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HomeMy WebLinkAbout0325 BRAGG'S LANE - Health 325 Braggs Lane amstable i 1 L O CATION S E G E PERMIT NO. 031-aoo, VILLAGE INSTA LLER'S NAME D ADDRESS ®)PllV® JA CL< -7: �4-1 ILI57- 4 L� SU1LDE_R OR OWNER WILL SIA.IF'r DA T E P_ERMIT ISSY E 0 ,Qc� DATE COMPLIANCE ISS-UED /�j� a L.4 � M � G C P ........ - `. Fxs. 5................_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ,-, .ZZ_ ,EAL� T... ... ... ....................of....,vr�.F.&S =.......----...------------ ApplirFatiun for Bhip ual Works Towilrurtiun ramit ®®� 3 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat: .... ......................... --------............................... .-- Location-Address -- or Lot No. ......_•---lac 1./_�: ..5 ��l6". ................................ .....................-• ............................................... Owner Address ------------------Jl ?02.�, ................................................ _......------------.......---_..... -_ + " _l�S � Instal;er Address d Type of Building Size feet U Dwelling—No. of Bedrooms.___.___.__............................Expansion Attic ( ) Garbage Grinder OQ Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixtures ----------------------------•••- . --• .-• -- W Design Flow........._.5 tt .......................gallons per person per day. Total daily flow............?_3.jQ._...._....__._....gallons; 9 Septic Tank—Liquid*capacity,/020gallons Length__V'j6�. Width.Y'-A�.._ Diameter.. :. _.__ Depth.SS_.V. xDisposal Trench—No..................... Width.......'*............. Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........./.......... Diameter.:-____�.__..... Depth below inlet.... ..... Total leaching area..;-?..Q0...sq. ft. Z Other Distribution box (4-1 Dosing tank .( ) _ aPercolation Test Results Performed Test Pit No. 1...A�Z-_-minutes per inch Depth of Test Depth to ground water...IV-01's.�_IE. (s, Test Pit No. 2..�. _._._minutes per inch Depth of Test Pit.../3.......... Depth to ground water__1 �?y .. 04 �T!�-------- ----------------------•-••---••--•--..........-• .�'/.7_`.:n ............................................. 0 Description of Soil------ .�7._. 4>�I�J.v�--u` '� d1 -------------------------Q �`�`�lL--------- 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 TTTILE 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.............•----•--.................•-...--•------.........••--•-•-------------_-- .......................... Date Application Approved By.. ............... r( �� - ate Application Disapproved for the following reasons-------------------------------------•-------------------------------------------•---••-•--•--••-•-............_ -------------------------------------------------------------------------•-------•-----•----------------------------•-•-----••••-••- Date PermitNo......................................................... Issued....................................................... Date No......................... a, Fss............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '3. ....... .................OF...... Z_. .:........................ Allpfiration for Elhipwial Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................B'le"Z4 "r?.. .........4-94Z ................... .......................... r.....!!!��........................................ Location-Address or Lot No. ............16U..;064..e............:twr 01------------------------------- ...........I-----------------------------------Ad--d-r-e--s-s............................................ ................... ----------------------------*"*......... "-----------------------------*........ ----Ad"d're"ss`­... ----------------------- Size Lot____ CP Type of Building ,X.10Sq. feet U Dwelling—No. of Bedrooms_____________...3.........................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ............................................................ ........................................................................................ Design Flow...........%T ......................gallons per person per day. Total daily flow........... ®___._._......:.._gallons. 7;.......... 9 Septic Tank—Liquid capacity./O.00gallons Length___ Diameter---6�' .. Depth..S.."T Disposal Trench—No_ .................... Width.....................Total Length..______.__..._..._. Total leaching area....................sq. ft. Seepage Pit No........./........ Diameter........0........ Depth below inlet_____.:........ Total leaching ft. Z Other Distribution box (/— Dosing tank Percolation tRisults mdyTest Pi No , ....4%A9,­.minutes per inch Depth' of Test Pit...4:1.%f Depth to ground water..- Test Pit No. 2..:�LR......minutes per inch Depth of Test Pit...Z3.......... Depth to ground water. ............... ............................................................ .................................................... 0 Description of Soil........Q i�Z, ........................a-.V 9 U ............................. I:._S4 ..........J_ ...�.V?9ZMO. ......................................................................................................................................................................................................... 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 TTTL_ 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....................................................................................... .......................... .4 Date Application Approved By ..................... ajj -----, ---- ----------- ......... ...... ...... 7 Application Disapproved for the following reasons: ............. ......... .................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......77 ...........OF..... .................... Trrtffiratr. of Toutphatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by--------------------j/.jr Installer at....... .........loetAlf ............................................................. ---------e-----;w'r—Z------------- -----------�? 74 e e has been insfile? in accordance with t1' provisions O'kf I L�' of W ta e Sanitary Code as described 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 SATISFACTORY. DATE........ j��........................... Inspector............4#4;P( ... ...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rO4Q IV 0 F.......... .................. No...... FEE._. . 0 Disjumal Workii Tonotrurtion "punfit Permission is hereby granted....................0��. . ......................................................................................... to Construct )o"'or Repair an Indivi u ewagc isposal System P at No..........ei.' ............ Str­Z 7Ae;'V_ ....... --------- ............... .......... _ 1 as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ... .................I....................... DATE.-- ................................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS © 7- / y fr . 12��✓� `. TaP C� Z kQ I 60 v � N,D 5, � � -H: TEST ° 34 p/7- s 23 4 S TEST fr'UL S )Lpo"-I GiFr7ole .. . f FL • 23.5 22. o -- l 1 0-3 ' COflA4 O - 3' Lo,gM N- Su�35c�JL. 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