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HomeMy WebLinkAbout0019 GOLDENROD LANE - Health 1 ezoA&n1.-.c� . LOCATION SEWAGE PERMIT 00. VILLAGE I N S T A LLER'S NAME b ADDRESS BUILDER OR OWNER Wt N► ci ery i ^` y �/�/f1 .ems 4 C '�. r D ATE PEItMIT I S S U E 0 y r DATE C01APLIANCE ISSUEDL Ilu �C`� No.........G` 2.2,0 ~� , �a FE .... .... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH p V0/1l...........................................OF........... o . Applirtation for Bi-gniial 10ork,5 Tonvitrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at•/ D^ n --• .. a ...1.-�--•t-9-1i-1-�_..�. f .... .. � ...:. :C? o .- _...........................................� Loca Add rNo ........... ¢ti... Owner + f7T.... Address .-.-••• ........V -_------ Install er Address d feet Type of Building Size Lot___________________________S q. V Dwelling—No. of Bedrooms............... .........................Expansion Attic (NO) Garbage Grinder (1VO) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) G" Other fixtures .•-----••---•-----•-------- W Design Flow...........5_5-------------------------gallons per person per day. Total daily flow.._..._....._�_�Q._..............`:�lobs. WSeptic Tank—Liquid capacity.1 .gallons Length__9.-.6.-•-. WidthA..I®�-. Diameter----_—....... Depth__Z .&....._. x Disposal Trench—No........�.......... Width....`............... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...........I--------- Diameter.._...'.......... Depth below inlet...(P.............. Total leaching area...©. .-sq. ft. Z Other Distribution box (✓f Dosing tank ( ) '~ Percolation Test Result Performed by...._.:_�_.. ..._N\je_...... __A � ?-Date....... . ._�_ % ......� i--------- aTest Pit No. 1... ._. _minutes per inch Depth of Test Pit...... ........ Depth to ground water..�."?L,1S� Test Pit No. 2................minutes per inch Depth of Test Pit.,................... Depth to ground water........................ a ................................ p4p___••____---------- _.................... Description of Soil..........®-----?............. - ? ......... f----Gj�2-�..._... x U -----------------•----------------------------------••---•-----------------------•------------•-•-•---...---------•--------•--•--------.--------------------------------•---•-------•-•-----•---- --------------------------------------------------------------------------------------------------------- -----------------------------•------------------------------------------------._...--•-----•-- 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 TITTLE 5 of the State Sanitary Code— �he undersigned further agrees not to place the system in operation until a Certificate of Compliance has b1A.4 sued the bo d of healt Signed..... .... . ..---.... .. .. ... •------•------.....-- .......................... Date Application Approved By...... '.Jq• •' /¢—'C Date Application Disapproved for the following reasons:.............................................------•---------------------------------------------._............ -•..........--•--•--•---•..............•--•--•-•--•--•-•-•----------•------------•-----•-••-------------.._.....---------------------•-•------•------•----------------•--------------•-••-•-••----•...... Date PermitNo......................................................... Issued....................................................... Date } THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � Appliration for Disposal Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -_--. q a� �p©.---...•--I� C................... -----------..07�...---................_..............._...------. .....___----- ----. • { Loci, ddr Lot No. ....D. at es or .�YIYiR t t i... ........ Q ' ......_1.� ' .. "Ca ?.1 . .�L a.......� ..�.....:7.�. 4.It� ' Owner Address a '`�lt.....!._.......t./..l -�-------------------------------------------------- -----------------------------------•-....... ._...---------------------................. Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms................-`+.........................Expansion Attic (NO) Garbage Grinder (Nt) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fix res ......................... •••••- Design Flow__________ ____________________________ __gallons per person r da . Total it w.............. s-c)..................gal�o G4 Septic Tank—Liquid capac y_.___.