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HomeMy WebLinkAbout0016 CAPTAIN LUMBERT LANE - Health l �e co-p+ Lu a--be� LI�� 1 I -00 1 r. Fizz.......... ............. T THE COMMONWEALTH OF MASSACHUSETTS BOAR I-1 TH -•--- l� Appliration for R-4 aii al Work Cnnnstrurtiun thrmit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal Sys em at: I-A:. ..... ,�. ... ---------- --_--- o ddress o t N n ( o- Addres •-----•----•......... .r-- ----•--�-�J•� I!t---------------•- --•-- f1..`..�,..:......�r..... �...........-•---•--------•-•- Installer Address Type of Buildin Size Lot_�i�r/5_ _ q. feet U �4 Dwelling—No. of Bedrooms______________........_----------Expansion Attic (/v/V Garbage Grinder �) Pk Other—Type of Building ____________________________ No. of persorW,_.__4.................. Showers (Zj — Cafeteria ( ) a' Other fixtures -------------------------------------------------- - W Design Flow................. _________gallons per person per day. Total daily flow_._.._.___��.._740...................gallons. G4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter__.___________- De th................ W Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area_� 6__._._sq. ft. ' Seepage Pit No----------------------Diameter____.___________. Depth below inlet.................... Total leaching area_ �-?___._sq. ft. Other Z Percolation Distribution Results Performed byin �k�ofest / �. Date__._ate Test Pit No. 1_'� _..minutes per inch DeptPit.______ _ -_ _ De to groundr ,P1✓_ .. 4% Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ G4 ------------------- --- O Description of Soil _: _�__A - ..� _..._.. y ........................................................... 1' � s 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 iITL E 5 of the State Sanitary Code— The undersigned further agrees not place the system in operation until a Certificate of Compliance has issuey •d of�e h� Signed y�f� t.•- ---- --------- Date Application Approved By......... � /� ....... --...... ......... Date Application Disapproved for the following reasons----------------------------•----------------------------------•----------------•-----------.._..--••------------ ....................•-------------•-------•-------....-.-.--..-----------------------•----...---------------------------•-------•----------------------------------------------------------------------- Date PermitNo---------------------------------------................................................. Issued_..................-----............................... Date 83-1ST 40 ... Fss.............................. 71. THE COMMONWEALTH OF.MASSACHUSETTS - --` BOAR P'" . FH E T H- r .............OF.....t . ....... ................ Appliraiion for Dispaaii al Works Tonotrurtion Prrntit Application is hereby. made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal �-- - - fy� ,vim - • � Ad3res W Installer Address Type of Buildin Size Lot Sq. feet Dwelling—No. of Bedrooms_______________ --------------------Expansio Attic (^49 Garbage ririder Wfl Other-T e of Building ____.. No. of ersons----- __________________ Showers — Cafeteria Q' P - ) d Other fixtur. s _. ..-----•---•----••-- W Design Flow_....__•-____.___ .........gallons per person per day. Total daily flow_.____.__ _. ____gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter________________ De th................ x Disposal Trench—No_____________________ Width.................... Total Length...........:........ Total leaching area..;�: (rr�......sq. ft. Seepage Pit No--_----_-_------ Diameter.................... Depth below inlet.................... Total leaching area_161�.....sq. ft. Z Other Distribution box (j Dosin& tanif ( ) a Percolation Test Resuult Performed b - '._•_ ✓v._! � ':_ ___ Date__.._ .._ ._�__[. y �" f Test Pit No. 1.. _. -.__.minutes per inch Depth of est Pit......_l+�_ De j to ground ter (s, Test Pit No. 2___.............minutes per inch Depth of Test Pit.................... Depth to ground water__-___________________ w -------------------------------------------....... O Description of Soil........ Y j � x - '" ''�." +'i - ---- --•-- --------------------- ------•-------•------------ U 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 TITIZ 5 of the State Sanitary Code—The undersigned further agrees no place the system in operation until a Certificate of Compliance ha issued y d4Xhth.4--•-- -•-•-••---• -----._ ...--. ___' -r, Date Application Approved By-----•--•-•--•-•--•- *:.