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Home My WebLink About0011 OLD MILL ROAD - Health II Ow -n1 �ok WCC kGod - 7 LOCATION SE ACE PE OMIT NO. VILLAGE INSTALLER'S NAIVE i ADDRESS R U I L D E R OR OWNER OATJ PERMIT ISSUED DAT E C0 M P L I A N C E ISSUEDlz� I fa � 3 Q� '�--5 �� - � �� b� 11 / I No....0�'. _ Fim............. @'.... THE COMMONWEfeLTH OF MASSACHUSETTS 6 BOARD OF HEALTH -�i�l�. .....OF....A614X�S: Eo�............................... ApplirFa#ion for Dispati ai Workii Tomitrurtion pamit Application is hereby made for a Permit to Construct (4-1 or Repair ( ) an Individual Sewage Disposal System at: OCD /7144L )ZV- OST tl1e_446r- - ............ ........•---......------.........--•---...._........... -••--•-•-•---•••••----•----•--• ----••--•---•--•--•-••--•----•--•-•-----•--•-••-•-----... Loc tion.Address or Lot No. .... - .. .. ner Address W ✓ a *e...... = ....ddres....... ................ � Installer Address - Type of Building Size Lot-_1S®4 Sq. feet $ Dwelling—No. of Bedrooms.._.........�...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e a yp of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----•----------•----------------------------•--•-----.••••--•--•-•------••-•••......•--............................................................. W Design Flow.............. ......................gallons per person per day. Total daily flow----_.......3.39...................gallons. WSeptic Tank—Liquid capacityl ..gallons Length..6.-"... Width.4 4'... Diameter________________ Depth.5"06.:r'. x Disposal Trench—No.......1.......... Width..... 4e.......... Total Length......APB...._ Total leaching area...39q.....sq. ft. Seepage Pit No----_--------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other.Distribution box ( ) Dosing tank ( ) Z �rf8 3 '—' Percolation Test Results Performed by.....5%�'� .... :._ . Ss Date.�i'�✓....... .................. aTest Pit No. 1..AI Z___rninutes per inch Depth of Test°Pit.....94."...... Depth to ground water....... ---------- Test Pit No. 2._*'--.7-...minutes per inch Depth of Test Pit------ L..._.. Depth to ground water........ ........... .................. .....-----•••... -••••-•••-••---•---•...••.......----••-•••-..._..--•....................•---••.....--••••-•••-•••••••................••-- O Description of Soil..... f ¢rr.....Ge��...... :......:¢�.`�� T SA=' x /L-~ 9d ----............•--......... ...----•----•--------------••---------•-•---•---•-----•-•--------•-----...-----•------------------........----•---•-•------------- 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 iIHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b,�eepn is ue y th board of health. Signed---C.._. -_ ... .....-- -------- ----•--•------------------------•- ................................ Date Application Approved By•••-•--- ......•----•............................................. ........8,42_51',t------------ Date Application Disapproved for the following reasons:•-----------------------•---------•--------------------------...------------•--••-----......................-•-- •••••--•---•--•-•••-•----•••-••-••----.....--•--••••-----•-•.._....-•-•....--•••.............••--•.....•-••••-••••--•.....-•----••-••-••••-•-•-•-•-••••--••----••••-•••-••--•-••-----•.......=••------- Date PermitNo......................................................... Issued-----------------_.................................... Date J 6 No....aln_aCl Fins.............. U. THE COMMONWE.A.LTH OF MASSACHUSETTS BOA§D OF HEALTH v tAr.t �vs > G E' ................... _............. ..OF......................... ... ApplirFation for Dispvii ai Works Ton trnrtann unfit Application is hereby made for a Permit to Construct (&,I or Repair ( ) an Individual Sewage Disposal System at: ............ --•- .._................................ .... ---•---------•-- Location-Address or Lot No. G_/_!/}�2 , C + Ju-ve ts:... .:.. ,�'-'t'�G G�/Z-'-e V/LL e AI I-S S _---------------••--.---- ---•----.............. ---- --••---....._._...7:.---.._..------------.............................•-- O ner Address W Y Installer Addres!-k Type of Building Size Lot___l `:'............ ... ....Sq. feet Dwelling—No. of Bedrooms.__....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons.............................Showers — Cafeteria P4 Other fixtures -----•-------------------------- - W Design Flow.............-52i_........................gallons per person per day. Total daily flow............. 3.c--)..................gallons. WSeptic Tank—Liquid capacity.✓�099.gallons Length__'.G.".. Width__ Diameter________________ Depth..-''d." x Disposal Trench—No. .._.._.?......... Width...... f ........ Total Length....... °..... Total leaching area....3 ....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank '-' Percolation Test Results Performed b 5�7 sv.� �._ Date..................... ................. Y ........................................ . Test Pit.No. 1_._�__Z-.--minutes per inch Depth of Test Pit....... ......... Depth to ground water--------.7............ ri, Test Pit No. 2....... _.�.2-.