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HomeMy WebLinkAbout0159 WHITEHALL WAY - Health -- - 15q i�h►�� UJau�� , . ._ / � _ _ _ �� R._ i` ,` �. _ ,I ��i., �� � 1 �,i �Y��� 1 r I �;� � t ��. �,°t � �� l .. �. ,.` ���; �.. _ _. J TOP 9WRNSTABLE 1� a nLOCATION L0f '4/y (�, ,lk ('l (I n.a SEWAGE # �� " !611 vV VILLAG Ea n IS ASSESSOR'S MAP & LOT! \INSTALLER'S NAME & PHONE NO. � SEPTIC TANK CAPACITY too LEACHING FACILITY:(type) NO. OF BEDROOMS `� PRIVATE WELL O PUBLIC WATER �� BUILDER OR OWNER G r- E.'rt 9 �+�6' LQ r 1'' l'.DATE PERMIT ISSUED: V DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r•d�d�� Iq j S7 39� �- r" 1 ' - c u —� • ASSESSORS MAP NO: cg� �� LOB l PARCEE0.: �S No... ........ � Fmi.................... ...... t THE COMMONWEALTH OF MASSACHUSETTS OAR® 3F HEAL H� ...............0 F.....11/% ............ `.- .-----_--------------- 4 Atip iration for Bhipvii l lVorks Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal 1A ell system at: 6.E ..�. - r Locatiy6l Address �� ' e � ..:. Q.c- ---------------------------------- ------.---,-..... ..C� '��t._ �. r..._._e................. Owner ` Address Installer Address // d Type of Building Size Lot/�jl ..Sq. feet U Dwelling—No. of Bedrooms.._._.__..____________________________Expansion Attic (� ( "rbage Grinder kip& aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P' Other fixture ------------------------------- W Design Flow........... ....................gallons per person per day. Total daily flow-_-_-----j, ._..._._..._._..__gallons. � tY4 Septic Tank—Liquid capacit3 60-0.gallons Length................ Width................ Diameter-_.--_-_____._-- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_--•__--_--_.------sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................s Z Other Distribution box ( ) Dosin& tank ( ���� aPercolation Test Results Performed by�—Ct/.�-f .Gam. l�d��!/P Tate.... _.. Test Pit No. 1 .-Minutes per inch I Zth of Test Pit....... .. ..... Depth ground water__& fz, Test Pit No _minutes per inch Depth of Test Pit.. ............ Depth to ground water........................ xr-------- ---------------- --- ----.-------•--------•------•--------------------------.------------------..---- . ._.oDescription of Soil_- i.� �.... ...... ................ 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 i i 'L p 5 of the State Sanitary Code— The undersigned further agrees not to place the s stem in operation until a Certificate of Compliance has obeessued by t�ard,of health. Signed.. •- --. ..... .......... ••.---••---------------------- �--�.. Dat Application Approved By................................................. ----- �' Date Application Disapproved for the following reasons:--•---' ----•----•--••-•-•--------------•--------••••-----•-----------•-•-•---•------------ ••----------••-----•---•---------------•--•---••••---•••------------•-----------•••.......•••--------------•-•-•••------------•------•-------•-----------•---•---•-•-••-•---••••----•-----•--------•---- Date PermitNo......................................................... Issued--•------•--------.................................... Date • �ti J THE COMMONWEALTH OF MASSACHUSETTS .•. --B0 A R DSO F H E A T H ..........OF... . ............S 'r ' Appliratioo for %gpooal Workii T000trortiort Prrmit Application is hereby made for a Permit to Construct (t;.ror Repair ( ) an Individual Sewage Disposal System at � _ { ..�-i... ... ... � �. . . �_ ............................................................ ¢ � Loca n•Address r Lot No-! f J f.3 ! .............................. .......................... E���f,�'!��r�-A��/_3..................--- Owner' Address -------•-------_... Installer Address /J U Type of Building Size LC4S_)_1 ----Sq. feet Dwelling—No. of Bedrooms_._..._...............................Expansion Attic (-'7 Garbage Grinder f `) a �j Other—Type of Building ............................ No. of per.sons.....................__.____ Showers ( ) — Cafeteria ( ) a' Other fixtures --------------- ------------- W Design Flow........._5" _...... ._._•._gallons per person per day. Total daily flow------- ' n...................gallons. 