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HomeMy WebLinkAbout0061 HEAD OF THE POND LANE - Health � � �-,s 7-o n s vn; c�50�I l��7 No. .:��4—. o F�s..... �.— THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH h Apli iratilan for DispoiiallUorks Tontitrnrtion ramit r� Application is hereby made for Permit JtoC/onstruct ( ) or Repair ( ) an Individual Sewage Disposal System at: -- � %i'' 9 nr� gal ...-. .. .1./. l r..t1z;............................................... .................................................................................................. /J Locatloh- ress 1 �a or Lot No. / ner ...............................Address .. Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms:__.._�..................................Expansion Attic ( ) Garbage Grinder (1f 9 P14 Other—Type of Building k-OO ......... No. of persons............................ Showers ( ) — Cafeteria ( ) PaOther fixt res •--•--•-•--•-•••-•-•---•......•. . -----•• ----------------------------- ............................................................. Design Flow......a l$................gallons per person per day. Total daily flow----- .©_.____....................gallons. W Septic Tank—Liquid capacity/k�D---gallons Length................ Width................ Diameter................ Depth___..__.._____.. x Disposal Trench—No. .................... Width.............._..... Total Length.................... Total leaching area--------------------Sq. ft. Seepage Pit No... e.S--------- Diameter.....0_...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (y•4S Dosing tank ( ) Percolation Test Results 1 Performed by.......................................................................... Date........................................ Test Pit No. I-----------_----minutes per inch Depth of Test Pit_________-__------- Depth to ground water------------------------ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil .fl----- ----•CO-�d2S�..... .��_.. x W ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------=-------------------------- V 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 L L' p 5 of the Sta unitary Code—The undersigned further agrees not to place the system in oper ti n til a ertificate fiance has bee�O, suedVbyhe bo d of h lth. r/�( 1 Signed..... � -�"� -----•------------. - '� .�9 �5 / Date Applica ion Ap roved By-•-.••. 0.....rLf....7........--•-•••-•--------------------- •---•---���� .......... z Date Application Disapproved for the following reasons----------------------------------------------------•------•---•••------------......•----• ••------•••........•-- _ -•-------------------------------------------------------------------------------------------------------•---•-......---•-•--•---------•----••---••------------......-----••••--•...•---•--••••••------- Date PermitNo......................................................... Issue(L....................................................... Date j THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALTH _...................OF..:..............................:...................................................... Appliration for Disposal Works Cnunutrurff"- Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an.Individual Sewage Disposal System at: Loc. --A,,�'ress or Lot No. ----- -----••----••-- ---- -....-••-•............................................ ner Address a r C fl ....\l�_... Z --------------•-••--•----------- ------------------------------------------•-••----•••---•----------------------------------_------ Installer Address .Type of Building . Size Lot............................Sq. feet Dwelling—No. of Bedrooms........... ..:............................Expansion Attic ( ) Garbage Grinder ( Qb Other—T e of Buildin t p ( ) ( ) a ; yp g (,Arlon.. ._...... No. of ersons............................ Showers — Cafeteria Otherfixtures --------------- ---------------------------------------------------------------------- ------------------------------------------------------------- W Design Flow_....,__ ._4.5-'-_---_"----__-gallons per person per day. Total daily flow....... _S_D.........................gallons. WSeptic•Tank—Liquid capacity../60D_gallons Length---------------- Width................ Diameter_____-..--_--:_- Depth................ x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft. • Seepage Pit No-----tp-S_______ Diameter--- __K. ..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( 5 Dosing tank ( ) a ,Percolation Test Results I Performed,by-••--..._..