HomeMy WebLinkAbout0198 FIVE CORNERS ROAD - Health (2) 08 Fiver &Ynt4e Pcp .,C - .
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No...................... . . Fzc$..............................
THE COMMONWEALTH OF MASSACHUSETTS
.Y BOARD OF HEALTH
l!.W-At................OF.......R/.9.RN.S AB,6.,....-----------..._.._............_.
Appliration for Disposal Works T. ustrnrtinn Prrutit
Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
System at:
Loc io •Address ,e or Lot No.
........ •--- ---•--•-•------•---_-- ....................
Owner Address
a yz- d.:..••-•---•--••...................................•-••-•••-•••---••• -•-••-••-----------........_..•••-__._:
Installer Address
dType of Building Size Lot_,/S.6.5 Cf._......Sq. feet
U Dwelling—No. of Bedrooms......... ______________________________Expansion Attic (NO) Garbage Grinder (NO)
PL4�, Other—Type of Building ___p j_,ltg_____.•_____ No. of persons____________________________ Showers ( ) — Cafeteria ( )
Q' Other fixtures __________________________________
W Design Flow......//0.............................gallons per per day. Total daily flow-_______-�3.0....................gallons.
WSeptic Tank—Liquid capacity,/OOP--gallons Length8 16.7.`'_ WidthA?D__"__ Diameter________________ Depths...
x Disposal Trench—No_____________________ Width____ __._:__._.___ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......./._________ Diameter___._.._..__._._ Depth below i e - To 1 1 chin areal_ _L�.___sq. ft.
Z Other Distribution box (t� Dosing tank ( ) d � 2
►y
a Percolation Test Results Performed by__R0 A.4Lh___.__.t4::..___.��/�i�P!�4,��_s. Date_M/.P—C- Y.._A 3,,_A
a Test Pit No. 1__4__�a—______minutes per inch Depth of Test Pit.-Z;k.......... Depth to ground water________________________
Test Pit No. I..............__minutes per inch Depth of Test Pit..........-......... Depth to ground water----_.........._........
-••-•-----••-----------•-•a ••......................•-----------•-•-••--•-------------.......••••-••••.........................................................
O r�
x Description of Soil.............. .M.....�/Q1v1,1----------S-a-'asp1 G-----•----------------•--•----------•----------•--
(� -___- --•---`��� - --- .l��, Ia/L! rA.14/�5,r� �R1�t D
UW -•••--•....................•-----------•----•-••---------=---------••-•-----•-------------------•------•-••-...---------------•--------••--•-•----------•----------------------------------•----•----•--
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 TITL U 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.
Sied......_---••-•---------•--•••••.........-•-••••......_..••--•-.....---•----
P
Application Approved By
'Date
a te
._....
Application Disapproved for the following reasons:---------•---•-•------------•---...--•--••--------------•------•---..___----••--•---------- ••---------------•-
.................................••-•-------•--------..__..._.....-•--••-•-------•-•...•••-••-•-•---•-•••------------------•---------•--•------•----•--------------------------•._..--••--••-=--•-------
Date
PermitNo......................................................... Issued.._..!_-.=_ ....._ ---•--
Date
l7 =f~ ' 4
. .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 . ..............0F....... �V. i /9 �r ....................................
Appliratinn for Disposal Works Tons rn.rtion rrmi#
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at
/j(j�// \/�.S'SJt Address or Lot No............ ....._.
..... i l-i--•__.::I. .................. ................ . ....•-•---••---........................ ......._...._...._._................_..__..._.
.. ...Owner Address
Installer Address
d Type of Building d. Size Lot_16.11_.......Sq. feet
g
V Dwell-i4j`
No. of Bedrooms_________________________________..._.......Expansion Attic (A711) Garbage Grinder (Nth)
aOther.'. Type of Building ___ ............ No. of persons____________________________ Showers ( ) — Cafeteria ( )
d
Other fixtures ................................... ------------------------------------------------
0004
W Design Flow.....e���................ -gallons per .person per day. Total daily flow......... 30'______._____________gallons.
P4 Septic Tank-Liquid capacit}v�+�Q _gallons Lengths" _1 __"__ Width':✓�"__. Diameter________________ Depth.s.'s. �..
€ Disposal Trench. '�To....................... Width.................... Total Length............. ..... Total leaching area____. ______sq. ft.
Seepage Pit No. ;: Diameter_____ __________ Depth below i et.__._ To 1 ea-ch reap 0_....sq. ft.
