HomeMy WebLinkAbout0194 KNOTTY PINE LANE - Health (2) 194 Knotty Pine
Centerville
A= 191 —090
1
I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
r .-• ..............OF.....// ...111 .. ..............................
A�
Applirattnn for Disposal Works onunrttnn Primit
Application is hereby made for a Permit to Construct or
y
Repair ( ) an Individual Sewage Disposal
S tem at tZimi+
Loc dressf' or t N
:..Ad
w •............... ► 1. ......... ` ....................................(J ------•- ..PC,-..
Installer Address
d Type of B ding ize Lot..... ...Sq. feet
V Dwelling—No. of Bedrooms............................................Expansion ttic Garbage Grinder (M®
Other—Type of Building ............................ No. of persons..........t.............. Showers ( — Cafeteria ( )
a' Other fixtures ................................. .
W Design Flow.................... .�............gallons per person per day. Total daily flow............3.30.................
* Septic Tank—Liquid capacity]C0"MO.gallons Length................ Width................ Diameter---------------- De th................
xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area- 6.....: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...... .......
.............. Date.. 2?✓._._C1_/__....
�, "°
,.1 Test Pit No. 1......_ _.minutes per inch Depth of est Pit___.__._.. _ Depth to ground water..46� � .
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground,water........................
............... ---' ---�------•-•. - --•-...... -- .
O // L
Description of Soil_.._......__D.---Y (�.�� -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 THT,TL. 5 of the State Sanitary Code— The undersigned further agrees t to place the system in
operation until a Certificate of Compliance hai
issued by e boa/r� of ealth.Signed �. .-- 1 ...... ... .. ... . ...�- D to
Application Approved By...... z � - ------------•--------•--•-•------ --------- =...........6'...-----
Date
Application Disapproved for the following reasons:-----•---...--•---••---•------••----•-------------------------•----------•--•-------------------..._......_......
----------------------------••--------------------•--------------•--------•---._..._....---------......------------------------------------•---------------------------••------•---------•------....._..
Date
PermitNo......................................................... Issued_.......................................................
Date
No. . . ...' Fizic .le..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�? ..
......r64_711-�___.............OF...... .............................
Aliptiratiaan for Digpaaal Workii nnstrnrtinn rnmit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
Sysem at
i.c' .......................................................... ••----.
Loca , ddress / ��yS yr/ Apr t No./7u - E
D
...
W er a F J
Installer Address
dType of Bu•ding ize Lot.......�1.-0--.�:-2n.-Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion tic ( Garbage Grinder ( ' f,7
`4 Other—T e of Building No. of person ........... ............ Showers — Cafeteria
a YP g P . ( � ( )
WOther fixtures -------------------------------- . ---••-----------------•--------- - ------
W Design Flow......................:r�.5 ..........gallons per person per day. Total daily flow__._.......•. -P„�--....._.........._.gallons.
WSeptic Tank—Liquid'capacity_/O- allons Length................ Width................ Diameter..._.._ .. De th : ----..
x
Disposal Trench—No..................... Width.................... Total Length....._.............. Total leaching area..,.Z� q. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.,. _Z
``_:sq, ft.
z Other Distribution box ( ) Dosing tank ( ) `
'-' Percolation Test Results Performed b .._.... '..._
a Y r � Date "' ....
Test Pit No. 1....-._..Z,--minutes per inch Depth of Test Pit............ Depth to ground Ovate ;l !.f�'!
fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground,water- __......._......__.
•---•------------------•---•----...... t....------••------...------................ ........---...---
Description of Soil............. .{� Z` ... 1 j.� ----- - •--------
f.- 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^I':ILL 5 of the State Sanitary Code— The undersigned further agrees n.t;to`place the system in
operation until a Certificate of Compliance has been issued
/fby�the board of ealth.
Signed_ r 42
.... .� � ...... ...............................`
D e
Application Approved By....... - �.... .... ................................
