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HomeMy WebLinkAbout0377 LAKE SHORE DRIVE - Health _ � � .._ .�.�,_ ._ _. _ .._.. �_ � _ _ _ �.r* \'�' "J {�J"1. v���N�KI,��O�,V d ✓;`�V—;�5.ltf � (#�f - � C2 `�` Y L 0 CAT ION S EZ A G, PERMIT NO. Y LLAGE mc L-S I N S T A LLER'Sf✓ NAME i ADDRESS B U I L D E R OR OWNER NDATE PERMIT ISSUED _ �y k DATE COMPLIANCE ISSUED O a I I i I+ I Now....._....... } Fx$ .................. r� b j E COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....QA.�.w....ce. �� . ;�.���trtt#tan fnr �t��nsttl ,axk� C�un��rnr�tnn rrtnt� Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sitem.. ................ Lot CV4....... ....... ............. ... ....... W � ocatio -Add es or .. ............... IOwnef A�7p•gs, - d..................... 1.......__._._..__............. Installer Address Type of Bu Iding Size Lot a,Tx_ p......Sq. feet Dwelling�—�o. of Bedrooms................ Attic /p) Garbage Grinder (/O) Other—Type of Building No. of ersons____________________________ Showers Pa YP g ------------------•--------- P ( ) — Cafeteria ( ) 0.' Other fixtures -------------------•----------------•---.....-----.._..-•---•-------------•-----------------•-------------------._...------...••-•-•-••-•-........--•• Q _ W Design Flow.........,JS.......................gallons per person per day. Total daily flow..... ______ ___.._._____gallons. fx Septic Tank—Liquid capacity/ ©_gallons Length,?.�a__. _ Width.//�­._ . Diameter................ Depth_ . W- Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. x ___._:. Seepage Pit No._____/..,_.:_._. Diameter._._,�_� Depth below inlet__��___ Total leaching arealz��<:>_....sq. ft. Z Percolation Test Results ) p Dosing tank Other Distribution box `'' Performed bY. 64 LC__-�_:_v5W Date ......:...::.....•-------- ,'4 Test Pit No. 1________________minutes per inch Depth of Test Pit...`Z..... Depth to ground water_..__....._.__.__._.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p� ------------------- •------- •••••••.................................................................................................................. 0 Description of Soil........................................................................................................................................................................ x U ---••...............•-•--•••--•--•-••-•--•-•---•-•-••-•••--•-•••••••-•-••....._....-•-------•-•...•••-•-...--•--••••--•-•...----...••••-••-----•---••••••••-••-•----•-•-•---•--••-••-...-•••---•------•- -----------------------------------------------------•--------------------------•------•------......------------------•---------------..------------------------------------------------._....•---•-••-- 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 iITAIL 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by th oard of health. ` Sig -----••--•_...•••••-•••• _-_-- _ 6. T Application Approved _..__._....................•--•- - -••_= � Date Application Disapproved or a following reasons_______________ ________________________________________________________________________________________________ ............................••-•._....•--....-••-•...•---••-••--••-•••-•_.._..•-•-•--•.................•---••••-•_--••••-•-••-•••••-----••-•-•-••--••--•-••-•--.._...-•------.---------•---••-•=------- Date PermitNo......................................................... Issued........................................... Date ----------------------- a F , G' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ....OF....................................... .............................. AVVfirtttiun for KliuVu,ial Workii Tonutrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System t: / —�--� . • .......••• .... ._ ... -eocatioAdd ss0 / (�� or Loter ` .. ....-•-•---•---•-• ............. t"''t!�a.d...._..----•-••----...........---••- ------•- •---••--- ...._. .:�.Q'8 .............................._ Installer Address dType of BA ding Size Lot.:? . l:ZZ z......Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 1 p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .............•-•----•--•---••••. - w Design Flow............................................gallons per person per day. Total daily flow............................................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.................... Depth below inlet_.__................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by•••--...•-••••-•--.....•-----•.........---•--•-•--••...............••---- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit..................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----•--------------------------------------•---------------•---....-•----•----------•........................................................................ 0 Description of Soil........................................................................................................................................................................ x U w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•-- --••-•---------•--•-••••-••-••-•---•-•••-•-•---•••.....-•-••-•-•-•••••-•-.._......••••••-------•-•----....