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Home My WebLink About0048 MOORING DRIVE - Health -. ,- M6&,,ing TDriv :��l.11l Lk IY� d�0� A A ,�ii,'t��•- r�fy4� � �. r � ��144 20 No... ..........._....... Fss.. ...._............... THE COMMONWEALTH OF MASSACHUSETTS ' s_ BOAR® OF HEALTH �.,.V.............OF...... ! ... ... Applira#ion for Disposal Works Tonstrnrtfun rumit - Application is hereb made for a Permit to Construct or Repair an Individual Sewage pp y (� p ( ) 5 ge Disposal Syst at _.....lf.. -• ----Ze .....�_..�. ---- f......................................................... Location-A s 3 or Lot No. ..... ... '� = •........ ........................................... ..--•-•-......--••-•.......................... Ow r Address ...... d.................... Installer Address Pq U Type of Building Size Lot... d.Q,.PQ®_..Sq. feet Dwelling—No. of Bedrooms.................. ......................Expansion Attic ( ) 'Garbage Grinder ( ) aOther—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures.-----••-•-•-•--••----••-••-•----•-•-••-•-••-••-•-•--.....-•••••--••-----••••••---•-•-•-••••--•-••••••-•---•--••---------------------•...........-•-• W Design Flow.................5_5 ...............gallons per person per day. Total daily flow-------- .....................gallons. W Septic Tank—Liquid*capacity-/OOP.gallons Length._,F. .�/.- Width__-'��. _.._ Diameter................ Depth................ u x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..._• .._ _. —sq. ft. Seepage Pit No............/------- Diameter.......7.__..._. Depth below inlet_-•.,Al...?... Total leaching area..................sq. ft. Z Other Distribution box (/ ) Dosing to ( ) '~ Percolation Test Results Performed by..... 'L.... ......:................j. Date...._/. al Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground'water•-_._..�_._ ri Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ a -- 0 Description of Soil.... .... • .._.... ,.. ....... ---•-••---------------------•-------------•-•-------•-------••--•-----••-•-•.............---••-. x ........6.�.� .... V VW -----------------------------�`�- .D -.1.��- -------�� ------�---------------,------------------------------------------.......------------------------....... 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 TIT 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 i sued by th�boar� ealth. /Signed.... .. . --------••-•......---•-•-•...•-- ..... ! _ Dat Application,�lgproved BY ------....P---1 A---------------------•-•------------------------------------ --•-•-�' e - ------ ff Date Apoica.tion Disapproved for.the following reasons-------------•------------------------------------------------•---••-•-•-•-•••---•-.....:----••............---- t Date Permit No ........................................................... Issued--••-- 1 _. ................. Date 'LO ATION _ SEWAGE PERMIT NO. `' 3 b-3lO0 _ VILLLAGE 4 Zt,� Il INSTA LLER'S NAME i ADDRESS UILDEIII OR OWNER ade-t, dc,(-m dz DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � p s oed No......... .......... FEB.... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Al Appliration for Uiipooal Workfi Tonutrurtinn Vrrmit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: , --....... __...... ___---�............................................................X11, ..................................... ..................................... ---------------- Location•Address or Lot No. 1` � /�, ........^ ._..._..... .............. ............ •--....-•---....._...._....._.............._Address-___....._..............____-_-_••---_•..._ OOwwnei q J W -74.i1✓�.# � . ....cl..:! .af7�i!--•'-•.................. .......... Installer Address Type of Building Size Lot... ...Sq. feet U Dwelling—No. of Bedrooms................. . ?._______.___._.__..._Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building �L' r f A-t No. of persons ................ Showers G.i YP g -••==-------•--=------=---- P ( ) — Cafeteria ( ) PaOther fixtures -------•••--•--•-••-•-•-. 7....................................................................................................................... W Design Flow................:�__.?.__.................gallons per person per day. Total daily flow___....._7__'__Q.....................gallons. WSeptic Tank—Liquid*capacity.Z �('.gallons Length._.1_--t`_.�Width.... Diameter................ Depth................ x Disposal Trench—No. .................... Width.....`.................... Total Length........:_._....