HomeMy WebLinkAbout0154 KNOTTY PINE LANE - Health (2) 154 Knotty Pine
Centerville
A= 191 -092
I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Z
HEALT
d�
Appliratiun for Dispati al Works Tonutrur#tun Frrutit
Application is hereby made for a Permit to Construct ( ) or Repair (L-),/an Individual Sewage Disposal
System at: �
• .....1,11'�.�.... ..................................- ........ � ..............................................................
..... - .....
o aton-_AjAress or Lot No.
' .._. ------•-------••- --•-•-------•--••-- ..................••------•--•----..............
�— Owner Address
a � - -. ................ 1 ....��`'_„ -f .. . ----------------•------...--- .....--------------------..._
Installer Address
� Type of Building� Size Lot............................S q. feet
�-, Dwelling�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aa Other—T e of Building No. of ersons____________________________ Showers
YP g ----•---•----------••--•---- P ( )•_— Cafeteria.(...•.).
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 ( ) Dosing tank ( ) l
Percolation Test Results Performed by.......................................................................... Date------•---------------•--•---•-••-----
,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
GT4 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................
9 ---------- --•------•------ v- -:t
- -- --
0Descriptionof Soil---••-• � C -----�----•---- ----- --•------------------•----•-----------•-----------------------------------------•-----
x
U .._..----•------•----•-•-••-••--•---••-•-•-•-••-•.......................•..---------•••--•---•-------.•...•---•-•--••--......
UW ............-----•-------•-----•-••----•--•--------••--••--•---------•--•-•-------••-••••••-•-••------------------•- - -----
Nature of Repairs or Alterations—Answer when applicable.______ '._ ____' /. r____{.............................................
--••----------------------------------•---•--------•--------------------------•---••••--••-•.......-•-•-----•---------------------•---•••----•-••---•------•----•-•-•-•-•••••-••-•.........._..._-•----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITA 12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been sued by th boay of h Ith.
Signed_.
._�Date t(
Application Approved By.-.... - v
Date
Application Disapproved for the following reasons-------------------------------------------------------------------------------------------
...-...-•-•••--------•---•-----•--•---••••---•--....-----•-•--•--•---•...------•-.•......-••--•-••-------•-----•-•--••-•--•-•-----•----•---•----•••---•-••--•-•---••-------••-------•---•---------------
Date
PermitNo......................................................... Issued_.......................................................
Date
(No,11...?................ Fees/ .. ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF. HEALTH
........... /�,� .C'. ..--...-.OF.......................' f ar`eI,ts r
,.,-. F ..
Appliratiou for Mipviittl Workii Toutitrurfivit Frrnti#
Application is hereby made for a Permit to Construct ( ) or Repair (t,,,w)'an Individual Sewage Disposal
System at /} T
-4 i�rf ' ram' - .; �r `�! y' ..v,,,;�
...r... / ...,....a ?r!1' .. ..................................................—� .......� ••_----------.....-=--•--------........._....--------------....._•-•----------•--•_
f Locat,on Address or Lot No.
/ r /. ------� L
•-------- ---------•-------•------------------------•-------•-------•------------••---•--
I Owner r7 ! Address
____._ C J........ ....... ......... ......... Jr
Installer Address
d Type of,Building fo Size Lot____________________________Sq. feet
U Dwellin d . of Bedrooms______________________________ __Ex Expansion Attic� g --------.-,. p ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
QOther 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: __.._._.______-_. leaching area....................sq. ft.
3 Seepage Pit No-_------------------ Diameter..................... Depth below inlet..................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank,(
Percolation Test Results Performed by-------------------------------=------------------------------------------ Date.........................................
,� Test Pit No. 1...........:....minutes per inch Depth of Test Pit.................... Depth to ground water.........................
P4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-----•--•••--------------........................................................
0 Description of Soil-------`i=�� r4 '' __. " . '.,2/�� ------------------------
:V Nature of Repairs or Alterations—Answer when applicable-----i .-'.:. "�
•-----------------------------------------•----------------------------•--..•--------......-•--------------•--------------------------------..........................................................
