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HomeMy WebLinkAbout0098 WAGON LANE - Health .9$ tea on cane , �4�.ann il' - - - y � � � _ � � � � � � Got" ��119Ao-140�1 �_ lfOtJIBU1003N�A �1�1101 118fl 1i 3m o«zL-mn r 9/s" LOCATION SEWAGE �ERMLT N0. VILLAGE r INSTAL R'S NAME i ADDRESS F - a"14cley BUILDER oR—O. ER DATE PERMIT ISSUED 1 DATE COMPLIANCE ISSUED .. Fes,, ,. �'`� �: � � , � J �` � � � � :� �� � �' �' U `� `� No 3.....o_/ F�s....1,� .............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1-&rTlll1!L•........_......OF....... ... ................................... Appfiratiou for Uhipoii al Works Tomitrurtiou rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat: ........................... C •--:�.... - ............. Loc ti d s ..... A ............................... / • or Lot o. .... ..-- - •- .. ........... ..... -- :.. -•----•-- W : .... ... 6 �...... :. . ....... a » ` � nstaller Address Type of Iding �7 Size Lot__ •?,_S._ ......Sq. feet aDwelling—No. of Bedrooms.____").............................Expansion Attic ( ) Garbage Grinder ( ) p,, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------- - W .......................gallons. Design Flow...................1.1Q.................gallons per person e day. Total daily flow____ WSeptic Tank—Liquid capacity_ -gallons Length__._ r._____ Width------..... Diameter................ Depth................ III x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__)l_a--.0..... Diameter_.__.3---------- Depth below inlet.....�R.......... Total leaching area__` 9C9----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by—....................................................................... Date........................................ a Test Pit No. 1.... '._2.-minutes per inch Depth of Test Pit........k2 Depth to ground water---A)_0_&. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... R: ----•-•-•• ........................ -,T----•-:..._yf----------------------------------------------------------�•----•-- -...I._---•...... O Z _.____ Z_ - © Description of Soil------ ------1---... e�t?.!'�.�------.�..-- 3 0 _.__��.�•-�--°-- �------ -�pt L-------- -----•------------•-----------------------------•-----------••---- 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 TIT 4 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 health. gned8 J Application Approved Bothollowing ---•-••-•--•••••-••--•---------•--•------------------•••••--•--•-----•-------- .. Date Application Disapproved reasons:------•----------------••------------------------------•---------------------------------------------------•--- ......................................•••••--•••---••--•---------•-----...•--------------------------•------------.--..-----------------------------------------------------••----------•••--........_ Date PermitNo......................................................... Issued....................................................... Date l — No......................... Fizz 414.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........tAl'I"C"n, ................OF........ ------------------------------------------------- 1 Appliration for Disposal Works Toustrurtion Vvrrmit V: Applitatiod is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System ........... at . .............. ..............4. . ...... Loc dd. so or Lot o. ..... ..................... . ..... ............. ........................ ..................... .. ......... ... . ...................... .......................... ........................................... staller Type of ding Size Lot../_3,.5A42.........Sq. feet U Dwelling—No. of Bedrooms......­3. 7 ............................Expansion Attic Garbage Grinder Ak Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ......................... ....................................................................... ................ Design Flow...................11.0------)__ --ga long per person day. Total dai�Lflow----- ................................. ....gallons. WSeptic Tank—Liquid capacity_�j ga Ions Length......Tr...... Width....... ...... Diameter.........._..._. Depth............._-. Disposal Trench—No. .................... Width..........._-_-___.- Total Length....._..- ........ Total leaching area....................sq. ft. Seepage Pit No----1prll.-O----- Diameter------I......... Depth below inl'et.................... Total leaching area...IP4....sq. ft- Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Per-formed by.......................................................................... Date ................ Test Pit No. I--- -minutes per inch Depth of Test Pit---------/.X.1. Depth to ground water....1FJJ6................ ---:-------- rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit___............_._.. Depth to ground water.___._.............._.... ------------ N ... ... ..............Ar------ A M ...3,45 .... ..... ..........................._........... ................................................................... 0 Description of Soil....... V . .­ A.15: W_)��........................................................................................................................... 7.........3- - 41........................................................................................................................................................................................................ 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 provisiouls'of`i IT Il 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 health. ne ...... ...... _ ....... ApplicationApproved By........ .... ...................... .........................................i----------- .... ...................... Date Application Disapproved f theollowing reasons:............................................................................................................... ......................................................................................................................................................................................................... Date PermitNo...........................................c............ Issued....................................................... Date THE COMMONWEALTH OF MASSACHYSETTS BOARD OF\ HEALTH ........... .............. . .. ...OF.......................... .................................................. '­--THIT SVI� IFFY, Th Individual S6wage Disposal System cooftructed. (4..0 FIrepaired w0poop— by------------- ----------- --- -11---------- .. ......... ­ -------------­ ---------- ............................................................. taller at........................... ....... ........... ..... ......................... ........ ............... has been installed in accordance with the provisions of of e tote Sanitary Coe .....e.... es in the Perm* o­ application for Disposal Works Construction �O ­ dato..... ... .... ................................. .-Perm* THE ISSFUA. EOF THIS CERTIFICA ALL NOT BE CONSTRU S A GUARANTEE THAT THE SYSTEM WIL U ION SIATISFACTOR ..... . ..... DATE.Ze. .............. Inspector.... ... . ...................................................................... ­ .. ........................................ THE COMMONWEALTH OF MASSACHUSETTS BOAF;H9--0_F HEALTH ........... .....OF........ r .. t�, ...... No... FEE--_.................... Disposa No ks s ion "antit Permissionis hereby V................................I.................. . .................................................................................... to' Construct r i n I al Sewage spos System atNo. ......................... ................ ....4 ......... ... .. .. ............................ ----- ---------------------------------------------- -1 Street -- ------ as shown on the ap ti for Disposal W` s Construction Permit N .............. Dated.......................................... 7---ai�S .................. ...... .......................................................................... Board of Health FORM DATE--.-- .. ..... ...... ..... .............................................. 1255 HOBBS & WARREN, INC...,PUBLISHERS __ �I►�GLC- FAM���{ - � BGORooM . �C/ AL�� � � /�. IJ->✓ GAQ5AG& —Y7L/ -- I, PA%lLY FuoW z IIUX 3 = 33o6.PP I� 5EPTIG q TAQK = 330x15c>% ' 9%6.PC> PXP Iov oc� D15Po5AL PIT v5E •Iy00 GAL. ',._.__ 'S DGY/AlL ARCIa = I;o�, na L o N BOTTOM AREA= .. �0 5.F. 44 qB.g 50 5.F X I. o = 50 G.P, a. . --T oT A " [>E.S 1 GN -- 42-5 G.P D. 00 7oTAL DA I L',( FL-OV4 = 330 G.PD, • � i, PE2COLATION RATE : 1''IN ?-MIN ot~L�SS � loo. l � N V ^' At nr: RIOt•IARD /vr SAXTER " No.240480 4 GISTS�� a' Np SuRV i i — s I Top FWD= too.o � 1••1 A L F �-//� �� ^ v._ y,.y,may, ^ ' INv q7.o ►oou INS. r. (.f-S DIST. INS/. Z BOA �EPriG I � IOUO lJ�I• GAL. SA,va LcaCu 9� 44A✓br . PIT INV. INV. w I T u 9G"L yG 4 s W AS"GD Al I 6ToN6 r Mao. _90 rb 1 r: SAND C>✓ ZTIFIGD PLOT PI_A.W :� r LoC4'� ION /2 No SLAI.E SCALE AIL , VA.T � 9�1�L f33 I CERTIFY TNAT 'TNE �dv►.I�A•flOt�.� �j1101rYN PL N REFS2E►`I GE HE.R-SOW COMPL% 5 YJITN -THE S i o6LIN AWD SE75ACK 6Qu► R.EMENT� F�-TNG- ! � T0WN 01= -E (42 `13US AND IS kar LOCAToEID� •WITNIIJ T E G1.OaD P a►N �"� �G • 2� �DAT a la— BAxTE Q.e N YE INC. R.EG i S'T�Q6�'t-A►`I H s u R.Y EYoeS i T%AI5 PLQNl 15 WOrr E3n5�n old AW OSTE2VILLE' - M5ug ` I IN5TK.uMENT SVQVe-Y F- -THE 5uouLD ! NoT (�E USEDTO �E"TEIZI^INE L.oT - INES APPLIGP.rJT ------------- 5Iw6Lt_ FAMILY ^..3 Bc02001A i it ►.JO GARBAGE 6¢aa.IDE2 —= —'F;x7 -- I, D/+.►Ll,( FLUW :;I10 X. 3 = 3306.Pp I� 5F-PTIG TA►•rK = 330x15o% = -A976.P. 0 v o� G �xP. AL. Iv �I 015Po5AL_ PIT USE- J000 GAL.. 5%DG.WALL A2Cta - 1 go S.� k-bL o �Q 37 BOTTOM ARE—A:.. 10 S.F, 44 ; 5p 5.F x I• o 5o G.Po ; . -TOTA " ESIGN = ,[425 G-P. D. -TaTAL- DAIL%( FLOW = 3306.P0 ` PE2C0LATI0)4 RATE : 1"jI J 2MIN or--LE55 -TF1 8 . 8 • UF RIGHARD�cyG� (AN '�J t A. BAXTER g jo' Na 24049 +.\� ( t7 v o0 sua" ` r. 'SOP FNU = too.0 Wv- IOou tNJ. LfS DtST. INS. GAL. qG 3l 2 Du>c 9�.G �,EPriG 1 Uoo IWY, TANK �y 5 A,cror G LEAG11 G,eA✓eL, PIT I N Y. INV. WITu 9G•L 90 4 r WA,KGD 11 I 6T0NE MCC =90 Tee I 3 CAAJO CEzTIFIECD PLOT PI-A.W PRoFIt_� {I � WO S CAL_E x` �7 GA L C It l do V AT 1== , 1, CER'T1FY TNAT THE Fac�NOATIo�) 5>{o.wN PL-ArI REFE2ENGE NEREo►•1 GOMC�I.-`(�j 1nlITN"CHE S 1�6L►N '� q�II ' AND 56T000K [L6Qv►R.EMENY'� .QFT1-�E- �dWN oI✓ �Afz A`�lc� AND 1S Ndr' L0Cp.TE0 •WIT91W T E GLOOD P AI �•'1 r G 2� DA-T E B AXTE w E 5 NC. RE6 'r�QETD'2e t-AN u ev e�oes - %Al:1 PL6,tJ I '5 W07 AN OSTE2VILL& - MAS$. IW5T9-UMENT 5v9-Vey -TNE 011FSETS 6WouL.D NoT DE U5EDT0 CP.pETEFZ/^I►�E L.or V,l►1E�j APP>`I ►-j-r s .:,•£ ,4,..t� , ;� >T ,,,:,.. B?Z,�*J G ATE �S SSG, r.i G