___. Total leaching area..... -_._ q. ft. 3 Seepage Pit No------------ ....... Diameter.........7.____._. Depth below inlet.___. Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) '-t' Percolation Test Results Performed by.....,f/.X...a.:r/?_:r....' � =r: _'-ram- Date._._/� .... F-1 - y Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.._/(:.?... . ------------------------------------------=-•-•--•-•---•-------•----......................................................... O, Description of Soil---- G..._......� ..................................... --------------- •-•--------------------------------------- ....... • --•-----•---•--- U •--•--••-------•........_••--_.�.:. Ca.......2<rz .............................. .............................. ........................................................ ....................................................--------------••........... ... V 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 L.L .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-liealth. r j Signed-- r-�lfftr::• f� �G ......................•--••.........._.....-----....._....._ r .� ---.:.....- .. Date . Application Approved By--------------- ------`l-' ...._..----------._..........._...--•---.............._..-- ----• '/k_.!!-- ------ Date Application Disapproved for the following reasons--------------------------•--••---•----------•-•-----•---------•---------------------------------------..._...__ .........................................--•---•--•--------•------------•--•----•----------------------•._......_...-••--•-••-----------•-•-----------••----••--•----•------•••----•••-••---••---------- Date Permit No....----••-------------------• Issued-.-•--------------••---••--•---- • .......................... Date -•---.....-•-------•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.......................................... .. ..................................... Cprrtifiratr of Tontplianrr THIS-IS TO CERTIF•Y!That the Individual Sewage Disposal`System constructed (, ) or Repaired ( ) by.........''-�� < _...t //�.% /...._. ..., . -• --_--• _. ..-- ................................ If er at.._...r.f .� ��.{�1' -car_; .c'1 f ,r r cll ( ,.. /r.� .-P .+`X has been installed in accordance with the pro isions of T �, , of The State Sanitary Code as described inthe 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------�� 3.:.... .................:. ................. Insp,,ector--••--. ----- --•--•----•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ............................................................ /^� No......................... FEE....,,__CJ........._ Disposal Works Tunutr ion rrmit p•. Permission is hereby granted....... ! '---:-............................t................ `.�---------- '--:-•--•-- to Construct O or Repair ( ) an Individual Sewage Disposal System ,� at No. ` f?'J .�... - 'e, t . , r7 /1.:�!��..� � 1`r�G ------ -- ----- ----------•--,-------- --------------- ---------••----- --------•--•-----•----------•--- ... Street `~ as shown on the application for Disposal Works-Construction Per No _____ _________ Dated____7:..1A_-Xd..._.... ..............F..-. J'r !d�'' ._----------._.----.------•---_ Board of eal DATE..... ."--�-�-"=- ---'....................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS p. M yr. r , 3`. F.FL. ELEV.-- --- FINISH GRADE _ FINISH GRADE FINISH GRADE---- --� M TOP OF FOUND. OVER TANK = _� OVER PIT >�vrti I^ E LEV. 4„ G.I. CHIMNEY BLOCK - BACKFILL - 3 PEASTONE DWELL I NQ -- _4.� V C *V. WHERE rrEEoeD - 0 o o a 0 1 , d Ii - _. _- o O O OGALLONCELLAR FLOOR 3/4" TO 1-i/2 ELEV. = REINFORCED GONG v �� o O C Q o i ° ? CRUSHED STONE o O O O • 1 _y •• DIST. BOX �i 4 o o C o o ` � o Q O O o se - o a o o o o Q O 0 SEPTIC TANK ( TO SE LEVEL I to f� O o o y BOTTOM OF PIT AND STABLE 1 a O O o ° q E_EV. = SYSTEM PROFILE ! 1 ! NOT TO SCALE) _- LEACH ING PIT DESIGN CRITERIA NIIWBER OF BEDROOMS GALLONS PER DAY GARBAGE GRINDER TOTAL DAJLY FLOW LEACHIN AREA PROVIDED -- ,' ,-!S. '•.""' }a � ,�J'J4�.e,��L.Z, .4Q,�;lt z aCCi .7`•$' G �.T? r1 - �-� --�•-� `V� c o SOILS LOG of, PROPOSED SEWAGE DISPOSAL SYSTEM iNSPEGT6DM _ y- PROPOSED DWELLING . ,n, : MASS. DATE F: . _ ; /r PERCOLATION RATE 04INYINCH SCALE AS NOTED �UATE °��► � 'J, DINNED BY: .s'�E•� .�v .�!:�^1 x i - ✓/4 <H OF A14s:q r. ' •'. /6.7 �'.A14QF7 20 , '= ?.C3NS a NORMAN a �.t»,k`�T" t '7.` - ��Ua 7• ,1y . �'L.d©L� t'.F .w i�s� GROS:a-f, ,C(� , YA-r M n► )`�-E 4 73 x Sa INORMAN GROSSMAN PEP R L S. �G-Ac x 5*0 r-'�` ` 226 HOLLY POINT ROAD 1F' �rCA17aiJ�G. — 76- ,p�tti`�G\ CENtERVILLE, MASS . �.