HomeMy WebLinkAbout0230 RUSHY MARSH ROAD - Health R 230�Rushyy Marsh Road
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# TOvk'N OF B.A RiNSTABLE
F, 1.00ATION Lor � �yS�i y a�s� 11o4�P SEWAGE # '9'6- ��d
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VILLAGE (_ OTU/T ASSESSOR'S MAP & LOT PAN 30
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INSTALLER'S NAME & PHONE NO. SfEvc Jrf�iPreY
C-
0O SEPTIC TANK CAPACITY LSD a
Cj LEACHING FACILITY:(type) P / (size) 6-, J
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER GtJELL 5.
BUILDER OR OWNER ��7kr SG AW4�
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �''
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THE COMMONWEALTH OF MASSACHUSETTS
r OARD OF HEALTH
j..............OF.. L T � .......................
Apphration for Disposal Works Tonstrurtion Prrmi#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
-
Is
_..r. :...r.. --- .:...... .
ocation dress oral.ot No
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----.--
Ow er
W --------------------------------Address
M Installer Address
Type of Building Size Lot.... 4�.-�4-�j--......Sq. feet
V Dwelling—No. of Bedrooms...........a..............................Expansion Attic ( ) Garbage Grinder ( )
�-+
Other—Type T e of Building No. of persons............................ Showers
a YP g ...-----•................... P ( ) — Cafeteria ( )
fs, Other fixtures ..............................................•--. --.--
W Design Flow............................:g .......gallons per person per day. Total daily flow....��.._._......_.I................gallons.
WSeptic Tank—Liquid capacity/gallons Length..M� .'. Width.......5.' Diameter-___:—..... Depth_=�.��_r...._.
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No............. Diameter.......f ,.... Depth below inlet....4.......... Total leaching area...?47....sq. ft.
Z Other Distribution box ( ►-) Dosing tank ( )
aPercolation Test Results Performed by.....-.&-4:...C-.4.en-..... %5'/!✓ ....... Date... .-�.'. ...:..........
a Test Pit No. 1........Z....minutes per inch Depth of Test Pit........5. ........ Depth to ground water_--.F'S............
(i Test Pit No. 2........0...minutes per inch Depth of Test Pit....! _.s.'. Depth to ground water........................
.....---•---------------------------------------•------...---...............---•--------....---..............................................................
ODescription of Soil.........%- ...........�*E45 t/�!E..�zr 4i,C ----------------•---•-----....-----------•--------------------...---
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------------•--•--------•-------•---•-•--------------.-- --------------•----------------
W -------------•--------------.......------------...._..........---....................------------.MSIQI,41P4e-F.,,1(31 FFR..N14lST--SUPERVISE
....--- -----
VNature of Repairs or Alterations—Answer when applicable..........°.N T.AL.LAT1ON-AND._CEATiFY.��I STRf G
--•-------------------------•-•------------•----.....----•-•------------•----------................--------.•---- ?'�aE..SY�TE�_WAS.. S7 49P IN STRICT..
Agreement: ACCORDANCE TO PLAN.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has.been iss by the boa f health.
Signed...... . .-•-------- -------- ------------•-- ................................ .........................._....
D
Application Approved y---------• ._..... .. ................................... ...............- ............
--•--..�/.( .....
Date
Application Disapproved for the following reasons:..............................................................................................................
--•-•-••-------•--••-•-•-----•-•..............................................•-•-•---..............-----.--•------------------------------•-•--...-----•--•---•--------•-----••-----------•-----------•-
Date
PermitNo..... ............................... Issued_......................................................
Date
--- - -� --- �_��. -----. ------------------------------
No.. ........... Fizz ............._
THE COMMONWEALTH OF MASSACHUSETTS
---BOARD OF HEALTH
1J,J ........ 0 F..... ..............:.fy. .......................
Appliration for Disposal Works Trrntrudinn Prratit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
ocation A dress or Lot No.
Owner Address
a .......... .�-n-•• ........ ...............................
Installer Address
Type of Building Size Lot...--4./-4`?......Sq. feet
U Dwelling—No. of Bedrooms.__........3..............................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
P I Other fixtures ------------------------•------- .
W Design Flow.............................�%--------gallons per person per day. Total daily flow.... :I.............................gallons.
WSeptic Tank—Liquid'capacity-l-.`>. -'2gallons Length._f:2.4.::. Width..._5_-Y . Diameter-----.-c-..... Depth-t3:�V::-.-
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No............. Diameter.--..... Depth below inlet..... ............ Total leaching area...7!,7....sq. ft.
Z Other Distribution box Dosing tank ( )
~' Percolation Test Results Performed by..........................Z'G:-...!r= !:o ....... Date Date... .:. =...............
as Test Pit No. I........''...minutes per inch Depth of Test Pit.......` ......... Depth to ground water...Z�........--.
Test Pit No. 2........zZ...minutes per inch Depth of Test Pit._._.e� -5.:_. Depth to ground water...
.....--•----------------------------------••---...........-•---••--------......--•-•-----•-------........----•-----.........•----•---......._..----••--.-----
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Description of Soil........ -----...------.._..............----m---•------Y--------��su-�------------------•------------•---........-•---•----....-----------
x
w -•-----••-••-•---------------•---••-•••-•-•-•-•--••---------••-•••-------------------------•------•-------------------••••-----•--••----•-•------•----------------.............._..----•-•--•---•-•----
UNature 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 TITLE 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 by the boa health.
