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Home My WebLink About0056 PLEASANT PINES AVE - Health top- ASSESSORS MAP NO: .mil I& .. - _. PARCEL NO.- No .-G..... 0 � THE COMMONWEALTH OF MASSACHUSETTS L� ! BOARD �OFFp,HEALTH j ...............OF..........` a� - ................................................................... Alirtt#inn for Dintt1 urk Cnu #xnr#inn �ernti# Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal 7 Sy at: .. I.O.-c ............. .. ..............._..... -. .__.. .... ----•---• ---- - ------ ---- ocati n-Address or Lot No. = ><ta.� --------•-•----------------------- Owner Address a ................. ............................................................. --.......-------------------- --------..............:...........--•------ Installer Address Type of Building Size Lot............................Sq. feet U Divellin _ ".� g—No. of Bedrooms ` ...........................Expansion Attic ( ) Garbage Grinder (llv®) aOther—Type of Building __._. � j_.. No. of persons............................ Showers ( ) — Cafeteria ( ) Other,�fi`fixtures __.:..... = _—�--�-----.---�... er C� SDesric Tank—Liquid I_i uid ca acity.�ObO_.-.gallons p Length person per day�idthl daily flow Diamete:~�r�..�_..._. Depth W P q P g g P ------. W Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ t aTest Pit No. 1................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..._. ri :� n o ................ ........••----------------------•-------------•------------------ (.• l•-� -• x 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 IE 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....................... . .......................................................... .....--•••-----•--•-•-•...----•- �ate Application Approved By............ -_.T�. C.�� Date Application Disapproved for the following reasons:............................................................................................................. ...................•---......••••--•-----..........••-•••----•.......•----•---••.....---••-•....••-•••....-----•-•------•---------••---••--•-----•••-••---•-•--••-•-•------•-•--•-----•-•--••-••...•-•-•- Date Permit No. : .y..? '`..� .._.. ._.. Issued:.....................................................- Date VAR THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1MtiJ...............OF.......... ............................ Appliratiun for Disposal Works Tonotrurtiou Permit Application is hereby made for a Permit to Construct ( �rRepair ( ) an Individual Sewage Disposal Systeamat: ............................... •--- -......... ..... f' .....----- •-- --- ....... ........... f z� ocati n-Address or Lot No. - --- .............................. . .................................................................................................. •---...............•..._...._.._....._-_._.......•••. a .. Owner . Address •......... - ....... Installer Address dType of Building Size Lot_..........................Sq. feet U DwellingNo. of Bedrooms a — ..........Expansion Attic ( ) Garbage Grinder (ft) pi —Type g _. _. ' 1 ) No. of persons............................ Showers ( ) — Cafeteria Other—T e of Building ____ _____ ____ ( } P4 Othe fixtures -----•--------- d -------•----... -: ........... --------- -........... W. Design Flow........... � .....................gallons per person per day. Total daily flow.._..- .........................gallons. WSeptic Tank—Liquid capacity.r1C.*..0..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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --••-------- -•--------•...............•----..._•---..._--------•--- j --•--•---------•-------- O Description of Soil....... `1_!1 •_ r1 -JQe� r�' c>u4 n _}....: '!Gt1 T r f qq a r 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 TITLE 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. f. SlgrleCl --------------- --------- ------------ate---------^ Application Approved BY............. ��"� .....h....