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Home My WebLink About0005 SHADY LANE - Health 2.(�a- tad No. � 0 Fxs THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....7 .......OF........ /.c��✓ t .T�/ �... ... Appl ration for Disp.aiial Works Tonstrn.rttnn Famit Application is hereby made for a Permit.to Construct (W✓) or Repair ( ) an Individual Sewage Disposal System at: n-Address ...or. Lot No. ......._.. __ .................................. ......................... - eT cg Address W .......................... Installer Address 7- mad UOP12 Type of Building Size Lot_::-.._ ___. ..Sq. feet U Dwelling—No. of Bedrooms.............. .....Expansion Attic (, �) Garbage Grinder ( ) `4 Other—T e of Buildin �< a yP g _I&S�a1�4 -K-------. No. of ersons---------------------------- Showers — Cafeteria P4Other fixtures ---------------•----------------------------•-----------••--•....--•-•--•---------•-•-----••------•-••........__...-- ......---- Design Flow........... .......................gallons per person per day. Total daily flow...........P.-2_P?.Q...................gallons. W Septic Tank—Liquid capacityfUUOgallons Length.,,T` .6'-�"Width..z/'lD`Diameter__- Depth_.,5__--F_.. x Disposal Trench—No..................... Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No......f_.____-__-- Diameter../&7_.._..... Depth below inlet___ :.4.. Total leaching area..Z.,10'.97sq. ft. Z Other Distribution box (4-1 Dosing tank ( ) aPercolation Test Results Performed ...... Test Pit No. 1.:4...a2_.minutes per inch Depth of Test Pit..... ..... Depth to ground water.._ll�. 44 Test Pit No. 2_,.-_'..Z..minutes per inch Depth of Test Pit...... ...... Depth to ground a' .TCS T---1°/T ` ........................................................... e s.7`_!1'!._T._`.. ................... 0 Description of Soil..... �1- _J0.0.. _n -91?2...................................................................................................-•-•----••-•----•---•--....1_a• .3Ic Syr �,as�s� 2S owe.................. ........./. ZU /yy- 1 ,Q - o �J'e si9ri0 •--•---•-•----- .............. 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 U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued by the board of health. Signed. ...................../ .... = ----------_--_--.- c 7 .. 3------ - Date ApplicationApproved By..............•--•--•-•--•------.....--•--•............-----=-•-...........---...-----------_--- ........................................ Date Application Disapproved for the following reasons-----------------------••---••-•---------------------------------------------.....---------------------........-- .................•--•-----.................--------•---•-----------------••-•-------••-•---------........-•-._......._...--------------•----••....----•----------------•--•---------------•---.......... Date PermitNo......................................................... Issued_....................................................... Date 'ems • ` No...`.,>.'.r� _0„ Fss.. ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......o F........... ..----- Appliration for Disposal Works Tonstrnrtion frrmit Application is hereby made for a Permit to Construct (y) or Repair ( ) an Individual Sewage. Disposal System at: ......a- _-a S �. .'..........., ....................... .. ... ........................... Location-Address or Lot No. .... :..... .......................................... ------------...................................................................................... ✓ w er Address "_ .....'•....................................................._ a Installer Address Q iC. Q Type of Building Size Lot.. ::__. .:. -Sq. feet V Dwelling—No. of Bedrooms................��_........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons........•................... Showers — Cafeteria a � Other fixtures ............................---•----------------------.._......----------------------------------•-----------------------..._.....---.......--------- W Design Flow.......... ... gallons gallons per person per ay. Total daily ow#01 .._..._...-�2 ... ............gallons. WSeptic Tank—Liquid capacity�-.--.---gallons Length.............. Width.. `.:... Diameter___ _........._ Depth.u'�"__ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------- ........... Diameter./op......... Depth below inlet___+. .____ Total leaching area..,l.-.?J!7:sq. ft. z Other Distribution box Dosing tank ( ) �6 Percolation Test Results � Performed bye:�'�b�U._....�r_._,�"f�l±�:....................�!�+�/1�ate�.,��at��..