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HomeMy WebLinkAbout0050 MAINSAIL LANE - Health 28 �5 — a toy( 1 '` 1 - -- TGWNiOF-BARSmw L(A.XTIC3N ^J o l�� SEWAGE # VILLAGE- Leo ASSESSOR'S MAP �3c LOT •�� INSTALLER'S NAAME&PHONE NO. SEPTIC TANK CAPACITY 9 ,mil LEACHING FACILITY: (type) � I'l—, (size) NO.OFBEDROOMS BUILDER OR OWNER �S PEMMITDATE: COMPLIANCE DATE: Separation Distance Between the: 1 Maximum Adjusted Groundwater Table Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) - � F Furnished by �t�� cl� cl� fig ' }, I Q4 S - Se - Q� 03nssi 13NVI1dW03 3111a s 03nSSl IIWa3d 3 1 V a a3 NMO a0 a 3 a l i n a SS3aa 'aV T 3WVN S. 311r1SNI -971 /V� �9 43OV111n '0N 11Wa3d 3 0 V M 3 S Arl601, te _ /$ , f , �01 M ��I c� i u i No................ .... �$.. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......1.Pk7Vr�. ....................OF....... ........................................................ Appliration for Dhipaii al Works Tontrurtion 1hrutit Application is hereby made for a Permit to Construct (�) or Repair ( ) ari Individual Sewage Disposal System at: ....:_1,a _-1.......fM !►� n, ................................... ...1 4'nnxSPA-7--...AA...................................................Location-Address or Loi No. ....................................................... ............ ---.....-•---- .... ......_ &................. ......-•- ........................ Installer Address Type of Building Size Lot...1. ____......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder 9b) aOther—Type of Building ____________________________ No. of persons............................ Showers. ( ) — Cafeteria ( ) Otherfixtures _----•-----------•---•----•----•-• --•---••---------------•-.......__••--•- W Design Flow.............../140._____________:_____._gallons per r per day. Total daily flow...............3.1G?...................gallons. WSeptic Tank—Liquid capacitylftO_._gallons Length_9!'k*1._._ Width_y'_ O.' Diameter________________ Depth_d.`!?`��._.. x Disposal Trench=No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..../C?............ Depth below inlet...(e. O_......... Total leaching area_SY%.'7......sq. ft. Z Other Distribution box ( ) Dosing tank (Y �.6 Percolation Test Results Performed by.___ . .m__�__ _______________________________________________ Date___st/iY. of ................. Test Pit No. i__ _ __.minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ xf ......--•----------------•---------..._....-----•.....--•- Description of Soil-- =f�F !,fIF_�n-;S' �............... "I° C� m_�1 wcxa_ v� ............................................ x w --------------------------------•---•-•-•--•. ........... V Nature of Repairs or Alterations—Answer when applicable................................................................................................ ...................................................................................................=.................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the -isions IITI.i✓ 5 of Sta anitary Code—.The undersigned further agree not to place the system in op ra • n it r •- to ance has en issued by th board of health. l`) -i scc,'A�; Signed.._. . + - _ • ..------... •••••_`�ll�D PPlication Approved BY..............--...: .:__v! !.._.._.... _. ---- ---.----•---........ .......................... Date Application Disapproved for the following reasons:.............................................................................................................. --.._....--•----•---••--•--••----•-•--•••.._..--•••--•-•...................................•-••------•--•-•----•-_..__.....-•-•-•--•---•---•-•--•-------•--------•-----•--------•------•----..._--•-•--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH slV�......................O F.......�!t:+r!^tS Appliratiun for Disposal Works Tonstrurtiun Vprmit Application is hereby made for a Permit to Construct (Y) or Repair ( ) an Individual.,Sewage Disposal System at: ....:..�»o. __ ..._. car!�.Saa.�.�-amp..._.....-•................•--.... _...�' . �a; ►.5 ..T..._r ......................-----....».................. Location-Address t ' o!Loy No. 1 p ..................................- ---...._._..._ . . :.4... 1•+1_..�..l.......Qoollr•,�,lr� a .........................� �. — � 2 f.............. !.. f .