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT11' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been}ssued by tl�e bosh d of health
J Z`/
� � r. .Signed.✓ air.^�+,<�/�f 7 f r4' GI sl!�t y d fr Ji r j .�J
</�r
y ..oj�................................� . —atetApplicataon Approved By -�— ! _ ^ t--- ?-- K 8 ------------------- ........................................
►
Date
Application Disapproved-for the following reasons:...._ •-----•-- --------------------------------------------------------------------------•---------
.......----••----------•---------------------•-------------------•-----••-------•---....---------------------------------------------•.•-------•-•--------_..-----------------------•-._.--------._..._
Date
PermitNo......................................................... Issued.......................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
• F
.............F...... j �" s.�tr #?! �. dnrr'r C
....:........:....OF..........: ,..., ....... ........_.......:..........
Trrtifiratr laf f omplian'rr
THIS IS O#CE �TIFY; �TV�t�the Individu�l�Sev`�age Di posal System constructed ( ) or Repaired F„)
b ,-' " �4✓ �'!p i���Jl l; s1 +` fsJrIJ r �Ml
y ------------
at
r
r �� r b Installg ✓ �
.� - r :=
has been installed in accordance with the provisions of T T LE ..5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No %Y ._ !-_________._ dated_. -: ,/ _ 15
-1
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
hh
DATE.........................................1-�`/1 ----z1-------_._.. Inspector------•••--- /v I.---•----••---------•---......_---•-----------•--•-•--•-_..
THE COMMONWEALTH OF MASSACHUSETTS
.- BOARD OF HEALTH
N :........ '• - FEE.e
F...../L'62
.. .........
Dia-Vol tl nr Tuner ion rprutit ,
Permission is hereby granted .... ...............................................'r �,l'�G�'.__..................................................'
to Construct,,.( ) or; aar an Inc vidual Sewage isp-1 Syslein ��
iat No.---�'� �---- //. /1� , �'f''J -- -(` �'`..... ...fir--Y �! ---��------- --------- ---
r Sheet t� �I1 s
_I f
as shown-on the application for Disposal Works`Construct n-�P•erini Na _______ Dated_1 2/� ��u
-•--
Board of Health
DATE-`---•-----•----•--•--------•-•------•-------------•--•-----------------_--•-
FORM 1255 A. M. SULKIN, INC_ BOSTON -
LOCATION c SEWAGE PERMIT NO.
h v `�I L/ 7
VILLAGE
_(v��T�r�UIf 1�C
I ,NSSTA L L E 'S NAME ,11 ADDRESS
V . 186h S�
U I L D E R OR OWN ER
L A �A lob
DATE PERMIT ISSUED / __/V
DATE COMPLIANCE ISSUED
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LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME i ADDRESS
U I L 0 E R OR OWNER
p/
DATE P RMIT ISSUED
DATE COMPLIANCE ISSUED azzv �1
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No..g1=-(121 ~ FRs....Jam...... ...
THE COMMONWEALTH OF MASSACHUSETTS
�ol�— BOAR � H TH
�j _
\a� .............OF... .
�Q ApplirFa#iun for DispoiiallUorks TouBtrnrtion ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at
..... .. ...... - .. ................... .---.2: -_ -_--- .-...._
...
ocati re o Lot N
..
- ner Address
A. ______________________________
T
.......................................................
Installer Address
____
UType of Building Size Lot..... _7:P..71.....Sq. feet
Dwelling—No. of Bedrooms........._:? ttic 069 Garbage Grinder___________________________Expansion ! )C,-
P., Other—Type of Building ____________________________ No. of person .. Showers ( ) — Cafeteria ( )
Other fixtures .........
W Design Flow................_ gallons per person per�ay. Total_ dui flow..__.___._..____ 6-galIons.
