HomeMy WebLinkAbout0332 WOODSIDE ROAD - Health 33a l�t�od s e5e -41zcu','�
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LOCATION SEWAGE PERMIT NO.
VILLAGE
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INSTALLER'S NAME i ADDRESS
BUILDER OR OWNER
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED 5-- 2-3-d�9
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THE COMMONWEALTH OF�MASSACHUSETTS
BOARD OF HEALTH
-%�---_................OF.. - ...................................................
Appliration for Bhipoii al Works Tnnitrnrtion runfit
Application is hereby made for a Per to C struct ( Repair ( ) an Individual Sewage Disposal
System at: r1i9 s .�
.......................... ..---.•.••.-----------•.-.--......_.------
. Location-Address
... ...... ,�� -------------------------- .... Gl..... /a c.. .....f... ..........:_g
61 ne �� dress
Installer Address
U Type of Building Size Lot_•44� a� .z______Sq. feet
Dwelling—No. of Bedrooms.............. ........................Expansion Attic ( ) Garbage Grinder (va)
`4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ..................................
W Design Flow.................................... ......gallons per person per day. Total daily flow.................._..7S_3_0_.._...._._gallons.
W x
Septic Tank—Liquid ca acit _f °O_ ailons Length idth--------------" �epth-___---
----------------
Disposal Trench No. ............... Width_-_ Total Length Total leaching area.-" - sq. ft.
Seepage Pit No--_------_--------- Diameter........ -------- Depth below inlet...... ... jotal leaching area_.A44_...sq. ft.
z Other Distribution box ( ) Dosing to k . �,f ,,e -
'~ Percolation Test Res is Performed by..___ �_. 1�!7/.._..!t________________________________ ate._.___ __A.0.
�� e
a Test Pit No. 1_. esS._._minutes per inch Depth of Test Pit___._/��._.___ Depth to ground water........................
q
(i Test Pit No. 2____j4.'...__minutes per inch Depth of Test Pit......1_7..... Depth to ground water______________Al......
-
Description of Soil------------------- 9.eY1.-- 1`r Q "----"----------------- - -----------------------------
x . . Y---••-•-••••___13.Q.. _. . .fin _ _..------. ` '''--------••----•-----•••--•-•-••----
v W ----••----------------------•----•.._...._..•-••••-----------.....-•-•--•---•---•-•---•---•---- -----------------------------•--------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer whf n applicable.•-__"__""".__""."-"_"-"___-•----...--•--"."________________"_"___"-"--------.---_•--•_--------.
• - ---�7,.._.__ _f�...............•- -----.......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of 1 i.�.
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been - sued by the board of.health.
Signea ................................. ................................
ey Date
Application Approved BY ..-•--------•••••---------------------•
Date
Application Disapproved for the following reasons:................................................................................................................
............••--•-•-•--------•-•--•••------•-•-••---••-••--••.....•-••••......••----•----------•--•-...--
---------------- - -- --- ------------------------
Date
PermitNo......................................................... Issued-------•--------•--••---...
Date
N .... ... �" FEB..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.�-
Appliration for Eliivooaf Works Tonotratrtion Virmit
Application is hereby made for a Perm to Cstruct ( Repair ( ) an Individual it
Disposal
System at: /
._.....
a L�•y/ �. J `L ocationl-Address 14�L....---• . T --.. d essOwner
/¢.. /f
�r= ......../..'.Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.........................................-.Expansion Attic ,( ) Garbage Grinder
Other—Type of Building No. of persons............................ Showers — Cafeteria
aI Other fixtures ............................
W Design Flow....................................a--__gallons per person per day. Total daily flow...................3.3................gallons.
WSeptic Tank—Liquid capacity��_.._.__gallons Length---------------- Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width ....... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter..___._�o-------
------------- Depth below inlet._
..... ..�otal aching area. ....sq. ft.
Z Other Distribution box ( ) Dosing t ��/ /�� ��.-� yC- �A /
Percolation Test Res Its Performed by------------------- ..._.............._......._._. ................../Date.._.."a. ./.-�
,_A Test Pit No. 1 _--_T--..minutes per inch Depth of Test Pit----- Depth to ground water........................
GT4 Test Pit No. 2.... ........minutes per inch Depth of Test Pit...... ..�J......... Depth to ground water......................_.
a ---------------------- ,-------•----•-•-- � .1........................
0 — /O q/77 ...g fv S&/
Descriptionof Soil 3..••.•-•--•--------•--•-----------• f------------------ r---------------------------•-------. /.....---•---•-•-------------
U - a wiz erA.cr ' q
------------------------------------ ,� ..•--. •-•---------•••....•--_.....
W --------------------------------------------------------- ................................... ---------------------------------------...............................................................
U Nature of Repairs or Alterations—Answer when applicable.---------------------------------------------------•-------__-_-______--_--___--_--•----_---__.
W ..........................................••-------------••_----•it- ----------------------------___-___________------_---____---------------_----------------------------------------•-
Agreement:
'
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE y g � g p y
of the State Sanitary Code— The undersigned further agrees not to lace the system in.
operation until a Certificate of Compliance has been issued by the board of health.
