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HomeMy WebLinkAbout0043 CAMELBACK ROAD - Health �� C������ ���� � O C9� ., p�3 �Ma�s�.�,.:►�s �rn��� C F BARNST B E y LOCATION O �? J SEWAGE # !/ '/49 VILLAGE JgL ASSESSOR'S MAP & LO 0 INSTALLER'S NAME & PHONE NO. M ASEPTIC TANK CAPACITY A900 LEACHING FACILITY:(type) / (size) `0Q. ®� CIO. OF BEDROOMS c�Z PRI ATE WELL O UBLI WATE BUILDER OR OWNER DATE PERMIT ISSUED: � DATE COMPLIANCE IISSUED: VARIANCE GRANTED: Yes No t 1 a �� , � �6 f �� . , �� W � � �: r u >�. ���,�,�_ __ f. 4 ..rl N - 4.......... ....... F. ..... ......... ;Appliccation THE COMMONWEALTH OF MASSACHUSETTSBOAR® OF HEALTH►..�...............OF.......f.�,.�N�' 1.�--............................._�a� liration for Dig •anal orkii Tomitrn.rtion unfit is hereby made for a Permit to Construct ( -) or Repair ( ) an Individual Sewage Disposal System at: - M�LjAUL ..................... L A Location dyes r Lot No. C p.2 Pc ........................................ -------/� ger ('� /s� - W rJ V........-------------- I .�(�f._a.A......_ ress �`! .. nstaller Address $ Type of Building Size Lot_�L.3055•-....Sq. feet Dwelling—No. of Bedrooms.............................................�...............................Expansion Attic ( ) Garbage Grinder ( ) '-_l Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .................................. W Design Flow............15..J�..........................gallons per person per dal. Total daily flow.........330.___._...............gallons. WSeptic Tank—Liquid*capacity A Q.gallons Length_ _�.'. �. Width.4 I!� Diameter................ Depth.(a........... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.... .......sq. ft. Seepage Pit No.........I---------- Diameter...I_..... I. . Depth below inlet.. `:®°.`..... Total leaching area_ �'!.......sq. ft. Z Other Distribution box Dosing tank ( ) • `-' Percolation Test Results Performed by.���W-----F.__�._6!�`,- PN6 �1 G_ Date... ..`�................. ,aa Test Pit No. 1.....rl�-......minutes per inch Depth of Test Pit......1_!........... Depth to ground water.4? !- -_,__. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............................s--------------------------•------------..............-O•-•--•---------•--....----------•---....--------•-••---............... O Description of Soil...... --'??,---- � _.s--�� - i .............. - 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 iITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the oa of he h. A Signed.. ---••••• _. . . -•-•-•• .......................... Date Application Approved BYt -G - ......................... Date Application Disapproved for the following rea ons: ---_---_-_------------------------------- ...................•....-•-•-•••.._._...............-•--•-•••--•-••-••-••-----........---••••••--••-•------•--•••-••-•-••--•••••••••••--••-•---•...••••--•••• ......................................... .Date Permit No. -'...... •n.............-------- Issued.....-�... -,/.. _ .. �• � THE COMMONWEALTH OF MASSACHUSETTS /v (� BOARD OF HEALTH -may-1..=�. OF.......?..�. .�"-;L.. . i ),�% .....-•----. , Appliration for Disposal Works Tontrurtion Frrmit Application is hereby made for a Permit to Construct ( -'or Repair ( ) an Individual Sewage Disposal System at: .... ......__...�:�r :::A ; n_�. ..._..�'�t............................... ---•----------------------•---•--- l.......................................-........... �r Location 1/Address -r- r Lot No E -� - t"t$ f �. e �'�� �"' �t�. '.err Cyr ' '`L»?, C''. €Li l� f 3 tj r I ��'}A ...............•-----•. ......... ._ .... .