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HomeMy WebLinkAbout0173 EAST BAY ROAD - Health 1 3 64s+ 60 goad, =�,�J4D -air - �oa i 1 { 3 III I SMEAD KEEPING YOU ORGANIZED No. 12134 2-153LGN A l LE MIN,RECYCLED INRWTIVE CONTENT 1096 Co4@daoerSourcinp POST-CONSUMER wwvApmOramwg 5ii0120p MADE IN USA G T ORGANIZED AT$MEAD.COM i • � ���. � ��� is �i i e No. .:. .�.,�.` J FEz.............................. THE COMMONWEALTH OF MASSACHUSETT,_tX_SIGNING ENGINEER MST SUPERVISE OF HEALTH `vsTALLAr10N AND CERTIFY N WRITING THE SYSTEM WAS INST -ED IN STRICT -•--........-��-t�.1.-J.....of...... �.1J..S�A..���C�4RL3�6�E TO Pam, Aplifiration for Miyos al Works Tonotrurtion Frrutit Application is hereby made for a Permit to Construct (OTC) or Repair ( ) an Individual Sewage Disposal System at: .... .........-.. .... � .a-•-------••--•--------•- -.-_.-------------�---�--- ---�.--._-._-_--..� -�-----._...�:c�c_, ' Loca ion•Afldress or Lot No. f�Ab .... __.._ ...... ------•---------•.......... .............................................. .................••---- ._..... •- wn •""'-"............•.............Address g_� Installer Address Type of Building Size Lot t_S,.I S.O_-_....Sq. feet �. Dwelling—No. of Bedrooms........... ..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------- - W Design Flow................. ................gallons per person per days Total daily flow........._....�3.a................gallons.E� WSeptic Tank—Liquid capacity-l.D. gallons Length... ..-6. Width.4..7).Q biameter....:........... Depth..S-_-4- x Disposal Trench—No. .................... Width.................... Total Length................`. Total leaching area....................sq. ft. Seepage Pit No..._......�......_.. Diameter��..� ..... Depth below inlet.._-.�...... Total leaching area....54 G..9gr4t6 /gyp Z Other Distribution box (p<) Dosing to k ( ) Percolation Test Results Performed b �OCDate....._.__.�d_ -7. _____. Test Pit No. 1.......2.....minutes per inch Depth of Test Pit.....1.7M-...... Depth to ground water.._._OZQt2[f.._. 44 Test Pit No. 2.......�--•:minutes per inch Depth of Test Pit....j.�4..._.. Depth to ground water.......1P1P17'..G_. a ----------•--•-•... ....... .... ............ .....:---_____. .. .......... O Description of Soil...:t��-•: 4-8 • ,gp�ai. S 1 � ....efol.� :t.�l/✓�.. 11 r U ........................••......._... W ----"•-•-•-••---------------•------•-•-••-•-••....-----------..........._.......--------""""--...-------"------"--------"------....."""--------•----•"-"-••--"-"•--•-""-----•--•----•................... VNature 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 TIT12 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 health. Signed.......�!MML''�Y.st,:h.,...���....._. " ?.e�.a- ✓ :.'� Da Application Approved By......... (................. .-- --------------•---------........................ "--" Z I 6---•"". Application Disapproved for the followi reasons:..•-----•-----••----•'•---------•-------------------•---------"-------•----------------"-•-----•"-----•--•--•-- ........................""-""•-••-••-"-""...•""""-"-"--•--"-".....-"•""-"--"••--•--•-•---•...----"""..."-••-'"-"•........--"----"-""•-•-"-""••-•-"-"•-•-""-•---"----"--•"------"-------•-----••-'""-.___ . Date PermitNo......................................................... Issued...................................................... Date /73 Ecksr IBa5 a- � ASSESSOR'S MAP NO. 64 0 PARCEL a� o LOCATION SEWAGE . PERMIT NO. bf v 'Ile VILLAGE 6 -7 (j, 0 e- � r t STA LLER'S NAME i ADDRESS e5 0,0 B U I L D E R OR OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �_� 18G r �,r IA 1 U� 1 '� HOS ENGR. ASSOC. INC. P. O. BOX 15B RAYNHAM CTR., MASS. ,0276E 617-B24-0362 TO M-k)- E ' '?—' 0 C-0-AJ JE:-LL..._._-.-— SUBJECT �a� -.-a,ox MESSAGE DATE /._ r--Ar , -1- l 5 - l_/? fit✓! Gt-cc_ord�.ri __.f-�!� i_ I - - SIGNED,4 W -- - - REPLY DATE- , SIGNED. _ INSTRUCTIONS TO RECEIVER: QUICK REPLY LETTER FORM QRHET•QUILL CORPORATION•32M ARNOLD LANE•NORTHBROOK,ILLINOIS W062 1.WRITE REPLY. 2.DETACH STUB 6 CARBON.KEEP WHITE COPY,RETURN PINK COPY TO BENDER r n� i 5 ! ° 4% +i } % _7 of No................_....... FEB............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..-•... ..........Q tea&j OF.........�"i`�.*.�:��..��..0..�_"..%f.9..1�.. L..e.:�:,�......................... Appilration for UhiposFai Works Tonstrnrtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Lo Locat'on-Add or Lot No. •- l` --- -----------•-•--------•- ..............