HomeMy WebLinkAbout0379 GREEN DUNES DRIVE - Health (2) 7
4
No.._�J..�►.857_ Fics..... �............_.
THA COMMONWEALTH OF MASSACHUSETTS
BOAR® OF H EAL•T
..a
,.........OF.. . .-
ApplirFalion for Uhiposaal lgorkii Tnntrnrtiun rami#
Application is hereby ;;XA
or Per it to Construct or Repair ( ) an Individual Sewage Disposal
f System at: - ._, 11,11
..... ..: .. g_ ....
c�tess Lot No
�. r ----_-_ .
W Ow er ddr
_.. ..
Installer dress
Type of Building Size Lot ` _ 2__r8q. feet
Dwelling—No. of Bedrooms............ .........................Expansion 4°thk—ice Garbage Gri de (
4 Other—T e of Building No. of persons............................ Showers — Cafeteria
a Other fixtures ............................ .
W Design Flow............. ..............__ __gallons per person ay. Total dfil pow..........__.-. ...__...._..._ Ions.
WSeptic Tank—Liquid capacit gallons Length •--•-• Width+._` --- Diameter................ Depth.---- .
x Disposal Trench "�_............... Width_...__._........... Total Length............I.......
Total leaching area
.___-._._----•-_____sq. ft.
Seepage Pit No..... ............. Diameter___ _._.__... Depth below inlet_......... Total leaching area .. ft.
Z Other Distribution ox osing tank ( )
'-' Percolation Test Re is Performed by.... _ Date..-V -
a Test Pit No. ________________minutes per inch Depth of Test Pit._._..1 ---___. Depth to ground water_._ ._.__-__--__.
Test Pit No.�... -.___._minutes per inch Depth of Test Pit_TM.A..._.. Depth to ground water_=
�+ ---------- -- ..• • -----...•••-
it
x Description of Soil.... °p l ..... _ ._ .. t___ -
U .......--•...-------•.............•-•-• � 6611 ...--------------••-------------------••-•---------------......---------------
-----------------------------------------------------------------------------------------------------------•-------------------------------•-•---•--------------------------------••---••------------
V Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------------------------
.
...............•--••-•---•--------------------••-•-----------...-•---••-----•------------------•-............-----
Agreement:
The undersigned agrees to install the aforedescribed Ind idual Sewage Disposal System in accordance with
the provisions of iIli U 5 of the State Sanitary de— h undersigned further agrees not to plac the system in
operation until a Certificate of Compliance has b e issued y the board of health.
Signe ... ... .._......_ ---•--
Date
Application Approved BY � .-J-••-••--
te
Applieation Disapproved for the following reasons:.-------- -••-------------•-•-----••-----•-•-------••-----•-----------------••-- -•-----••---•-•-•-•---------
.........---••---••------•---••-•----•••-•---------------•••--------•------------------------•••-•-------••-••-•••--•••---••-•••-••-•------_.......------------•--------•----------•----------•...._....
Date,
t"
PermitNo......................................................... Issued.......................................................
Date
No............-y..... Fus..................v.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,.........OF..... � --t---------------------------------------------
. 1tr Ilan fur his n �a1ivorkii Tonstrur#ian wrmi •
A�Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
stem t
e.t... _• - . .. ...
' f L io - .ddre
t N ,
Ow
W
l' Installer A dress
Type of B ilding Size Lot... q, feet
U Dwelling No. of Bedrooms......... ....•-..-... .Ex Expansion Attic a g— - ------------------ p Mrbage Grinder ( )
sOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfi tures ----"--"----------"----------------------------""-----•--•••-•••••......--•-•---•••-•-
W Design Flow......�� .............. allons per pers er ay. Total it w____.__._........ Ions.
f�
WSeptic Tank—Liquid capacity allons Lengt -•_--. Wid;f _ Diameter_,d0_------ Depth.....__.
x Disposal Trench ....... .......... Width_ ..�...._.._...... Total Length..._._. ..t Total,leaching area---
.---. ft.
Total area ft.
Seepage Pit No.....:..Xts
iameter.... Depth below inlet._ r.._._... g � ".
Z Other Distribution bo Dos tank )
Percolation Test ResPerformed by . �. _ Date.._._. --------
Test Pit No. I..�� p p "{`
._.minutes per in Depth of est Pit..... .......... Depth to ground ater_._�_ _.._�_.......,.-.
Test Pit No. _. -- ._minutes per inch Depth of est Pit.....15p...... Depth to ground water.._
a -------------------- -Description of Soil._ 'o�11�,�?._.__`��- .....
••-• ••---� ... ----"-"-"-----------"--....-"-"---"----
t� I � ` � ---------------------------------------------------------------"------------------------
W ---•-------•----•--•--------------•••-•••--•--•••_•---•-••-•-•••----•••-•-•-------•••-•-----•--•••••----••---••----------•--••--•-•---••---••-----•-•-------••••••-••••••••••-----•-••••-•...._••••...--
rJz Nature of Repairs or Alterations—Answer when applicable..............................................................................................
...__••-••--•••-••••--•-•--•-•--••_•-----...•••-••••••••_••••--.....••_•.........-•_•................•-•---•_••-•--•-----•--•----•-•--•---••--•-----••-••-•--•-........................................