••••-•----•--•r-••••----•-•----••••-•-•-••••-••••--•---•••-••-••--•-••••••...••••...--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by the-;oard of health.' - .. Signe ..... __."`..... .._.��. `� ...Gf .7_... Aa e Application Approved R- .....- = . •�!G�' ............. ffi Date Application Disapproved)f ar tie following reasons----------------•-•---------•-•--------------•------........----------------.....----------.................... ........................•...•--•---••--••---••••••--••••-•-•----••-••-•----•••--•....-----------------•••-----••-----................-•-•....-•-...-•--•-----•--•-----•-•-•--•---•••-------•....•••-••-- Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......................................I——......................................... (9rrtifiratr of flom;iftanrr THIS71,.S✓TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by ............. .---=� . -•--• . '` if f 'nt u f Isaer at..... -2 ;fit;------. .w is6�-_.'_.::...� `� ' ----•---------•------------------------------------------------------ --- - has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Coded es reed in the application for Disposal Works Construction Permit No._� - :_ ................ dated..... -__- _ ._ -....._..._...__.._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATIS A TORY. G DATE..................................................... :._ :�;: . .. Inspector........----------- ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF..............................................-...................................... �' No..11...................• FEE..-..-...--............. iu o t- rku Tonutrttrtion rrutit Permission is hereby granted...... = ?� .............................. ...... .•-----••--•-•---•-•-•••--•----•........--••..............::.:... to Construct ( Vo°r !gif, ( _ ) an II d alS >age D osal S atNo.................. -- . ; .............." ---. :.;t! :.. -= "C.-•------------------------•------------------------•--...•......... Street as shown on the application for Disposal Works Construction Permit No.__..... . ........ Dated.......................................... .............. --------------------------------------•-----•---•---•--•-•- S Board of Health DATE................................................................................ G// ��/=�•-�-� FORM 1255 A. M. SULKIN, INC., BOSTON _ i <�I;,j +:.G- FAM►t_Y - :5 BGDRoDM �E0 GA¢6AGE 612jwDeQ A, i x'3 = .)3 G. v, D At t_Y F �V - 7 O P. SEPTIC, TAQK = a3ox 15 A9 r b.P o Usc- 1000 GAL, r D15PD5AL-_PIT vsE tao0 GAL• �E� ��-•4/✓ O�� 9 5 t VClIWALL A2C S•t= ►50 5.F X 2.5 � 3�5 G.�'o I BOTTOM A2E.As . Sp S.F X ►• 0 � 5p G.Po� •• }� -T OT A 1.. 'TOTAL. DA I►-Y FL-Dy.( = 330 G.PO, x PEtZ. .oLATIoN GzA?EI I''IN 2MInl o�LESs �t DAV s= ' J A. I C. r R THULIN NO. 29976 / Al Erb'\ TOP FND=A—V O 99 s G ,,, ' 97 7 ►oov INS. GAL. sr,PTIC. . t000 INY y73 TANK o Gal. yC s LEA(-" PIT INV. IWl 9�9 97/ CauP_.sc w I T u ,S�.Ya I�/3/q•��i WASUGID 6TONE t GEQTIFIGD PLOT PLAN y F l l_� ► o SCALE r7oALE �'� �Q ' SATE 1/31* E 2E IJ C.E t 1 ¢Eoi`I GoMPLYS Y�TN"TNEOS1p4lPvYN f` N E �• aT 3� AuD 56T�.GK V-60QVIR•EMENT�l OF 'Tµ� 'TvWN OF BAQN15'fA ANC IS I-4G'T— LOCP W .TED • ITN1�11 'r .E G�.00D PLAII�I DATE 13 t ,� ,,, • r BAXTEtZt W`(E INC. � REG I S'T rr-Q6D'►-AN D.5 u MY EYo�S "fins PL&KI 15 WClT Bl 5c p 4:11'd AN OSTE-2VILLr—. - MASs• lw5T?-UtAe -r Sv9-ve\( ,Y-THE DI=FS'E75 Suou►,D t ►.10-t 6 tc •V 5 E D TO E'f E R1^1�► c--r t-1 N E5 A P P L I C A r-I T' ,iay.✓L�G' �,4SSUC-//,t/�; v 97-7 1y� y - b ; i � oLG�—IJ 9 Z. v. 33 .sEo..� �� '99•� /� 3 i D o N M y9' N yy•z eAC OF CrX� i s9 0 i - -r � 4 DAVID J ( C. o THUCIN No 29976 • i`art u•� H 10 p, it rho Massachus Water urces Commission/Division of Water Resources TER ELL COMPLETION REPORT WE L OCAT N ' Addre City/Town G.S.Quadrangle Map Grid Location Own Addre ELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From To Rotary(type)_ Cable❑ 2) From To Other ' 3) From To 4) From To CA SING Depth to Bedrock Length '4v Diameter a� Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface .2' Sand: fine❑ medium coarse Date measured • / f �> �� Gravel: fine❑ medium[:] coarse❑ GRAVEL PACK WELL Screen: Slot#_9length_-�V from to Yes d No Split Screen(or 2nd screen) WATER QUAOTY TESTS MADE Slot# length from to Chemical Biological ❑ Depth To Bedrock PUMP TEST Drawdown_feet after pumping - days hours at GPM. How measure Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To I AA ei DRILLER A Alf, Firm ° a Add, SS ` Cit Registration No. Aerators Signature ease print firmly 1OM-8181-164843 -PgoPoS> � LSITGHCN _P¢,pPU��1� �l.irlP�LbM �El_F Tt o1.1 -- 1 Az- v IN 5 L ' i - ct�Z-�1vaos�sn FSRooN .• II � AgAC-� E _ � —P'��MO�/E EXOh►��.a �� � - PS�Mac! v�gt.l_ PS EP LAGE Y/� 1�� w r o_X 2Co �E�.M 11111� — 4)k it { D ly iIj - A 5 FFz,c-tao^y F_ED AflD tT r OAl TA - No-�-E"S- O AY tAN PyE�irG�EMCI` 3T 7 MA"P,5";ot�l N►�LL S-,_wlAS;AGrli2S�6� -t—A LL _ C O N�iT_(�a.L1 GT i a>J S 4-4 A�..L_ C'�E 1� �et�l�o P>M Ar•l�@, vV�TI-4 E -— fvi A`7�7 A GH r i5 E'7i"'7 TATE nr,%fl A L_L_ t_as cA R-. F' L GO O Towt�i CoD_E�j- 2_ AFL t i�vtElJ�jlU1�1�7 SHA.L-L. 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