Loading...
HomeMy WebLinkAbout0023 PRUDENCE LANE - Health z� ^ � - _ - OD s M E A KEEPING YOU ORGANIZED 10334 2453L WDE W USA GET ORGANIZE®AT SMEAD.COM LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME & ADDRESS B UILDE R OR OWNER � DATE PERMIT ISSUED r - DATE COMPLIANCE ISSUED \ 33 Ln 40 - 5? No... �?7 j FEB.. .../'_............ ©. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......................................... App iraatiou for Disposal Works Tonstrur#inn Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ' ) an Individual Sewage Disposal System at: T Lot" c.�.. y �..- ...... '0.7�ui.f f .............. - ... - . ................. r s Loc ioy.;A dress J rr d7 or Lot No. y�'�' `=",Ys r ...- �[•�-- jc --... -----------------------------------------------•--•---............... r N �^� q Owner Address Installer Address d Type of Building Size feet Dwelling—No. of Bedrooms...............3............_..........Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria dOther fixtures ..---------••------------------•-•----........._....--•--•----•••-•---------•--------------••---•--•---••-••-••••--•--••••........-•--..........--•-- W Design Flow................... ........................ per person per day. Total daily flow................. 3.Q..............gAlon s. t� Septic Tank—Liquid capacityl� ogallons Length. .-...._ WidthVia_ _.._ .. Diameter................ Depth:r...7.. W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. , Seepage Pit No........./--------- Diameter.Z.A...-4.... Depth below inlet.G...- .._._. Total leaching area..?.r sq. ft. z Other Distribution box (K) Dosing tank '-' Percolation Test Results Performed -_. Date_.. ..... aTest Pit No. 1.......2......minutes per inch Depth of Test Pit.... ` +.. epth to ground water.._No'!...... Test Pit No. 2-••--Z.....minutes per inch Depth of Test Pit...... Depth to ground water... 0 Description of Soil..o-.?.• ..............7�aa�s-i/----•-......6 e . ........... - - - V ........ . ............ ..i.Sf�F.. ��!,c. `'� " -•-----•-••---...-•-------------------------vr'.�.,/ 2....-.��±!� W /y - E•s " -------------------------------------------------••---•.................-- 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 TIT?L: 5'of the State anitary Code— The undersigned f ther agrees not to place the system in operation until a Certi to omplia a has bee s ue by h bo d of h G ed----•-•• ..... ..... ...•-•••...... .... . .. . .--•••-••--•--••-----Applicatio Approved By..••-•-••-•_.FSi.,gn .--.. . _••. . . . . -•-•-• --••---•--•-.-•-••. ---• . Date Application Disapproved for the fing reasons---------------•------...-------•----------------........--------------------------------•••-•••--•...-----•-•-•-----.....-••-•-•-•-----•-•--•------••••--•-••-- -----•. -•----------------------•-•--••......- Date ePermit No....................................................... Issued----------------••• Date No................-....... Fss......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w r. OF. '34z7 r n-s 7� 4/c' ..... ....................................................................•-----•- Appliration for Disposal Works Tonotrurtion rumit Application is hereby made for a Permit to Construct ( 7C). or Repair ( ) an Individual Sewage Disposal System at: --•-•---•------._..•...... ..........•-•••---•-•-•••--------------................. ......•-----•••-•---•-•-----•------•----•-•---•••••••..........._.._..