______gallons Length__ __.......... Width__9.....___... Diameter-----........ Depth.__._______._.. W Disposal Trench—No_ ________ _________ Width.... Total Total Length._______..____._.. Total leaching area....................sq. ft. x Seepage Pit No-----------)---______ Diameter___._.0......... Depth below inlet... ............. Total leaching area....49._o.sq. ft. Z Other Distribution box (✓f Dosing to ( ) Percolation Test Result n Performed by........ ........... e...__.... t�ate_.______J _"fit'°' ! _........ ,aa Test Pit No. 1_._.__._.Z`.minutes per inch Depth of Test Pit._.___0 ________ Depth to ground water_.b!�t(Z . Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' •-•••-•--•-•-•••-------• ...............' •... ' .............. i----- ...........--------- ........................w O Description of Soil..._.._...Q_�--•-•--•-••••.p.ortt ..-----r�--tt Shi ' �� ------... .........................cvaITV 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 TITL% 5 of the State Sanitary Code— 7he undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ssued the bo d of ealth f Signed •. `•-------•- D to Application Approved`'B - � ��A''. "` =y ------------ --------- Date Application Disapproved for the following reasons:------•----------------------•-----------------------------------------------------•--••••......-•.._........._ -•-----------•.............•---------•---....----------------...----------••-----•---------....----------I-••----•••-•••--•••----•--•----•••--•••-•--•----------•-••-----•-----•-•---••--••••--•--••-•--- Date. PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ..�... BOARD OQFF HEALTH ......CD. J..................OF.............is�_:.�+7 P Vrf� .�-_I" (... ..-..................... Qlatif irtar of ToutpliFaurr THIS 1 TO c17RTIFY, That the Individual Sewage Disposal System constructed (V'(Or Repaired ( ) by................. _... .o... 1---------...........------..--------------.....----------,--....-----------.............----.....--------.....-----.._..------------ I aver 1 ( +a 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----- ......... dated................................................ x THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................... •/ V....L------- Inspector......................_-.j��1 '............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH �a c� ....................OF..............:..:....._...1 ................................ "__• °°f No._........ � FEE........................ UisposXl Workii noir ion rrntit Permission i hereb ranted_.... O-.. f..t..------.A fZ� �' Y g to Constr ct (s ) or Repair ( a Individual Sewage Disposal System ,J p at No._•-••�Q ..........M b 01: CZ.C�'Y�.........A. tMV�`--------------------------------------------•--•--------•----------•-----.........---•-- --- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Boar of ealth DATE..................................U• J1A---------------•- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 6tW6LZ-. FAMILY( - 3 BGOczooM I F.Jo GAQBAGE 6f2A?JDs2- — c�AIL.r 94' 5EPT1G TANK = 330x15cl-%--4956.P. P USE loo0 6AL. 015Po5AL Prr U51~ 1000 GAL. Zo, c, �o SQ. FT. 5 I DEh/ALL AP-S,& = 15a 6.1= } BOTTOM ATLEA= jO S.F. 5o S.F x I. o - 5 o 6-P o j -ToTAl-• DESIGN - 42-� &PD / Q ^ -TOTAL DA I LI,( FI.-Ova! = 330 6,Pm 1' PE2CoLATIDt� RATE: 1��1N 2MIN oR.L�55 � ' J= _ ��.ui.A;- fie, GX P. I t '_ .'�•' - s WILLIA IV y• �. /� � Mo t9�39• � N ;�i � - � � II TOP FNO=CZ.oo ' /� /� /•/�I �G i� ��.�Y. �/� /� ^ _ IifV.S9,00' :. \OAM d loov INJ. ;t sut so��. DIST. 1►J�. GL1l . 58.70 . bB.�Q .�iEVTIG �` g9 p 1000 INS TANK GAL. S7. i PIT INV..-. INV. WITu 5'7.90 5g�10 SAN DY i'/3/9•I�i (�RP.V I:L VJASN>isD + i Tel . . .. . ! STONE . . .. . �. G�R.TIFICD PLOT PLAID < PROFILE L0C4710o J MA25TOK 5 MIL.L 6 NO 5CALE SCALE _ DAT I I N � F T 1= /Z-t/e No WATEQ ;•,. I o/9 1 so Q L p.t�l R 1=F V, zsN GE 1 CEt•?T►FY THAT TNEpRopF'cVn1�ATtoySti-IoWN NEREo►.1 GoMPL.�(5 WITN-CME SIOEuN� LC) g . i A1.iD SETtGK 2EQV►u.)rME.N15 oF -t>rl�- PL FOR M•IC-HAEL. -TOWN O�pARNST/�$LE AND l NOT (j LO -A-TED WITNIW 'G\-odD PLAIN ACTED • �E • Csa, 19`l� DATE 4 ��• "�2-- C - -•.-• _ .. i BAXT E cz a t�•J Y E I N C. I' TIl15 PL&KI 1 y NaT BASED ob ti REGIS-Tf-l-2E•U'LAW0SuiZ-VE�(oeS IWSTR.uMr--W-V 5VeVE�-Y ��'rNF_ 0r- F--T5 So0U1_'D d3TE2.VILL� MA55. II NaT [: 1, V�C.DTb pEl"G2 1►�E L-aT' \-11.1E,j APPL.IGANT •�'' +