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HomeMy WebLinkAbout0169 WARWICK WAY - Health 169 Warwick Way Centerville = 171 — 099 . No. 3y:.y? .. F�$'ez�®............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...•....................._.................O F................I........I.............. 1%.& q Appliratiun for Disposal Works Tonstrurtiun Pun it Application is hereby made for a Permit to Construct ( tf or Repair ( ) an Individual Sewage Disposal System at ........ ......... ........O.ee0........., :'92`J �e.e. .......1� Z ------- Location - -_. -.... Location-Address or Lot No. ...............................................O ...r....................................._...• ..........--------•...._..........._.........••-- es.s -------•-......._.......•--•............-- Owner Address W Installer Address - U S Type of Building Size Lot........................... Dwelling—No. of Bedrooms.........13...........................Expansion Attic ( ) Garbage Grind aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafe teri 04 Other fixtures .................................. W Design Flow.............. ..................gallons per person per day. Total daily flow___............._�a _ ........gallons. WSeptic Tank—Liquid capacity.e-VOO.bgallons Length___��'_._/..... Width.... ... Diameter________________ Depth_:Y/...... x Disposal Trench—No. .................... Width........_ .�._._._ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._-_/--..--____-- Diameter.../dr-_t5--_. Depth below inlet--- Total leaching area..z v..sq. ft. Z Other Distribution box Dosing tank ( ) , 0/2 � ✓ `�/ ^�'`�• Percolation Test Results Performed by..�_54...k. �. Date....�r� _. ,.a Test Pit No. 1...a-,—_ minutes per inch Depth of Test Depth to ground water..AJ=sl_ .s " fT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ CY .....•••••••-•-------------••••••••••-••-•-••••.....•-•••...---•-•--•••.............------......•• - 0 Description of Soil...i --._dam__.......... `7e ---------_;% V --------------------------- •------------------------------------------------------------------- ---.-------------------------------------------------------------- ----------------------- .. -------------- 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 TITLZ 5 of the State Sanitary Co — The u dersigned further agrees not to place the system in operation until a Certificate of Compliance bas been ued by t board of health. igned •.............:.. . ........................................................ ApplicationApproved By•••-• •. • • ... ..•---•-......................................................... Dat ------'-- Application Disapproved .or a following reasons---------------------------------------------------------------------------------------------------------•------- .................•••---•-•--••---...-•••...•--••••-•••--•--....--•--•-••---••--•--•--•........-------•-..._....•••-•-••••••--••---•-••••--•-•-----•-•--•••••••--•-••-•-••------•------•--•--••••.......•. Date permitNo..................................................•--___ Issued....................................................... Date FEB....42.4.�............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF.......................................................................................... ApplirFation for Disposal Works Tnnstrurtion ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: .........:K.C/...... Location-Address / - or Lot No. ......••--------------............................••------•---........................•.......... ..........--..............................................._........•......---------..........