Loading...
HomeMy WebLinkAbout0020 EISENHOWER DRIVE - Health 9 5q P o3c� oon cd LOCATION : . SEWW:C E PERMIT 1UO. WSTALL.ER 5 IJ�NIE �', ADDRESS f -ems - - BUILDER 5 Q WAF— ADDRESS — ����,►� 1. j�c` —6✓��i- 1�r�o✓ — — — DNTE PERNAIT ISSUED =- - — — — — — — D ATE COMPLI &&ACE ISSUED : - - - . I 'IMP � 0 :ram All =`lam Alrwl�7 F�s. .4`.../ ..... THE COMMONWEALTH OF MASSACHUSETTS EOARD HE L OF Appliration -fur Disposal Worko Tous#rurtion Vrruti# Application is hereby made for a P rmit to Construct ( or Re air ( ) Individual Sewage Disposal System at ------------- - .... = ....... -� ................... 2 --- ...................................................... L cation-Addre ` or Lot No. --•..... ••........ ....... .....•............................ ........... -................................................... w er A Tess W Installer Address Q Type o Building Size Lot----_a_c'C __Sq. feet U Dwelling—No. of Bedrooms__.___ _-___Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .............:.............. No. of persons............................ Showers ( ) Cafeteria ( ) Q' Other ^fixtures --------------- ------------- - W Design Flow......s,� __________________________gallons per person per day. Total daily flow-__--__�.077P..�___..__....gallons. � Septic Tank—Liquid capacip gallons Len th________________ Width-______---__-- Diameter_-.--_.._-.__--_ Deptli____--_____._. x Disposal Trench—No _____ '_'___________ Width .._.._._.:. g g � '�---. q. ��`` _ Total L n th____ ________ ____ Total leaching area s ft. Seepage Pit No---------------�s� el ... . Total leaching area.------ ----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) D o / - �-/- Ill- aPercolation Test Results Performed by--------- ---------- ..................................................... Date--------------------------------------- Test Pit No. 1................minutes per inch Depth of "lest Pit.................... Depth to ground water....---_.-_--._-...___- f14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water--------------- --..___ ------------------- ------ --------------- --- -----•---------•----•------------- - Description of Soil �� �__ = =- x 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 Article \I of the State Sanitary Code— undersigned rther agrees not to place the system in operation until a Certificate of Compliance has b en i su y the b o alth. Sig ----------- - ` � e�X Date _ Application Approved B � . Application Disapproved for the following reasons:................................•-•--------------------•----------.._.._....................Da e..._....-_-__- •••••-•-•----•--------•-•-•-•---••----------•----------------•--------------------••--••--•••-------•-••--------•-------------------•--•-•--•---•••-•-- ------------ ---------------------------------- Date Permit No.--------•---•------•-----•--•--------------------...... Issued.......... -'•----- -- ................... �e 2, r No......................... Ficx./61.................. SI THEBOAR®AOF FHEALTH rs c'/1 — 37 — .. ..... ..OF.............- ..... .:.... ....61. ................. V Appliratioo -for lhtipmal Workii Tatuitrortioo Vrrmit Application is hereby made for a Permit to Construct (\,)nor Repair ( ) an Individual Sewage Disposal System at r L Y /f. T-.•--�/ .�-------/-..�...i /i-btu.+------��-�------------- ....L-..-----..........---...----------------................. ------------------------------ r ( Location.Address ,! or,Lot No. ..... r. .. . ( .. F.... Owner //// / (/ Address ✓f(�,v (� /. /.. A l fL�.t/.-tpil l ( AA.i,fit.{�� 'U Installer Address QType of Building Size Lot-.--__ _.�;_t` ..Sq. feet U Dwelling—No. of Bedrooms------_..�________------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons--------------------_---_- Showers — Cafeteria a' Other fixtures ---------------- ---------------- ------------------------------------------------------------------------------------------------------------------ �2 W Design Flow--------' ---------------------------__gallons per person per day. Total daily flow.......z_f` ______. ._.._.-_.._gallons. 1:4 Septic Tank—Liquid capacity!�i gallons, Length________________ Width................ Diameter----_.__..----- Depth.___-_-_------ Disposal Trench—No------------------ Widtli/-___-_____l--_ Total Length...... Total leaching area--.-Y--_--*- _.sq. ft. Seepage Pit No...............65Diameter.--V._1/.-..�1_&Depth,t elow�'inlet L/�. Total leaching area------------------Sq. ft. Z Other Distribution box ( ) ✓ Dosing tank � -- Z 1- 7iF Percolation Test Results Performed by------- ---------•-----•--•--••----•--•-•--......-------------•----...... Date--.-•----------------------------------- ;� Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------------....... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.__--.-..--_-_-___-..._. Description of Soll 09 ---------------------------------------- ------------- ----- -----1-------1------------- 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 Article XI 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 ofthealth. Signed. ��/./it`i. ....... . ...............................................:f ---- ------z-----;--------�--- Date Application A A � � - / Approved By - _--= -- - --- --- Application Disapproved for the following reasons:--------_--- --------------------------------•----DaDa.te.............. --•--•--•--------------•--------------------------------------•--------•-•--------...........................------------------------------------------------------------------------------------------ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHY l 3 ............l./!�(..!L.J..........0F...I....!..�..a....................................................................f Trrtifiratr of f IlImplittnrr THIS IS�TO CERTIFY, That the Individual,,Sewage Disposal System constructed (.�)'o`r Repaired ( ) by ........................................---- ----••--- .._ Installer at---------------------/ '` •---- ------------------ �=---- - r_ has been installed in accordance with the provisions of _Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------ .;:__ __ll__________________ dated. —-----1, -_.. b............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE© AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................................-•................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH A �...'.. : , OF.........../� �r A.�� --� !-::..r�.......--••............. v .....c............. . . . p �.. •'--' ( _ FEE....f! .............. %sVagal grk -C o�c tr�trtioit rrmit Permission is herebygranted �I 1 (Jf�..�_, ,.. ' -4".-=-'• 1 ! • ( i i. . g .................................. to Construct (L,,),*`6r Repair (,j ) an Individual,Sewage Disposal .System at No.....Z.....i ,r � ' // /_ . . / . /, / -I-, , f ---—7-------- •.................................................. ---------..---.-...------------------------------------_.-------�----- i Street y as shown on the application for Disposal Works Construction/Vermit 4 .....A—------. Dated:--.J.`.%...Gf.`"___� ---------- � �o = Board of,H DATE.---•--•------------------------------------------------ ----- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - - Y { " 1 -�2 40 CERTOFIED PLOT PLAN ESQ ( I f F' f j 1a LOCATION QO,143, . SCALE t..AND S0t7.'ai' . . . . . . . . . . I CERTIFY THAT THE . .TtQj1T; 3�1rJ•.' (' I `_;HObvN ON THIS PLAN IS LOCATED ON THE GROUND b'1.E.D.Realty Trust _ AS SHOWN HEREON ANDTHAT ITCONFORIMS TO Irlillia m E. Dacey Trustcc THE�AOi<!1h12,, fifAlIS OF-'THE TOWN OF West Street i.\i�i.:' . �:J'r. V:°tE'hl. f%J�vST!tllCTr_ j 570 ti'�est Main � reef ' },-i . ; Ify,:,nni v Alas yachusetts, DATE . PETIT IONER : REc . )LANO SURVEYOR