Agreement:
The undersigned agrees to install the aforedescribed Ind• idual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— he ndersigned further agrees not to pl/theem in
.,;.� .
operation until a Certificate of Compliance has issued e bobrd of health.
Sign
Application Approved By...........................�- '` = -��' ^ •-• -•-•--•••_
Application Disapproved for the following reasons:..............................................................................................................
-•"-------"--__"--......_......_---""-"--"-------__-•---_""--•------"-•------"--------------------- -_---""--"----
Date
PermitNo.......................................................-- Issued.........-"""""...........................•--....------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f `
�rr �f�rtt of �nrnt �inr�e
THI IS TO CERTIFY. That,the Individual Sewage Disposal System constructed �r Repaired ( )
byi l ' ...........
In llez �"�•
at 1-- �-t ----�--.-"_- 1
has been installed in actor ante with the provisions of TITLE ofcThe, S�nitary Code as described in the
application for Disposal Works Construction Permit No______________'�_._......��� dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE_-"........................ f Z Inspector `
_ • ••-------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF............... ..............
S
No......................... �..�.. . ... FEE....................
Vn
Permission is ereb ranted.. � `� ---------------
Pp
to Construct o Re a ) a n ividual Sewa > os S stem
at No. ... . •••. -• ...•-- ` -
Street
as shown on the applicatio for Disposal Works Construction Permit , o.-_._..... D'f ed..........................................
................... L; .................:........................-
DATE...........
Bo�x d of Health
FORM 1255 A. Mi SULKIN, INC., BOSTON
� dU
�l!1.
J-
-Va
141
N ��fir--• �� ``� �o ,
Q ` \ /5e
Ag
SE-Z--A&. re: v c
KELLEY r
` No.Z6100
G/STEa oc
Eri���sueve'k
IV
P � �
wCAT!Ory wNs7- �lyq�/iv�sya,�7-
SCALE . DATES. 3 /984
/ PLAN REFERENCE . . . .41.7.
CERTIFY THAT THE . .. ..... . . ... . ..
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
No7'g- 624-VA-770-IS .Shbw.v p,v A AS SHOWN HEREON AND THAT IT CONFORMS TO THE
ALAS Fog S77-f1RNd-l.,s /C Wo--Z.FO1. SETBACK REQUIREMENTS OF THE TOWN OF
fft/ 3��L Ny(- X;-aC. WHEN CONSTRUCTED.
DATE : . . . . . ... . . . . .
REGISTERED LAND SURVEYOR
s yG- T 0,C7 7- 51416-Z?s
TOP OF FOUNDATION ,� •
CONCRETE COVER
a
CONCRETE COVERS
•'� 4"CAST IRON 2"MAX. r °
12"MAX.
OR SCHEDULE 4
• P.V.C. 4��SCHEDULE 40 PV.C.(ONLY)
PIPE
PITCH PIPE1/4"PER.FT PIPE - MIN. LEACH
PITCH I/4 PER.FT. PST PRECAST
INVERT
-� LEACHING
•' ' •
° EL..24c!Z.• INVERT INVERT W �? P,a PIT OR
SEPTIC TANK EL..!9.-G6 . . DIST. EL,y.1/ �_ EQUIV.
a INVERT BOX
o; EL.��1,9./.... / o.. .. GAL. INVERT 8° F-F- '�'
�°- 3/4"TO 1Ili'
INVERT ww •:►�
EL/9•. 0 WASHED
•;'• STONE
6 DIA. -�
Nr.Vfl
�----1,4' DIA. �Ncov..rEe�a
PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM No,-&-_ lq4-4 ,,,o&-'s
NO SCALE hA7��ei�c. iN TiK/E LE�KN
P-/.538 8�yotio, ra 8� ,e�-Hover n
w1 7-7/
SOIL LOG WITNESSED BY . cat sA-x-D '
DATE .P,:SCr . . . . .... TI ME E.{q:.''o/-1!1 . J,-WAI I •T•9Ca l•3 / • • • • . .BOARD OF HEALTH
TEST HOLE I TEST HOLE ¢. �f}} .7Z F�!V�/�'" ENGINEER
ELEV. . .Z-.2-0
DESIGN DATA
NUMBER OF BEDROOMS
CF'1 CLA)/ TOTAL ESTIMATED FLOW . . ' ¢�. . GALLONS/DAY
El,//,zo /.5,3
/� BOTTOM LEACHING AREA /� . . SO.FT. /PIT�G,P•D,
SIDE LEACHING AREA SQ.FT./ PIT/879.G1,-/'D
GARBAGE DISPOSAL AREA INCREASE)
Sip TOTAL LEACHING AREA SQ.FT
PERCOLATION RATE MIN/INCH
/.$ 7Zo
LEACHING AREA PER PERCOLATION RATEI�O-T3'S SQ.FT.
.... ...WATER ENCOUNTERED NUMBER OF LEACHING PITS . . . . .. . . . . . .
APPROVED . . . . . . . . . . . BOARD OF HEALTH
DATE
AGENT OR INSPECTOR
H OF rbq S
s
C? ED1NAJtt
Lo T t'// . . . . . . . o L G
N
WEST• J1/N/S�d2T' �GISTBA oe aronaR�p�'
PETITIONER : M85UBVE