HomeMy WebLinkAbout0087 WARWICK WAY - Health ��.�W�c�
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...........................................OF..............................---.._.......---
Applira#ion for Di,spniial Workii Ton,strnrtiun rami#
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Systems at:
.......G. ` ........... ... cl7 Zl�f c 5; ............. -
' Locatio Addr ss 3�� � � oy�G d• �
,Own r Address
�Wj ZC-�----------•-......--•........3... ---------.0KIC-1-1-1..... ..---•-----
Installer Address �
Type of Building Size Lot.�_____________________Sq. feet
U Dwelling—No. of Bedrooms------_3..................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. .of persons............................ Showers ( ) — Cafeteria ( )
P4Other fixtures --------•--------•------•----•-------------• ---•••-----••-•-•---•-------------------•--••-•••--•-•-----------•-•.....--•-•-•-•..........----•
W Design Flow..........5!5..........................gallons per person_per day. Total daily flow.._............_-3-_�-'..........gallons.
i
WSeptic Tank—Liquid capacit},/�Dt.>---gallons Length__ _________ Width__;:_,--------- Diameter_-.------------- Depth,`1--_•-........
x Disposal Trench—No..................... Width............j...... Total Length_................._. Total leaching area....................sq. ft.
Seepage Pit No-------/..-------- Diameter._/b:_:5�... Depth below inlet_...•_ ..-._. Total leaching area..; _-sq' ft'
Z Other Distribution box Dosing tank
'-' Percolation Test Results Performed by.Zm�?__..c ��:4....r.....
Date..... ®_ .. ...
a / ---------------
Test Pit No. 1"'^'_�inutes per inch Depth of Test Pit/__X1...... Depth to ground water...'
�14 Test Pit No. 2................minutes per inch Depth of Test Pit--------............ Depth to ground water........................
9 ....•••••-------------------•---------•---••-•-••-••----•--------••••---•----•-••-•--------.._.....•-•-•----...............------•......------..........--•--
Description of Soil.... _____ ________ 71 .
W �_ 1--------------�-----------------------------------------------------------------------
V ---••-•-•••••----•••--••-------••••--•------••-.....•--------------------•--•-•-•-•-•------•-••--•--•--••••-••--•-•-•-----••---•----------•--•---•--...................................................
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 iT Y 5 of the State Sanitary Code— The undersigned f tl:er agrees not to place the system in
operation until a Certificate of Compliance has been issue by th.-
Signed_ �'
1 ---•----- -- e
Application Approved By....... 6d' -. ---- . -- --•------- -------•------ ,< D
Date
Application Disapproved for the following reasons-----------------------------•'-------------------------•------------------------•-----------------•--••------...
------•---------•---------------•----•---••-•-••-----•••••----•--•••--••-•....---------••••--------------•---------••--------•-•--•----------------•--•-------------•--------•••......•--•••----•••-•--
Date
PermitNo......................................................... Issued-.......................................................
Date
FEs...............-�..•�^
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......... .- ... ................OF................---......................... .........
App iration for Disposal Works Cfonstrnrtion rumit
Application is hereby made for a Permit to Construct (,--�`or Repair ( ) an Individual Sewage Disposal
System at
cc1/C ......_.!.... .......... .......................... L�=:..............•--------`S.......----��----
Location-Address j or Lot No.
...................... .._.............................._..._.._._.............._._....__________ _........._.._......._-------•---•--•-......----...................__...._....------..__..........
Owner Address
W
Installer Address
Sri�o
U Type of Building Size Lot ..
feet
�-1 Dwelling—No. of Bedrooms.....__---�?__.................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures --------------------•--•---•---•---------------•----------•-------------•----•-•------------•---......-------=
W Design Flow.........�5 ..........................gallons per person perday. Total daily flow_-_____-__...__:?�_�-'......a..........gallons.
WSeptic Tank—Liquid capacity7,2 _.__gallons Length........... Width_`.......... Diameter________________ Depth ............
x t` Disposal Trench—No_____________________ Width..................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.._...Z........... Diameter.ZQ:__:5.._. Depth below inlet__-__J_ Total leaching area_._-7.__�_"_sq. ft.
Z Other Distribution box ( ''�' Dosing tank
Percolation Test Results Performed bye__ ..__...._......._:-=...._.._.rz t'17- Date......
Test Pit No. 1'!S;::-:minutes per inch Depth of Test Pit�� ,`�'_____.. Depth to ground water___'U.�'.!
44 Test Pit No. 2.........._.....minutes per inch Depth of Test Pit.................... Depth to ground water........................
--•----------------------------------------------------------------------------------•-•--••_..............................................................
Description of Soil_._S_� ._....�.-:�`-!3:�-=�.�................�`'"'�
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 ILTI-; 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.
