HomeMy WebLinkAbout0103 CROOKED CARTWAY - Health �c�� �,.�1�� �u� ,� .� .
LO CAT ION-1 SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER/'S NAME i ADDRESS
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R U I L 0 E R OR OWNER
DATE PERMIT ISSUED �,,..,�
DAT E COMPLIANCE ISSUED le
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.......& ___..............................................
Application is hereby made for a Permit to Construct (,/,"or Repair an Individual Sewage Disposal
System at:
......... ..........4 .........................................
Locatioa Add[es or o.
OW er Address
aller Address
Dwelling—No. of Bedrooms.........3..............................Expansion Attic Garbage GrindeZ LATP
Z Other Distribution box (tj- Dosing tank
Percolation Test Results Performed by....4t el. .......... ................ Date...QE
Test Pit No. I................minutes per inch Depth of Test7it.................... Depth to ground water........................
7 — —3--�2----7- *�&--- .................
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TJI T= 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has lbess e y the board of health.
Date
; Date
___________
Date
PezoitNo......................................................... « "
N'o.............�.11r.... - Fss..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....OF......�f
Appliration for Disposal Works Tonstrnrtion Permit
Application is hereby made for a Permit to Construct (! ) or Repair ( ) an Individual Sewage Disposal
System at:
f /� I
Z.*p._.__,�_.. ! k��'"«�. !.r- �� ��� .......... .....••• .. �.�f.�.._ ............................................
«.• Location-Ad ress or Lot No
14 . .. '. ► .......................:............... .............•-----......----•-•---•-•--... ..----••-•.....----------•-•---........._.....
Ow er Address
• y......................••................. --•------------•-----------•----- --•----------------•----••-•--•-----------••-•-"'••---
staller Address
Type of Building, Size Lot............................Sq. f t
�..� Dwelling-No. of Bedrooms........ ••...
--------••-•Expansion Attic ( ) Garbage Grinde
pa-I Other—Type--of Building No. of persons____________________________ Showers — Cafeteria
p•' Other fixtures .--•-•-.••-----•-------•--•-••- •
W Design Flow
---
______-----------
.___.._._'_;.._..__gallons per person per day. Total daily flow_.____._- : ....................gallons.
9 Septic Tank—Liquid capacit3dAV_-+1__ga1lons Length................ Width................. Diameter................ Depth................ 1"
Disposal Trench— jo_ ____________________ Widt. __ Total Length.................__. Total leaching area....................sq. ft.
Seepage Pit No ________ _______ Diameter A6 �pth below 4ilet.__.__ // Total leas ing area..................sq. ft.
Z Other Distribution box (� Dosing ( 7 ` '
Percolation Test Results Performed by___ _. *Tes
.._-_ C s�._A............... Date__ "_."!._y_.��__.:______....
Test Pit No. I________________minutes per inch Depth of _.__._.___.__._..___ Depth to ground water..:.....................
Gz, Test Pit No. 2................minutes per,.inch Depth of Test Pit.................... Depth to ground water.__........................
` 1____ _
O Description of Soil----.._..._�_'_-- '� _j_ :` ... / � ` a
_-••- _ ----------•••••--•--•••••••-•-•-- --•••-•-••..._..-•••• _ .......... }
U ••..._..•••••-•-•••---•-•-•--•---•-•-••••..................••----•--•-•............---------••------....--------------••---------•--•---------._.......................................................
UNature ofARepairs or Alterations—Answer when applicable...............................................................................................
-•------------------------------•---------------------------------------------------•-•-----•---•-•-----•---------------------------••------•------------•-----._.._._:._....._..•-•.._..---•-..........
Agreement: `
The undersigned agrees to install the aforedescribed-Individual Sewage Disposal System in accordance with
the provisions of TILT
p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b s e y, the board of health.
Signed"
Date
Application Approved BY-•- f_. � � y'`�''`sa- F•- -- t '_�._....
Date
Application Disapproved for the following reasons______________________________________________________________________________________•----• .-___._......_..._
.........................•--••-••-•--•••----•----•-••---•._...._....--•-----•-•••-•----•-•-••--•••---•--.--•-•••---•-••--•--•-•-•-••-•----••-••-••-•-------••--•--•-•--•••----•._...••--•-•••---•-------
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
........................................'� •.. ...OF...... t
T rtifirate of Tomplianrr
:Ha TO C TIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by_.,- ....r ..... ------------
7"T -. - .. _....�
t4fler
.......... /-.1
has been installed in accordance with the provisions of T MrIl j of he State Sa ' ary Code as described in the
application for Disposal Works Construction Permit ______________ dated__ ._ _': ��"_�__ •'
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
t kSYSTEIVI WILL FUNCTION SATISFACTORY.