WSeptic Tank—Liquid capacit _ k__gallons Length__ _/)_.____ Width.. Diameter________________ Depth................
xDisposal 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 box1 Dosing tank ( )
~' Percolation Test Results Performed by...... -_'___________________ Date__ __ .... ...
,.a Test Pit No. 1_ . ......minutes per inch Depth of T st Pit _p p __ .__ Depth to ground water..___=�1gl-_✓_
4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...___.__._______._.____
i ---...
x Description of Soil---------Q j -!ni ?. �C - - --••--
...
• 1
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 TITHE 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 b t oar of 11
Signed . ..._... ... �✓ �/
Application Approved B . --- - -
Da e
Application Disapproved for the following reasons----------------------------••------------------•-------------------------------•----------•--•----------......_
--------------------------------------•--•----•-------••-----------------••-------------••--------•--------•---•----------•-----•-•--•----•--------....................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
�r BOARD CIF HEA T
3� ,1
%rrtif irau of Tompliana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
/ Installer
at..-------- " ....... -,!lam^/.: ---- C.... ✓---•-----------------•----------...-------------•---------•----•----•---
has been installed in accordance with/he provisions of TIT E 5 of The State Sanitary Code as described in the
___9/
application for Disposal Works Construction Permit No ______________ dated_.............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. J
DATE................•-•-•--......._...---........._..--•------•••--•------._........ Inspector....................................................................................
F< �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F H E TH
.G OF...... .:.._
Appliratilan for Disposal Works Tonstrnrtinn rumit
Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
System at
.. ...................................?.....3.,
/yNoca* ade Ly Address J f
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..........- :------_-. _-__--__--Expansion Attic ip Garbage Grinder
Other—T e of Building No. of ersons........ .....
a Other—Type g p ._...._.__.. Showers ( ) — Cafeteria ( )
dOther fixtures ......... -- ........................--------------•----------•----•------•-----•--------------•••-----••••--....-----------.........._......---•
Design Flow................ gallons per person per day. Total daily flow.. 40_gallons.
WSeptic Tank—Liquid capaci ...gallons Length__r/-I,j...... Width............ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No...__../........... Diameter.................... Depth below inlet..��..... Total leaching area .,Fa. .....sq. ft.
z Other Distribution box l Dosing tank ( ) q
Percolation Test Results. Performed by..... :.. "'_... :.'..................... Date...7.....�,�... �..�•......_.
� Test Pit No. 1'G ".._...minutes per inch Depth of T st Pit.._I '_...- Depth to ground water___.01.OA
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a' ,... -------------•-----.------.--
D Description of Soil----- "' ................................................
U
_... .... -'-�"' '' r'W, ". t/.r°'.---- .............................
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�_l 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 h boar of heaaltiz.
Date
.. ........ JEW
Art
Application Approved B ... -
PP PP Y �...>-•-f
,_ ....
Application Disapproved for the following reasons----------------------------•----•--•--------------------------••-----------------..............................
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD .O. HEA TH
...............OF....... ... 1.. !'..... ............................._...
Tntifiratr >af Tnntplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer ,
at ........ ,� •�J • , ' ^._,r.............. = ----------------..._.........----------------
-------------------------
has been installed in accordance witl the provisions of TI' Z 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No___c,/�._ -------------- dated----------............................._........
THE ISSUANCE OF THIS CERTIFICATE SHALL OT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................................•-•--.....................--•-•.............. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARQ--• F HEALaTH
..............OF..... i �+ ..................... o'
N ��a'��... '"' FEE.... .....
Bisposal Works Tnno#r tan unfit
Permission is ereby granted----- 06E'L.........C..6 "................................................................................
to Construc,t� ) or RepairJ' )1
an Indiv' ual Sewag Disposal System
at No........t ......ZJ. n... " ..._..` -+:. ..
--------•------------------------------•--------•-
Street l
as shown on the application for Disposal Works Construction Permit No------(d . Dated........_rQ!..
......................
---•-•.......
