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HomeMy WebLinkAbout0073 KATHERINE ROAD - Health 11e No.-4.3���- - j F� Fss.......... ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF w. -�.. L--5"- ......-.. Appliration for Di,gpviittl Marks Tonotrnrtiun Punfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location Ad ess or Lot No. L.e•Yl '. .?.L C Ci E? mil,�=.... J.. _..��............. ...... .... t.i�S. P .U'.�C�:..d..........-•-•-•----.. t owner a Address w 11,�.i w..�0? L f c .7! ....MfJ zee. : �- �•an.�..5------------------------- a � Installer Address9" dType of.Building Size Lot................ U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Gri er (/y�) per, Other—Type of Building No. of persons............................ Showers ( ) - Cafete Other fixtures -------------------------------- - w Design Flow.............�,5t.D....................gallons per person per day. Total daily flow......... ......................gallons. WSeptic Tank—Liquid capacity!i9tCcl.gallons Length..i".`W.'... Width..Y.`A".'-.. Diameter................ Depth................ x Disposal Trench—'No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------d,-____-.. Diameter........&...... Depth below inlet........?..-...... Total leaching area..................sq. ft. z Other Distribution box ( Dosing tank ( ) H, Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1....?h.......minutes per inch Depth of Test Pit....f.:k.......... Depth to ground water..Y_4_.i%.k_lYTe—rZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------•--------.---- ------------ ..... •-•-------- •............ -------- --....... •......... ---- ------- ............ -............... 0 Description of Soil.... ...v..._�1 •w.z 5 r.�. ................•----------------------....-----------•-•-•------------------......---------......--•----- x 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 LITL B 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. S• �.. . ----- ----• ... �. P ------- _�... . .. ........ D Application Approved BY .......... ••. ......... ................. �.. = lr� . .......... Date Application Disapproved for t f oll wing reasons:............................•--•----------------------.....---•--------------------------. ._........._._ .................•-•---•--•--•-•----•-•-••--•-••--•--••-•--••--••-•--•--•----•-••-•---.........................--•------•-•--•--••--••-•------•----.................................................... Date PermitNo......................................................... Issued-.............................-=-------•-------------:.: Date r W-.5e, 72 \ " LOCATION SEWAGE PERMIT NO. o T 2- VILLAGE du ay%E I N S T A LLER'S /JNAME i ADDRESS- c y S U kl D E R OR OWN ER �i� c �c - bC • � DATE PERMIT ISSUED �g/2 ZZ�� D-ATE COMPLIA. N:CE ISSUED (oil 3S a° FiL.o,v T • F No.iJ U ....... Fins.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.�'a.W_^. .............._....OF.....:043 --------------------------- Appliration for Diupuual Works Tom4rurt"tun Vamit Application is hereby made for a Permit to Construct (><) or Repair ( ) an Individual Sewage Disposal System at: .... .......�a�'91 f !:v����... .... ...................... ........................,x........ Location-Address o Lo . '"-^-' ---0�...... c Cam....-••--••--•------•.-- ----G•R i-r .c?•-�- ' !'=r tom. . .. ..................... ..i Owner i Address lf� .i r,.� ,,r 5�•a a it �J.fr. Ai3.L^......................... .......:Zia mc.A_.... t . �:3:_..... . ----------------....---- Installer Address.. �v�.ta.►..t d Type of Building Size Lot............................S U Dwelling—No. of Bedrooms-__......�.............................Expansion Attic ( ) Garbage Grin r Wq) Other—T e of Building No. of persons............................ Showers — a Other—Type g _1?���,�,�,,-=-r---- P ( ) Cafet QOther fixtures -------------------------------•---•-------•---------------•------.....---•-•---------------•----•---•-•---------••----..................._..- W Design Flow..................^_......................gallons per person per day. Total daily flow........'?.3.t2......................gallons. WSeptic Tank=Liquid capacitvl.nQ t.gallons Length__f+_'�'.'... Width...`y_A,'.'... Diameter................ Depth...._........... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area----_---.--_------.sq. ft. Seepage Pit No------------I------- Diameter........la. ...... Depth below inlet......... 2..... Total leaching area..................sq. ft. Z Other Distribution box ( T) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1--- __......minutes per inch Depth of Test Pit....l�........... Depth to ground water... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 9 •---•-•-------------------------------------------•-........---•--........-----...........-••-•-.....-------•--.....••-•--.....•-•..........-------••--....