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HomeMy WebLinkAbout0080 LONG POND ROAD - Health ql )l� L_� LOCATION, SEWAGE PERMIT NO. .a, c� 6 f VILLAGE INSTA LLER'S NAME i A-DDRESS L� _ �J 4�f��:i� ��i Y1 .ice•6�4 - BUILDER OR OWNER DATE PERMIT ISSUED w� _ F . DATE COMPLIANCE ISSUED' ����� �=� '�� �: _,: r�'-' p I �,o` .�'s I �^ � a���^ �'� I � •� �� � . � .� i �� -� �=:, : . y � �� �. 1 �� �� � �' �' THE COMMONWEALTH OF MASSACHUSETTS O)q O BOARD OF HEALTH 7. �.�--.---......0F....... , 9. - ................... Applira#ion for Uhnpoii al Works Tnnstrurtinn Vrrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: .... __. - ........_. lei ,P.S� MiL��' f •--•- -•---••••--••••-••••..........-•-•---•••--or. t ... ..... Location-Address � Lot No. /ft�1> P—U6S4tF Gi� Mt'Z�� 1 Owner Address ........................••-•-----• � f+40 InstallerAddre ss-�--• _ Pp �-- - U Type of Building Size Lot._ ®_ _ ..Sq. feet_' Dwelling—No. of Bedrooms............................................Expansion Attic. ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .----•----------•-------------------•-••---•----------•--••-------••-••----------•------•----•--......••-•-------- W Design Flow............_`"-5......................gallons per person per day. Total daily flow................... ........................_ gallons. WSeptic Tank—Liquid capacitylPP j gallons Length........... Width..... ---�_.._ Diameter................ Depth...../.�..... x Disposal Trench—No..................... Width.................... Total Length............_ Total.leaching area................._..sq. ft. Seepage Pit No---------I......... Diameter....�_d!.Jf Depth below inlet......�..�..... Total leachingarea,,4-��_ '.sq-ft.C,�•� Z Other Distribution box (Dy Dosing tank ( ), '-' Date Percolation Test Results Performed b '17 ..._ - 1� �� = Test Pit No. 1...../........minute&per inch Depth of Test Pit:__ ----- Depth to ground water A)0_-71•�.-. Co&I AJ fs, Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ ODescription of Soil............j��AF-_G_....... ----•------------••--•------------------------------ ------------------- ------------------•------•-•-- x 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 TITL% 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. ApplicationApproved BY----------•-•--•----------- .-----•-••--•---------•----•--•-----------•---...----•--•------- ---- ------------------�=�•--- D e Application Disapproved for he flowing reasons: ---•-------•-------•-------••------------------------------•---------------••-------.._...•----............_ ••-•--•••-••----..--•-•---•-••-----••-•••---•-•••••-----•---...-•----•----...•------•-•-----•--•----...•.•-••-•-•.............•-•----•---•••-•-----•---•--•--•-------•---------•-•--•-•••------••------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS CP BOARD OF HEALTH s> hA, Owrriifiratr of Tomplinnrr 5TI9 IS CE Y�, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by.... ....... .. . .. •--------- --------- ---- -- ----- ---- ------ -------•--------- I aver at•------••---•._-•....... ......................... ...........................••--•---------•••----•.....---••-------._...__.....-•------------•-•-•••. has teen installed in accordan h the provisions of"yy� 5 of The State Sanitary Co, � s d//c��ribed in the application for Disposal ��Vor onstruction Permit No.. .eZ ............. dated._;T �� _.J-�.._.__.._.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................................---VZ,.1 --•------------- Inspector.......X-1.I '.......................................................... No.�3�, --- �F�s.... ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH '�..'�J..........._O F...... Appliration for Disposal Works Tontrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: • ...... ....................... ........ ...... Locat' n-A dress-. or Lot No. t • . Oe Owner Address w t�• � G0tU(S/{.... " .................................... r Installer Address 1 `/•j s UType of Building Size Lot_:-�Zllt _ ..Sq. feet:". �., Dwelling—No. of Bedrooms..........._ ' ...............::.........Expansion Attic ( ) Garbage Grinder ) a s...................... . . Showers a Other—Type- of Building ....__.. ...._...... No of person _ ( ) — Cafeteria ( ) Other fixtures - - ----------------------------- -. n---- ------------------ Design Flow...... . 3 .. _gallons per, peraTotaldailyfow � .W gallons WSeptic Tank—Liquid capacity/, "4o-.gallons Length....9'_#._.. Width....' r... Diameter_,.'._......,.._: Depth .. x p Disosal Trench—No.................... Width.................... Total Length.................. Total leaching area......................sq ft. Seepage Pit No........./.......... Diameter.._®?V. Depth below inlet.....:.......... Total.leaching area4_Z4.� .sq*-ft z Other Distribution box (1 .) Dosin tank ( ), aPercolation Test Results Performed by Q� L. .. .rA1�!.l.. ! --- Date. ..-...