--•----•---••--•--••-••---------------------------------------- Date Test Pit No. 1----------------minutes per inch •Depth of Test Pit.................... Depth to ground Water--__•-__-•_-_-____---__- (i, Test Pit;Ni o. 2................minutes per inch Depth of Test Pit........:............ Depth to ground-water........................ PG D Description of Soil...... ._ � ------!'_ 4 W U - Nature of Repairs or Alterations—Answer when applicable..................::....................................................................::.... ..---•=••------=-------------•------•--•-•-•--•-.._....-•--•••---------------•----•......_..___....__.._.._..--------_........_•-•------•-----••---....--••-•-••--•------------------•---------------- Agreement: 1,The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �'1 x. the provisions'of .-Tf!.-- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in oper t n APIi ntil a ertificate f iaiice has been ed by the board of lie lth. *:t' Signed --- -- --------------• 3 �. Dat P on 'Ap `roved By = -�_� �� E�%-.�(Er�-�l:..•...................... -----•---- /t 5../7 Date Application Disapproved for the following reasons-................................-•-----•----•---•--......-•----------------•--------•-•----._.._............_ w„ ••••-•-••-••••-•••----•••----------••••-••--""•-••-•--------••---------------------------------"-•-•"•------......_....----•----•--......---•-----•------------•--•----•----•-------------•----...._..._ Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD: OF HEALTH . . . .: ..........................................OF. _ Tntifiratr of Tuutplittnrr - T S IS TO ERTIF/Y Thatthe Individual Sewage Disposal System constructed ( ) or Repaired ( ) at.._..:_k �{4. ig�..4. ta.er 47,_XI)•:-•"-•-----••-•--•--•••--- has,been installed in accordance rth the provisions of TIT13 5 of The State Sanitary ode as described in the application,for Disposal Works Construction Permit No----------C,__< :____ F--_ da.ted_....__� ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME SYSTEWI WILL FUNCT ON St%TISFACTORY. DATE__---•-•----------------� ......................... Inspector.................. --- ------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F..........................................------................._................... No......................... uisp. at urku ' nstr ion rrutit Permission is hereby granted_...t -- ........ to Construct ( ) or Repair ( ) aa�]Indivi al Sewage Disposal System _.._..at-N.o., ._. ,,3..•.,---eO .=.�------�`�.---�.••''-�••'�--`�---••-•--�✓� ..................................... Street as shown on"'the application for Disposal Works Construction Permit No..................... Dated:._.._______ _.____..............._..... m , Board of Health DATE......... � ..........:..:...................."--------- FORM 1255Bes WARREN, INC_ PUBLISHERS , LOCATION SE_WA G E PERMIT NO. 01` e 9577eZ,�—� VILLAGE Por,� 4 I N S TL LER'S' NAME D A.DDNESS G U I L D E R OR OWN ER DATE . PERMIT ISSUED r� QDATE COMPLIANCE ISSUED -� 3 � S i ,A S 0 1 l LOG N0. 1 0 N0. 2 SITE PLAN r •, I , -i 2 wi 4 n TOP OF FOUNDATION El .: --4914t5 5 -- c 0 6 IN EL. • C • • e •1ST L • • • i._E.. __._'—„' .. - �, , -10 IN.EL. 11-Z— IN EI 3 • - , --- - 1_ -- COVER 1/8' 3/8 WASHED STONE d I N f L. 1 ---a -- -i .• - 12 • r O/ B W/ 6" SUMP IN E1 1 .1 r - 3/4 1 1/2 WASHED STONE �. I�6.� -- 4 LIQUID LEVEL �� � 1 14 6" EFF. DEPTH = -- 15 - _ PERC TEST RESULTS PRECAST SEPTIC TANK WITH ;h_° -> '� j ' - PRECAST LEACHING PITS PERC RATE : - SIZE : _ _ .— - CAST IN PLACE INLET AND r q ' r �� WHITNES.SED BY : OUTLET T "S PER TITLE jC �,/ � � �,_ -- -- + , � _ " _ BOARD OF HEALTH I � SIZE : -/ D1A . -� + DATE - 4oG Z i a� PROFILE OF PROPOSED SEWAGE SYSTEM _ SYSTEM DESIGNED BY THE TOWN OF REGULATIONS AND I STATE TITLE g FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4S= 1 Q I N . B . f# 1 . ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE 2. All PIPES SHALL BE SLOPED 1/4 ' PER FOOT EXCEPT FOR THE FIRST 2 FEET OUT OF THE D / B WHICH SHALL BE LEVEL 3. DESIGN FLOW BEDROOMS AT 110 GALDAY PER BR . 33o GAL/ DAY SEPTIC TANK SIZE � =� __ X ___ _ GAL . I �0T USE 0200 GAL. WILD GARBAGE DISPOSAL - LEACHING SYSTEM . USE ., r^ _ , EFFECTIVE AREA : SIDE /L x 2, 5 BOTTOM 1 TOTAL FLOW_-----�_. j -- 9 ,tea TOTAL REQ 'O FLOW J2--O X 1, 0 = 3 0 --- W/off GARBAGE DISPOSAL LOT RESERVE FLOW-,—'-.--}_ _ -=21`__ _ GAL/ DAY -_ yl , nr'- ' _ of , REFERENCE PLANS . ---- -- - _ -- ------- r - J- - - —�--_ _ -—-- {moo GD Cz v -. ,,✓i ? �, 1� APPROVED BY : Av r << - - - = BOARD OF HEALTH DATE PROPERTY OWNER : -- --- - Sl`TE ANO cL WAGS PL A N 3 , -. -- ----- - ' WIi.L1AM '�[.�1'C.Q 1 1 t��': FR"@�rs b� 'l t{�s '�:�..� ,t�'t� s _ , c>` L.ICBERfifAf of * � LLT— / D �I ILL W-NM UEG{ F-- 1---) MHN —P, E,-