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Home My WebLink About0450 BRAGG'S LANE - Health `.,� - �:�, i � �Lr C A T ION SEWAGE PERMIT NO. VI'LLACE 1NSTA LL It S NA E i ADDRESS BUILDER OR OWNED DATE PERMIT 1SSY E 0 =�5/__�> DAT E COMPLIANCE ISSUED A,�ag� or -- � „s � yew / I � p 1:0•-C A T ION. ya a Sl W A G E PE RMIT NO. ►z , VVU.: AG E I° INST LLER'S NAME & ADDRESS --T�; (B ras - - , ---- , . - .-.— Vi 6 � �k-1 0 U t R OR OW ER DATE PERMIT ISSUED MPLIA ISSUED DATE CO NCE r�.zy-,7 ? ' .;3 ' y'z No...'........... ... ..� ,, Ymi& ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applira#iiait for Eiapusa1 Works Cnnnitrur#inn Prrmit Application is hereby made for a Permit to Construct ( Zr Repair ( ) an Individual Sewage Disposal System at: - 2� cis...�:�'►1J� ................................................ .......... .....-------•----..............----•-----•-•------------------•---- Location-Address or Lot No. ST ..................... ............... 2 5.%_. ..................................................... wner Address " w �ETE211.10 L6i 1?I 2S s " P&QS_TA Lam.._..... Installer ! ' Address ��Type of Building Size Lot......::......SLl.............S. q. feet U Dwelling—No. of Bedrooms.......... ..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building a YP g ---•--•--------------•----•- persons........ ------•--•-•-•-• Showers ( ) — Cafeteria ( ) a' Other fixture ............................................................ No. of Q ----------------------•--- -•---•---• .... W Design Flow...................`.. �._ gallons per person per day. Total daily flow____-_----.�J__3...............................gallons. WSeptic Tank—Liquid capacitylQO gallons Length.....`+....... Width ........ Diameter.........:...... Depth................ x Disposal Trench—No........... ..... Width............... __.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No___________ _______ iameter..�/�``L e- �'`� epth below inlet.........•.._....... Total leaching area..................sq. ft. Z Other Distribution box (� Dosing tank ( ) ' �_q Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1....7.........minutes per inch Depth of Test Pit......I.X........ Depth to ground water________________________ fxq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-••---•---------•----•---••--•._...•••-••---------•--........-•--••............................•••-......................................................... O Description of Soil---- .' 2`..11..... OA F.......(:Wi'�--....._ � 1 L 4�' vM E_D 1:�.?�!?.----5 !.��........ );--.A A4.......A CIDI.O tA----SRhp-----------------------.................................................. W .......................... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---- U Nature of Repairs or Alterations—Answer when applicable.....................................:.......................................................... --------------------•------•---•----------•----------.......--•-----------------------••-•••.......------••-•-•---•-•---•----••------•-•-•-----•--•-------------•--•---------••-•-•-•-•......•••.•••--- Agreement: t The,-.,undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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._. .... -- �o- ._1 3_..�.. ... C, / "/ SfV�1 Date Application Approved By........ -i��:.----- . liz 44 r ...................... ........... -------- .................... Date Application Disapproved for the following reasons:----•----------•------------•--•------------------------------•-•-----------•------------------------.........-- ........--•..........................................•--------------------------•------...........--•-------•-•----•--------••---•--••--•---------•---•---------------- --------•------•------•----•-•-- � �-- Date Permit No....................................................... Issued..... ----------•--•-----•----- ---------•----- .. Date121 6 No................ ........... Fuz..... ...... THE COMMONWEALTH OF 'MASSACHUSETTS BOARD OF HEALTH . ..... ......... ---_------ .....OF.... .................................... Appliration for Disposal Works (foustrurtion Prrutit Application is hereby in.ade for a Permit to Construct ( 4r Repair an Individual Sewage Disposal System at: q & .......................... .................................... ........... ........................................................................... s or Lot No. —�)0 E I 1_ i VT�k ...�tion ........ ........................... .................................................... S......................I............................................ OC _V e ,Address .......... � 21.5��AL........ �4 Installer Address Pq 4 Z),S L- :11 Type of Building Size Lot_._.....__._...............Sq. feet 5..............................Expansion Attic U Bedrooms........... Dwelling—No. of Garbage Grinder Other—Type of Building ............................ No. of persons........ ................ Showers Cafeteria P4Other fixtures ...................................................................................................................................................... < ��13 '6_�C) W Design Flow............................................gallons per person per day. Total daily ly flow__._............. ..-gallons. 1:4 Septic Tank—Liquid capacity APS�ggallons Length------ ....... Width---------------- Diameter---------------- Depth............._.. Disposal Trench—No..................... Width....._......._...... Total Length.............._..... Total leaching area....................sq. f t. Seepage Pit No--------------------- iameter-------------------- Depth below inlet........._.......... Total leaching area..................sq. f t. Z Other Distribution box (e Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1...2-:........minutes per inch Depth of Test Pit------1_�........ Depth to ground water________________________ 1i Test Pit No. 2................minutes per inch Depth of Test Pit.................._. Depth to ground water........__.........._._. ............................................................................................................................................................. 0 Description of Soil....9�__ 114 " 0 ID b': L_ ...................................................................................j........................................................................ W C 1b k 0 11_11 -I-L." - j 4 4" "E,D� u t-A vzb U ........................... ....=�............................................................................................I...............I................................. .......................................................................................................................................I............................................................... 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 TLITiE 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. ned.- .....bg:41 Z-A ----- ............... ............................... D t Application Approved By.... AV. .................................... ......../tl 4e-7-7 ----------------------- Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued.... .. ..................... ............... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T PIbLE 0 F..... ................................................... .... .......... ....... ... Tntifiratr of Tompliattrr THL�4S TO CERTIF. That the Individual Sewage Disposal System'constructed ( �or Repaired t N)C) -k _Q_C�_% by............................................. .................................................................................................................................................. -1 taller at........L(Z)T 7* 2— �-J-)K)CE I ------------- ..................................................................................................................................... has been installed in accordance with the provisions of T of The State Sanitary Code as described in the 7 application for Disposal Works Construction Permit No. ......................... dated__..Je- 4.-A. . ....7. .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector'.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0�7 .......�..O.Lo.f-3................OF.... Q.ZS T P�6 L C_- 7Y . .............. ........................................................... N ............. FEE...............----..... Disposal Works Tonstrudion rnmit Permission is hereby granted..._.......U E_-TE2_i Q0 tk 0-r tA................................................................................................................................... to Constiud or Repair an Individual Sewa Disposal stern at No.... -#_1 L f U ge8 V� �y-3 eSL E ..................................................... ......................................................................................................... Street as shown on the application for Disposal Works Construction rgmit 0. A---------- Dated.. t�-.-7.7.............. .... .... ........... ---- Board of Fitw----------------------------------- DATE.... ................................................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS / TOWYOF BAIO STABLE LOCATION "7S�O A — SEWAGE# f l VILLAGE ASSESSOR'S MAP&PARCEL CG!S INSTALLER'S NAME&PHONE NO. Z SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER Q�J�yC4. b PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1. ou t oo 5 g tIN� m �_... ... _...._ j,U xz N U T x r � Nh i 'sFv+ic m a TA IN,X f rt ' `1 { „ _ ." : ,7' � S ` F a,. 4 Sr&� r' �..: i'.X.� 'ot'E lq`• y y T1- , 4 r . v � Y s; t}ids •, . . + r,•, „t - 'wT � r ;, ej� s s -d Y 1 �' P •C s L 0710 a TEST /!�.'. .4 SY, f ! 9 `MOLE Dt$T rtA \\ NP 18 .4 356� t ELEV /7 6 5 RAID 36-i#4 /'9D/U/N 5R /D 'j, NO WATER EN ELEV 5.b i�ct�tYEk ; • M/n!/tilUM r3 u/c_D/nrG S ETl3AC , 2EQ U/ E-MEh/7! -.. S G 30 F�20/vT / /S-. 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