--•. . •-•-•-----•---•--- ..............C� 6-------- Date Application Disapproved for the following reasons:-----•..................................................•-----•--------------------...----•..._------•---••-•-- .............................•••--•-•-------•------------••.....-------•-••------••--•-•....--------...•.----------------•------•......-----•-•----•-••-•-•-•---•---------•-•-•------------•......�._.. Permit No....... ........� �-•--•............._ Issued.....-----•--------------•-- ...ate...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..�.... ..... .........o F... .................... .... Trrtif irate of TomV ittnrr THIS 1 TO CERTIFY, That the Individual Sewage Disposal System constructed (44•oY-Repaired ( ) by.................... It .-......... ---------•----------•............ .....................:..... ...........................-- ..._. In�ta11 at-•---•------...'(,�-•-.---��_�...................� �, � T-t_n�'.. .......p� t .................................................................. has been installed in accordance with the provisions of TIT T. 5 of T_l} State Sanitary Code as described in the application for Disposal Works Construction Permit No.... `' _.._�................ dated...._ _y1f?0/GS..................... TI.E ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION SATISFACTORY. � 01 DATE �... ........... Inspector .................•--•-------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - - ^ ................ ' :' ......o F............. .r Le No...f� ..��..�.. FEE..... Dispo.6• 1 orko Tonotrurtion Permit Permissionishe by granted------- ... .:.:..:.:.......................-----•--•------•----•--......................................................._. to Construct ( or Repair ( ) -a Individu Sewag�jDis osal System Street as shown on the application f Disposal Works Construction Permit No •.��Dated... /Q� `�................. ............... C ---'CBo��.Health= ................................ DATE.......... -- - - •..�._ r ."1. t- -------------- FORM 1,5,�5 A. SULKIN, INC., BOSTON " n O ��,` f S�So TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 4"CAST IRON 1I2"MAX.OR 12"MAX. P-V.C. PIPE SCHEDULE 40 4"SCHEDULE 40 PV.C.(ONLY) •P. PITCH 1/4"PER.FT. PIPE- MIN. i LEACH PITCH I/4 PER.FT. PIT PRECAST INVERT h Q LEACHING EL..4.9.4P.. \—INVERT DIET. INVERT PIT OR . . SEPTIC TANK EL.. .. . . . . . ..,..38 ' j= S: EQUIV. e INVERT. EL BOX GAL. INVERT G' .., � EL''.�.�.... INVERT ww p: .., 3/4 TOII/2' �a WASHED w .f'• STONE 6DIA. PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE f- J 77 SOIL LOG WITNESSED BY : v� 8 / gam DATE .. . . . . . 9. .... TIME.��:O� /�-" �on/ G'iGf�/zD 2-S. / • • • • • . . . . . . .,� BOARD OF HEALTH TEST HOLE 1 TEST HOLE 2 ELEV. ENGINEER 4�c c1o. . . . ELEV. .. .. . . . . 3011a—Z _ DESIGN DATA : Ez.47.40 GENE NUMBER OF BEDROOMS 3 • �� TOTAL ESTIMATED FLOW 33p G L LONS OAY CDA�zS� BOTTOM LEACHING AREA /�3. �, 'i, . SO.FT. /PIT/C. ID, SAr/o SIDE LEACHING AREA . . ?0-7 -3 SO.FT./ PIT/S8 4,,/?D C24NE3L GARBAGE DISPOSAL (50 %, AREA INCREASE) IN/TN ,Qo TOTAL LEACHING AREA . SQ.FT 144'j 1 e7Z 3790 PERCOLATION RATE ��35 . 1WO" �o MIN/INCH LEACHING AREA PER PERCOLATION RATE .�;5e•.� SQ.FT/C.P2 No WATER ENCOUNTERED NUMBER OF LEACHING PITS . o^!49� Piz- !4/iIW . APPROVED . . . . . . . . . . . . . BOARD OF HEALTH ` T OFSr`DN�' UN ,�j2L S/Zj�3• DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i _ . . . AGENT OR INSPECTOR Ei J ' •�o \i PLE sAA17- PtiEs Aye ,: ` Nz CeNTV/fir MASS, P �'/STC.P PETITIONER BEDiI/ - --.:.. s�krtnR,a�,y,� !GNA a' I Z-0 112 o 20 � f • 0 Ez�v Tvp aF � Go 7- 4 704 \ septic O 7Tsr 5,�f 77hv� 0 A404LC I. j 1 I 7) P,r 1 _ ) � 3 lot ` A I I ? i / ioe'10 t! R Z402tI I RI 7/ ' t-3 4-s si Tom" �'L�✓ - - WCATION C'E' SCALE ./ _.��. . . . DATE PLAN REFERENCE lam/ �, EDN' �\=LLE ( Y �`1 . . . . . . . . . . . . . . . tv o. LV�QQ ff CERTIFY THAT THE SHOWN ON THIS PLAN 13 LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE . . . . . . CZL-�9AIO& REGISTERED LAND SURVEYOR