HomeMy WebLinkAbout0019 YEARLING LANE - Health �Cac Lar �
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VILLAGEC ASSESS R'S MAP & LOT _—
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY \S o
LEACHING;FACILITY:(type) �NpiL, 6 (size)
NO. OF BEDROOMS PRIVATE WELL OR BLIC WAT�
BUILDER OR OWNER L �p �,� S C)
DATE PERMIT ISSUED:DATE .COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS `✓
BOAR® OF HEALTH
...... .......OF........ :N.:..
Appliratiou for Disposal Works T000trur#ion Frrmit
Application is hereby made for a Permit to Construct ('-') Or Repair ( ) an Individual Sewage Disposal
System at:
VV
Location- dredre ss or Lot No.
s L 2 j _
Ow e Ad rd ess
2�
� Installer Address
Type of Building Size Lot__ 5727
,�-----------------Sq. feeta�e
Dwelling—No. of Bedrooms............................................Expansion Attic.{ Garbage Grinder-—7
Other—T e of Building �.. g............... 1
a —Type g .._(_...._r...........:. No. of persons......_..__.. Showers (�= Cafeteria�j
04 Other fixtures -----•--------------------------------------------------------------------------------------------------------.--
w Design Flow.........................`-�.._.�....__.gallons per person per day. Total daily flow____.._...._4 4.�__.....__.___.__..gallons.
WSeptic Tank—Liquid'capacity��P_. .?gallons Length__?.-._.''._ Width..._._..... Diameter................ Depth. ?-
x
Disposal Trench—No......I............. Width._.L®......... Total Length...; ...... Total leaching area.._.9 a`;---sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet..._................ Total leaching area..................sq. ft.
z Other Distribution box ( ✓j Dosing tank_(-�
'-' 21
Percolation Test Results Performed by.... .................
� �� _-
- --- Date------ —-----------
Test
a Pit No. 1----- minutes per inch Depth of Test Depth to ground water...... _ ._.. _J___
Li. Test Pit No. 2....�...z:-minutes per inch Depth of Test Pit..1--- .... Depth to ground water.......
�bt
a _
O Description of Soil------. i- "''' -�@.---��- ---5r � �'�°).0-- --- -- ,-
x
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 TITLE 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 bo d of health.
Signed----- --- ----- ...........................................................
to
App icatic Approved BY ..................................
...................
' Date
Appli 'ion Disapproved for the f oll g reasons--------------------------------'----•-----------------------..................................................
Date
PermitNo........................................................ Issued.......................................................
Date
��- 5 66 a j .........._No. .................. Fss:..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......T`.� `''........�........OF........Z��.'fl: .....'.��..........................
Allp iratinn for Rnpnsal Workii Tong rnrtinn ramit
Application is hereby made for a Permit to Construct or Repair ( } an Individual Sewage Disposal
System at: y
Location.Address -� F ?> or Tot No r
r `
..... .ac_.....c..�`.�..�.�. /..�-.._._..--..5..`-------------'-.--•----------------�a --^-----.L-..-_ ... ...... /.:5...._....- ...
Owner Address
W /� ..........................................................
Installer Address
UType of Building ,rt Size Lot ....2��`. ... ....Sq. feet_La�V re
Dwelling—No. of Bedrooms.......... ---t------------------------------Expansion Attic- `R) Garbage Grinder"("")
PL,4 Other—T e of Building . ... No. of persons........�?............... Showers — Cafeteri
QI Other fixtures .....
W Design Flow........................ .`- ........gallons per person per day. Total daily flow..........440......_............gallons.
. ,,
WSeptic Tank—Liquid capacity/� .`?.gallons Length":"._....'... Width._' ._._.._... Diameter________________ Depth____._..._.__..
x Disposal Trench—No. ...1.............. Width__(. _.......... Total Length.. ........... Total leaching area...:0 4....sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (' Dosing tank-(—)-
Percolation Test Results Performed by..............................................' �........................ Date_.... .......7 ..................
Test Pit. No. 1..................minutes per inch Depth of Test Pit_ _.5�--____- Depth to ground water--------_--._.......
1
Test Pit No. 2.... ?--minutes per inch Depth of Test Pit_ _.l:_ _.._... Depth to ground water._.__
O Description of Soil `` .•=• ' '• -= = - 7 -•`... r , _`.. =�I� 4"
------------------- ------
.------------------------------------------------------------------------------------------------------------•-----------------------------------------------------------------....---------•-•'-----.
w
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
---------------------------•---.....--•---•-------•-------•---------------•------------•-•--..................--------------------------------•---------------------------------------.................
Agreement:
The undersigned agrees to install the aforedescribed_i,Individual Sewage Disposal System in accordance with
the provisions of TITLE: 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. {
e �e
Signed............. •............... .......... ..........._.....
'00 �-f' - ate
APPlicati Approved BY '. - =- -m- �-
/ Date
Appl• ion Disapproved for the f olfo ing reasons:----------------------------------------•------...._.....-----•------------...-•------------------•--.......--'-
----------------••-•----•--.----.--•------------------------------------------.--.-------------•-•----•----------------------------•----------------------------------------------••-------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. ..`.-'.'" .`'... OF.....................................................................................,
(9rdif irFair of TnntpfiFanrr
THIS IS T9 CERTIFY,,_That the Individual Sewage Disposal System constructed (l, or Repaired ( )
by................................... .............................•----^ n
.........:--' Installer-----........................................_.........._..._._...._....................__...
/ /, l s
at �C> 7'" / f 4i..• o' s.; ..�a Via .{ r cpy .r d j j� _.As v
.._..__.._
has been installed in accordance with the provisions of T 5 of he State Sanitary Code as described in the
application for Disposal Works Construction Permit No.. ._ � .._.__... dated---...y......�.Z_-__>._t................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................�.. "� = ................................. Inspector..-----........----- ► ............................................
� �- THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF_-HEALTH
5C
NW...................... � FEE.....1
Eliapoo a1 Endo Twnns#rnr#inn rrntif
Permission is hpreby granted.... - -
to Constru t ( or 4epair ( ) an Indi idual/Sewage Disposal System -7
at No 7 r
Street kkr' -^ i
as shown on the application for Disposal Works Construction Permit Nd.I_._ j.(3.._ Dated........ . .....7.6....4...
n U—
i^ Board of Health
DATE.................... L/-- .'
FORM 1255 A. M. SULKIN. INC., BOSTON
i
1'ei rii t Number : Uatc:
Completed by e
HIGH GROUND-WATER LEVEL COMPUTATION
Site Location: Lot No.
4— / Address: /
Owner: __ :<, i ,,;
Contractor: Address:
Notes:
STEP 1 Measure depth to water table
to nearest 1/10 ft. G /2q/8� 12,
date
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
s i to and deterin nne:
S
A) index well . . . . . . . . . . . .
B) Water-level range zone . . . . . . . . . . . .
STEP 3 Using monthly report"Current
Water Resources Conditions"
determine current depth to S�-J
water level for index well 6 / ��'
mo yr
STEP 4 Using Table of Water-level
Adjustments for index well
(STEP 2A) , current d&pth to
water level for index well
(STEP 3) , and water-level _
zone (STEP 2B) determine 4 J
water-l.evel adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
STEP 5 Estinate depth to high water
by subtracting the water-
level adjustment (STEP 4)
from measured depth to water �..3
level at site (STEP 1 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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