--... Test Pit No. 1....f........minutes per inch Depth of Test Pit ...... Depth to ground water"t"_' ". Gz, Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground-wat .............. -------- ----- ; O Description of Soil..........._ s ._.. - . ---------------------------------•----..---.-------- x - V ......------•-----•------•-•--------...-•.............•--------•••••------•---------•--•--------•---------•-----•--------•---......-----------------•---••-------------.--=-- W . ---,. U Nature of Repairs or Alterations—Answer when applicable....... = � { Agreement: y t ,. � rr The undersigned agrees to install the aforw'described Individual Sewage Disposal.System in accordance with the provisions of TITIL- 5 of the State=Shtaita Fy 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. lthe�jollowing, r + Date Application Approved BY = . r ... .................. D 1 Application Disapproved f reasons: �? ---------------------------•----------------------..---------•-------------------•----------.----------•----•---- ..........................••-------.....--•----•-•--.....---•--------------------.......-----.....------------------•--••---------=---•-=----•--------•---------- ................................ Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................O F..................................... ......................... ................................................ Trrtifiratr of from fi nr�e , IhcSfO CEl FY, That the Individual Sewage Disposal System constructed ( ' or Repaired ( ) bY- [. .... . f . .........._.-............... ------. --------------- ------------------------- ----------------------------- ............... at........ ..........� . r nstauer • -------------------------------------•--------------------------------.......----- --- has been installed in accorda rth the provisions of T 5 0 The State Sanitary ?Cd as scribed in the application for Disposal Wor onstruction Permit No..........`.A1.?hZ.............. dated- . .......................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................� llo-----......-•-•• Inspector...........�...1a ' --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. ....................OF................. .d ....... FEET .................. �i��o �t1 rk� r�n�trnrtion rrmit ��:., • y`<�t Permission i reby granted. ...... ............................................... ............................ to Construet� ) or Re air ( ),�ndivlr�' 1 Se age isposal System atNo.. .` ..... _.... . : .........-------- --------------------•--- •----....------------------ ---- Street as shown on the a pli tion for is sal Works Construction Permit No.. --------- ate (� B,ard of Health DATE.--------- b ................................................. FORM 1255 A. M. SULKIN, INC., BOSTON 1 - Bax n-- EXT&A-1D AL L H ,oPL/Cf3 BL r- e X 5finc� c�rocJrra F,-oF ' ' e —o -- --- propose groun �ro f-�'Oerz SOLE .. o' S E C T' IJ LE O, MANHOL e COVERS TO :nJ/TN/ V o—o Ai 15 S C H E D. 4 O 0 V C. O,e - - --- F L O L.J --- --- EGQuf3L `� SEPT.%C c o� /B„ �2 c�as�eu Sfo� \ �min�rnurn �, fir- • ' DiST BOX , ° ° o f /4 /� y /000 GAL. SEPT/C Tfa�_'K � ° • i wa 5 he d Sf one LE 1 D - ral- 42 4 :.. R & 41 �FaN' _ — TEST 14aL / 7-E 5 H 6.. Id, \ .T GaF; �5E r -1v L .5/+AJ E,E'T f F Y T/--/AT -'-H E B u/C. D r ti/ F'�OPOSE P ON THEC- Sf/ OGti'/V -TH, S F'L. F?JA! DOF S �0.2 : • C.n�/FO,E'M '-O Tf-/E 5U1L')/A/G SET- BO�CK APE- aL/i 'E=/`'7E:/`ITS O,r-7 THE ESN OF MA4p 4dy SCr9LE yS SHOtn/ �V' DRT� 1' or EYEREr H. or Argsr HINCKLEY ON"H9iVCK�,EY v; � - O O O le v a t r o n r f3 ,9 C / ;�. ,-`" Y ,� /` c c J T f-l '1 F� S S. 0 00 - Pr oPoSed ei� vatron �E ,eE / 1e &./-r5 ' ex /s ror, fours �c de = /5 �?�'a,20 /E D -- --- a -- Pr-o/vOSE'd 0r) f0ur'S _- �- - F_3 0 ,4 A2E O NE �QL TH - y T of FvuN 1J157-. - C!8 —+ 44 — i y--- 42 t70 "�- fix ` 4 5: Z l/ i�1 D1� -a 45. 4b wras. E > .57'0I../45 4:5,75 'A O TE EXTE"tiJD RL L R 1-LPL/G�9 BL.E - - - ---- e xrs-ftin,� gr-ounc� pl-of'/ /e - " ' ---_ O &J—o — PrpPoSC G�roc�nrFror COVERS -'-o l�l/T H; lJ o—o—o 12'" OF F /tir5HEi G �eAC E . EOUf�L SEPTIC 2 vt �e -- �2 c�asf�ed s/one n i rnurn r�" per ¢'o of� CAl e ° o T T °0 D/5T BOX 0 2,o-1c 31,4 /;/Z, i TT wa sM faS- e d sf o ne . LJ Al O L E:7 L O G ' ve' ', 5� D,014, D T� S H S6—: T C T,-9A-1 � TEST HOLE! T OLE #c~' o , el) \�/.� Q ��i •' �8. / S. F r - 3�`� C� P D. w� - C�' o'r ro�-� —/ lce,)VEL �..-- 40, l Q / G E,E'T/F Y T/•-1 AT r H E B U/L D/�./G � Tc '- S C� FP, ?0P05E•LD OA.J THE- G��UAJD f4c $H O !�/ / O nJ r H/ S f-'L R n/ LD O ES n_ ' ��`T �:' 4 - -- r (-7,,J :�` O CD,'�' ���f F'Iq� • CONFO.el"1 TO THE BU/LD/A/G SET- LDJG Bf�CK r2EQv/�'EME�/TS OP' T-f-HE TOInJN OF ► ; Ot.1�> C_ 5 �RA2EZD F'O,e: , / Gr`lH �eL 4c- 1 v�N 0 ASS E1/ERE�T H.. ScF3LE RS SNOwA1 OF o� �J, -- WNCKi.EX a �E JI S`c ti .. 4�2 g /3 No, 1787 EVE'EI H.�. .' HiNCKLEY - f L/V E L L E— O 0O ✓a-r/on BLDG SETBfgC,� v�,�"ET': }�R /� /"I c� U7- ,OL / SS- O © O Proposes` e %� ✓Gti0n �2E C?U/A2E ME A-/7-5 o n-f' - 3 0_ ¢'-t -- -- - -- - — PAC /Str n Con fOUrS s