HomeMy WebLinkAbout0089 CAMMETT WAY - Health C
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�9 Sewage Permit No.
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Location:
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Installer's Name & Address
Builder's Name & Address �rf�/Zy �CwS
Date Permit Issued 3z
Date Compliance Issued P A'2 V111
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THE COMMONWEALTH OF MASSACHUSETTS ."_ '
BOAR® OF HEALTH
..........................................O F..........................._......_....-------------••-------------..__...--------........
ApplirFatinn for Uiipniial Works Tnnitrnr#inn rrmit
Application is hereby made for a Permit to Construct (k4 or Repair ( ) an Individual Sewage Disposal
System at:
$S C'a�,sn u�n_� l .�" �yRr K. l.� ... 4... °l'
•• ----.......•---- ---•-••_. ..... -A - -• ..............
—-� tocation-Address or Lot No. v
Owner Address
a R•G(.iG ...._.. ` -K.)................................................ ---i-•-AG.".0y?---r H . 5 -•-•--•-----------•-------------------••-•-
Installer Address
d Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms.............._______.________.____..____Expansion Attic ( ) Garbage Grinder (116
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
W Other fixtur
W Design Flow................. S_____.____________gallons per person per day. Total daily flow.................... 7;�ne.............gallons.
WSeptic Tank—Liquid capacity..If.Q°...gallons Length................ Width----------------- Diameter________________ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-________I-._________ Diameter........(_�___.._. Depth below inlet....____.(a._..... Total leaching area...2._t'.....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by..........---------•-•----•-••-•-•-•----•--••---•-----------•-•-•---••--- Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P ----•--------------------=---------•----------•------ ----------------------------------------------
---
-•-•••------------------------------------------------
0 Description of Soil-•-----------------•-•--•---------------.....-•--•--•----------------------•---------------------------------------------------...-------------------------------•----•-
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U ---------•-------------------------------------•----•----------------•-•------------•--------•-----------------------------•-----.....................................................................
---------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------
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 til Certi to of ompliance has been i d by the bo health.
z 3P
Signed------ ••--•----- ----------Q............................................... •--•- / --• •-••--
Date
` Application Approved y........... r�i ...... _: at?1.-.........
Application Disapproved for the following reasons--------------------------------------------------------------------------------•------__._..._._..._....._______
---------...........---...........-....................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
1%.
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................................OF.........................---
Appliration for 3linpoottl arks Tonitrn.rtion rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..............•--......-•---.........---••------•------.......................-•-••-•-•..._..---•- •......---••-•---•----•-..........••--...----•----•-•-•--.....-•-•----........---•--.....-•••••.•.
Location-Address or Lot No.
......................—.......................................................................... -•--.........•--••----•.....--•-••.....•-•.....__...........
.---------
............................
W Owner Address
•-------•-------••------------------•-••-----•--....-----.....------•---..................•-••-•-• .................................................;................................................
Installer Address
UType of Building Size Lot------------------- feet
4 Dwelling—No. of Bedrooms...............Z_........................Expansion Attic ( ) . Garbage Grinder (�17 0
Other—Type of Building No. of persons............................ Showers
a YP g -•------•----•-•------------ P ( )--- Cafeteria ( )
Otherfixtures --------•---------------•--- - ------------•----------------- ----------
W Design Flow.................. . ..................gallons per person per day. Total daily flow.......... ............gallons.
WSeptic Tank—Liquid capacity..x'pLa..gallons Length................ Width................ Diameter---------------- Depth......,.........
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-----------1.-------- Diameter.........I...?.1--- Depth below inlet........... Total leaching area..... ....sq:.ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by........ Date........................................
a
Test Pit No. 1................minutes per inch Depth of Test Pit.._.___............. Depth to ground water-___--._:.--_•__--_-:__.
(s., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..........................
--------------------------•-------------------•-----------------------------------•----------_......... ---------
......-••-•-......-••-•--•-••••---
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U -••-••••...••••-•-•••--•••-••••••••••-•-•---•••---•.......•-•--•••••-•••••-•••.....••----......•••.:_...•-•••••-•----•••-•-•-••-•--•-•-••-•--•••--••-••••••-••...............••-•-•--••...............
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 TITIZ 5 of the State Sanitary Code— he undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss d by the boar of fiealth.
\� c .
Signedjn ........
Date
Application Approved By.............. ,/- `� � ✓ z
. - _-- ---
Date
Application Disapproved for the following reasons:................................................................................................................
---------------------------------------------------------------------------------------------------------'--------.._.._..------------------•----...--------------•----•--------•••••-----••-••-•-•---•--
Date
PermitNo......................................................... Issued-........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................................O F..............................................................I......................