Z Other Eiistribution box ( Dosing tank
a Percolation Test Results Performed by._ P&&.&______A-.. lit l��pR��/3s�= Date.&tft4li!...
s+�_9;�_1�
Test Pit No. 1_4_�-.__.minutes;per inch Depth of Test Pit � :_.__....... Depth to ground water________________________
f� Test Pit No. 2................minutes,per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil .........egI4't
UNature of Repairs or Alterations—Answer when applicable.............. _:.
Agreement: ,
The undersigned agrees to install the aforede.sd6ed Individual Sewage Disposal System in accordance with
the provisions of T I T I-E 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.
Sined _ --•-••-•-•---•-•--•-----------•------------------------- ................--•-•-------
w Date
Application Approved By /1 i� � . �............................•-- ...��
Date
Application Disapproved for the following reasons---------------•-------------•-----------------------•----------------..........................................
•----------------------------•-•----------•-•--------------_-_---•---_------------------•--•----------------•-•.......................................................................................
r Date
PermitNo............................-•------ •--------- Issued-..............................----••-:_'.:......:••----
Date
THE COMMONWEALTH OR,MASSACHUSETTS
BOARD OF H`EALT
... . ... ... _.OF .. . . ........_:..............
r"ifirtttr of fgompliFanrr
T ,IS TO CE TIFY, That the Individual Sewage Disposal System constructed ei ) or Repaired ( )
U.. ,
by....4&. ..
....
at_"`___ __� _.___�__t!'s+s_t "___k�.-:. "___.__Ind ` Pistt: S!__t _____ ^__________________
4
has been installed in accordance with the provisions of I r of The State Sanitary Code as described in the
application for DisposalsWorks Construction Permit N ._._______ D dated �'
�� 7
THE,ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM_WILL FUNCTION SATISFACTORY.
DATE................ Inspector..................... _. .......................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE LTH 4
ram-
No......................... FEE....2.:r.:�...
to rn orks onstr ion rranit
_ ...........................................................
Perm> Sion i!s_hereby granted-----�------ -- :------- -•--- .. .- -------- ...............
to Con rumi� or it ( n �d}•v�d Sewa �' Disposal Syst 'f
Street
as shown on the application for Disposal Works
�..^ Constructo n�mit at-ed_. '.. �
•---------...
Board ofA h
DATE s ~
FORM- 1255 HOBBS & WARREN, INC., PUBLISHERS
LOT 3 TEST H D L E
MARCH 29, /9 76
w ` PAUL MURRhY - .INSPECTOr?
ELEV. 18.q
LOT 4 Leh �'+°1
/56 50 ° t T
40,. t AND S UBS O I L
TEST
Nor.E ie,s /a," -24 - 144 MEDIUiLL-j -
57
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f
' PROP biATER D15 T G
LINE �8+3 SEPT/C �qto _i
E LEV. 6.9
t;� v TANK L EAC AI
P/T
NO OR TER ENcouN T FRE D
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SE P T/C 5 y5 TEM CONS T2 GJC T/ON
SNA L..L. CONF02M TO FL o�t/ ��_ GALS as y
EN V/Q OlVMGNT�[, CODE TiTL� IT
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v 0 GA 28AGE G,e/NDE,e 9.8 C
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l of<17-/p,-/ EARN 5 T R' (CENTERV/L�,E) l� A
�2�nrCE_ aEINC Lod 4 RS 590
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I N CAE to ,. ` �ilr .SEATic TA�v a/�T��BUT/ON Box
-O,2 s.'i �CpS OuT�ETs� AND LE.4C.�,�/n/G ,a/T-
fl: �; �`'_•7O .c3E OF ,LE/n/FOr2G�D GO,VC/zETE '
Q ,��1 3000 ps/ tiJ/N.
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7-,A LOADING
{ :L L. Lt.,s D�/VE VVA NO O 3 LOCA7-,'
Y,4 0M( (J 1F/
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J CERTIFY T//AT THE FOUAIDAVVY 5#0(L)N ON R= ,;. K am{°DE.s/Gn/ LOAL7/,vG /S uS�D. .
°'TN/S PLI'N /.5 LOCATED ON 7 h(4r
'-ROUND A5 5H0GJIv AND /! D.oc5 COWO M A
70 TRF RV14DIN6- SET&CA Rb-OUIREM, AW'5
nA- TIC TOLLS OF IPARNS 1"ABLE 0 -
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