Signed )
/ \
Application Approved B , - t
Date
Application Disapproved for the following reasons:..............................................................................................................
.........................................••-----------------.._..---------•-----•--------------------------••---------------------------------------•--•------------------------.......................
Date
PermitNo.......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.4' ,,ram..........O F...... .j................................................
Tnrtifiratr of Tontpliaure
THIS IS TO RTI That the Individual Sewage Disposal System constructed ( /or Repaired )
by.............. .........-•--.._._....-•-•---•----------------------------------------------
a Installer
141114
has been installed in accordance with the provisions of f" - LE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No-----G _<-,L.� _.......... dated_-...-_--_..--__--_---_-__.....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE DATE............................................J_`1•��`!�L...._..--- Inspector............�1_ -�tJ------•--------....--------------------.......--•---•--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1..�1 •r. ►►d..............OF....... _.2i.....--•---------------.._..---....._.............._.... FEE...�.._:T.............
]Disposal Works Ton trttrtion rnmit
Permissio is hereby granted--------------- -- ---------------------------------------.....-------......__..._.....r..._..
to Constru t r Repair ( ) an•I Ividu 1 Se age Disposal System
Street
................
as shown on theHWARREN.
or Disposal Works Con ruction Permit No_____________________ Dated. ............................
oard of Heatth
DATE-----•-•----_. -•-•--••----------.._....__...._..._--•---
FORM 1255 HOB INC., PUBLISHERS
LO�CAT ION SEWAGE PERMIT NO.
VILLAGE
[ MSTA L ER'S NAME & ADDRESS
&0
B UItDE R OR 0 ER
DATE PERMIT ' ISSUED,. . Ll /15/ (50-2,
DATE COMPLIANCE ISSUED
0
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— - - - - - -- ex%st1nq grour,cl RrofilP_ H /�r-
--o - o—o -o -- �roPoseo/ around Profile o0 elZ. SGAL E-: /o/' _ ' S �..' G 0 AJ t/ E ,e_77 s C -9 f /"= /0'
S C H E O. 4 a P v C. Dig F L O h/ ----------T-
EQvHL TO aEPT/G C �4" O -foot )
o f �e �Z washed/ 57�orse�
rn�n�rr�v rrl per
Al
yx
_ O/sT Box_ i- /
6" Sump
/000 GAL. SEPTIC T,Q/l/k • � ° ,
L200 GEAGH = / T
alrC �1'1
//> VC eases
O S / G AJ - 7 �- S 7 f--� O L_ Oe
o , So _
^7
__ BEO�EooM Houses �� TE 3- /O -Bc �04AJ i✓) LL
J _ - TEST B Y� —.—�_—_�_,
V r7o des oser
`V / C. .2RTE- /A/.//A/CH � , 3
tom. Gig =o� � i�? enf c">1��-n_:- fit%pile
P _ l+t/. T ill ES _
!b wq��M1' 3G^ i'. 20• �\ F L. O!�/ .2 A 7�h
G9L5. O.QY L o�r-
K o x / .5 s 4 y-s #
USE : /000 GAL. T/9/Vk TEST HOLE #/ TEST NoG E Z
J / EFF. OEPTiy 6 //l Ss/9nYip 24 "
4' 9� 5/AS)EWAGL
3 L BOT TOM S F. /. 0 c B(o GAG S/OAY M E D.
0T / TOTAL - GALS/
USE ' �- GEAGN '/7- OAY sL4
/ ` GQA bEL
A/ 105, q
` co92SE
/04, q 6e.9vEc 106 ,
MED.
/0/. 9 144 "
l v'` 7
7."_� -- S �- / �--7 C.7 OE- � s% /�1
i��OPOSE® nN ,THE G�OU/VO i95
S/-(O lit//l/ O/V TH/S F'L fq A/ O O H S F D i ! i;'' 3 O 3 S O P/9
G O/t/F O CEP/vJ TO T H Er B U/L O//t/G 5 E T- 61-1/9 le w k, GkJ/19 �
B19GAe eC- QU1,eE-ME-AJ7-5 OF THE
T O!.t//l/ p F' = TZ,y 5 T H E --- C iL' 7'a✓.� (// L L E /-^ F3 S S .
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FAG 0AJ7- = , GO FT.
S /LSE _ / O
F OF S,�P�ZN MAs sq�ti
r3 s�, /off EVEREfT H. G S G A L E : 1� S S H O LA-1 A,/ O HT E
tVERET7 c HINCKLEY r
j H. �f! o No. 17 7.44
5 / 7 Ilet? /V �0 �Q$ �G/STE��pQ`
��QfGISTE �� C4A,1 SUR"i
/A/ C_
Sc � � E : / = 50 • �
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