• - •-- . -- •. --- ,.- OOwner, t Address ,.-I Installer------......r.............................................................. I LJ/�i - .. tY_/�........:.................!...................... r Installer Address d Type of Building Size Lot__...... .. -----Sq. feet Dwelling—No. of Bedrooms............. ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria dOther fixtures ............................ W Design Flow............ .=✓........................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity_.i'.__..____gallons Length_`�'__._._�°_ Width-I._)_' _. Diameter................ Depth_!"'...... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. M .. � Seepage Pit No---------�`._____... Diameter.__�............... Depth below inlet_..�___�=_ Total leaching area_._.___._:_.._...sq. ft. Z Other Distribution box ( �)' Dosing tank ( ) `-' Percolation Test Results- Performed by. '� '" 1'' ..-�E. .... 'X. Date.__..................................... ` l � •. •--..... ... _. r . Test Pit No. 1..... _-____minutes per inch Depth of Test Pit....''_.......... Depth to ground water_'-':->�'I l=-_._- (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------•-•-••----..............................---------•--...................------.............--------....•••-•....-- DDescription of Soil......j2...... l f� ti.....y ,............. ---- ---------------------------------------------•----------------------- V --------------•-•------•-------------•--------- ---------•-• --------------------------------------------------------------------------------------------------------------------....... .. ...._. W •-•--•----•.....................................:.••-----•-•-•--•-.....-•----._...........-•----•-•----•-•---•---......__.._....---•-•......•--•--..................................................... 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 iITIE 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. Signed---- . =. fF: .' �..:.. ------- ..........................----- '._ a� Date, r Application Approved B .`�/r_....=` ' 7fj j `=l�t�` — ----•-•........... ........�. PP PP y............. Application Disapproved for the following reasons:-------•----....----•-•---------•---•---------------------------------------•--•--------.............-•----•--- -------------------------------- -------------- -----------------•------------- --------------------•-•---------•-------------------------f••-•-•---•�----- --------------------------------- Date Permit No. .. � ...... Issue .. r----- - --•--. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF. .�,( s-v�v+ .�°'1 !` � .................................. Tnrtifirate of Tompliana THIS IS TO-CyE� RTIFY, That the Individual Sewage Disposal System constructed ( ' or Repaired ( ) 4� Y .. t.."� �.l ' � t. ' I T ,t F 1 F_ 1 . ........ Installer at................... ._...... ? ' ---•---•-- %...--•------•-------------.._....---------•-------------••-•--•-•----........................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the T t ,. ------•---•- dated---... {�''"`�"' ,,d ..... application for Disposal Works Construction Permit �o_____________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL . OT BE CONSTRUED AS A GUAR NTEE +IAT THE SYSTEM WILL FUNCTION SATISFACTORY. ��"° �� ?� DATE......:.........•-•-............---...--•----•---.....-----•--•------•--••---•-- Inspector.................................................................................... 6 :�> THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r P -No R �. A/OF.................�.z �.. :: �...