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HomeMy WebLinkAbout0487 LINCOLN ROAD EXTENSION - Health y8� C�ncol n Q.�I • Est, grfm; t a ,a / oaa ION L o -e.�J� T l �rti 12J! SEWAGE PERMIT NO. VILLAGE INS A LLER'S NAME i ADDRESS J UILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 5'/ 23Ag� 1 �Q 'J r Gjj� d U' 0� I� r No.._._....li? ,.. FEB....��.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �lN/4�-...........OF....... . Allp iratiou for Uhip ial Works Toustrurtiurt Vantit Application is hereby made for a Permit to Construct (,SG') or Repair ( ) an Individual Sewage Disposal ys at J l P4._ �...__r..l�. ._..._... .............................4 7", Location•Address or Lot No. r'.0.................... ......�..A,;�� A; t�1 .......�X"m.:----...--......... Owner Address W ........•---•---••--•---•------•-•-...---•••--•--•------------------ ------------------�� __>..:�..... o �Installer Address Type of Building g Size Lot_/_.f.J'__.�..__.___._Sq. feet -- ., Dwelling—No. of Bedrooms..................s-............._._....._Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures ...................................................... W Design Flow..............6.....................gallons per person per day. Total daily Aow............��v..................gallons. WSeptic Tank—Liquid capacity./000.gallons Length__.__'°__--__ Width------ Diameter................ Depth_..._..... xDisposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/----------- Diameter----ld---__.... Depth below inlet--- ._s ...... Total leaching area._1R..k...._sq. ft. Z Other Distribution box (V) Dosing tank ( ) Percolation Test Results Performed by..Oa__P 600n.....tgw....d.___. ..4.......... Date_...�_`�_�.Z..�'_.�.�__.. as Test Pit No. 1_4_4-___minutes per inch Depth of Test Pit----/Z......... Depth to ground wat N !P_ -e 00Aj—;a P—aEA f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Descri�Pti�on of Soil a=� Y ye,® 63---•---��511, .�al� � ( --'....h!1N ----------------- W ------------------------------------------ ----•----•-•-----------------------------•----•---------------------•-----.._.....-------••------•-------••--•••----=---•-•-•--•-•-••------•-•-•••••-•....... U Nature of Repairs or Alterations—Answer when applicable.-_-.------------------------------------------------------------------------------------------- ..---•---•----•------•------•---•-----•-•-------------•-•--•••••-----•-----•-•--......•-•-•••----•-----•-----••••--....................=............................................................... Agreement: ge `� fef The undersigned agree to I a ed c i e n ivi ual Sewage Disposal System in accordance with the provisions of I-I T p 5 of the State Sanitary Code— he undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t e board of bealth. Sig t . . •••• .. •• •• •-•-•-•--•--......---•---•---•• . ._'....g--•-- DateqApplication Approved By.:.____ �` ' _.... .... ..... . � _ / -- ���. Date Application Disapproved for the following reasons:----------•---••----•----------------------------------•-----------------------•--------•----•......--•••-.----- ....•.....................•..-----•-•-------•------•-------------------..........----•-••••----•-•-•••. Date PermitNo......................................................... Issued--.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C oki,/............OF.......: al T�9 L. h Aliji irativn fvr�Diiivao al Works Tanstrurtion 11nmit Applirition is hereby made for a Permit to tConstruct ( k) or Repair ( ) an Individual Sewage Disposal at � •17 -• -=- ..... Gc: '.......(:y .. .... ....... .............. ..... -----..............._......-••--•........_ Lmatwif Address or Lot No. .....•-••-•...•.••-•_....................... _---.. ........... ............... •••__.G:.....,vco a .......cea>.1...... X?...:................ Owner , .�..... Address ........................ . ...................._............._............................. ... � Installer Adr .............._.......................... ess Type of Building Size . Sq. feet 'f U Dwelling—No. of Bedrooms................. .......... .....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dr Other fixtures ...................:...:•=----.._............----••---......_..._.._._............_.._................_._........-----............-----•..._•••....__.. W Design Flow...............%5. ................._.gallons per person per day. Total daily flow............�Q_.._._.........___gallons. WSeptic Tank—Liquid' capacity.10dlD.gallons Length._...:._:::.Width...... .'_... Diameter................ Depth...... .. x Disposal Trench ,=No. ............ Width................ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No;_.__../..::.--__.. Diameter:__.I d..-_..._. Depth below Total leaching area._/49.. ....sq. ft. Z Other Distribution box (�) Dosing tank ( ) a Percolation,.Test Results Performed by..Q5 Je.6(.F.....L- ...... ._�.......... Date.... Test':Pit No. 1_.`�.__Z__._.minutes per inch Depth of Test Pit....1-_Z..._..... Depth to ground watcgVO-7� !i Test'Pit No.`2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ........................................... .............................................................------------......._.....-••-_... . O Description of Soil.. �._. z..�.. �-� ..............�SU SOl.�rr......_4�.'.:... .I... �� ... :1_7?._4 ... W UNature of Repairs or Alterations Answer when.,applicable............................................................................................... .._---- •--•-- .. ..... .. .-•..... ..................... ....... .. --s-........_._.........._...._......-•--------._...-•----------............--•---. Agreement:, � W� aOedThe unders>gned .agree to iSewage Disposal System in accordance with the provisions of LiTL , 5 of the State Sanitary Code undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig .............. .......................... .... Date Application Approved By........ ;'L°�'7• � =c `? �.----••--- Date Application Disapproved for the following reasons':.......:.........................................•-••---....._...--•--.:'......--•-•-••----••--••----••--••••-••- •••.......................••........................-. .................._..........._............................_........_._..__..__._........•••-••.._....... .-__....Date.................... PermitNo....a:............:::................................... Issued............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OAF HEALTH ..... l`..t*)7...... .OF..... . , a.. ' ................................................... Irdifiratr of TuntpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by........... .................................. ........... 'sc -... ......... .. at...`•...... . - /. ` ..,�1 ..�:3..._. ...... , has been installed in accordance with the provisions of TIT r of The State Sanitary Code as described In the application for Disposal Works Constiuction Permit No.-":. _ ............. dated.-- ............ THE,ISSUANCE OF-THIS'CERTIFICATE,$HALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. -:.)_ . 7I�-._.................. ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE LT �... ...........OF..... . ... �.............................. � No........................." FEE....�.1.. ... �i��rrr�s�al grk� �un�#rnr�Uan anti# Peiiriission is hereby granted............................... to Con stt t or Rep"(� ,.andivi Sev; g tsp System y ..... ..avevel.- ............. eet as shown on the application for Disposal Works Construction Pe f' D d.._ �-. _. .-..-79%`---•••- v_ ...•_•_...••�' Ll �: Baardrof Health DATE..... 10 ......................••- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '' i r •rCT CIS'G"'.f= �. 1 s� A-1 T 1,3 .12 SO +It1. ' �•. f00 9 ICX+ ' � Gboo • �� � /�� �� pro P � ,�1 - ii� '� EPf3N/oo —4-r 35'�` M �oT /z �� TEST AoOLE E s u�.. -r j IVO c✓,1971F;(E PER T O !v//`I R EC OR DS Z)f-? T E : - 13 T O G./A/ b,443 7-E R /s .70 ac MFFt R !fA / L �9 L E /NS P. i?. M✓ iz 2 Y /`9 U•/`7 /3 U/ � D l l\./G 5 E T B/9(2 R"�_ '©U/ )E E M E N T.S DRl .V,EwR49Y A/0 _r T-o Z3E LOCA -r'ED P�' UPOSED BEDi20oM, 0 VIE .e? S EQFqG' E 5y5 -rEN7 UI /LE•SS DESIGry Flow 330 GAL�DA DES /GN LOAD/NG IS USED . P;eopco5.ED LEAeH /q;eEA SETT c ,SYS -r E M conl57"k' Ue -r/ o R L ,EROOLAT/ON TEST M 7 1-7119SS. EnIV/R0AJA/ ENT, C C) D E y D/9TE' D TULY /, /977 AND TOti/N of �E5(JLT.S z M/�/� /i�/G'H SILL ELEv, TO BE.7 FT 11423OVE 'RD, oNS?� / r~ - ' •ron of l'RzOf'1 SED / / P ! L J'! / GRAD/ 090oVE LEA y Fo uNDAr/ON 47 ,Sig /v o S c z3 epvE� MANHO1_Eo eo✓ERe? To EXTEND 7-0 /MT'E�ev/oUS WITHIAJ /' OF E/�lJ/SHE2? G�E'f,7�E F OB`? /NFILT�i9TING' ° 2¢"eovE.es, �ats'r. yo t Cpvz" t;%ASNET.� so�v /fQ box 2I"N F3L L r9 o Uiv D 1 • _ �:17 1''lCy7A;_0jv, -1N� rl/A!••�F-p� i¢ Four �C - �'�,� L✓fJ�'HE'D D`MIN. „ %�' � -----`�. / 0 0 "%Poor Gf�,LoN i' p-rl(2 TANK S 9© 761 " { ��✓fTTE,2T/GNP' ��YRe-r /N vE)eT Z EAC' hl %NDE� f'R2EA ,$•'MAX - R • 9 Z, `f 4",/� I iV D/5.3 Tc3_ NIA, 1C sill �.0 G!�: ORS Z,,o7 l3 i9S SJ4OL.1�/ k: . ° C'C ,U)V 7"'Y � /STP-Y' 0,= DEEDS T o cr T/ U �l A N A L E f� L' f 1 1E'I T S . . e c roc C ,y c� c . TNf'O�T 1-1A5.5 . T C � -r / IC- �}_ rN�? T- rN 'L) LDt.AJC� ... 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