---- Owner Address a .............••-------•....._.........---•--••••-------•---....._..._...................•••....... .----•...........---•--••----........................... •...._............_..-----.....---••---- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........3.............................Expansion Attic ( ) Garbage Grinder ( ) PL4Other—T e of Building ....... No. of persons............................ Showers — Cafeteria PL4Other fixtures --------------------------------------------------••--...-----------------•--------------------------..........;...--------••--------------......._... W Design Flow............... .I�...................gallons per person per day. Total daily flow................. . ._ .........gallons. WSeptic Tank—Liquid capacityl.'Oo—Qgallons Length.:........ Width...� ..... Diameter---------------- Depth...l...... x Disposal Trench—No.................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____ _____________ Diameter../-;?_,,.5_..Depth below inlet.. .... Total leaching area..Z_�*A.?..sq. ft. Z Other Distribution box ( Dosing tank '-' Percolation Test Results Performed by.t ..-s.)_. '.. -? - -__ ._._r'! '7 . Date.._,- . -r . Test Pit No. 1.._e_ .minutes per inch Depth of Test Pit;�' "` __`_. Depth to ground water._Q_a__ha-!�^ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P; --••------•-••-------------••--••----------••-•-•-••---------------------•----..... •-•••-----...-----•--------------......---•--••---....•---....----._--- 0 Description of Soil--,..5 `- 5"-......... ......... --------------------------------------------------•------ 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 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. igned -,--------•-----•-•-....••••••-•-------•••••.......................••--••----•...... ---•• <.'':........... to Application Approved By`Iffollowing Application Disapprove C ' ' reasons----------------------------------------------------------------------•---------------------••---..........•..... ..-•----------•-------------••-------------------------------------------....----•-..........---------.....-------•--._...-----------------•------------------------------------------------------------- Date PermitNo....................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of ToutpliFanrr —THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructedor Repaired ( ) by- - : -----------------------------------------------.-------------- •-•--•-•-----------------••----•----------.-----•-----•---•-----------------------------------•-••---------- Installer •' -•-••-••-•--•-••----•.......-•---•------•----•--...-•---•--•-•----------•................................ . . --- , t ax ... w has;been installed in accordance with tl e provisio s of TITLE 5 of The State Sanitary Co has scribed in the application for Disposal Works Construction er it NoV, _!�"___Y�:�-----•-__•--__- datedw". __. ...................... THE ISSU NC 'OF THIS CERTIFIC SHALT. NOT BE CONSTRUE® A ' ANTEE THAT THE SYSTEIaIVIA FjfNCTION SATISFACTORY. DATE. -----•---------------•-----------------•--.-•---. Inspector..... - - THE COMMONWEALTH-OF MA SACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................................... Disposal Works Tnnstrnrttinn rrmit Permission is lae eby granted_ Ash,-•-------------------- ------------- -•---------------- ---•-------------................ ........ ........_.... to Construct r Re it )tea dividual Sev�� Dis ystem d. at No. $� -•------- '' -------------------------------------•---------• �••---........ -• ---•---•••-----------«< y� s t as shown on the application for Disposal Works Construction P t N�;Y' �._ Datedc!4- _ ._:. :.. /�' _.......... ----------------••--••-•---.........