEE.......................• w Map Mork dun atr#iun rr Permission is h grant •••----•- r'�•--•.......... ------ ...................... to Construct ( or Repair ( ) an Individual Sev, e Disposal System atNo............................................................................. ...................................... ---••----••-••••----• ................ Street as shown on the application for Disposal Works Construction ert = -= Date ' `� .............. .......... .... ...................................................................................... r /0r( / Board of Health DATE-----------------•.`......•----•---•••--------••--•----•----------•-------'••-- - FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS i 51NG,L� FAMILY 1.1� GARBAGE �jWNDE2 45.1 p/a1L FLOW .: I10 A 3 = 33oG.PD. I Y f 5EPT1G TA►JK = 330x150% 495G.P. q�l pe.•4i 1— _ 015PDbAL Prr v5E 1000 4437 / ►50 S.F, X 2.5 = 37 5 G.PQ �i 9GZ BOTTOM ARE.Ar . �O 50 S.F.• x I• o = �'o oQ I PE2Go�.ATIoN GZATE s i''IN 2MIN o�LE55 71�- 7 tJ 1174 ti 1m y WII.LIflM yG� ��h ���y / /'� .�✓. C. o ALAN G T. N Y E H W. ,p No. 19334 O ES `9 � BTV� `.9 P {•1 5UR` TE=��T TO P FNp Lo,4,vf dr l o ov INJ. � D►bT. G4►.. SU�10/L BuK _ INS. 56v?IG '8 Z� {Dpo INV. 'G TANK LEACt4 INV. INV. Mca• u Ste.z. SE3. �.a�l/.!7 I'J 3��•I�L � • IWASNGD 6Tvµ6 , { � f'- C1=2TIFICD PLOT Pt-A-" 1.3 yox/rF2 PRyF1<_� '' L o c A-r_1 o N. ,��s-I-orls M I Ll-S I N0. .SGtaI.E_ SCALa ATE PL.p,N REPE PEN GE MO PoSE,7 f=�L1�5l101rYN NEczEoN COMPI-`{5 YJITH'THE S l�EL1N � •C oT /S AN��15bT�.GK R6Q�►R.EMENY� oF -tµ� 'Tv W N OF B AZ 45TABc-F-- AND I S N vT LOCATED •WITNI THE 1,.OoD PLta.11J ��v�G Lo✓� lZl�. BAXTEQ.e W`(E INC. R.E6 15-T 6Z6D'I..A►•1 o 5 v PLY TINS PLWQ I �P NOrT STE2.VILLF-- - k 55• - IN5T9,uMENT 5v2VE`( f 'T1-IE UhF�ETrj Suouty No-T DC u 5 E To C>e7 E.FL,M 1►4 E L oT t-I N E�j A P P 1_I c P.►-+T�c�sJ.�'1vN?y�o�,QTiEs,Ae. ' N 1511W i•ll+ FAMtLY - BEORooM WO CAQaAGE 6WND62 �G (/D p�alL•( FI-oW a 110x 3 = �3OG.Po 5EPTIG TANK = 330xl50% ' 14956.P• O`I USE 1000 GAL. _ G�iO• 015P405AL 'PI-r USE I0000AL. 375G.P4 50TTOM AREA-.. 50 5.F• x I• o 5�' G.P� r -TOTA I- D E.51GN r 4215 PSZCO�-ATION RATE I I'+IN ZMIN n 7 o Q 9 s7 • � I. • OF 44 1174 40 „J• o WILLIAM C. ALAN \yC\ No. 19334 O y E v � I _ + VV •. Q�STEP���' N� S UR`► i Top FND= 6Z:-O -40A f s" (o 0 v I NV- i DIST C, SuaSO/L 6u7Cs INJ' SEPTIC '8 , Z.� 100o ITV. `�'G TANK G°p IT'L S1y.o LEacu ' INV. INV. /VlE,a, W I 14 SEA.Z, SE3. r �A.V.� I'/ I WA,Nt:D 5 � 6TvN6 Ce9--T1FtED PLoT PLA►J Mo9 rFZ PRUFIL� o I.oGL>"T I0N /�A >rals / yfjr NO SCALE SCALE �'_ ��} SATE �/Z41 P A t�l R E F E ZE N LE GEcsT•1FY -tHAT :TH� ► PoS� SHo�r(N HEREo1J GOMC�I-`(5 Y�ITN SHE S l o6L1N �. � G� /S A 5E6'C5A.CK R6QUI9-C-1A NYC oF 'tµ� 'TC>W N Or- B AzgSTA3lF-- AND If, I.I vT LOCP.TED •WITW THAF 1 Oop PLAIN �%U-'C�j �G ✓� ,oar D AT 1r B A YL-r'E rZ.a [`.1`(E INC. I . `z.EG1.5TF-- ZEr'D LANo•5uP-YIcY�es 'Tu15 PLAN 1 Na'T 5N5C p p►d CvSTG9-VILt E - MA66- IM5•T-R.vMEsNT 5vZvey �- -rHE 0l^FSE"r5 6u0uL.3> NoT DE VSEOTd E'TERl^INE t-C,T - INES . APPLICA►-IT',:"c>yJr1J�1?y1,0e