� ate... a . Test Pit No. 1�._.._�--.3____mmutes per inch Depth of'Test Pit.....�._r�______..__ Depth to ground water.._,lJ,.�._Fa,rr!t/,�'� Test Pit No. 2 -r'....-.'�__-_..minutes per inch Depth of Test Pit....L?!n ..... Depth to ground water-4Z.�6✓-_ Tc's?" ........... i .....................................................•••-.T '.�?"./�' Y --.......-•--------- D Description of Soil__4'! !�✓ G2 wC Q,�.rYI •----•-••-••-••••-•-- ••. ---------------------------- '►4' ri . ��T"w'"L+' .................s ' , *5 ate•............ V �; -- 5 W --------------------------`---------------�'--... ---./��,�?r� .'c..�?,�c.,.S.�.. .s.�r'�!.1.�------------------------------------------------------------------------ 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 TITIE 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. .............. ApplicationApproved BY........-......................................................................................... ........................................ Date Application Disapproved for the following reasons---------------------------------------------------•--------------•------------------••----••......•-•-•-......._ .............................................. ............................................................-•-•••-•--•-••••---•••••••--•--•-•••---•--••-••-•••••••-•••-••••----•----••--•-•-••--•--•---- Date PermitNo...................................................._.... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH •�-OF.. y .................. "' ............ ! ! ' ./.../s, j:! Torrtifiratr of Tompliaitrr T xTO #RTIFY, That the Individual Sewage Disposal System constructed (V<or Repairedb . -.... .. -- --------------------------------------------------------------- •-- Installer at......A- e_1,T 'Z"f ��.. .__ .!R ----- "; -¢.''3t."M5,1.�.............. ... ,� has been installed in accordance with the provisions of T ? ,. The State Sanitar oRe ascribed in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSU N E OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM WI CTION SATISFACTORY. DATE.. Inspector.-- THE COMMONWEALTH OF,'MASSACHUSETTS BOARD OF HEALTH N: ... FEE....................... Disposal Works T-Ponotr ion rrutit Permissionis hereby granted...................................................................................................................... . ............... to Construct (✓' or Repair"(: ) Individual Sewage Disposal System ,/"'Street as show on the application for Disposal Works Construction Permit No------- __.'_._� Dated.......................................... Board of Health DATE................................................................................ FORM 1255 A. M- SU LKIN, INC., BOSTON f. -o 'er'xAT !' Zso 3 4+5 3¢+Z pRivF.tiq 4%;t ! Q 24' Xp . ' X 4 TES r.Z� 1.94-7, 25-+3 1 I- A �� 9 y 37t3 34+5 %5 2•S�S'•' • ':. 24 t�4 ,3 �s7 KoLE 2 1 . o o -g-�.7 1{��.� � � 3S• � s:..1' •31" L100D72.0 Go#" 6t_. -4. I`rf,Nr �uti ` I &ffrs � srD of- ray 5 r , r S/,7-2,53 G-L,TDPC�FaIJ� FL, 2o23.Z 40,0 4Z6,14Ev Ajo tc3AI�6k pD a3,4T6,k. ®�?o F V4Ur-40A t0 BAN o To X D o fiN1sN R�►vE ►> 2''/0 . V 37,50 WITMIM ONE Fool of FIPJ15H CRAPS Ovt R LEACR AREA 2u OF FOA STONE FOR ._._ ,,zr �l rt ��fi - �..__"7 '�cam: -- �- _.:.. SF B � - - M PW f a3 S`�,iW M � Box � t .%4"/FcwfPi , ZLEYI i. PRp-Vej.4-r dE,�a 1 oM CA 'f 1i2oN 2 IIJ. � T i2 NV►a. 5..Zzw�777 -' oR'�c++.•ao IToIVi � �F�ar t_ 'ti'U rcfir e t �'I 44 �t Irn1N. I y4 FuQT c� f 4 I I \:3:3-LO � �o tNVI;RT f DO lRVSRr 33,l8 JI ' PI'f 5�'oNf GAL.LoN: , , , T I i.� 33. CI P G i't� Am rI 33. 4n P1 A. . .C. !s 3.S P►>z r►1 51=C� 1 L TAt�i K tNv+ RT1/ ` ' WATrc PIP>~ L3 o F' Q N� GARSA iF- GRIMPSK 1 ;w .E L g4 ba o .0 sys-r A DaTA J r= . Z�- --- '- • �irPTl G SYSTEM CoNS"fRUC'('I4N �� ' Af 5 .. GM4NFORM -TO 'THE MA*&. .r r' � ss UM��L OrP>EOROaMS: � _ . vtR�ONENTAl- COPS 'TITI S'K fv R 777 tit v i SEo - 1- "CHE 'roWl1-4 EL3V tR' ��«`•1 D!✓gtto IJ FLo�t! _ _o 00ARo of IASALA I-4 REt4Ui A—n0P45 tv, ta EY ,C ►' �, L SA C441 P-I& RATE- — -- — -- SEPTiC-'fANK, - AN O.y/1�.�{��/�/o`►�C�H I NCB 'PAT lv / T-ro als orFzslt.J M Nc.�Z&T>✓ �TNG?lR 3oQoP�► PRot? 5 �. LE CAPAC.i?Y ._.. ... ,... .:_ tN . Co N '1 O LOADt f4Cq f P;Zf4s Yw Nor To OF, WC,AMCP ova WS'fEM Ut LASS 1+ 2p �R` 4 aFj, RAMAO Al,L F)Pg*To oe WAY9.ficaHT 3 r�a 5�►07P1z14as t.i�� T i � � 0,, R��E�t�.NGE• ��, z gySTFA� A vo D15. >m FIRM soorvl✓ 0AIRN05. aEa, CO PSEPSo per c.c 7 o3 ENGINEERING #a ®Re DESIGNING BUILDING ---- -- -- - - - -- INC. - HEAL•TH AG e4V APMOVAol. OR7 DENNIS, MASS. Sob °2041