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Home My WebLink About0116 EVERGREEN DRIVE - Health 71 Co �v�� ►�` cx rs. �n t►, ZS LOCATION �v�s�; llfp SEWAGE PER IT NO. PIZ- P I L L_A G E 0ESSOR ..S MAP N0: PARCEL NO.: INSTA l R'S NAME a ADDRESS o ef ef _ //fir a U I L D E R OR OWNER 4 c�f�1Gz-z- A Ail u/.qr- ,0� DATE PERMIT ISSUED � �2 DATE COMPLIANCE ISSUED -3v 2—..........ZIL_ ... THE C.6WM_6NWEALTH-OF_MASSACH USETTS BOA OFHEALTH ... ................................. A _Rh W J ........................................... Appliration for llhipooal Morke Tomitrurtion Frrutit Application is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal System at- LOT#4:�; ( ................................................................................................ ............................. .... ............................................................ Address or Lot N ...g�n ................................ ................................................................. ...... Owner Addre --!�,�----------- ..... .................................. .............. .... . . ........................ Installer Address Type of Building Size LoAE :�49.�_ ..I......S f t Dwelling—4;05o. of Bedrooms..........ell..............................Expansion Attic We) Garbage Grinder A? aOther—Type of Building ............................ No. of persons............................ Showers Cafeteria V-b Otherfixtures ....................................................................................................................................................... Design Flow............... ........._......gallons per person per day. Total daily flow...........4..4_4Z..............j�djons. 9 Septic Tank—Liquid capacityM gallons Length................ Width................ Diameter.--------.--.--. Depth. ........ Disposal Trench—No.....w r:- Width....— Total Length.........-..--Total-.--.-.-=.. otal leaching area....................sq. ft. (.......................... sq ft Seepage Pit No..........7....... Diameter.Jr:V,... Depth below inlet.... ........ Total leaching area.. .... Other Distribution box Dosing tank 7-')A) log 66A�AA Percolation Test Results Performed by........... ........................................i--------------------- Date................... ------------------ Test Pit No. 1.... ._minutes per inch Depth of Test Pit Depth to ground water-MCOO'C7 .... Depth to ground waterl-I------ Test Pit No. 2................minutes per inch Depth of T 4 ;04)4: EV C, �T4 Test Pit..... ................. ....................... ..... ------------- ......s............................................................................. 0 Description of Soil.0_4."....i&ail2P. X.,........ ........� 4 ---------- ...... ---------- ---------------- ..... ...... ............................. .0.... ....................... rp. .............................. --------------------- ------------------................................................................................................................................................................................... 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'iI HE.,- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certifi te of Compliance has been issued by the board of health. Signed....4...1. e............. ...... �........... Date Application Approved By----- ..... ...... ........... ........ ----- I Date Application Disapproved for the following reasons:................................................................................................................ .................................................:....................................................................................................................................................... I Date Permit No.......... 41 (,3....... IssuedL....................................................... ................. .... .. ..... ..... Date THE COMMONWEALTH. OF MASSACHUSETTS jBOAOF HEALTH -!?.W. ...--------4.OF.............t1�.� AV �1'�-' sun for Diuposhl Works Tuntrurtion Prrutit Applicatio <` 4"' made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: f�o ................_.. .............................................................. Lo.T" 5.-.....j.l I v E.................... ------.............•- ° ; gZtion-Address or Lot N�. .......... l L.. .:..:........o v ice,....................................... ..........--------------------------.--------------.--------•----- ---...--•---..... Owner Address a � a ......--.0.5 _1 --------------•-------•-•-----------•. ............. dZ aTv!J S .... �-........................ Installer Address Type of °° mg Size Lot_4�j.Z9__�_.._..Sq. feet Ua Dwells g o, of Bedrooms..._.__.............................Expansion Attie Garbage Grinder 4A) aOther—Type of Building ............................ No. of persons............................ Showers �� — Cafeteria (� Otherfixtures --------------------------------------------------------------------------------------------------------------------------- ------•-------- W Design Flow...............�._.5_................gallons per person per day. Total daily flow..........�.4..Q.........._....gallons. WSeptic Tank—Liquid capacityf.&�.gallons Length................ Width................ Diameter................ Depth_�.......... x Disposal Trench—No. .._..-.--.---- Width...-�-----... Total Length.......-- --"_-"Total leaching area................:...sq. ft. ' Seepage Pit No..........2...... Diameter._._____________ Depth below inlet....&..._........ Total leaching area_6�.3 Z...sq. ft. Z Other Distribution box (>� Dosing tank ( ) 1-' 0 F 'S,-''C 1 U9 6 U A`-/DA/ Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1....Z .....minutes per inch Depth of Test Pit....1.4n......... Depth to ground _� Test Pit No. 2................minutes per inch Depth of Test Pit-----1.4n..._._. Depth to ground water �./i,<_N�...4p . Description of SoilU`.4. �`�/� 11 ..Y... ,�.:�. �'�/ �........................................................ t 6 _ =� �J c-�ctx_ ......... _ . U _ -------------------- -�4-•••..-�......... -•-••--lG- . _ s... 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 TITL1: 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= '" `� //� (�G j t ---•--•----- r !'',• ----- Date Application Approved By........ �-=- ..... � -__• . ............................ ......... Date Application Disapproved for the following reasons---- ------------------------------------------------------------------------•--••-•--•...--•••-•-•••-••••...-- -----------------------------------•--------------•-----.._.......----------------------------------.......-------•--------------------- ------------------------------------------------------------•--- Date Permit No......... ---•----•-- ....... Issued------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS } ' BOARD OF HEALTH �.. ...............................of �ZT�4a3. -.c......................... Tnrtifirate of Touts hatta THIS-IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X or Repaired ( ) by................ , -,1::=Z-------i .,a c.......--•---•-----.............----------..------......------------•----------------....................----......-----------•------...... Installer at.............. ------`-- - .....1.