DATE.........................................-••............................................................... Inspector............................................................. ......................
" L, _ ^y511
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THE COMMONWEALTH OF MASSACHUSETTS
'
IN BQARD F HEALTH, �tf
................OF.... ....4"�` y. ... ._...... : ✓
_.. ..r/�s/,---•-. FEE........................
N .
Disposal Works Tonstrnrtion rrmit
Permissionis hereby granted..............................................................................................................................................
to Construct or R7air an In ivi al Sear e Dispb Srtey
at No.. 4VA .�----,/s%u.. "004..._ � ._..... 1. t -t_e lLAtl i.--
�- 9
Street „y
as shown on the application for Disposal Works Construction Perf it No.-.- _. .-�-9__ Dated___���_'./_':2 -.;....�....•..,
Board of Healt}
DATE.__ /�. ! 7 .'
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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CERTIFIED PLOT PLAN
LOCATION !yAesroAls
EDWARD E. KELLEY SCALE ./��-!oo ' DATE Dfc. 6 -'l`78
CUMMAQUID, MACS. " '''
PLAN REFERENCE dE?!vG.. . LoT. . ... . .
PL,41v .3B 973 Q
I CERTIFY THAT THE ..
SHOWN ON THIS PLA TED ON THE GROUND
f EiTitYt '� _•� .
AS SHOWN HERE . AT IT CONFORMS TO THE
7- SETBACK REQ S OF THE TOWN OF
L . . . . WHEN CONSTRUCTED.
DATE . . . .. .
PETITIONER:
/-m.,, p,vs Hilc S,�`'IASS. REGISTERED LAND SURVEYOR
TOP OF FOUNDATION
CONCRETE COVER
. )CONCRETE COVERS
4 CAST IRON 12"MAX. � �� 12"MAX. •
PIPE (OR 4 ORANGEBURG(OR EQUIV.)
` EQUIV.)— MIN. PIPE- MIN. LEACH
' PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT PRECAST .
° LEACHING
o' N VERT °
o EL-gWq- . INVERT INVERT
PIT OR
o , SEPTIC TANK 47�a DIST. EQUIV.
EL...r. . . . . . BOX EL......... ' ; ;s : ��•
, e INVERT /ooa GAL. IN
�B Ww o ;:;; 3/4"T011/2�
EL...?..7... ELq(.z7 INVERT
EL o •� �o o•
WASHED
w �' STONE
'7 0 ...
DIA
PROR LE OF GROUND WATER TABLE
SEWAGE- DISPOSAL . SYSTEM
NO SCAft&DMONARY
SOIL LOG WITNESSED BY :
DATE ;;/78.. TIME 9� .A?`�. P��L M�e�! BOARD OF HEALTH
TEST HOLE I TEST.HOLE 2bfs�� EGl / .�• /�E ENGINEER
ELEV. .So.3S . . . ELEV. S.!>S7 .
E�w,.,e . .. .ems ! V
wmr�.4r� wocDloay
6. DESIGN DATA
S�8-So�c. spa-so�c. NUMBER OF BEDROOMS '3 . . . .
TOTAL ESTIMATED FLOW . . . GALLONS/DAY
BOTTOM LEACHING AREA 78 . . SO.FT. /PIT
7w7- /88,5
� SIDE LEACHING AREA . . . . . . . . . . SO.FT./ PIT
C�.rs.sE ��rzsE _
GARBAGE DISPOSAL ovt/� .. .(50% AREA INCREASE)
TOTAL LEACHING AREA 267°O. SQ.FT
144 / PERCOLATION RATE . . 30 . •. MIN/INCH
LEACHING AREA PER PERCOLATION RATE .:�7O. . SQ.FT.
.No_ .WATER ENCOUNTERED
NUMBER OF LEACHING PITS .tR"T L'Y "V 71VO .
APPROVED . . . . �T o/F`57V-d aN i 44 SiDE� _ 45 L 7D^/ f
. . . . . . . . BOARD OF HEALTH KBLLEY CO.
GF 576 /CEP PiT ENGINES$$--SURVEYORS
DATE. . .
346 LONG POND DRIVE
. . . . . . . . . . . . . . . . . . . . SOUT
AGENT OR INSPECTOR ,
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OF �ss� OF Mass
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PETITIONER