Tntifirate of Toutpliattre
THIS IS'TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
_bY.............. c �cs -------- '=- �:�---------------------------------------------------------------------------------------------------------------•--•-•----........._
Installer
at.............. -4 =--------j 1�'?r K J "`' ,. tf
- ---------•-------------------------
has been installed in accordance with the provisions ofTTITIZ 5.of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..........fir°'%__::_5..?1....... dated...............................................
THE ISSU NCE OF THIS CERTIFICATE SHALL NOT BE CONST A A GUARANTEE THAT THE j
SYSTEM W L F 1CTION SATISFACTORY.
DATE...... ' ..._....l�C..... --........ ................ Inspector-•---= '_...._..-----------........----------•-----.......-------
THE COMMONWEALTH OF MA SACHUSETTS
---.--BOARD OF HEALTH
......................................OF.....................................................................................
No.......--. .-,y d j" FEE........................
Disposal 10orkii 10.1,onotrurtion erntit
Permission is hereby granted................Ai-c.4aAa..........z,-'V.p..'-......................................................-....................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
sus (. J-C. ,�
at No..._.... ._... .... ,�, cTM i� ........................•-•••......•......••.-----
I Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
✓ �J
DATE.................. � .:............................. Board of Health
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS `
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� .1�1 I � I ,I . n � � I r I � I 1. . 1, I r, . � I 1, I 1w, I , I I 1. I I � I - 1. I . GENERAL NOT 11, I
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I . � I . . I � . 11 I I I I I 1, I . - � . � I . I 1� 11 I I I . . � , I 1. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN
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I � . .1� I I I I � - . I � I I I I 11 I - 1 . I 1 .1 I I _" EXCAVATE TO ELEV. 3 6 + OR LOWER AS 11
� I � . I . � I _� I � . � I' ll I I . i � DATED JULY 11 1977 Bi ANY LOCAL RULES APPLICABLE.
I I I � I I . � " I . I I 11 . . I I I 1 . . 1.� I L I I I I I �. �I I I "I I I I- ,� � I I I .I REQUIRED, TO REMOVE ALL LOAM AND CLAY CONTAINING - ' 2. ANY CHANGE TO THIS I PLAN MUST BE APPR I D. IN I 11
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. � I I _' - � , 11 1, ., �� a I . , � 1, � ., I I : I � . MATERIAL BENEATH PIT. REPLACE EXCAVATED MATERIAL � I WRITING � BY MR. CHARLES D. SPOHR. - '
Ir, I �, � - I I 1. . � I � � I � .
� I �l � IS I � . I I 1,r .. I �. I a . I . I I I., 11 .1 ., I � . � � � - I � I . ,� .
� OWNERS . I AREA � PLAN ' I . '. I - �l 11 I 11 . I �.I - L WITH 'CLEAN,CLAY ,fREE GRAVEL,' M 1_.ECHANICALLY, .. 11 _ �l
, I - 1'e 11 � . I - 4 - � �lil , I I I I I � I � , I I .. � I - .-1 I I I - 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING,
L, I I I I 1� I I 11 COMPACTED IN PLACE. ' � . I
Mp. � , - I I I 1. I , NOTI FY THE ENG I NEER AND BOARD OF HEALTH FOR I NSPECT ION.
_ _1 M 9,�5 , Q I ,� -A, �P L.^,,Q P P_SPAr-K�IZ) T=ROt'A I� �,.� 1 . '''' I " l, 11 I I ' S.F.Q , -4 S.F./GAL -4"-?'5 GALS , ., � I �
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1 _ , C>A w , ,. A�P_E= I . � - I . � S I DE* AREA = 19F- - � 4. FOUNDATION ELEV. MUST BE I CHECKED WHEN COMPLETED.
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F OX-,Z 0 0 �C� , . 11 sft441se�r ..;64, I . . . I I I BOTTOM AREA= . S. F/GAL � 187 GALS � '
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. 1. 1, � I � -1 " - I I . I I I., �,,- � , I I . THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN
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1. . -1 _F,�A,0_k j;Z.0AN,V�>_ - 1� ' I I - , ...�,� I I I�, � , ,� I I . TOTAL AREA '= '9 as I L 582- GALS ' � 5 1
1 I 11, 1� , . _ � - I . I I - � I I I -1 I . � I � � �� - I , � - �. 1: I I I S.F .1 � , I
I I I I I I I I . I 1, L 1 -11 . I I . . � I I 1� .I � I ,� � . APPROVAL BY. CHARLES D. SPOHR.' I .
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