--•--•-•-------•----------.. Loca ion Address or Lot No. - rw �-s`✓ r tss_... ../ c �? ... 1 ....... ...........................•-----.............. -------------------------------- O ner Address a .4 [t!�...._.1! �t.��.�?--------------•-------------- _•-------------•..........•---........ .....,. ----_.. Installer Address Type of Building Size Lot___ feet Dwelling—No. of Bedrooms................ .......................Expansion Attic ( ) Garbage Grinder ( ) 'q Other—T e of Building No. of persons____________________________ Showers — Cafeteria P4Other fixtures ...................................................................................................................................................... W Design Flow..................... ...........,.,gallons per person per day. Total daily flow................... *..Q.______._____gallons. WSeptic Tank—Liquid capacity/,.!algalfons Length._�.'�:_15` Width_ °_:K"Diameter________________ Depth__s-_..._7� x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......... ----- Diameter._!_z.:_-G.:f Depth below .... Total leaching area__.'.? sq. ft. Z Other Distribution box ( X) Dosing tank ( ) 'P- -/? p, '-' Percolation Test Results Performed by- cf,�..r/fl�ry�5..._:5. _r" a �; ..... Date Test Pit No. L__.___?:.....minutes per inch. Depth of Test Pit_____ `��_____ Depth to ground water_._.r``.'.G..'?_q...... fz, Test Pit No. 2.......�.-_._._minutes per inch Depth of Test Pit........_y�_._. Depth to ground water..... u" _ 9 ........ --••-- •-•---•----•--------•-•-••••-•---•-•-•--- ---•...•---•-----•..........................•--.._....•••••-•-•-••••-••••----------....-••••----•-----••- D Description of Soil__�?,'. _`z!______________7 G_da Q/ / S�-6 1-1 / _ 4 W /F! F-`-u.1'/,r. ✓�� e � r,s , ;"mac -•-----•------------------------•-•.._..- - .._...--•-•----•-----.•-._._._----••-•----•-----•--••------•--...----------._..._.._•------------•-------- U Nature of Repairs or Alteration's—Answer when applicable............................................................................................... •-•----••-----•---••••••...................•--•----•=-•-.._..-___.-_------•----•-•--•.......••---------•--------•-•-----•-------•-•-••-------------••-•-•-•-----•--•-•_--••-•-_••--_.................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The ndersigned f ther agrees not to place the system in operation until a Certificate,of CompliL�e s bee s edpybo)d of he-of- d _•• �_f...... _.... ate/ A licationf A roved B _________________ PP PP Y v / Date Application Disapproved for the f lowing reasons:...----•-----------•---------------------------------------••-••--------------------._..._...•••-------•-••--•N, .................................................------ -- -••-•••--.......----•---•---...------•-•••--••------------------••---•---•------•-•-----------•-•-------•----•••--••------•------.....----- Date PermitNo......................................................... Issued..................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD �nF HEALTH .............^.......................OF..................................................................................... QTrrtifiratr of Toutpli ancr THIS IS TO CEI, ZIOF�I,5hat th,� Individual Sewage Disposal System constructed ( or Repaired ( ) by--------------------------------------------- 1. ....-----------•-------•---•--•-----•-••----•-••--•---.....--------......._..------.......-•-------•--•-----..._ Installer at .