__• ��`Date Application.Disapproved for the following reasons:................................................................................................................. ----------------------------------------••-----•-•------------------------------------•---•--------------•-•-----••-----•-••----•-----••--•-•-----•-•••••-----•--••-----------••--------------••••-•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR F HEA T f ...........O F...... /!✓ ........................... C�rr�ifirtt�e aaf��l�nt�rli�anr>e THE TO CERTIFY, Tea the Indivi u 1 Sewage Disposal System constructed or Repaired ( ) by-•-•--- Install (_- f'XL_ J/ has been installed in accordance with the provisions of.TITI,Y, 5 o The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated•--...-....._..__._.__._:._..___.-.._._.______._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE SYSTEM W G FICTION SATISFACTORY. DATI! r. - . ..d ........................................................ Inspector--• -•`y ............................................................... THE COMMONWEALTH OF MASSACHUSETTS �3/5f BOARD F No.......................... FEE........................ Dispos .1 10orhv Ton n rrnt ill t Permission i ereby granted......... _._.-.y.l .. .5 ___ _ �> to Constr t or Repair ( a an Indiviiduf�l Sewage Disposal S em � / at No.-- r 7`C/l;v. L --'-`.-�-� 'r ---- --- -- L, l/,, ....................................... as shown on the application for Disposal Works Construc P it"1VfO/ .......... Dated_.......................................... ----------------•------------------- ------------------------------------------ --•--- Board of Health DATE.......... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - /.� T f 7 i 1 s F' ��-rtiZo � r«� wtp��a ,r> 1• D v o. ��k OF bfgss- d, e / o ALBEF�f Ail' N . a { tSE &4�. 1v No.10951 O v Poi r" 7 \ 0 �/G 151E �Oj // \ �',•' \ 9b.4 \ $, Sly L--6 T 3 7 - �� ' o A�� 9A� LLM/�I.J :)N Cv�j�,,i F-CoM AA^k,,-1 AND L �a,r-Ci T t —F' ���� RLF- PEQ �rh'rE A P.z=-A .f'A L LS W i l?{ ',J PLrx 0 'Z1=" F� LEGEND CERTIFIED PLOT PLAN EXISTING SPOT. ELEVATION O'sO ��OFI EXISTING CONTOUR ---- ® ""'► �`' ��� LvT / ca=,�,�. LtiMl3C2T ��NE \ �✓/ FINISHED SPOT ELEVATION FINISHED CONTOUR p"'.."' H IN APPROVED $ BOARD OF HEALTH , .- . � sup► SCALES / 4 a DATE DATE AGENT ; agNT c1 SiD� _ i CERTIFY THAT THE PROPOSED t CIS ERE D REGISTER BE11:3 BUILDING SHOWN ON .THIS PLAN CIVIL LAND J'.� CONFORMS TO THE ZONING LAWS Yt ASS. ENDINEER SURyEY ... -R- OF BARNSTAO E. ' .712 MAIN STREET ' o2. = H YA N 141 S, MASS. SHEET--L.OF ,�: DATE . R�S- LAND SURVEYOR NOTE /F E�TNER TfIE SEPTIC T,4NK OR _ 20 FT. N4/A/. LEACH/NG 0/T.ARE MORE ` T/Y.A:'J /Z' BELOjt/ PT /�►lN rRAOE, �1 24 D1AM ETER CONCRETE .COSIZe , SHALL 460 9.eO4Ua Y r TO 4RA L .Z.�.-+N EXTRA CO/VCRGTQ' 41PYC PIPL tiE.9VY CA 57 /RO/Y C 0 i/ER Sf14 L L C3E US ELJ M/N. P/TCN JF/N OR/V.-WA Y . 1o1:s CovEJQs - Ya'JoF,P,�r CONCRETE' . �L= GALL• CO ✓ER CLEAN SA/V D ►• &AC CF/LL 2 L • • E -0"CAS •. :� promPJPE IOOO •.�eo •L41% IN/N:P/TC�I GAL. /• • . . . . . WA SHED S7t7NE %v /s/ . TANK DIsT.BOX31•,EFFECT/ IVASJIED/ST4rYE Q 7 1 C�/DPRECi15 TSEEPAEYolTlOVs x r.o o/7 OR Epllly. EL_= lHYERT AT Bll>LO/NG `�8 FT. UiT cAA4c��Y 54-1 !�ID G FT D/AI�►P. I,MLET. .SE IG' Ti4NAC 8':._l fT. �> to F7.. O/AM. CCSE.ET.aBULi1TJGN , d�TLET.SEPTIC TAN.#<•. FT INLET O/STRi®NIT/ON:SOX `�8 SECT/ON O F : GRou�Yv tTE� TA®L E CttJTLETDiSTR/B�ITpON BQX a._L F7 SEWAGE: A0ISj04"A 4L SY.S7& l INLET LEACN/NG PIT `�-1.`�.=/c.T. TAdlJLAT/®N t,�ae i VCr 0/T V sc.4;LE : %s.~ o� DJMEN.S/ON �4 2:.Lo FT. DOSAFIV CRITERIA Dl.�.enrs�s�e S -fT. N!/1NdER OF BEDPaOMS DJMENS/ON C _FT. tv1 t►J Y G,u?dtAGED/SOOSAL(//V/r �1ou�. : SOIL LOG So/d, 7"EST TO.T�iL E3TlA%-4 rED FLG rN -33o G.4L.�DAY SO/L TEST JO/ SOIL 7EST#2 iSIUHtBE.P OJc o EACN/NG P/TS_ 1 f^ELG'K q�:9 CLEY p�I TE OF SOIL TP.ST 03 I 1 7 I82. S/OF LEACNIKG PER f//T . l a Sit PT. (OPrM RESULTS h/JTJVESS . _ F � ED. B 3o7TOM L6�1CH/NG:pL•R,P/T 7 a $Q. F r o- t i �c�FSo�C PER COl AT/Oly RATE,�`/ LLaSS .MI/VII NCH TtOTAL`L�isG'H/NG AREA 2—�_so. FT �hCOL4TJCN RATE 4ESFRVE4HACN.I)YGARE•' 2�� 5Q• FT. l � iL TSr s® ,p - IC333 A�1 GIJM t 1�- OF P�tN OF y L,�DT 3 1 r-A Pri f l l-i e L� R 'T L/��1 sAN D C_�1,1�i V I i....L.E- BERG CA W i g. AM e EL.Dt�EDGE�l1IG/N.E�f�/IYG CO,INC. �c�i0� ��ONAL E _ d 1. 712 MA/N 57-. N �SM�S3 �•St�`' Q'KO GROV V0 kV,4TCR ENG'0U1V74`RB4P CL/ENT: 7.�i-r/st ba 'PRTE "LB S3 GROuvp yvATIER.AT ELev _ _ JOB NO: ' al2^�3 SHEET 2- OF 2