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HomeMy WebLinkAbout0035 BABBLING BROOK ROAD - Health 36 G.bLjj t g(.ok rd S M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT lOYo Cerofiad Rber Sourcing POST-CONSUMER w W.sfiprogram.•:g SR0im MADE IN USA ^.FT ORGANIZED AT SMEMPOU I I 1a. .3....—�.�:.... '- �. FEs... .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.........................................__...._..-....... Appliration for Diipoiittl Workii Tonitrurtion 1hrutit Application is hereby made for a Permit to Construct V J or Repair ( ) an Individual Sewage Disposal Syst / 11 2 � r/ /�' Location-Address or Lot No.................. 0 rt. TD rOr � �t�r.* :.�..,�... .....-I........................................... Owner r / dres ............................................... .. Installer Address Q Type of Building Size Lot. ._ .......Sq. feet U Dwelling—No. of Bedrooms.._...................................Expansion Attic Garbage Grinder (� Other-Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ...............................• • Design Flow....3. ®...........................gallons per person per day. Total daily flow....3..a..0._............ gal w -- ... lons. WSeptic Tank—Liquid capacity.��'®d.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width...... .............. Total Length.......... �.. Total leaching area___.._..... sq. ft. Seepage Pit No------ Diameter..._............ Depth below inlet....... Total leaching area. r ._._sq. ft. Z Other Distribution box (4-1) Dosing tank-( ) i- t� Percolation Test Results Performed by...a?..��..._....._. �'e.9 ..t....... Date..� ..l... ...... Test Pit No. 1..1,0....minutes per inch Depth of Test Pit.../3.�........ Depth to ground water...At. ... 44 Test Pit No. 2................minutes per inch Depth of Test Pit....13......_.... Depth to ground water. --!C- (x :................. ..................................... .........---••-------•-----•---•--------•-------- Description of SoiL....GCacr� la � :./ ._....... 6t11....... 4chs - /0�-•-•............................................... x w UNature of Repai or Altera,io nswer when applicable............................................................................................... - .....--•--•......•---•-•-•••-•. ---------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLi: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu�the4b0d o ����(�fi.�tSi -- ---------_------- .... ate v ApplicationApproved By......... .. ........................................................................... ---•l- f .1.--------- Date Application Disapproved for the o g reasons------------------------•--------•---------------------...----------.•--••-•---•-••-•-•••. •--......•..... -----------------------------------------•----------------....--------------.....------...:...............---•-•------........---•--------------.......------------------:.------•.•....•-------•------.. . Date PermitNo................................:........................ Issued_....................................................... Date y �Asc- T3- //uLOCAT161 �p /� EWAGE PERMIT NO. oC i VILLAGE I N S T A LLER'S NAME i ADDRESS (� d U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tatifirat a of Tomplittnrr I T CERTIFY, That the Individual Sewage Disposal System constructed �' o' r Re aired '��I7S S O C g p Y O p O by fi r ��.. f "/` -- :..... �` -----------•-----...---•...............•-•----•---•••-•-- .......... 1 1 -.t__ '- ` � ` l � �taller at =' f....{ i .c /,jd _!/-ition -"C - t - •-•----------------- ......------------.......------•-------.................---- `.. has been installed in accordance with trovisions of T j of T e State Sanitary Code as described in the application for Disposal Works Constr Permit No w? "•;1,f_--.................. dated..... .......................................... THE ISSUANCE F THIS CERTIFICATE SHALL NOT BE CONSTRUE® UARANTEE THAT THE SYSTEM��VIII AFUTION SATISFACTORY. DATE....7.. ..�7 Inspector.. ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................................... No......................... FEE........................ Mop nrk5 (1-Constrndinn rrmit Permission is hereby granted.• ...........................