HomeMy WebLinkAbout0043 UNCLE WILLIES WAY - Health y9 Unde a) ; Il+es way, Nya
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF - HEALTH
Application is hereby made for a Permit to Construct (X or Repair an Individual Sewage Disposal
System at:
i .............. .............. ..................... . ....................
Installer Address
_4 P 4, > -717
Test Pit No. I_!<2-----minutes per inch Depth of Test Pit-----/Z. .... Depth to ground water��77__��_—
Test Pit No. 2................minutes per inch Depth of Test Pit--------------_--- Depth to ground water��,�4Hii�Aep
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TL-TTL_ 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.
Application epprov*uuy-...... .._^.. -------
Date
Application Disapproved for the following reasons:................................................................................................................
........................................................................................................................................................ .
Date
Permit `
oxCe
No......�i_ ....... r.�s.... (. .:...:........
X THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-�
a -----/.�li.u.._ ..................OF...... ...`�. 0.. .``..T�.I� ..............................
, pplira#ion for Biiipoq ai Works Tnntrurtinn ramit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
..........: ...•- -.......... .._ ,:':._.._..._.. .....------------ .......................... _ '.. _.'7.._......--------------_..-.........................................
Location-Address or Lot No.
W -• �t Owner Address
.. f",_' _ _ .1._� J.....------•-•....:......................................
Installer Address
UType of Building Size Lot..____......................Sq. feet
Dwelling—No. of Bedrooms.........................................---Expansion Attic (- ) Garbage Grinder ( )
aOther-Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
QIOther fixtures ........................._.............................................................................................................................
W Design Flow...................5 ______________gallons per person per day. Total daily flow........... _ ................gallons.
WSeptic Tank—Liquid capactty4040_gallons ,Length____9__`____ Width_____ Diameter________________ Depth__4__`.......
x Disposal Trench—No_____________________ Width______ ........... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.------I_......... Diameter----- 0.#`..... Depth below inlet....... _'�._..__ Total leaching area_a..7.....sq. ft.
Z Other Distribution box ( Dosing tank ( ) f
Percolation Test Results Performed by.(w�_05---- 'o.! ___ ll�'_h .Y_.�`_a l_S, .Date_. �_':.`��.". ..........
a Test Pit No. __..minutes per inch Depth of Test Pit------!_Z.'... Depth to ground water�W:T._Ln:'_&�_—
fe Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground watereQ0 N_�_ e ED
a -•--•--•--•------------------•----•-••----------•---------•-•-••••-•-----------•-•--•....._......-•-........................................................
o Description of Soil-- ......... ------dl�'. .!._ U /L.: f "'`� 1 1-06 e":K "
�+ �!` i-) i/C G 4 ' -•- 1 !�v `yam! _l?�Cam. e -------------=
U
W
UNature of Repairs o, Alterations—Answer when applicable._______________________._.______--______.-______-____.___-_-._---__`__-_____-_________-_____-.
---------------------------•-------------------------------------------------------•-•--...--••--------------------------.-.---------------------------------..........................................
Agreement: "=4,
The undersigned agrees to install the afore'descF bed Individual Sewage Disposal System in accordance with .
the provisions of T_:I- 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.
Si ell......... '
Date
Application Approved BY { .-----------------------------
Date
Application Disapproved for the following reasons = =
---------------------•------------------•------------•---------•...•--.••.....----------...............................................................................................................
Date
<'.. Issu'cL..•--•---•••-•••---•---••-.....Permit No.-----------•.....:.:...............•------------•---- -...------------------..
Date
THE COMMONWEALTH OF MASSACHUSETTS
,r ` :_BPARD OE HEALTH
Qurrtiftr4hr of 9nra�Yt r�'alurr
T I S T CERTIFY, That the Ind vidual Sewage Dis.posal System constructed (/--Tor Repaired ( )
> �""' ,
by... .. _..- - --------------------------------------------------------------
- Installer
at.--- ,c�•1" / . ..J -------------
- ---------_----------_--•- ----
r has been installed in accordance with`the provisions TIC > of The'State Sanitary Co°e as described in the
application for Disposal Works Consir.uction Permit No--- _-- __rBE
/__�,_/___________ dated_-... �. -r? _...__.___.____
i�THE ISSUANCE OF THIS CERTIFICATE SHALL OTCONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
FF
DATE.......... -�^r' .��; :Z_ m�.....: Inspector..�; "/. ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No._....... J.!... d FEE_ .............
I
13ispos al rhn Tonotr ion amit
Permission is hereby granted--- ..............=-------------------------------••-••-••-...------•-_-_.. ..
to Construct. or a air ` an, n� ' dual Sewag `,Dis osalm,
at Na - ) ---•--IV
P
a
Stre /
as shown on the•application for Disposal Works,Constructi KVit*O'n___ ______ A__ Dated._.__=_z r-
Board of
/�SWI^
DATE. ----------•---
FORM 125*,- HoeBS & WARREN, INC.. PUBLISHERS
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SEPTIC ' 6 ,ti 8L0CK: _ _� fi 95,g
TANK t� E , y 0 i '
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-- 20' MINIMUM �{�,' '- �o# 'folA':G.
FOUNDATION I /fie'
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ELEVATION SKETCH'
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SCALE: 1 4
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RS BACKHOE OPERATOR
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TEST MADE ONS/
to �c 3 ,`' !o!X 73
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ELEVATION SCHEDULE ..11sv>'�` i
PROPOSED SITE PLANv�"
I INV AT FOt'NC;••'ICN
�y SEWAGE 8Y8TEM DESIGN
2 I+Y• INTO SFVT I TAN✓
3 , NV C - 1 OF SEP'!C TANK,
4 1•. . 70 C CTPIEUT+ON EOX G.��6_7 SCALE 1 = �� mil•-'1— IS 78
5 NV OUT OF C'STP;6JTI0N BOX =
SG CAPE CC: SURVEY CO� S� i_'ANTS
6 I�,V ItvTQ rcFNAGE F:T = —_--
FOUTE 132
HYANN-S, MASS
7 80770N' OF P'T = 1 Z •
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6 BOTTOM OF STONE LAYER