HomeMy WebLinkAbout0104 WAYLAND ROAD - Health�roy a1af And ed'), N�,hrvs
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L O CATION S E -A G E PERMIT 00•
Rs
VILLAGE
INS-LA,L ER'S NAME i ADDRESS
B ULDE R OR OWNER
DATE P E It M VT ISSI-Ely
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DATE - C-
OMIPL I A N ISSUED
C E
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............Town................OF...Ba rns.tab-1-e.-..--------------...----..------------.---------------
Appliration for Dispatiai Works Tonstrnrtinn 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sstem at* ... ....: .a.S.,................. ......Hy
Locati Address or Lot No.
Ca-pricorn Really '
.. 65_._ alms�.uth..Rna.d; .H,yffi�nis..............
W
Steve Lebel Owner - Address
Installer Address
QType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms......3........................ .....Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building Ranch______________ No. of ersons............................ Showers — Cafeteria
a YP g --------•----- P (2 ) ( )
a' Other fixtures ----------------------------------
W Design Flow........5.5...............................gallons per person ?er1 day. Total daily flow................3.3Q....................gallons.
of
WSeptic Tank—Liquid capacity100 0_gallons Length 8-__6...._.. Width. '__.......... Diameter................ Depth.5--_8.00-_._
x Disposal Trench—No..................... Width...-.__......_...... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-----1.............. Diameter.......6.......... Depth below inlet......6.......... Total leaching area_266.........sq. ft.
Z Other Distribution box ( ) Dosin tank ( )
14Hdred e En ineerin 11-25-81
a Percolation Test Results Performed by---------------------.................__......._.....2g............. Date._...--.._.-- -------.--_----.
04 Test Pit No. 1. 2.__0__minutes per inch Depth of Test Pit.12.'........... Depth to ground waternOne---encounter
(s, Test Pit No. 2----NV�_...minutes per inch Depth 'of Test Pit_N�A.......... Depth to ground water__—N/A............. e
Q+' ----•--••-------------•-------•••-••--•-----•-•-----•-------•-•--•------.............----••---------.........................................................
O Description of Soil......... `.-2.'----•._..Loam__&___Tops oil--------------------------------------------
x 22 10-� Me umv . ..Yel ow... a s - - - -�-
W ----•-••--•---------------•••---------1-�--•--12----- Nled.....White-_.Sand trac d Q ' .G aVe:VY.Q.._.wate-r..at...12..'
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%. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss ed byyie board of health.
Si ed.. - --• ....-•-----------•----------
I�zc�
J� Date
Application Approved -•- ------•---------------------------•--------- l L! e
Date
Application Disapp v o the following reasons-....................................'�-.........................................................................
..................................----•------.....-----•-•---•----------.....••--------------••--------•--•...•-----•----•-••------------•------•------•--••-•-•-•••----------------•-•----•----------
Date
PermitNo... a.� �'.S................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.^ 'T 1...............pp....T2 ,•w,n t-n?I,l ..
.................. .......--.--......---..........•----.......................
Apphration for Uiipog ai Work,i Tonitrurtion amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Locatio -Address or Lot No.
vzp%,S.Corr. �3al iv _rus ?I��i ?.1,_n ii_�-h T`na rI `Itrx r-n i c
._.... . .............................................................. -••----------•-- ----- •...................,- -...............
jlyvve Lebol Owner Address
(S� 1!
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms....... .............................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ..A.....?1__....__.... No. of persons............................ Showers (2 ) — Cafeteria ( )
a' Other fixtures ................................. .
W Design Flow........5.5..............................gallons per person per day. Total daily flow................33Q....................gallons.
WSeptic Tank—Liquid capacity Q00_gallons Length.$'.61.... Width.4°10" Diameter................ Depth_5`.Q.....
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No....... Diameter........6.......... Depth below inlet._....6........... Total leaching area.2.6 ........sq. ft.
Z Other Distribution box ( ) Dosing tank
'-' Percolation Test Results Performed by...." =:..... ... ..-'.. r G'i t-?�_ 5
a
. Date._Z_1.-2.. -$l
Test Pit No. 1_<._2.,.Q.minutes per inch Depth of Test Pit.-1.2'.......... Depth to ground watern0ne --gn4.0ounte1^-
Test Pit No. 2....VA...minutes per inch Depth of Test Pit_ VA......._.. Depth to ground water...NIA............
•----------------------------------------------------•--•--•----•--...................------......--.........................................................
O Description of Soil.......... -'--2.------...LORM...&..-a Q�2
U sa�..L--•---------------------------•---------------..........-------•--.......-•-•-•----------------
-•-------------•----•------•--••---•---..2..ml.Q:'----..MadLum...Yanow... and--------...-----•---•--------....-------------------•-------••-••...........--------W ------------------------------------- 19_'_-1. ' Ml tlh-i e...Sand/traae-d-__IIf...C:--ra 'nI/Ma._t n-ter...a t..12.`
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 TTTrE 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 he board,of health. f
Date
r i
`-/St
.Application Appro2v�e4d-
Y '� --------------------------------------------------------
.......... ........................................
Date
Application Disappj the following reasons:............................................................................................D Date
.................••....--------------•-•......--•-.•----------------------......_.....---------•......--•----•---•----------------------•-----------------------•--•-------------------------------•••...
"M Date
PermitNo... .~3. ................................... Issued----------...----------------.........................�
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................
Q�rrtifirFate of TomptiFanrr
THIS�IS•�TO CERTIFY, That the Individual Sewage Disposal System constructed (-A) or Repaired ( )
by ---- ......
1-1
Installer
�) it . � ` c...ems.,`a � _ ._ __............ � ',�.
� .�..:fE..'...., LL •------------
has been installed in accordance with the provisions of TITlr*X 5 a The State Sanitary C�id'e'as d" escribed in the
P Y
application for Disposal Works Construction Permit NO......................................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector...................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
� . 3 ,. BOARD b OF HEALTH Fi
............�... .......OF....... .... ........
1
No......................... ". FEE........................
�i��o��1 oa`k� �on�fra�rtion .rranit
,.:, .��
Permission is hereby granted.._.'t` Je I' 01 v
to Construct or Repair ( ) an Individual I Sewage Disposal Syst
at No. w9 -A-- ��✓�.f�� y ) 1�( t 5
Street
as shown on the application for Disposal Works Construction Permi .................. Dated..........................................
....................... ................................ ............................................
DATE..� __�3,.:.�f..y:_
............................... Board of Health
FORM ZS HOBBS & WARREN. INC., PUBLISHERS.
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EXISTING SPOTGEL,EVATION 0%0 ���NOFMAssq CERTIFIED PLOT PLAN
EXISTING CONTOUR --- 0 ---- o� MBE
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,'FINISHED, SPOT ELEVATION BE
FINISHED CONTOUR 0
APPROVED BOARD OF HEALTH IsTE IN
su
DATE AGENT SCALE: I = 30 DATES l2-
LDREDGE ENGINEERING CQ IN CLIENT F��co I CERTIFY THAT THE PROPOSED
LEN
ISTERE REGISTERED JOB N0. Ql'Lo5 BUILDING SHOWN ON THIS PLAN
IVIL. LAND CONFORMS TO THE ZONING LAWS
GINEER SUR EYOR DR.BY� OF BARNSTA E , ASS,
712 MAIN STREET CH. By: AA^^
HYANN I S, MASS. _
SHEET L OF DATE CR G. LAND SURVEYOR
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