HomeMy WebLinkAbout0016 CAPTAIN LUMBERT LANE - Health l �e co-p+ Lu a--be� LI��
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T THE COMMONWEALTH OF MASSACHUSETTS
BOAR I-1 TH
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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 -
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LEGEND CERTIFIED PLOT PLAN
EXISTING SPOT. ELEVATION O'sO ��OFI
EXISTING CONTOUR ---- ® ""'► �`' ��� LvT / ca=,�,�. LtiMl3C2T ��NE
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FINISHED SPOT ELEVATION
FINISHED CONTOUR p"'.."' H IN
APPROVED $ BOARD OF HEALTH , .- . �
sup► SCALES / 4 a DATE
DATE
AGENT ;
agNT
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_ 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
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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.
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_ JOB NO: ' al2^�3 SHEET 2- OF 2