-minutes per inch Depth,of Test-Pit.......t.......... Depth to ground water--------- ............ R+' -------------------- D Description of Soil.....-`-�--_. e•,....... ��---........!......i�---t`'`''�'"t�'`_."�....�� -------------------------------------------•---------------- 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 issued th oard of health. Signed t -• ------- D • • --------- a' - .. ...... Application Approved BY-----............ ..............•••--•----.._.....0..•--•- s � ---------- Date Application Disapproved for the following reasons:................................................................................................................ ...............................................------------•----------------•-•--------•- •=-----..........--------------•----------------------------------------•--------------------- r _ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......... .......................................................... (Infifiratr ,af Tomplitanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) bY----•---------------_-----.--At!5 ...........-............-..................................------------------.......----....................---------------------------...----...... / t Installer i ------•--•-----•-----•------------.......................... 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........46'3 ,.�.410...._.... da.ted------------------------------------------------ THE ISSUANCE 9F THIS CERTIFICATE SHALT. NOT BE CONSTR AS A GUARANTEE THAT THE SYSTEM WIL TION SATISFACTORY. DATE•••- r L .... ...................................... Inspector... .... -------------------------•--•-------------------------•-----........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9.34ed % .......OF.........t 'i- t i3 .' .� No......................... FEE........ UispauFal Works Tonsir ion amit Permission is hereby granted...................... ----------------------------------------- ---- .............................................................. to Construct (W or Repai ) n Individua eaa os System • at No Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... -•-- ..� ------------------------------------------------------------------- •.................................. Board of Health DATE------------------•-----•----------•------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ,; sN 'r- f 6 �. ' ky Z 7` f rograaaiA�. m Be ,Pro 6�' / a¢ Ai: & fr �'Q67YpNm I SG7�G •� i A7�NA /avD I�iLdeD 8` r ./!��Ik'•. ,d_ a/ 7o� o ZL }� krxj, r t Y ':1 i 3•' Yw L�1c.+✓y�,xtz�evvcr � .tom Y . }��,• + r� , a y �,t r•��; � A r �s, it ;I �_.� -�' �. ��, �%t ?� •i gip,aF , OEM Z �"/ t 40 7- Ae ',�. Fp�IV�►r17a 3, �'F,t �. . ' KE LEY 1 ,p Mo,26108 co 'T�/, T ti �.p fa +dip Wr o oSE7� .S/ W Al' Oiv 77 4 I l l .W17YJ''7711E' 8 . � ur'.e!'�'h'!s°'� ®,�'•�6 ,;715:��•! oil - or -Tyc 6 ,q. .74AI be- A,E- n 770.v��s ��. t.�is :S&/Z d' k TOP OF FOUNDATION • ^. CONCRETE COVER CONCRETE COVERS 'e a 4"CAST IRON 12°MAX. rn�rnrmrr 12"MAX X. f3/4" PIPE (OR ''ORANGEBURG(OR EQUIVAEQUIV.)- MIN. PIPE- MIN.PITCH 1/4"PER. PITCH 1/4"PER.FT. TGELVEO.T6.. INVERT INVERT o �� t SEPTIC TANK RT DIST. 9¢Zi=tcw_ .EL-9.- . EL..INVERT BOX gsGAL. INVERT /2EL..9.-... . . INVERT ELr1. J. EL.9.00 � o ° PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE �gB-3 TIME. 3;30 P/'1 f30~ TA•GoBf BOARD OF HEALTH TEST HOLE I TEST HOLE 2 A.e- iAG� /�,5, ENGINEER ELEV. . .`�. 40 . . . ELEV. .�. �,fulL�?L Bf� -moo s 7 ¢' �9 l DESIGN DATA co-PAW-t•-o c"r')p�`T NUMBER OF BEDROOMS 1 &Z. 7 /6 1 4-2.8,v7 TOTAL ESTIMATED FLOW . . 33o GALLONS/DAY i BOTTOM LEACHING AREA . . . SQ..FT. /PIT SIDE LEACHING AREA . . . 84 . SQ.FT./ PIT Sirti� SA�vD , GARBAGE DISPOSAL . . . . . . .(50% AREA INCREASE) TOTAL LEACHING AREA .380. SQ.FT dz./.� mot. /.�Iv PERCOLATION RATE 44'3S . ! .77^/0. MIN/INCH 96" _ 9c" � LEACHING AREA PER PERCOLATION RATE SQ.FT. -WATER ENCOUNTERED 3 `Low NUMBER OF LEACHING PITS . . . . APPROVED . . . . . . . . . . . BOARD OF HEALTH DATE . . . . . . . . . . AGENT OR INSPECTOR 11111 0,A OF hlgS. L KEUI� STEA� PETITIONER I� APPLICATION FOR P COL TION TEST AND OBSERVATION PITS ,OCATI N `"( �DD N0. '2/_/ TILLAGE _ DATE Z__K �P P L I CANT FEE Z_j �DDRES TELEPHONE NO. (Non-refundable) :NGIN E TELEPHONE NO. )ATE SCHEDULED (Applicant' s signature) • • • • • • • o • • • e • ee�00 • • • • • • • • • • m • o • o • • • • • • • • o • • • • • • • o • • • • o • • • • • • • • e • o • • • • • o • • o • • • • • • SOIL LOG iUB-DIVISION NAME C, �C, SAV-p4 DATE_ z TIME �,I ,XPANS ION AREA: YES NO _ ENGINEER:.:) '.OWN WATER V/PRIVATE WELL BOARD OF HEALTH e R EXCAVATOR ;KETCH: (Street name,etc• ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to t st holes) NOTES: / ,00� I I � e 4 0 0 ?ERCOLATION RATE: 'EST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: ::lG _ `,. COih?RCTF��,q✓� /(o COAIPACTf'�V'�n/� 3 3 5 /''!e:p �Ar� v 5 Nli� �J'A`✓� 6 6 7 7 9 1_49 13 9 10 10 11 11 12 12 13 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES 'JNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION . RIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH ^OPY: RETAINED BY APPLICANT