--------------•-------•-•--..............-- caner' Address Installer Address - QType of Building Size Lotl_�E,--L5-K2......Sq. feet U Dwelling—No. of Bedrooms.............. ..........................Expansion Attic ( ) Garbage Grinder ( ) '14 Other—T e of Building No. of persons............................ Showers — Cafeteria PAOther fixtures -------'-----------------'--•-------------------•-----....-----------------------........'-----------..........---..........-------•--•......--_------ d W Design Flow__________________ ................gallons per person per day. Total daily flow................ ..0 . .................... WW f^:g . Septic Tank—Liquid capacity allons : Length.... _.:!f>biameter._._.: ._. Depth.... ._..x Disposal Trench—No...................... Width............._._.... Total Length.........._._... Total leaching area....................sq. ft. Seepage Pit No........... ........ Diameter.f _."": _.... Depth below inlet-. :_.'.. }..... Total leaching area._._ _sgot.6 Z Other Distribution box ( �140 Dosing tank ( ) Percolation Test Results Performed by__ ..-':4. ._--;... 100ate...........�?. a i_.... s Test Pit No. 1........�.-:-_minutes per inch Depth of Test Pit....___ , __ Depth to. ground water.____4?4,-l_C`,._. 44 Test Pit No. 2........ "_minutes per inch Depth of Test Pit..... : ..._. Depth to ground water._.....�r':':: A.4.. _ r O Description /of - or .........7 ......... .............. .... ..... ......................................................... 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 TITIE 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 ol health. Signed------. G�....... . - .. Application Approved BY-------- Y C Z �.� ate Application Disapproved for the following reasons:-----•--------------------------------------------------------•--------------------------------------....._-•--- Date PermitNo.......................................................... Issued...................................................... Y Date ` I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH €... sa..........O F.....:...( ,,�. ,� .7`�`%' .......................... a.n (Irrtiftrate of Tomptianrr THIS IZTI That t e Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ' -..� .� ---------------------------------•-•------....................................--------------...................------••-- ... L„n'r r — Installer at............................................. ..............J -�......-----.`"1�......-------- ..._S_�Ye,U..........-----•-••---------------------------...-•----------.. has been installed in accordance with the provisions of TI 5 of The State SanitaryCode d scribed in the application for Disposal Works Construction Permit No.__...__._6 . �___')...�______.____ dated ...___��.__ _ �_ ...�a.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE SYSTEM WILL FUt4CTtON SATISFACTORY. DATE.. �, Inspector .(/R� ' ?.l_�__�.....--•--•----- THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH No... f=73-1 FEE. t tt rk.5 lTons\#r ion rrntit Permission is hereby granted....................?D.._ . 1G( ....................................................................... to Construct ( )'or Repair ( an Individual Sever isposal Systtem at No.......... Street --- as shown on the application for Disposal Works Construction Permit No _ Dated.___._______ Board of Health DATE....................... ................. f FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS .. i N 4ol 78 �_..., 2 o J 1 \h C•,Are N ° $ �. ski O ` 2v' 10 .lo PRO Pos0 1 �� 0 /ay,1 B El�zoo M t� 3� O 30. � w/ So° sG /v '�.�/ 8 6. 3 3 /"1 48° EA s 84 14 c ( S^,{'E70 9 ,GAB°�79Q, f15Sc�G� P'.}< . i� t lov/ ♦ ♦ . ♦, 447 10 �t� D 79,7; iti ono Co Fr. D i,-N A4. I 000 Cw1. Ccnc. 79.4 A o oa Z;"C-IEAC-f41"4 P,r. SeP�'ic- Tank 79'S 444 A AAn Q AA II Bor. Ps-r Eav, 7�7— I6%N D A-c-A ; FHRCoL-A-n oN RATI=.; 41VIA111mc" DROP r S v 6 s m i t EST PFS21=0;zm ED J v kl e- Z 7, / 9 8 6 Bar,>RooMS K I tO ajp[> = 33© CPD LEAcNI1JC, IV O C-TAR'aAC;6 DISPOgA� li S- o00 - S I CAL.SEPFcCTA+vl - MEDIUM CAPAGrry PIZoV1�,� D ; . - - coAQ>c l30T-roM x_ o- S 3 = 74 C p D 5AIJ0 15 S Z K- . oo = ZIs z C-1 PD_ r TOTAL- CAPOITyOVIDeD J`-4� Cps AcLoR D "CE W I T - PROVISIONS O.F Sfl�w T'I T L.E E=LN ! I Iz0El MENTAL cop= . L 0 7 8 E-A BA`( (-3, o CRo��»b.lA r1: