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HomeMy WebLinkAbout0081 CAPTAIN BELLAMY LANE - Health Zoo- 1 � �. - - 1 Norte . F� JO,..Q.©.... . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r� O ....... `?wN ................OF.....B4P,( STA84_94;................................................ Appliration for Uiopos al Works Tomitrurtinn Famit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at ......_.s!�caT. ./..-•--•. > .hl...... L Y_....LAN_ ..._ 7 ?�Yl. ..� ............... - ... Location-Address or Lot No. ..............��,�i%.....•----------.... _ X...Sts .. T .Y.t ............. .�wner Address W ._. SC' lJ�. .......?AFL...._.. ........................................... Installer Address 23 ZO Z - Type of Building Size Lot.__.___.�...................Sq. feet Dwelling—No. of Bedrooms..3.....................................Expansion Attic (!vo) Garbage Grinder (nto) aOther—Type of Building ............................ No. of persons......................._.... Showers ( ) — Cafeteria ( ) Otherfixtures --------................... ......-•-•-••-•-••--•---•••--•---••••---••••-----------•--•-•--••---.......-•-----••--••-••---•-•-•--•-••-"•....--- W Design Flow........... ------....................gallons per person per day. Total daily flow-----3Z�0.........................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 ( ) '-� Percolation Test Results Performed by.......................................................................... Date.--------••----------------------------- aTest Pit No. 1..�. ....minutes per inch Depth of Test Pit.....12 ....... Depth to ground water_.NoN ...__. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ----------- •--------------•--•----------.-- -------------------------------------------------- ••"-"'----- ------------------------------------------ •-- 0 Description of Soil---Q-- � ..-----TN1N._.�A I?Y 1` ----------------------•-------------•---•---•--------------------•-----------......------... a SUNS---�t443.�......................................................................... 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 iI1ILE 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..... "°`� --� .r�--------------------------- f ` '-----•-- ll D to Application Approved By............-.3 ..... .• -•--------•-•-•--•-------•------••-•-'-- "...-G 2_27;S•••-_.... Date Application Disapproved for the following reasons------------------------------------•-------------- ------------------------•---•-----------•---•-----------•--- ----------------•--......------........-•----•-----------...-••-------------------------------------.._...-------------------••---------------------------------------------•----------•-•......_..._ Date PermitNo..... -•----•---------• Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .at N.. ...................0F..... ................................................ Appliratiaan for Dispa sal orkai Tumuurtion Vrrmit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at .................................................... Location-Address or Lot No .. ................•..... . �::'ti... a c � i =e'�.�t?. .�::.:........---- vner Address (� 1 : JAB ?l _S__ .......................... t *.C�! . ,-� Sq. feet � •Installer Size Lot.4• .__ - U Type of Building V` •Address � I—I Dwelling—No. of Bedrooms... ......................................Expansion Attic (V,•�.J) Garbage Grinder ( - ) a'4 Other—T e of Building No. of persons .............•.......... Showers — YP g ---------------------------- P ( Cafeteria Otherfixtures .....................------•........................................................................................................................ W Design Flow..•..._..� -_-.•..•..................gallons per person per day. Total daily flow c ...................._.....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 (A Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date.....:.................................. ,� Test Pit No.. minutes per inch Depth of Test Pit.... Depth to ground water..�� ..,.:. Li, Test Pit..No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•--------------------------------------------•-••--- ...................................................................................................... 0 Description of Soil.... . ------------------................................... U ................................... .h . e't+\+ t ... .........._........... UW .... ...........................................-. ...... ..... ?:lA_ se.:...._._.__....---------••-•----------------------••----------••-•-------------........-----......_..............---^------ 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 TITI.I 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 �. `.. � � . •---------------- _--- f Date Application Approved BY .... ✓ 7 Date Application Disapproved for the f ollowing,rea-sons:..................................... xi ....................••---••--•---•-•-----....---....-•--------------------.........----•--:. --•-------------------•---------Date-----•------- Permit No. ...' ... ....�z _.. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS HOARD OF HEALTH ..r-. �.............a.: ...... OF...... d .1� ........................................ (In ifiratr of Taamptianrr y THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Aor Repaired ( ) f, Installer at - - �• ..._ .� �"- -- -------•------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction.Permit No:_���� ............. ............ dated------ �._f?_=::_ .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRt1E®�S A G RANTEE THAT THE SYSTEM WILL F' ° NCTIO SATISFACTORY. -� DATE. .............•-----..........-•--•••-•......-••-•--•..._•--_.. Inspector... ••-•-•--•-- .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 a Gro v OF..... LA.-......Aa Z�.._..... ............ No ......... .......2 Disposal Works 00aaano#r iari rrmit Permission is hereby granted..------.. ......... _R�:Aft�......-•-----•---•------------------------------•-------••---..... to Construct (,/) on'Repair ( ) an Individual Sewage Disposal System atNo..._, : a 1 •---- `. = b. .�x:_br. >'_................................................... Street c- as shown on the application for Disposal Works Construction Permit No .'. __ .... Dated...�;°l.? "�. . ..--•---•--....... Board of Health DATE: �.-?. ...................................... FORM 1255 A. M. SULKIN. INC., BOSTON ►_ :""a . r..-','�,�_,�0 2-.i_,?��,��L�k-':`-,",,;.,..�"-j�`­l,,,ee�4 r,�;,,,,,:--t-,--!-I­:..,.,,,,l�,�-.,,6 L�-4 r,,.�r_I�-1:'�,.r"�!:'_�,I:;,­,,1,,�!._�-��---",�"�"�r.�,,,!"r..,,-,r�,�..!�.-�'.�.l�I,:��,,,-.,�­,..i�,_;"._,-",,,",r I',X�?.,1�'-I,:.'.,"�-I,­.z,�t,��.I:�i`�x-,I,�,,.,,;.'C,�-�.._�.-�,....,,,",_'�­II�-_&-7,.'"�'1�"'I.,,-�--,,, . .. tr, .«.�.- � r ° /.2,5° /, T"1 " r � lr/O7E . 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O F�!5_ �j��>4 r r' `x d'Ot t hr n +µr� rz o • " ' ' l z;'°;,4 :LE.GEND fkI' y, ELDRFa���. u? ;� . ,,ItitIs,— NA�M�IPOT `}ELEVA.TI0N �r ' �����s��Pc�s ER`�oQ��� CERTIFIED PLOT PLAN "� ,EXI9TIN.0® CONTOUR 0 s ' AL'LAN9 ;r.l I° � t1�18M( D'_:SPOT ' ELEYATI ON -•=; l l_o-t-° // Cla'i^) 66 `-A /Li�i." fzy t l - JI "q -,i 1 IIN18t�1E0 CONT041R;y O —' ..". > A N,F,Ei The location 'of:>.any,,existIng `under rMind :sewerage, I N +'��,, wIXS. #Ol' otherYautililtles. `shown 0Oj1 t}:.I5p pl`an i5 apPrPX-, ee�� •\ �� 1 :' if ' �� a @,.`only.gas de ermined frQm,xecor.s and.%or rverbal od ►, a�� �J` 1► �. , ,p 'y , , formation The contractor. as,yxespor s�€bla fax. t, 0,� k m_ ;l x ratio of -.the exist}ng ;locations yin I­ ;'field: SCALE, / _ `/� DATE i 6 1��85 F . . r, usr RDGE EMG/NEERING Ca lIV F a ��;`� r _ CI.IENT, ...r 1 :;:CERTIFY TN AT THE PROPOSED;_ ' ®I�TEIiE RE41 R D JOD.NO� ._ 3�z�! 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P/PLC L�G '� . rj�iL. . • s�� r, sT! • • •. . • + + s WA .57� y'E a ofJ'V P/TC/r D/ST. � p • � • * • . . • • • + + ••• a a + t e , " CTra + •• o WASY,=Z> STaiYE. FE .• • • • DEPTH .�; � a • • • • • • •.• � Imo • �t .-'�. •'1S—/'x Z. 5.= 3:�7 ,• " • • + • • � � • • • • d�:� PREU CT SEDGE t 3 . • a. • • O/7 OR E4411✓_ `/-� 4 gV. C✓?-�.fad` o � • � • • • s • • • � • o _ t`LEVAT/,O V J PtT cRl�.°i c�7 .. �.� "IvYERT'AT ®UlLD/NG ¢ -� FT: i C ,SEE Td,�/L�tTION,: � L2- FT. VIA 1r1:. 'HEFT SEPT/� - OtlZLET SFPT/C 7ANK 4N•6 FT 4S:¢ GROUND /MITER TA44E ' FT SECT/aN OF lVtE7`O/STR/Bt?/ON �HOX� - ; it!'TLETDISTRIBtIT/OIY B4X '48.z F7•_ _ SEWA T LCACN/NG P/T FT`: GE G/SP05A L SYSTrEM TA F"Tholy , NG P/T: oiME^ts/oN- A 3 •'ITT JCA s � 'O�. �DltIENS/oN ��._Fr D.ES/GN' CRJTEJ4/�4;: D/MEJYS/ON G � NU,*ldE4 OF 9EDROOMS. 3" _ re GARO,eG f v(SpO.S• I- uw/,- No WE SOf L LOG SD/L TEST r0TA4 ETTf klA MED =I-ow 330 ,G,41./PA SOIL TEST #I SOIL 7ES7 �2 YuJMAA:O.r 4.:°Acmi)vG Pl7'S FLL"`Y S/ 6 . ELgY. DATE OF SOIL TEST S/OE L G`•i4CNlNG PE�Z R/T S,+�1, FT. fU '^ L �:. XESUJ-7-5•PV/T/VESSED ar R /(3 Z.. eRCOLATlOX I�.4TFf / . LASS M//y�//NCH 307'TOM 4Z4CN/NCs P&R P/T SO' FT Tff.I AEICCOLA T/ON RATE AZ �MIw.f lIVEH . c-OTt' LcitCHfNG �4REA Z6 9� .SQ. FT. . _ .S.+trrD�/�JA� 2.0 , ZESERYEL CIf1NCr ARER` S4: FT: -7ES7 - QSO 6 S .> e j l /��LC IVI E��ii? 1 _ raj .~ •I✓�, ' �����®�F /� � Curl' `..3 Pao Z ?j r N/9, MAss= t���1�` A t ;iQ dJ' y 4 -71Z..MAIN -ski. _ / AiV Fr' •ti r , cs�,f�. . m a`�f �•>c ti ;'': TER.. ENCOU/YTEREO i rL/F+t/T. 2CJt/b' %E? b fi� L4ici. [ : NO,GfiOfJK�?,'YYs4 a CST GfCD U/YO' avTE.4'pAT JELEd1. JOB- . / — +�`