�... Prw j7w ►�/ c "x V ----•---.._.....-•-•--••-------•- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........... J�._._w_ -3_... dated_! � 5__________________________ THE ISSUANCE OF THIS-CERTIFICATE,SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F �O SATISFACTORY. DATE.. ................................... inspector.............................................................................:...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O� .................................... ................................. _._.........._....__-........._.. �L No....$S_.../-O FEE........................ .................. Disposal Works TFAonstrnrtion frrmit Permission is hereby granted..........`� _ .1 ........r4.4L_'1.0-------------------••-------------------•---._....---------........_........._._.... to Construct ( 1� or Repair ( ) an Individual SeA e Disposal System at No................/.._... ,� '' t.l. Y-r`' Street y Cc�7t+. ------------------•--------....--•- as shown"oq the application for Disposal Works Construction Permit No.?_.` _l�043_ Da d........ ................................ �........................... .. of Board of Health - -• ---------------•--- DATE..... ................ _,_... ------- -------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS-, T Em p al Iu NO T'� rO SCA SYS D6 �d�tl?­ �F*TNISH,.,GRADE 'Z�0 n­ N F.MrSH 0 W 6MDE R F NrSH, SPADE 0 VE L 4A /V/<, 7z A T n P TIC i 8A CHING. -11A Y/r X\ /A%14 VA M PIES 77y F //A 1 7 -cl 41 OF 8 K v 7-A ONE, 'co/vc-.1 PEA 45 Z PRECA S T L E OUT To 1P -BE T PIPE,LE VEL RADF, FOR AD 0:0. OR P vc, TEES 44. 00 -BOX ,&S, r FLq D IS TRIBU TIOM 15010, GALLON,' rNsTALL' ON, SE L EV8L BA' X4&4ED, PRECAS T P 314 n-,-TO 1 "Y/42 RECA S T CONCRE TE 15HED 0 CPU. MC RE TE, dt S TONE: 0, REIMF SEP T TA IVK 'IC r vrous L DAIER-TO PEMOVE ALL-rMPER 'INS TA L L ON L E VEL BASE tv NO 7*E.'­ �.EXCA VA Tt TO 'EL 51 A E L8 AREA qA TERIA4 TH Tht' ACHING XCA iA - , . - Mr.TH REPL A C" VA �4�r NA TER1A L A,N' Ct A Y -FREE�'SA ND CL 0� A to r,T L 4:A CHrIVG j GENERAL NOTES-­ NSLTALL �01V L t VEL BA IM EE 0 SE, I ALL EL t vA Trous S�IOYN ARE BASED' ON '515L PIPES 'r1V 1_1E S YS rEM MUST BE S r rRON 2�, CA OBSER VA TION U OR SCHEDUL E -40 PVC 3. .7HE, BOAPO ,"OF.HEAL T1- MUS T, Bto NO TIFIED VHEIV 'CCIVS 7'qUC T.ToN '�'JS CoMpL E TE' PRtoR .9$�o� P, TION PEI?�C� 'TO BA C RA TE. Wrl-L ING MIN -PL AN *0S T BE A PPRO VED A D��8 yo SE hlr,7N,5S PE THE SOA RD, OF HEAL TH AND:Z� tSLANDS N`Y� CHANGES, IN THrS,, COMPI JA I"% A A 7H !,THE AL't E?E' ,IN y INC 5bRVEYrNG' CO -�AN ON 5 TERIALS� D INS TA L L A rl 'S TA TE'L SA Nr TA R y HEA L,I H LE DATE.-'�" DEsrGN 7A D COL OCAL , A) PLLICABLE T THL OF BEDROOM -PEOIX A 776NS RUL S"AND x§: RomRECORD, NOR ARRO)� PLANS,'ANO 0 GA 17BA GE DIl �00D��!H AZAP DAIL-Y-`f'L0Y,-' OAlE S vo USED OR SOL A R pliAbOSES': )POSAL FL Z A N _REG, 9EP b *A rEjq ""SUP) M LEA lz -P/?o �,:,SEP TIC: TA CHING L: T- 7 L Lay 4 I i9A L IJEC AST� LL, A 'rA /S AqE SIDEWA L S� AW G. 80 E N TT M A RE,4' L GE D PRO VIDED FWCAST M MWE ll,& �_X PROPOSED EL46VA TI LEA CHMS pf T OBSER VA 7701V IDENCE, SINGLE �FA MIL,Y XrS 7*.rNG "CONTOUR��IL _D 0 ON .6 ED SENA GE S, TEM PREPA -OR DrSPOSA L OX PIROPS u, PED ,F j ERB, .5 PV YEPS P OBEP SEPTIC TA NK T -H NCE, Ac v "8E§E,4�E P,R, E LAA 'k 7,9 0:TL II T L rPE­-,-lN 7, A VER T EV lZ BA RIVS 4 CIA IVDS S, Y, URVE iF_� SL, AP A DA TE. 1�1 ov PL OT-�PL-A IV: 4Q CA LE -7,u nN, -p SCA '1 3 NO 0 .3 4 5��, ED E ET -NO -A IV f L sr