-................. r'' ` J No . ' FEE..... ................ Disposal Works Tons#rirtion Upamit Permission is hereby granted ........................................... , .. .............:.�............................. ...: z :... to Construct ( - ) or Repair ( ) an Individual Sewage Disposal System f 71 r --------------------------- e"� f Street \ t as shown on the application for Disposal Works Construction Permit No .._ ._�.�_.. Dated.._.�..,..... Boaid of Health DATE.............•-t--------••.....'------. ..�3....... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS GENERA 4,, NO TE�5 444 E4 EYAT/ONS SHOWN A R'E OAJ � 7-1/��J /� t �+ �t g/ �/�/,,yam �-}�••� y• :. �.`..::`'.-„.,. ----•n-•---•'"-:-^..--•.,.n- :. . i r .. ... r I ; { }.!� .,—,., _ f�, --�--''-�' '. /'� . P!! G../�7 r 4 4, L IIV EV A �'i!t rya h+i�/vI S.I1+ O _.. ''.1 } t:....:. ;'.'_t ts: :;L;.:i• _--- - �"'}tf cam` V' ',..Y '+=r �✓ \l/ F i UN.G ,S OTHERWISE Sf'EG1�ir ( ' 3. A41, P1PES TO ANR 1N TXE S Y,'r&* ti..�HA4,-- -' 0 (D c 100003 @0 r I ul 1 i 0,45r IRON OR SCHEG UkE 40 Ptr':�. Q (D (D 0 O 0 � A4� SEr�'r/C TANr'15, rsr "f /r/C?N E3 , .�fN49 I.EA</IING P/TJ S`hf.4+C 4 n (D 0 O 0 G � " � `�:.,�.t '� a .� �• ...` l ,x :: : � (� Q � 0� C� � : k ( BEN46,4 T.4/ THE //1PYE'Fr'7 Yr4Trr r' '�. 4RY TE£ (D (D 0 0000 00 OF THE ��fFL/St�R�S FOR A RIS .ANC E' O oc' C� (D +;% 0 0 C� .4N�' B.q�`XF/�.� v�'r7H C,C,.�Y-��EE 1 } .. SANL'ANa'CRAt/E� N.4Y1NC A PERCOx.ATC3N : ! � �. T yPICA1 ,v�s�R��►�rION 46ox _ j-- 3 2 AfINUTE.S P4/f INCH OR lve, �. 0 w� r-� rc.�.}c 0u �A NOT Ta c3 .4 �� �"� �ywr_ ..__�.� � . � f, • 77H4`l��t,.a. ` T �r-E- � �,� � TYPICAL .�,EA�".>y1NG P��` IV07-E GP1' /�Pf, JT/ ! 8 X ,,41VP}oQ )GAS . :� NOT 7C3 SC.q,�E &E /10r/1�lER W EN 7,,VE S°YSTE*/5 Jlt6,4A' ° 0 3SERIOTION P1T,5 RE11VFoIrcEp s1°pr/o MNK eY G'4�6/f'�GET1l�NA/1!P PRIOlf MgWAc FI441N(;. T�"�'/�'��.. i ��� �G�4,C, v',E'PT/C TANK R,eR�`c�kAT/ON ,FATE - z i_'. ;4 A.�f61PICAN P �"C 4vT O r EQdA�C, 7 UNLESS OTHER W1,5E NOTED ,44 5X5r,6Af NOT 70 Sc,44 E � .. t v NOTE T /V r ,4,,EP I O,BS'E�Y.4TlOIVS . B Y: ,. ,r�.r���',.. `� ' A fCS RE/NFi�c ^EL� T, UvH01/7` CaPO11✓ / 'T�S 5f�'A�C ,�, 8 /N•STA�L F ;r•. , r„- BQAfi'1% C?F H 'A.C,rH ACCO.�i'G,4.NCS W I TX r/T .E -Y OF THE ,5T,47:f ' W/T,41 64 corRIC y&.,P� ����; ylr� z4,- �� �,4N1r,4.RY-cop4F ANP ANY 4,OC,4 , fZ/4 ,5 Ar�'/"�"rO.l�' E.'Y�J/1/t�"E,�'/N� /NC. E4,gmpei' �5rEEz I?op,.� /N TOP� Bea rTr�,4a. �fl/CH �1,4Y ,�qP0�Y. COiVC1F'ETE 1S -�OO4 P. ,�:,' TE_'iS'7` NOTE- ACC E 55 MAN!-fU,C.ES T'a SEP7"/G T�4l+J A A1D 4,EACH1A(C7 PITS T©B.E' BUILT't./P 70 >r � /Z" OeZ-OW FIN/5H 6,PADE. -AIN16H GRAA4 ' Ok,6,f T,4N,K �-FINISR GRAPE FNV15H GQAU D►/,E,Q r < GtYE.R .' d •ate , . ® , _ -.�- -�- - *-2 a , /1 t • ,, a--;Zfl 1N6!= ' ,' r- oca {, N .= a+ p T B o - � -- 1S LAX C .5></ED 5TON - (7'0 BE'ZEl�'EZ m � 19), 0 - ; X %SEPr1C TANK on lol- Q x < TQ AC 4,EV,EL 4` 5TA04E) _ F TO 5CALE NOT Will' SEGr1p1V PAIPCE'rC, .t t3 r :4f✓1c ES �o �✓ � � .,ems,_.>_ : ,e...-.__.__.._..-� v rS..C✓�,fl�v 0fV TRI4/ !'+sv+diili'" F�/'�Z,�tlR �S.Ol►'E NUM$ER Of BEOrPOOMS -��_.,�. E-.�'f5'T' CUN T JC./i'�' ---- .-_�__ ��._._.-g '�';� • SEWAGE P/sSPC�dA' SYSTEM PERSONS PER QEPAM-4f ..w PROP 1SEG CONTQUR --- GAS :ONS Pk'R.PeRSON PER SAY _ '� - ,CXI,5T Sf'Or A546"Y.4T1(JN Q ROi'CJS�,G' S T ESE.EY t Tlf.�A c'9 Q- �-4 A 4 EACNINC OROVI PEP L6- -,%Pr�RC0k A T10N TE"S7 NO P1SP06A4, 0B,5 RVATk01V P17' E"CC NGINEE`R J - 4RRO ENGINFERING ISO,, O EFo441ff 1r IVY s ; _ _ - i � PA E C�1 cr C "� P7 l BU 7`Tt�.4 f r 'EE "' ro rA . ,4S NO �., A ..4` N BY; CRECKEP BY: A OA 6 Y: Rk NC7. GAI ✓� , SEA .SI1