" / -- _
oard of Health
DATE............. % ..........................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -
ola
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s�ALI3Cf2T G
�0170-71
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A ark T5A4
'' • im.00 1$5LcD
T F,s F3.
. . .• 25 I..o-r 2,4.�..
L R.-S.M.
LEGEND �a vFgy,
EXISTING SPOT ELEVATION Qx0 CERTIFIED PLOT PLAN
EXISTING CONTOUR --- 0
FINISHED SPOT ELEVATION � � �oBF� � _ c-EE_ rEFP_ jL.lF'
FINISHED CONTOUR ---0-�
'APPROVED BOARD .OF HEM IN
�'�T�i ao Au EA �.1'S1'/- BLe-
DATE AGENT SCALE, � � �' DATE, ct1 29•13
ELDREDGE ENGINEERING CC
CLIENT 1 CERTIFY THAT THE PROPOSED
RE CIVIL RE E®LAND E JCD HQ.. $ 19
-- BUILDING SHOWN ON THIS PLAN
ENGINEERS SURVEY OR.By,
CONFORMS . TO THE ZONING .LAWS
712 MAIN -ST. CH,®Y� �F3� •.
OF a 2k"%AWI.E: M A
9,,,29�! .:. .. ..
HYANNI8,MASS, 13"ggT.,�,_QF„, ":' GATE 0. l.ANO SURVEYOR
NOTE /F E/TNE�? Tf1E SEPT/G TAN/C OR
GE THAN /2"BELON/
ACHING P/T ARE MORE
A 24'O/AMETER CONCR�T� COKER
SMALL BE ,®r�POUGiyT TO 6RA AD (AN EXTRA
CONCR�TB. NEA•Yy CA S7 /RON C'O✓E/? SfHAd L 13E VSl-
i COE - . MIN. P/TCN /F/N ,DR/VEJ'VA y
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SEPTIC- TANK :> o/sT . . . • ,�g. .
BOX`. p ! 1 B1 • f !• � � U �♦
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lNt�iC'RT' 'LEYAT/ON.f :S 'A 4-I t E;".
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- JAfVZJ T AT Ol1JLG/N! _ q o FT
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Ot/TLET SEPT/C'Ti`'/Vff qFT e.'<
INLET DJ$TR/1fllT101V' BOX=` 2' FT _ GR0l1NAPVP44TE4w TALE .
SECT/O/V OF
4�ITLETD/STR/BY7`/ON BC ►' FT
x•,
SE' A6E ,D/SPOSA:'L S YSTiEM;
/A/LEr L&ACN/NG' P/T : —FT T/1XULATION
LEACHING AV7
401meNSION A,
SCALE '•.�4
DESIGN C/417ER1A Ohf�Ns/o N FT.
NUMBER OF eELROOSM 3 '` D/HENS/AN' C 4° FT.
GARQAGEO/SPOSAL.IlN/T 0 SOIL LOG SD/'L TEST
TOTAL E3TI/r1647-EO FLOW 33� GAL.�DAy SOIL TEST / ,.SOIL 7ES7#2
NUM E QF I.-ACNIIVG A/TS_ I FZ&v q4•- ELEY. ATE OF SOJL TEST JULY Cl
B R �+- �D
' S/OE[P.4CHlNG PER P/T I$ -.S�Q� PT. I� ;
LOAM RESULTS AVITNESSED' 8Y g.P.
®OTTOMLE�iCt//NG PER P/T 7$ $Q. Pr , ��� S,,�g iL PERCOLAT/ON R�aTE CIE/ L£ss M/NCl/NC4N.
TQTAL LE4CH/NG �4REA 2 SQ, FT. PONCOLA7'ION RA�•'E.*2 f'� MIN.11NCN
RBSBRYELEA�'NIN6 AREAS SQ. FT.
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OF m4j
GQgVEL..
'JOHN � ALNERT: C-EN T-eP�j I LLB
,�kk-io�i,"i� / ��< ��.'� ELOf?EDGE ENIrlNEERlING CO /NG.
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