04 Septic Tank—Liquid capacitPo_L".a__galions Length...................Width................ Diameter......._....... Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..•------------------ Diameter.................... Depth below inlet.._.................. Total leaching area................. q. ft. Z Other Distribution box ( ) Dosing tank .- Percolation Test Results Performed by t•. _..4_...__ .......� i.............-% �e"�! �"Date._ ______.__ . 4 Test Pit No. Y`4 -____minutes per inch Wpth of Test Pit Depth-fo ground water-// ;, .. Lt, Test Pit No _ minutes per inch Depth of Test Pit ____:__ Depth to ground water_____________________ jai�'� -- Description of So .___ :{___ ,r» ,-- --- .._, x ..... .fit..., ,�7� i r,�•a U W ------------------------------•-•--------•----•------------•------ -------------------------------------------------------------- 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 A II T-.E 5, of the State Sanitary Code—The undersigned further agrees not to place the ,system in operation until a Certificate of Compliance has beene issued by,tthhe-b and of health Si ned_ P �v f ................. r Date Application Approved By............................................. e - -..._......•-•--•-•---• { j Application Disapproved for the following reasons:____ ---••---•---•---•-----••----•--••--•••----••-•-•-•--••......-----•--•-•--•-•.......................... -•-•---•--------•---•---•--•----•---------•--•-•-------•------------------•------.•..........--------•---'•------•---•--------•------•-------•--------•-----•----------•-••-----•----•----•-•-••---•••--- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARDF HE�T r7.................OF.. ts!/ .a" .,.. ! Tatifiratr•of Tomplidurr THIS IS TO CE_ IFY, That the ndividual Sewage Disposal System constructed .-* r Repaired } by ;�• "5" f ' S ---- -•--------------•--- Installer�` at._ �,�- /r ' j 1 r4- ----_---- ---------•--------------------------------------------------- has been instailed in accordance with the provisions.o iia-.4j of The State Sanitary Code as described in the application for Disposal Works Construction Permit ................... dated_..�t_._�_._z_��=�_�'____-_-___-_-_-- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WI L FUNC ION SATISFACTORY. DATE.•......•... �� t..................................... Inspector-is-•--------------•-•-------•---------------.---------------••--•------ sq THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA H , ...............0F..A-_, .r'�'_�1�. :.. ._...r FEES Rsvns l Vorkg Tom& iori rrmit Permission is hereby granted------_._ c l � :, ------------------------------------ to Construct °') Repair ( ) f�1 I divldual Sewage Disposal System FL iV T fit• E, f Cat l3 p1/ O. .. ' -... .._.Sueet ............................................................. I / \ as shown on the application for Disposal.Works onstruction Permit Nl.A_'t©! 'Dated...... !./�!�L��...........:. .............................. .................................... FORM l2 �HOBBS & WARREN. NC.' PUBLISHERS � - 4 �� Zo►-lam_ �.G -� Q 4 3 30' l�' sr of �e�Ac;iK ' oTKT F SrJ w(E �'K S© I 15 U&lots -rovers I'E�r- A- M-- r a n� L!J l 1 73 LOT14 o Q J— a z � `� 3 4 3 P N F t � � t J a t To 401 PIT- DAVID P. $ `� 5°poi- fJ,°l• n N ry 2� U L PAUL A. LEVY n No. 1g617 y ip- LEGEND EXISTING SPOT ELEVATION OjtO ' r' EXISTING CONTOUR --- 0 —— — C`RTIFIED PLOT PLAN FINISMED SPOT ELEVATION FIvaIStIED coNToult o L©7 1,.I VJA NOTE: The location of any existing underground sewerage, _ wells, or other utilities shown on .t;�is plan is approx- imate only as determined from records and/or verbal t� ������' information. The contractor is responsible for the SA .o�+D J verification of the existing locations in the field. SCALE# � = O DATE l ------ �8f°(EIC.. � LEVY do ELDREDGE ASSOCIATES, INC. ! CLIENT-a I CERTIFY THAT THE PROPOSED ENGINEERS-U,,NDSCAPE ARCHITECTS JOB NO BUILDING SHOWN ON THIS PLAN PLANNERS-LAND SURVEYORS CONFORMS TO THE NI 0 LAWS DR.BY, htilS WTE S B�!, ttJ. W,4in.l 57e—r&T CH. BY r.wycc�viLj_�, r�',A SHEET OF Z 7 . L ND SURVEY R