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HomeMy WebLinkAbout0508 LINCOLN ROAD EXTENSION - Health �WdA 0 -1 EKA ..* 0 C Crp o r &A w1 i Cf o �+ rn _ Z t z e� ul n , i o N 30 v p p N s 1 Ni ' 36 0 f No _. . ...._. . Fmc............ ... j.... THE COMMONWEALTH OF MASSACHUSETTS _ /BOARD OF HEALTH /OG ........................OP..--..O.; I.e .26.�>...4 ................................ Appliratioaa for Uiipoga1 10orkfi Toutitrurtion ramit Application is hereby made for a Permit to Construct (,—No or Repair ( ) an Individual Sewage Disposal System at: $ 8 0 .... �.. -.............................................. .... ��o r. .....---................................. Location-Address or Lot No � ,o ) 13C OYC' Cod /,vc fler / Ad ress ..............................................�`: ................. •---...-•-•-•••--••-••-•••..........------------....... Installer Address Type of Building Size Lot____f?�,.51.....Sq. feet V Dwelling—No. of Bedrooms............. 3--_-___•_-_____ _Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----_-----------------•----------••----------•........----..................................................................... ............. W Design Flow............6:;C......................gallons per person per day. Total daily flow......._34_.o....................:.gallons. WSeptic Tank—Liquid capacityl4�1a_gallons Length____9...... Width----- ..... Diameter................ Depth__ ."...... x Disposal Trench—No....................• Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------- __.. Diameter..........<6�... Depth below inlet.......!��'...... Total leaching area...ZUO_...sq. ft. Other Distribution box (M Dosing tank ( ) aPercolation Test Results Performed by----- .�__t.....-��4�F ...-.. �f.............. Date.7_-J=9 ......... a Test Pit No. 1�__.z.-_-minutes per inch Depth of Test Pit.....1 1_`. Depth to ground water_.,V P 77__4�! Test Pit No. 2..!!5..Z..minutes per inch Depth of Test Pit----111 ...... Depth to ground water.C9a,,-07iPe&--_'> --------- Description -------- - of Soil-_ 7........... ° _- P y__ ° �'I--- _s vB�SO/�-----30''— 6 0 - - --------------------------------------- _._.w �-r-----�'d•`.. leg .................�---•-•� �,� a 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 ii:LE y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has en issued by board of h th. �r Date Application Approved By.....—4;. Z-. d----- '2-y= .............. ..................................................Date Application Disapproved for the following reasons______________________________________________________________ ` ......................•-•----•-•----------••••-••--•--••------------•--•••--•-------....__._.--_...._------_...---•-----•-------••-••-••---..._....•-----------..........----------------•---••-••--•--. q—g— _�_..........Date- Permit No.......................... Issued- ----•------- . ------ Date Noo...44, THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /®6cJ......................OF...-.. rr�'.�L�S-T>7 -L Appliratiou for Bhipi j al Workfi Totw `nrtivrn tIrrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Systemat: At sot?.....• ••----...•-•-•••.............. ...••........ -•-••-•----••---------••...----•-•------••----- Location-Address or Lot v.C' ---a�.v �L��--,..OF C'f7P Cov /,plc. i>_LRt _.Uf_.%L.,c3�r f No 13r- ° ...............r . - ... .-- ' wn --_'.-_-- ... ....._ ........ ....... ........------............................. 04 Installers Address d Type of Building Size Lot_._.»�_S Z/.._..Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 'L Other—T e of Buildin No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures --------------- ------------------------------------------------------------------------------------- ---- ------------------------- -•------------ W Design Flow.___._.....-�_5 .....................gallons p" person per day. Total daily flow..__.. 31:.31:.�..O...................... WSeptic Tank—Liquid capacity/00U.gallons Length..... ...... Width-------k .'.. Diameter________________ Depth....- --_--. x Disposal Trench—No. .................... Width......._....._...... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No.___-_-__--.-_---- Diameter..........e.1--- Depth below inlet........ ....... Total leaching area..*r--.�...sq. ft. Z Other Distribution box (/- ) Dosing tank ( ) Percolation Test Results Performed by----- ........L.0 ...... ..0 :............... Date.7_../J.:'__6__U...._.... W Test Pit No. 1 ._.Z_.--minutes per inch Depth of Test Pit----- Depth to ground water.A,U7T..� fs, Test Pit No. 2_.'C... _._minutes per inch Depth of Test Pit..../�_�-_`_. Depth to ground water�v ?2 W O Description of Soil---#../ rf .. -..... ..- ---(�--- -3----- --of7/1'I--`�� . 'SUd�SU/�.... .�U�..-"6 a---I--------------- -------- - x .SGj,t/ ._.. /..G t1/ -�° 6/.....-.._l..¢.. ."... .E __....J_, _2 t / ---..5�9F✓,D-----•---•--•-------••--U W x ---------------------- -------------------------------------------------------------------------------------------------------------------------- ...................................................... 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_1T'.: p 5 of the State Sanitary Code.- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by board of h lth. Signed. ..----••-- ------------ -----------------------------•-•----------- Date Application Approved By..... ....... -----------------••--•------- ............... Date Application Disapproved for the following reasons:.............................................................................................. ................. -----------------------------•-----.-------------------------•--•------------------------------------•-•--••-------•-•----•-•-•--------------=------------•---•-••-----•-------•...------••------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH dct-sr+. ..........UF....Y... �,�, ..................................... Cprrtifartttr of Toutph attrr THIS IS TOXERTIFY, That he Individual Sewage Disposal System constructed (P) or Repaired ( ) bY............. ,t�.r .....0.' � .....--------..... Installer t � at ._.... ! —------------------------------------------------ has been.installed in accordance with the provisions of TI', F j of The State Sanitary Code as described in the __g9r_ - ---- dated-._............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. DATE._......---•- .......' .- ... Inspector.... . - . ---••--- .......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N . l .. ... a FEE.. . .. ...... "isposal World Twilmitrurtion ramit Permission is hereby granted------:.. ......4).- -------------------•...----------------....----•--•---............. to Construct ( I epair ( ) a Individual Sewage Disposal System - --- ------------------------------------•------•----••-- Street as shown on the application for Disposal Works Constructions Permit No.................... Dated.......................................... ��- oard of Health DATE � if/ �-----------------••-----._...------•-------------------• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 97. 5 0 " 9g, g 0 „ GoAN! �oRrb'1 L Q T q2 . 5U8SOiL • � 9S, o .3a n 9�.3 3a N �. 140• of ' ' SA ti/b Si9r�/D /oo O w 4 1 /0/ 35 'of PRoo t .1 Ex1�A�• ('� ion peoP- �+ /+-rE�• 9705 - - 97 479 �a6 �/326�1w 3�ow .Sf3re/l� yg' 2 9,8 .Q 85. /4. 86.8 /44 A/O w�37E E fpLlwl7"t; 1> T-E s . IYO'L E GoT 90 i RE S UL7�5 P T o pv/V P- C 0,e Z:r^_-i 7-J�" /,30 7-TOM = ¢2 X Tr = -5 0�' c-S/,q E S - 8 X 7T � 2,5= 377) ~ 4Z-7 GF'D ? LDE S G .3,3 O G .�� ,/ D R� OcE:� G_ tin ; r-, � f G4G QV. 00 ....,�� f tom, r {•f l -` C7 F 1 r /�/ r s f r�t- irr )2 Z7-`- _`�"�\ ka ,., r - ,q T _''eOAv � 1' s� y -- __.� M/�✓/MUM - `-��"/ -x E� Irv _ Gvy}�TCLj /FOOT. 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