-----------••------•--••--•-------•••---..........•...............--•-•- to Constrt (.,. or R. pair ) divid4l Sewa Disposal System atNo.. - c �. .._...4_ _:%......._ �.....�. ? - -------•---------------------••-------...----------•--•------------------------•••--•--........ f J� Street as shown on the application for Disposal ot7orks Construction Permit N .. ..... ............Dated.......................................... ..................... •----•. . •-••--------•----•......---•--• -•--•---•--•-------------•-•-------.. Board of Health DATE----✓ ✓ FORM 1255 A. M. SULKIN, INC., BOSTON ,a _ No. .. .:1� . Fxs. s�0.. "........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . .........................................OF........................................----............---------............•-----...... Appliratiou for Dhip al Workii Tuuutrurtiun amit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Syst a . � ................•-----...... ... ........................................................... 7/!y /' Location-Address / or Lot No. ......................_..................... f Owner dres _ _ l�,,t/ d!s, .......................................... ° E't- °` '!5— e�0''f.. _ .........._.... ...... GY1 "' Installer Address Type of Building ..y Size Lot.,A:Y...�x'. .......Sq. feet U Dwelling—No. of Bedrooms.__....:.................................Expansion Attic Garbage Grinder (••,� Pk Other—Type of Building ............................ .No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------•-----•- ----------------- :' ------...--------•-- Design Septic Flow....Tank—.� ••gallons per person per day. Total daily flow----��:� .............................gallons. Liquid capacity.Vie?(-. gallons Length................ Width.................Diameter................ Depth................ Dispo�te l Trench—No. .................... Width...... Total Length....._.....�i. �.. Total leaching area.........._. sq. ft. p ..... Total leaching area. ..._�....sq. ft. Seepa Pit No.__....,_____________ Diameter.._....�r........ De th below Inlet._..._..I.... Z Other Distribution box (L J' Dosing tank ( ) r `-' Percolation Test Results Performed by.... _1. .: ...........111. ,J.Z_........ - ` Date..., a/exe�.._.._ a Test Pit No. 1_.. :.G7....minutes per inch Depth of Test Pit--- .'.._........ Depth to ground water.._—?....e4�. LX4 Test'Pit.No.;2................minutes per inch Depth of Test Pit..../.: ........... Depth to ground water---/P.a..... u,• C ........................••. O Description of Soil..... 1��- Y:.- ��:,�� ✓.� r ......t-'�..... _ x w ___ UNature of Rep ' or Alter nswer when a -•-licable----------------------------------------------•_-------------------------• •---------.....-.. .. •--•----••---•-••-....-------•••-•---•-•---••--•••-----•-•......•••.................•--- Agreement The undersigned agrees to install the aforedescribed Individual:=SewagePi p,�sal System in accordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned furttl& grees not to place the system in operation until a Certificate of Compliance has been isstye4 the board eaA. Si ed` ..r`l,�.'. = �` e'. ��l:. /f. �. .....----•---••--. ,�.. `s_ Date 7. .... Application Approved By.............. : f ...... ' ....... f Date Application Disapproved for the ow y reasons:-------•-------•-•------------••------------•----------•---•------------------------------ -----•••......... ........------•---•---------------•-•-------•-----.........-------•-•---•-----•---•-----------...----......---...- .-----------. Date 4: �u q2. A , bt .V, ~ \pup �✓ .G 't. , � + �; • - foams � ior�•v��\43P✓�'� l�f`. .AS l '- . .f9117 ��'e� t �04� N �•- �, � � 4 '�,;. kA ei f #R 17 �.A N.+ _ ."F[ m N FM� F ---- y 2>ej F. y N Nr 4U e r MORSE _ o?' � � Na ^� rasaf_ K�a cs 0951 } �� IO ir'r 57 Z>LY,4zlj PO FFSS/ONA1 �a� '. LEGEND iEX'IS.TlNG SPOT ELEVATION' . OxO �KnrA CERTIFfEO PLOT PLANT' `EX[STIN0 4ONTO.UR "0 ��' _ oe,Ekr 4�;. , /�,ar ,51.r *', ! t . ''�:. e 'yeti FIPIISHED .' SPOT °E.LEVATION eRuc€ ' 7,. ` FI�ISHEO CONTOUR , O ri-- -- ,. DR .� a /bf, 1/1 C t i 4 " C .^ ax IN ARPROVEQ ' BOARD; OF 'HEALTH ''' � rsTEt��` �. s '` .` 4 �t sup+ . 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