Signed....... :..... --------- ................................ -•••-------------... .--••-•
� Da e
��------��
Application Approved By ::- _ �"-� �'= ------------- � 1
Date
Application Disapproved for the following reasons:-------•..............•--•-----•--•-------•----•---•---•------••--••--------•---......._------•-----...._•--.._
-•---•..............•-----........----------------•---------•--...--------•---------....--•---....-•-----------•-....-••-------------•----...............-•--•...........---...--••---•-••----•-•---•-
C Date
PermitNcL.....�..a._-- ............. Issued........................................................
t Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................................At O F......................................�, .............
Tntif iratr of Tlantphaurr _
THIS IS T TIFY, That thgIndividual Sewage Disposal System constructed ( ) or Repaired ( )
by.... -:<r ...............................................................
Installer
has been installed in accordance with e provisions of TITLE 5 of The State Sanitary Cod,,as desf In the
application for Disposal Works Construction Permit No._ `��..__Tl�.Q........ dated--.G . am_./-'.....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G AANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. - •.. e6 ...................................... Inspector...... .....
----------------
THE COMMONWEALTH OF MASSACHUSETTS
-� BOARD OF .HEALTH
�W- �`'^) OF.............. �tJ "'`;.�-1 rZ4 t
Nd ^. / ......................... FEE...7.1 ,`�`�'-
Mops irks (1-on#rnr#ion ranfit
Permission is hereby granted. -------_..•.. �'C?" �1 c ._
to Construct ( 'or Repair ( ) an Individua]Sewage Drs�'DsaL System
Street
as shown on the application for Disposal Works Construction Permit N �.. � Dated.....4-7 .
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✓
Board of Health
DATE................................................................................
` FORM 1255 A. M. SULKIN, INC., BOSTON
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Department of Environmental Management/Division of Water Resources
WATER WELL COMPLETION REPORT
nnWELLL/LOCATION ,p /
Address �V! 17�y/C ti C/1/i
City/Town C n"fC t r
G.S.Quadrangle Map
Grid Location \
Owner W a t 4pr JCA n I d-l- \
Address 65 Nerd h A1eu) iu 7Uq,,,,Fa 11s, ni/-7
WELL USE CONSOLIDATED WELL
Domestic Q/Public ❑ Industrial ❑
Type of Water-bearing Rock
Other
Water-bearing Zones
Method Drilled. 1� e r 1) From To
//�� p 2) From To
Date Drilled q �-' O� 3) From To
4) From To
CASING �rl Depth to Bedrock
Length � Diameter
Type. Pj0S4IC- UNCONSOLIDATED WELL
STATIC WATER LEVEL Water-bearing Materials
Feet below land surface /0 Sand: fine R medium®/coarse❑
Date measured Q — 942 Gravel: fine❑ medium❑ coarse❑
Screen:
GRAVEL PACK WELL Slot# 10 length 31 from—to-
Yes ❑ No 0�
Split Screen(or 2nd screen)
WATER QUALITY TESTS MADE Slot# length from to
Chemical 12 Biological ❑ Depth To Bedrock
I
PUMP TEST
Drawdown feet after pumping days/ hours at 7 GPM.
How measured_ e7,e-2 IP;,o_lr�1 "el Recovery feet after hours.
LOG of FORMATIONS COMMENTS: (On well or water)
Materials From To
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DRILLER h
}YIP 11 Firm / I It7P kQ,,3_I ��_1I bt IJI A A .
D Address �n A Y rob
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City l�Y P_5j:,444 I P
Registration No. ) y Q
Signature
'i Aerator's ease prrnr rrm y BOARD OF HEALTH COPY 25M-10-85•807101
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SMALL-SCALE DESIGN
BECKONS FIRST-TIME
HOME BUYERS
PLAN 2204. N _ Storage Deck
DESIGNER:NATIONAL PLAN SERVICE INC. _
❑ Compact contemporary, ideal for a start r Bath Kitchen Bath
home, may also be used for retirement Bedroom - 10's"x 14' Bedroom Bedroom
}' g 10'2"x 11'2" ° 10'8"x 11'2" W 1018"x 1l'2"
or a vacation retreat. -
Dining — —
❑ Central fireplace and a ceiling that slop .- e) Room
down from a second-level balcony add drama r Balcony
to the spacious living room. i----------- ---
❑ First-level bedroom could serve as a den, of-
Living Room Sloped
fice,or guest room;adjoining bath also opens 277'x 15'7" Ceiling Open
to the kitchen.
❑ Roomy kitchen/dining area boasts a built-in
window seat. SECOND LEVEL
❑ Twin bedrooms on.the second level share a Deck
full bath; both open to the balcony, and one
has a private deck. -- 2
❑ Material's list is included; mirror-reverse FIRST LEVEL
plans are available if specified. s�
❑ House measures 28' x 28'(excluding deck).
❑ First level has 811 square feet; second level, �t
448 square feet. r 1
126 SUMMER 198A"BEST-SELLING HOME PLANS To order blueprints,use the form on pope 189
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