{.!L/. t .._ ... ..... ............... ... ... Installer Address l Type of Building Size Lot...1_�.01 .........Sq. feet Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder 04 '4 Other—Type of Building . No. of persons............................ Showers — p•I )'P g P ( ) Cafeteria ( ) 0.1 Other fixtures ................................ .. •--...---.........--------••--•-•--------••----.._....-----.....:.:........... .. Design Flow................�4........ gallons e g / per per� ay. Total daily flow---------------- . ..................gallops. Septic Tank—Liquid capacity/ 2__.gallons Length .__ ..._. Width.!q__I! _.__ Diameter________________ Depth_j_._`.V...... x Disposal Trench—No..................... Width f Total Length ........._.. Total leaching area.... ...sq. ft. 3 Seepage Pit No____________________ Diameter I,0; ._ Depth below inlet...(r�0........ Total leaching area._ t.?. sq. ft. Z Other Distribution box O Dosing tank (� ~" Percolation Test Results Performed by.; m ?' :........................................... Date.... �:___........__ ; Test Pit No. 1.J�eZ"_.minutes per inch Depth of Test Pit......:............. Depth to ground water....................... 44 Test Pit No. 2........ .....minutes per inch` Depth of Test Pit.................... Depth to ground water........................ a _..... w 11 l D Description of Soil....�3_'_.L ...... !yr_..L �..---••... ...L ....l A......=, r_I _r ire...... ..._.. U ------..................................... :... .------•...---•-•.....---•---••-•----•-••...............•--•--.._.......--•--•._.._.._ W , '''hcable__.___._�---.---_--•-----.--.-•-----•'-•_•-••-----•.------•-•----------•.•-.-.•-----.-•••-•"_. Nature of Repairs or Alterations—Answer when a �. U P PP •--••----•---------------•--•----......-----............_..------..._..........•_-_._.. ---------------•---•---•-•----•---------•----........--•-•-.....__._...............--•--•--•-----.........•-•-_.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the sions �ITL 5 of t St4tgXanitary Code—.The undersigned further agrees�ot to place the system in op a ' n it a r ' too nce has b n issued b the board of health. (Je4 6f3sc� 6rs Signed . .---...•-•..................... PPlication Approved By................. �t X �1? �^� --, � Ic'�.; �__ ........ Date ..._ Application.Disapproved for the following reasons:---•................•------•---.......--•---•------•-----•-••-------•--..__......._..--•--•-•-----•---•--._--_ ......---•.............•------•-•-----•---.........-•--•-----.....-•-•-------._.._..------•-•-•-•-----....-----------.........-•---.........._...----.......__.._.........---..........._............. Date PermitNo. -•-- ------• Issued:...........................................-.......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................... .OF..................................................................................... Bert f rate of .Clam rlinure �•. THIS IS TO CEI?TIFY, That the In Vidual Sew' a Disposalystem co str cted (�) or Repaired ( ) by............................:" T .. -- ��... ....................77 .'......../........................... ._..... _, ..... insta at............ :�..... l ,r .._ .......... ^ ..--:-` `I.....of=T,-State Sanitary-Code a -ae---ribed in-. _ has been installed in accordance with the provisions of TITLES 5 y the application for Disposal Works Construction Permit No......1:3 ......................... dated.......... �_� _ft° �................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. i�o - as - DATE--•--•---.....--•...................... s•-••-•••-•--........._.. Inspector........---......._ ....... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD,. ,OF HEALTH Disposalurk dun tr�trtwtt hermit Permission is hereby granted. . >Ar ......---••---• . •........................................................................................ to Construct ( ) or Repair ( ) an Individual(Sewayge Disposalystem at No....... ) ----••}----•••. ~..... .��=.t.l.- L' —'" ..............o���+•n 5 R` ........ .:............ p ............ Street as shown on the application for Disposal Works Construction, Permi No......:.............. Dated.._.._. (...``.... ................. . . ........ /��� Board of Health DATE............-•-- [•- ------_-_..__...............................•-••-•--•- FORM 1255 A. M. 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