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Home My WebLink About0161 KNOWLTON LANE - Health (o I k 4-� A r ®2— pf- cxr t ZE�C5+ i�( 1� TOW BAR,b TABLE Z La 4 �,�Q LOCATION AZ t,u L )off ` SEWAGE # �. VILLAGE wj,4,L-L=>rtrv'F, n71LLSASSESSOR'S MAP & LOT /0'2` ISD+Ibl ?ZVI,INSTALLER'S NAME & PHONE NO. 6 C SEPTIC TANK CAPACITY 40 O LEACHING FACILITY:(type) f t oW ,0/jc�V S (size) �2 1. x� r � NO. OF BEDROOMS -3 PRIVATE WELL OR PUBLIC WATER v u BUILDER OR OWNER /// C K u L 0 L A- a Sri C DATE PERMIT ISSUED: o DATE COLIPLIANCE ISSUED: A! `� q VARIANCE GRANTED: Yes No 1 _ /9 /4 _ - k7 r6 _ 3 2I- �i,4 �-' l y e ,)SESSORS MAP NO: I mo No 0 - FEE....7,1 ....._..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTI I �W, � ---------- I�-?�------.OF................. ... .......... :..... Appliratiun for Uhgpoii al Works Cnunitrurtiun Prratit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal fystem at i --------------------t ...- � ...............• •--- ..-- - Owner Add ' � Install r u Address ��' �,�t s� UType of Building Size Lot.....T-?j.A�o_-_..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------- W Design Flow............................................gallons per person per day. Total daily flow__._................t� 2.......gallons. R; Septic Tank—Liquid"capacity./_:..gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................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.........../w/evo� 2 ®_._.. Date.......... Test Pit No. 1___ � __minutes per inch Depth of Test Pit.................... Depth to ground water_____________-__-__-___. (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •--••---••--------------•------- ` ------.----- .. ........ 0 Description of Soil........................... ------- •. --- x c., 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 iimi.L p' S of the State Sanitary Code—The undersigned further re not to place the system in operation until a Certificate of Compliance has been issu -by the ealth.a /��ate Signed................. . ...... ...Application Approved BY .. ......................... �8 Date Application Disapproved for the following re o s-------------•---•••-----........-=--•-------------......------•--------•------•-•-------------------------_..... ...........-•-••-•-••-----------------------•------------•-••-------------------.........._._........----------------------......----•------------------•---•--------•----•----------•--•-•--------•--•- �Q Date PermitNo..U.. ..... --------------•---------... Issued_--•--....----------------------••-------- --.......... Date r No.. :........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..-----. `:f ---....-OF............... ! `? ................................................. XVV tra ton for Elity sal Vorkii Cnoustrudiaan Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �-... ................................................. �--...-�-••,--••.�•-•-Y•-••7 t--g•-•-•--•-•-•--•--r-- {ma .. - Location-Address ra. + Owner - !'� f Addr se s ,� �W1 { -t/! e/ 7'r -• s :�...... . ....... ..........�-- Installer Address U YP g s ;------------- Sq. feet Type of Building `h.+l Size Lot__._2.?' �` Dwelling—No. of Bedrooms___________________.............._..........Expansion Attic ( ) Garbage Grinder ( ) p, Other—T e of Building No. of ersons____........_............... Showers — Cafeteria w • - -....._.------------------------------------------------------•-•---��-- •----_...._ � Other fixtures .........................-- --- ------ -------• P4 Septic Tank—Liquid capacity/..-..._._gallons P Length.__.P_____.__.. Width................ Diameter________________ Depth---gallons. Design Flow............................................ allons er erson er da . Total dail flow...................s-��.___ _____.___ Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................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...........'=�r 1y ..... Date___.___._.... , �/. a Test Pit No. I....!2 .__.minutes per inch Depth of Test Pit____________________ Depth to ground water_____.____________...__. fs. Test Pit No. 2___ ..........minutes per inch Depth of Test Pit.................... Depth to ground water........................ D Description of Soil.............................. v' t s �%'`.�'" U ------ •------------------- ------------ ------------- •---------------------------- •------------------ ... ._..._.... 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 TT'IL p of the State Sanitary Code— The undersigned furtl er a re . not to place the system in operation until a Certificate of Compliance has been issu d by the' >�i Of eaIthI J1 - Signed................. ti,J ,_... ......-•---'�- . c------ ---•- -•-------(............ •- Application Approved BY -..--_-_.. .�.�-•-------------•. ��D�t �-�L Date Application Disapproved for the following re S----------------•--._....----•--•-------------------•---•----•---------------------------------------------••--- -••---...-•---------•----...-•----•---------•------------•--•------------------------•-----•--------...-----------------------•---------------••---•-=---------------•-----------•••-•-•••-------------- Date PermitNo..9l!i_ •1 ----------------------------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................................. ��. Trrt f tra*� of Taamlitiattrr THIS-IS TO CERTIFY, That the Individual'Sewage Disposal .stem constructed j /) or Repaired ( } byi -t -t Vic! C :- r'-ram l�_.�g + tc t ...-------- ----------- f__ O -� Installer f ---- has been installed in accordance with the provisions of TT".,L, . j of,The State Sanitary Cod -e as describe, }n the application for Disposal Works Construction Permit No.. ______.��`1__ _ .............. dated------- ._"_Z_ ---- ________ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM W1 L FUNCTION SATISFACTORY. , - `'-r11- DATE._........ /2��`-- ---------•--------------------------- Inspector---•---KI..1................................................................. `"� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT No. 6.:. --- ............ ..................................................... FEE........................ Disposal Vorr ?RT114t0tr taatt amtt Permission is hereby granted................ .Le a::..... ...................................... to Construct ( or Repair. ( ) an Individual Sewage Disposal Systen} ti �n at No....L,6T------- --....t......---- --------��-� b`��?��•--- --------- ------- 'j ..�a 1- .------••-------- Street G as shown on the application for Disposal Works Construction Pe'mit N _ .��_ __ Dated____�.�_z ___'. g._._._.... __......- . . > ------------------....................... Board of Health DATE...................................................------•-•----•---•-----....... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ri Jfill � � � i- r s� �• �t` p� 00 cup PAUL A. . / �. / / '' // ., .. ( V^(I av n } t,.. t ..f � �.. ' Via. � t;h �t�• ' ; / -� ( � ��\ sir A• �" / �x r �66 o R�4 •�� '\ �/" � is s � � IDLEVY +1 �. ( ,✓ ��'' �e � � ": No. 10617 I J t./ J T OF All �o P A U L A. p L E V Y /. � Ri if/ ..•J�TS.4.Gl�f _.= 26 �SP�o,100 0 O" Ss o 'c ., r ._.._., .SST Frr �/.✓��/� ". :�� ,;��' � � y ,� . , F .. e "TU ''°` r;� S. �a�° € � ti ,,.�f✓�x � LEGEND EXISTING SPOT ELEVATION OAO eEF TIFIE.D PLOT PLAN EXISTING CONTOUR --- 0 -- - t �' FINISHED SPOT ELEVATION FINISHED CONTOUR In MA Its,7 -O � ,LT kii�mw.�T�i� ��4,c� =- NOTE:,The location of any existing,;.underLi-ounce sewerR�_�e, ,f wells, or other utilities shown on . this elan is appro'x p ', j y ' . (� RCS Rf a , mate only as determined from records 'and or verbal information. The contractor, is 'responsible� for 'he f� �f r: I t ,r verification of the existing lucations in:;the .field 9CALE� -1 "4a "[2QZE' LEVY& ELDREDGE.ASSOCi ►TES ! h C IEN � � *; � � k piC r L•T n Ytr C�ERTIFY �TH ATE ,fTHE PROPOSED y a ;ENGINEERS-LANDSCAPE ARCH(��CT8 ;,y;r III A.'N�� BUILb"1OV,Q: 'SHpWN :THIS ;4,?L ANC` �j 77 PLANNERS- LAND SURVEYORQ 4l� i �, ,` .r. � '' r � ;-.COAI}FQ<13_MS� '4t TI.911.�.,Z`ONI 0 LAIN .r p 712 M'A I N:.S�T.R E ETT< TRAY _ H Y A N N 1 S �"� ,,. � S1lEET.. ,`OF �a :. A. E� � R ,;�I:AN. D SURV.:EYQR "v•&` + 4 "� ''tf ii• '' '� 4i '73 t x, t B-1-40W .GiR-4,9F, .4, .04:.-- 1 FT/Po�/N. INCH ®JAMET.'IR CONCI?,iF74Z�' Co1lr-R S//A L L 19►N - 4"PYC Pipe -5,e dROUGNT To G,4V,4®E: CAW jFX `77TA I..EAVY EyQU_ .s r CDN-CRETE MIN. P/TCN CO1fERS CAST IRON COY�R 4gL �E: IJSEP /j= JN ^'PAR ET .1JRlY�¢1/AY L`�U/Vi4LEI�fT Q , f 2 7e Cs/T/�67_� o GALLe`!F/F S °C' L/QV7� L�`b�EL s /Iy SER/E3,gT EnfO CLEAN SA,,VZ> , 4"PIA SCHEDULE 40 rs ct iea t= c= t= Avc. P/y®E 0ry0 -0 • �+ .yCFAL- P cat n e= z-eACl4tMC# GAL-,LZRY g PVA514ZZ> sTcw.- sa-r $��' • 6y k/S x Z.SG/sF =2rfo S�C ®/Y OF GROUrYD R — �f q.L/ 616E = �PD. SE �GE /.SP®S.4C__e� STE/�'�.. 595/ TdTRL. CAPAC/TYr 0. Gr�Tt.. �Ik9Fe�a5 r®ed Z 4 S O/L .7 ES7" C r 0.7C"OF SO/L. 7'-=57 - --r---f-- SOIL 7W5•`T / r SO/t 72FST !2 xesuLTS wi rwL✓s'S'EU BY. p RCIj-A7 ION /%47--- At.I �ERGY�L. 4T/®OlI/�i4?"E �Z /►0/N.�lrI�CX i/• T��.5.-�sm�I CLEr4A/ h�aSICrN �/TE9/�4 TA No AlaM.®ER OF OE�RoO/sps J• GAYER aqT,&AgED/SPBSAL OMIT 1�D Fi'He Su .� a�ii 4` F-+ ® ri'•s oF�� ?Irv3 G.�Ll 3O � JS.E-S.N•6.41.�. / tS �� ' 6V,�SrV� F.STII�jAT7�0 FGOH/ D,9Y ��rc-a.ICpS�.�rr-s� S/®ZL,ACa/Nrr Ax&A _ � S r. r ., y'O bey �n1t•!+ _ -�' 60TTOM LEACN/NG A REA 9 G SQ.FT. �`b .SECT/D IV >C®X TC TA L. AREA �'8 SQ,�•T r1 t?�Sc e v = RAeS-,CRVE AREA "'0' ®T .4 TER E/VCov/YTERED / °�� //V 1 ER7 El-C-VA7'IONS M G,eoVdV,0 JVA7�R AT �t�y t ,4 0 r w4� '\ �H DFA/�S,r' L OT I K POW L� L tv PAUL A. v. o` P A (J L oy //VVRRT AT Bu/L0/NG D A s . T LEVY ak. A 1, //YLET.SL°RT/C ?iAHK ET. 51�� MILLS l`PA-SS. . No. ics17 rcQy 6 TLE T SFPTc TANK pd LEVY & ELDREDGE ASSOCIATES, INC.o.iooso o f LE T4/sR/BuT/oN Box F7 c,srE�` \�,�, ours T�D.Cs7R/euTiox�ox 5;.2 F7: 7/Z.f��/*V-qr HYANN/S MASS. U V %� 6 S/ NA .1Q8 iYO. sd47 z�„ S'151EF'T d� QF w • C Oirip l et e d .by r HIGH GROUND-WATER. LEVLL COMI'UlATIOrJ Y/l�tr Z"7"'.aim w Site Location: LNL Lot No. ;' O.wrvefi Ad d F_v_s.s_- Cont'.ractor: _ A_d.dress: r N Notes: STEP I Measure depth to water table to nearest 1/10 ft. , . „ I date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: ' A) Appropriate index well . . . . . . . B) Water-level range 'zone . . . . . . . . . . . . LA STEP 3 Using monthly report"Current Water Resources Conditions" ; determine current depth to water level foe -index well . . . . . /BCP mo yr i STEP 4 Using Table of Water-level Adjustments for index well TST�P 2Aj, current depth to _i water level for index well NY (STEP 3) , and water level - -- zone (STEP 2B) determine. ' water-level adjustment : . . . . . . . . . . . . . . . . . : . . . — i . . . . . . . { STEP 5 Estimate depth to high water j by subtracting the water- level adjustment' (STEP 4) from measured depth to water level at site (STEP 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -- — • i I i _. .�... _