Signed .. ---------•----------------
ae�'�` -- -•- Date
Application Approved By..... ........ ........................ .
(,F,/� --. ...
Application Disapproved for the following reasons: ...............................
...............:............................................................................................................----....... ..._.. ----------------------•---•-•------.-------------••--•---
Date
PermitNo......................................................... Issued_.......................................................
Date
ti
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................OF......
dL.v yinyl���r ...........................................
Trzfifiratr of ToutpfiFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( `or Repairedby........:9. �,
( )
.. Y...__ .............. ......._._. ...._._._........--
Installer t
at•-•-•--•...... -:34)......c�'t,� -•----•-------� . . .............. -
has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as descri ed in the
application for Disposal Works Construction Permit N ._ Q
Jam._ .......... dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHA LBE CSTRIBE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. g
DATE ••---•---•--•--..........5:.. ..2 3-
...............•-•----•-------------... Inspector---- ----- •- -- ........................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
, ....................O F..
No--- .� �'"�►`� ---•---......... FEE........................
Ropoottl orko %ono#r ion rruti#
Permission i hereby granted._cvv� �----------------------------•-----------------------------------... .........
to Construct or Repair ( �) an Individual Sewage Disposal System
`^ter..- _ ., ,.' .F'•� ..................... -4.r- - -------••-------•-----••-•--•---....
as shown on'the application for Disposal Works Construction Permit No--------
--- ___ Dated__________________________•------.-._----
--------•- --- = lC %�
DATE. — .................................. d of Health
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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• � EXii°fING xSPOT ELE ATION 0.0 . .' CERTIFIED PL, T`
EXISTING CONTOUR - - - .._
FINISHED • SPOT ELEVATION l0.-01 ,. rJ1l
FINISHED 'CONTOUR - 0 --' M� RZ57_0A45
APPROVED • BOARD ( N 5 JYy
R OF HEALTH. a\
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b bATE AGENT---- _ _ _ - - SCALE : /'"-,SOS DATE V
7=7RE®GE ENGINEERING COINN. --- - -- ---- _ =r�� �
.r CLIENT
I CERTIFY THAT 1 HE `pRQpO�Eb° {
EGISTEREC REGISTERED) JOB NO. _50009 BUILDING SHOWN .ON,,, THI'Sti`f►
CIVIL LAND CONFORMS `TO THE ZOAIINGA1P9st
ENGINEER SURVEYOR DR. 8Y 1 .�• h,. TTi rf}q
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OF BARNST B AA =A
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33; NC' MAIN ST 712 MAIN �T CH. BY R�.Ps_ _'
L;,S6 '-YARMOI�H� AAS,. �HIANNI_,t �IMIA Z.
SHEET 1._ OF qDATE R G.; LAND ' SUR�b i_
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20-F'T IWIIV. EITHER THE SEPTIC T.�1N/< OR
.PIT ARE, MORE Tf,N_s9J✓`/2.• .�ELDd't/
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ti `.• i SHALL �� S.F®UCoV7" 7•'0 C�J�AOE �,�/✓ EXTRA
" CONCRETE i •,PVC P/PE JDERVy C/9 S PeCIV CO(/ER Sf/.44L LSE USE10
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LIQUID LEI/EL
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IN✓ERT AT &U/LD/NG 9 6 .O JET
/Nb�ET SEPTIC TANFC �` 5- FT _l P_FT. 91AM C SEE T.gt�ULATJON>
OUTLET .SEPTIC TANJ,< FT- 1
INLET D/STR/.5UTIO/d BOX APT. SECT/O/V 4F GROUND 'W,4TER' TABLE
OOTLETD/STR/®!!T/ON BOX 94.2- F7.
/A/LET LEACH/NG PIT �3, 'FT SE1�0/AlCase .D/.S�®S�I .L .SY�.STE/�9
' -- L�i4Cf�//V� PIT Tiq�ULATlDN
_. �a = /,-o,. UJMENS/ON A FT.
_DES/6N CRIT.FR/R SCALE Q/HEMS/ON $ FT.
/V AMBER D/HENS/ON C_ /'
GAR45AG.EO/SPOSAL UN/r_ _- S®/L. LOG S�/L TEST
TaTAL EST/NIATEU FLOW �GAL.�DA�' SOIL TEST #/ SOIL TESTg�2
/i/Q/MBER OF :EAGHlNGr ,v/TS_ !-`ELEV, to y 0 /"ELE1�-6. ,OAT OF SOIL TEST . Zy � Z�
SIOF LEACH/NG PEK P/T 1 -SQ, FT. Ir 1j - 3 -I` O - 3 / RESULTS *V.17-NESSED BY L1'�_�vN/A--I-S
BCUTYpM LEACH/NG PER PIT Sq. FT. LaA i►'► 4-0 A--'011.7 RATE A�/ L.CSS /rj/N�/NCH
TOTAC.'LEACH//YG AREA ESQ. FT. $V 4- J-u19S0/L- PE/eCOLfeTION RATE 02 THAN MJN.�lNCH:
RESERVE LEACN//VG AREA;_h.C�SQ. FT. • O
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