-- DDescription of Soil.... n.n... .CA"=......... r_•.: .-----------------------------•----------------•-------...... � .................................................... V ----------------•------•-----------------------•--•-•--•---------.........-----------•------•-------•---•-•-------------•--•----•---•------•----------................................................. W x ----------------------------------------•--------------------------------------------------------••-----••----------------------------•---•••-----------••---•---•--•----•----.._........-•------...... 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 until a Certificate of Compliance has been issued by the board of health. p Sign ..... .. . ....... / .------ Dat Ap Approved By.. ............................................... ...... /1 Application Disapproved fort ' 011 ing reasons-------------------------------------•-----------------••------•----•-----------•---------....-••-------••------ •-----•-•-•---..»-•................................-•-------•---------•--.....--•---------•----•-•-------............._- ............ Date PermitNo......................................................... Issued_...._....---------------..._ ^ --------------------- •-'- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..........................................................I.......................... Trrtifiratr of Tootplitturr TI Vl TIF ,; That the Individual Sewage Disposal S,7stem constructed (�r Repaired ( ) -- --- -•---- ---•-•--•-- I er at .......... :.... v •c: -- - ::"*......... _:1....... ...................•-----..............-•-- .. T F r '/ has been Installed In accordance with the provisions of TI_L. of The State Sanitary Code as esc edj n the application for Disposal Works Construction Permit No.... . .�. r, ~..... dated......, .�,� ._ ,1 THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARAN EE THAT THE SYSTEM W L F CTION SATISFACTORY. Inspector. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No,� ,.- .........................................OF..................................................................................... -......��.._ FEE... !/ Permission is ereby gra ted-•-••--- ---- :- ............................................................. to Construct ( �or ( ) Indivi ge Disposal / Street as shown on the applicat � i for Disposal Works Construction Permit No.__.... �. � Dat ......�1/...��............ . . -• -- ._...... Bo of Health DATE.. y -••---......-••...•-•--- = ..... FORM 1255 A. M. SULKIN, INC., BOSTON 9 .__ 71: OUTLET 5 ,, �4 ' r-� KNOCKOUTS INLET KNOCKOUT � 31 /6 �----� 6 x 4 DIA. _� r -i` f \ ' 3, 5' • ''• w OUTLET OUTLET of OCKMTS 00 Q O 0 Oil HBO OOOpQ O U8 0 0 •ay 000000 o o ° 0 �('AILM /©A/� ,�`1 AGE SYSTEM 'RO .0 ,E rA /1.S - -- _ 10 � O O O O O� 0CSrJ��.Q0 00 _ - 00, 0 /N/SH G��A. = �'_"'X - i�c ✓� A O�_ C/ I- AJ/5N G;4A OE �'/�//5 h� G.Q,4G7� — O,01 GY/f r;4/1/k" _ S/aC Ol/Ek? �O)( . — k/�R L EAL h�PIT' �/��'t? 00000000 O � 0 � OC� a00 � pt� nd9 % rIA"O � t� G� aOQ000 - - L 4" o � ooQoaO ° o ° �- ; . . . -.-.� 1 --, r i o C) o o b low" LEACANC P 7"% I 4_6. S�xc>,' � x 0 0 0 m I� 4` O,. - I Lxx�o __ _'�- 8 ��z i 40 0 0 0 © 0 0 0 00 of, plot 3' l� i 0 o 0 0 © 0 m 0 0 0 0 1, � i CALLaAI •o ► / �'�L Loy l t ���_ TA�v,r✓ }'t BOTTOM= xG 1100 0 0 Q 0 0 0 0 0 or, ] " _ 1 - 3 %l t Tc 0000 so 0 Q? to 0 0 0 r; 1 r P To o a m o m 0 0 0 i' 1 x - ,� t �` .:.� 0 u '1 0 0 0 0 o 00 0 0 0 0 4 o G'ENER,4 L /t/oTE -� ,'�-/ SGt/L 5 1 c�Gs sir 2 ,� ! Ij 0 0 0 ® (J 0 00 00 of, ) �-�- /�/ �c ' — 5 f•, xgpA A ALL ZL.N/LJT/D/t/S-517O N 4,qE- � J 10 o 0 0 m cc 0 00 041 s ,10000mc�0 00000 2. ALL o/P�5 /.V Tt/E SY��M To BE' \ 1 k6 X 1 x CA5rIX'Di,/ D/P 3. ,PEMO!/f=ALL IN-5 /TABLE A44TE�P/AL , OES/G/V C /c'/TER/Q E��F,4 rN TAAE IIWIERT-,EL EVA77"OW I /UMBER O<"BEOROD�t�15 FD.P ,410401US 60 ,4AI2✓ ) L K�/LL -5A P.E,g50 1-5 PER&E,D.PODiv1 U.4/L Y FLOlt1 PER F'E.4'S©N �� '� r�.., a �� \. Cl�Ait/ <rOA�PSc GR,4i(/(�L,4.Q 22 '- L�C- -1/NAG REOU/SPED D `�'� X� • ► MUST, E /tIOT/T/EO W171-/ Tf E s'?r til /S /rVSTAL L ED Pk�iR TD CALCULA T/D,,V 5 1 � �► T� rN�� ` ��RCOLAT/D.�/ .�?ATC- 2 �'P/N//�t�'y z5gCA-�/LL/NG FOlP IA/5PECT/D1V. TJ� Zi'C" _ 52� . -_._. Sz S. Uit�LESS UTH�RW/SE it/OTEO ALG. �% i�✓ll}✓%'r�' 804R0 DFNEALT� S/VE _ �7�'H'f:.. = .37`'i ! a I 1 L1 E E TESTED -; ___----- � SYSTEM �� ii�1F'DrtlEti/TS ShG4 B G?4 T ._:•..,� -7 ? 3 L 4Z. / V57A - kPI?A �/L /4 PaL /GA/ /T: A00 oo ~s� M,4 55AC�4615E TT5 T/TL E g 5AN17A,4 r � �� SEI�tfER COGS IDL LOCAL .PL/LES ' - WN/cN MA Y BE APPLICABLE. �RfJ�SE� Ol�t/EL L IA , ZOGAT/Ok/ A'A7-�-IE,//lE- ,R--�,�} d / PRoPosEO SEKlAc,E SYSTF"Lo,,",4T/ON A 41 x01; - 7 A 6ARBA67E C-R/tioER -- /NSTALLED OA/ THE 5,V15TE14-4. , , Iti VA 55. 49 L eGE-/V D , c�1rL/ �' A�P A,&. 22 Z."7 V.4JF�. SPOT E-LEI/. = 50X �. IISC` 7V �?RAWiVB�': sox a AL L CA PE SURVE y C'01V5(-1L TA IV T 33 5 OL C� B-4 RNS T,4 BL E L. , MA .