-•-- DATE ' � .......................... 101, d o ealth FORM 1255 A. M. SULKIN, INC.;, BOSTON - / o g -----_--- - ----- - io9 00 _,— E P -1Q$.4U --- /04 •-� W S H 5 Tt��� -- - --- 00 loe - ----- -- ---------- -- g - 94 ---- -- - ---- ----- --- ------- - --_ --- --- --- ----- ---- __--- --- — -------- --- - --- /tJ O TE - - - ---- existing around P�oFi /e - EXT&A-ID ALL AoPL/CABLE -e— o—o—o — ProPos�d c�rovnd �orofrle HO'elz. Sc/9LE / ' = i0' S C T OAJ V E ,2T. SC �9LE : / /O' 1-MANHOLE COVE,QS TO !�//TH11V /2" OF Fi/v/s/-QED G +2F� l�E . 5CHED. 40 PV. C. D.e FLOln/ — EQUAL 7-0 SEPT/C CrIl nirrnurn % per foof� 2" Of % Y2 wcL5"'1Q -5>0ne --TA] j-- � —Iry T - AL • D/ST BOX °° ° • I ° G s v r"p ° f • I /000 GAL. SE-PT/C TA.�/AC ^� ° S ��,� LC- CH F> a, - - DE SIfGti TEST /--� oLE- LoG 0 oP HousE DAT c TEST BY: L c�v tiELL E E /Alc: i„P E ACC ,Q A T E- =.�.C.�l�.r r,�J ;^-�' 1 \\\ r L01, / Ae,19TE U GALS./DF�Y DATI�M � 30 x /. S = 4 �• TEST HOLE #/ TE ST HOLE 4*,F C2 - USE: i 000 GAL. 'rAlltA:f o T O LEACl4 P/ 7- 1 E FF. D E PT/-/ 0 � S/DE [.v�9 L L / q7. a F �2. 4 '• TOTAL = � G. P. D. M E D. \ - �4� 2 � ,t �) USE. LEAf✓H P/ T SFi/.!D /44 /O t-J/9 T�.e CC3 '- LS � l/V � � � � C..._ � /v P/2oPo5ED ON THE G�'ounJD �S S 14 o w ti O AJ -rl-!I S DOES ,=o,e : L O T C== C O AJ F O.e/") 7'O -r"E B uI L D I A/G SE• 350 7-- Bf�C.� ,2EQ(�/Fc'EMEti/TS OF' THE TO l.,t AJ OF b r=) ,Z it.I S TF i _ e -A.J 7- t,!`.' �► F�,e� P A,e E D FO.e: r..:.._ �: 1.1/f �•` �-� O� � � !'� (N f1F 41 /) / OF CEVERe;T H. MO og7-E HINCKLEY V '� v ? EVEREI SG <<, A0. 1T87 HINCKLEY .S C L E / — No 1320 s5 U o rE L/ , / n C ex /Stine e1e ✓anon 8LDG. SE:7-BfaC,� i' / S�ON4l,V-� }�A );2 /`-70UThH M /43SS. Proposed e /� vaf/on A2C- QEME AJTS fir- o of Go �f. - - - - - - - ex /Sf'/ rng ConfoUi-S = /u f�PP2OVED : -o— ProPos�d con->FOUrS S / cue BOA.QD OF HEALTH 114 ------------------- /o i0q.00 --- 8.2 3r=D W 0 - /04 - - ---- -- 4.- _L4�- — --- ------- - - -— --- --------- --- ------- ---- -- - - /©o - — - -- _ - - —_-- - ---- -- - - - -- - _ q� -- - - ° 2-o --- -- - _- --- _ -_— ---- -- 4— /v0TE : — - ------ e x 15f-ir q gr-OUncnl Pr-o cj l e --- EXTE-tiJD AL L F-4 PPLICA BLE -o — - �-0 - Pro os�d round rofile J-402Iz SC�9LE / _ !O' is C 7 D �V (� C- ,QT. SCALE : / " /O' /")A/VHOLE COVERS TO G�J/TH//-I P 9 P /Z" OF Fi�/Isf-QED GLADE . S C HE D. 40 PVC. 0,e F L-O!n,/ ----- EQpUf3L7,0 SEor/c (,r,-•,in1rnurn %" p4er- I'oo+) 2 of /e - �2 wash&& s4one � 3 TANK,► -IAJT I o 0 O O 7- e o , ( D/5T BOX odra e Sump o 0 0 s r e O O l /oc?O GAL. SEPT/C T�9tiJK oIle f H o • e e e Er9C F'17" VJti 8 'eDROOM HOUSE SAT E -Gel ` L Oly .t/�LCrE E' i�.AG c1.�t-ff-9Cr-18J ,arn, fzfaLAO F L o i,v ,2�l TE 3 v GALS/Dfg Y E)r9TvM 1 2 �'� f'(`�M • SEPTIC Tfl/lJ/C 530 )C J. S'r 495 �, �L TEST HOLE #/ TEST HOLE Z fl US�� _ w E: / Opo G�qL. T,q�/� , zN - GEfI9CH P/ —r c;` lc�g'o Sv�Sol� �•� '- � a EFF. DEPTy �— SIDEln/fiLL = i 7.�'' S. F C�- G. 14S• m ° tilCS �JhT��' E.n.JGd�>�.✓Tf_=�t=i� / cE,2T/F Y THgT THE BU/L DIti/G / �� (�V L ` - P,2oF?o5E D oA.I THE (S 2ounJD f�S SHO �/til OAJ 'T"/-!/S GL ,9N DOES cO,2 : O 7- 35o GO/VFO,Cc'M TO Tf-JE BU/LD/A/G SET- LtJ )eEQCv/,2EMEti./T"S OF THE 7-O 4A-1 A/ Pam' E P f3,2 E D F0A2: t 1-^�/`f `J ��. L� L% O C , / _ t HtcVCKi / v [ .EY /`f �Q� EVERE! lilo. lT!!7 H. HINCKLEY No. 13230 f`� ,�• _ A�"� a 4�Q am sum O �/� F ZA,_1 E L L E- f n C . e xlS-f-Inq e /evatron BL DG SE7 ,Bl9c,L , i �gs ALE y�q MO cJTH , /`�/95S. o p O _ ior-aPoSed e /e va�'ion r2E QU/,2E�E tiJTS '. --- -_ _ - -- - -- ex /sf'inq Conf'OurSf�PP20VEDar It : —�— — Pr'oPoSecf con fou�5 S J de iu " B0,-9,42D of HEALTH