---- r '•�� E --= --------------i 1� r:` .............................................................. has been installed in accordance with the provisions of TImLE of The State Sanitary Code as desFgibed in the application for Disposal Works Construction Permit _�?_.__Lfi'_'...... dated------- �- �/ f t ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE s6 SYSTEM WILL FUNCTION SATISFACTORY. DATE........................... . } =L--7¢`.....---•------••---- Inspector....------. i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s .C�. S. ... ............OF...............? .!J_5-. .�.. ..4..� ............... ----- I• FEE..::_.•.-X 1 ....... %V11pat Works Twunstrurtion unfit Permission is hereby granted--=_11. '•-.�_ :-(.......Z'`1. J-I~�--------------------------------------------------------------------------------•---.---------- to Construct 0<� or Repair ( ) an Individual Sewage Disposal System T , Street as shown on the application for Disposal Works Construction Permit No..................... Dated... ............ / .................. _ 1 Board of Health DATE. FORM 12S HOBBS a WARREN, INC., PUBLISHERS e�� SOIL- L0G N 0 1 SA�,D� 0 N 0✓ 2 SANDY 'P L .A N SITE IoS.3 to 4.3 0p � . ✓ v To P SOIL 2 to 3 'd. 10013-, TOP OF FOUNDATION EL.: - - Ep l- " MAD/_ eti t�� - 1060 E r rr( Co�25E - GoA4Sc _ �3 •1' , r SANt"7 _ + e EL 3 ' ►�Ax 2 GLa �,fLh 98 w r Saao ] i v r JV �0 r< 1 .. \A)I SONt • G° Z M►^� �1,3 ' 6ToNE-5 .o; EL Lod // M/nJ Ca�E✓L. • .` S�ouGS p 4 •` ` .7 IN.EI. Ida EL 104.3 L 103 ' IN.EL. it7Z,7- IN.EI. 10Z EL tot,4� � E � � tee• .� n - �- 2 COVER 1/8 3/8 WAS STONE °. IN.EL.1o3 3 IN.EI. 1�3 I — n 12 ( , l +a L // IN. EL. a1.3 G a o, t r °o 13 o n o T .e 9Z3 . L y• + D/B W/ 6 SUMP ° y ° - --_ 3/4 1 1[2 WASHED STONE - • 4' LIQUID LEVEL ; 6 % %3 f wA E� 14 /IJo�L T�r� baoo�� 6' EFF. DEPTH 7/,3 Ear. 15 •. ° .� 98 . �L. o oo� ; j 6ob �� 4 PERC TEST RESULTS PRECAST SEPTIC TANK WITH P E R C. RATE : Z t./i- � ►� c.►-� h : PRECAST LEACHING PITS CAST IN PLACE INLET AND EL. 3_ NO' : 2 SIZE : � 'EFF aF_PrN WHITNESSED BY : M.2. .'Ot M�K�- � OUTLET T."S PER TITLE SC ( �J,�� . 2' of eo-TO E. . `?_N ?ABLE BOARD OF HEALTH SIZE : t Soo C� aLLat.�s �~ �' DIA . DATE : � 1i31 � y _ D I A �_ s 14 I I r t L - I t a.l3►Zy �' t J Loy,p atk PROFILE OF PROPOSED SEWAGE SYSTEM SYSTEM DESIGNED BY THE TOWN OF � �o�� -v��LEREGULATIONS AND STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4"- Y' 0 "" N . B . _ -, _ rq� _ to 1 ALL PIPES SHALL ' BE SCHEDULE 40 P.V.C. SEWER---PIPE 2. ALL PIPES SHALL BE SLOPED 1/4" PER ' FOOT EXCEPT FOR THE FIRST 2 FEET OUT OF THE D / B WHICH SHALL BE LEVEL t11 3. DESIGN FLOW 4- BEDROOMS AT 110 GALDAY PER BR . 4-40 GAL/DAY � �0` _ SEPTIC TANK SIZE 4 4--.0 ' X 1, 5 = (GyGAL. , USE isoo GAL`. W/o0_ GARBAGE DISPOSAL LEACHING SYSTEM : USE -- L T) >< t- tF1= i?1L E_6AST ��.Ae.4-11►.�G. - - -- � �TD N� EFFECTIVE AREA : SIDE ; 10 Z, - = 41 BOTTOM 'ix ICUL 4 1, o = 1P� A� ,� - 78 ID4n2 ; o :- F 2�� XZ= TOTAL FLOW 549 KZ = 1n9 8 yAzt.�A�/ ( — TOTAL REQ 'D FLOW 44y X 1,0 = 44-`0 W/off GARBAGE DISPOSAL ► o RESERVE FLOW lo9b - 4.4o = 658 GAL/ DAY----------------- L�3 3 �03,, ,0,3 E�Er�c,� �� of L��D REFERENCE PLANS : _ _ n�--o---� tg�. 04 /�x7 E_fL 0�( E TU W E Z1 r 1919 vc_2c,rL�E_►,� iLltl �. -- L oZ B - I_c.?LA,►J 1zo 34%� L.(-. PL�� -�034-V APPROVED BY Ass s o NI _ _ Lds' IZrS _d$� _ - 4 Zo' � o^ a,� s 25__�,� — A2.i�S5`j"A3LE BOARD OF HEALTH stAL) 3Rt.l.. SCALElu . �a 1, DATE : SITE AND SEWAGE IDIAA/ PROPERTY OWNER : �n� i (�,,, s CAS\ALE. � � Ho0D� 41 A•2K w>,�► u F m ¢ FO - G ,� tvt ► L A , \-\ I\�I 2.II r"vt2 S. n v c 4 N� ►� fJ J I M A e -� 4- Q E D 2ooM Si N C Fl .W-f OW r-LA I►a -ID S LOT- 4 5 F.\ F_r1 Gi 2 F_E0 �L Q. lv MA.25Tv�S M1��s ;,. VADJSalee v No 11(0 ) 5g� W 1_L I N tin 1>=Z L 12n AN1 ` 23 5 71 - a g 617- -4?_ . .