Date
Application Disapproved for the following reasons-------------------------------•-----•------------------------------------------•---------------•------••-•------
..........................•---------------•------------------...._-•----....----•....._..---•---------------------•-----••--•-------•-•-------------•---••----•----•---------------•---..............._
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEA, T ��
.............. .... -- ...............OF..... ... ,el '., .. 't...%.....
Trrtifirtttr of Toutpliatta
THIS IS T CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
byj ,:x � --
r Ins ller
s
has been installed in accordance with the provisions of l I I r of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.... "''`._.�� _�`___-___. dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION
SATISFACTORY.
DATE............................. ./... ,/ �1------------•--••---- Inspector....-----... '/Sl._ .......................................
THE COMMONWEALTH OF MASSACHUSETTS
BQARD F HEA T
,n
No..... /...-. tY.,3 FEE... .........
Rapollat orko Tonlitrttr#io4 rrntif
Permission is ereby granted.............. -_ :Y::xa......... ,.':'? .� -- -
•..........................•------------.........................
to Construct ( ) or Repair ) an Individual Sewage D- sal,System i
atNo----------------� _._.... _... ---...._..lX .... _ r.�. �•=d-•------ �� 1 ..-•--•-------....................
Street
as shown on the application for Disposal Works Construction Permit Noo..................... Dated........___.._............._..............
':''`�' ...x-� .......................................
e of Health
DATE........47_: _ .........-•................•--••-----•---
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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D coIiERS �B p oFR FT /F/N OR/VEJrVr4 Y
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SEPTIC TANX ° A • • ik
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BOX p • • • • o • • ps J14~- / �2
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•. e • v D ' PRECAST SEEPAGE
o lNY�1�' ELE✓A�%oi1rS_ IFLY 89 5-
IN YEA T AT a!/ILD/J 6 w 97.v . FT. /b C(5--,-resuLATIOJv>
/J►,IL ET SEPTIC TANK 9 6.S FT FT O/.4!*J•
OVTL.ET SEPTIC TANK 9 6 3-FT.
INLET DISTR/B!?/ON. BOX 9 6 .O C7 SEG'7"/ON OF GROUND H/�ITER TALE
O41r1-E7-0157-R1.&Yr10N BOX 9 S.9 FT .S1�wAG�iE O/SIaO`SA L //�
INLET LEACH/NG V 7- .`95.5" FT. T/��11LA?TIDI'i/
LEACHING =/T DIJ►IENSJAN A ' 3 FT.
SCALE : Y .. I^®...
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Cl TE-N1A D/l•lENs/a N 8—�--'Fr.
WUJ+9BER 0I�®ED/F'OGMS 3 D/HENS/ON Cs�_FT. M:nl.
G,4RdA6Eo/5J9105AL-ZIN/r_ D SOIL LOG SOIL TEST ..
TOTAL E3T/MfiTEO 10=40hov 3 3 0 GAL.IDAY SOIL TEST */ SO/L 7EST492 G � �z1�-!
NUMBER AF' 40ACKlNIs P/T5_- I f`ELEK 97 ELEY. ,DATE dF SOIL TEST
S/OE LEACH/NG PER P/T I kg' SQ. fT. RESULTS WITNESSED 8Y H.
�UTTO/>t LEr9CHJNC� PER P/T 7 SQ. RT• Lv/1 $ PErt COLAT/ON RATE At/ LESS MJJV�//NCH.
TOTAL LEACH/NG .aREA ZG 6 SQ. FT. 5v6 O/4r PEhCOGATYON RATE fk2 '"'�M/NVINCH
Zp
RESERVE LEAC'NJNG AREA?6 6 SQ. FT. > ,_ /3
B'A YS IP,!
N OF Gv.4r2sE
M r L�4 JN Ilf
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90,E GisT ?`` EL, 1? 7/2 "AllyST. E..:.
r�lONALtiN: HY�tNN/3, MASS.
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GKO UND NiATER AT 6LEf/ _ JOB ND. l UZ-