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HomeMy WebLinkAboutApplication - 114 STONECLEAVE ROAD 10/20/2009 . TOWN , d� RTI I I)O E1,t,� Office MA ) M(@ M r S W14 lik" 1114'AL11-1 m DEPARTMENT 16 hill 0 4. 1 .i��t�, ,'I'; Lill D I 0 U llll t E -36 a"r, 978A8,9540 Mom, susalb Y.Sawyo,R1,11S/RS 978088 8476 FA X Pubfic Ilealsh Dhwtol, MA,H,:Uneaf tNlaw1�yy,E�by,gawa�tl�ur.pq�t';V� p 1,;1;MySf G b. Vw4kp;./F7vwvay.(��}yii,�ar�utiasr6„6�;w�u��,ww�a^�oa.°r�au:. SEPTIC PLAN SUBMITTAL FORM �.� .... . Date of Submission: 641a ce- Site Location: 1/4 ��h�G��(/� rci. Engineer: New Plans? Yes to $225/Plan Check# (includes Is' submission and one re- review only) Revised Plans?Yes $75/Plan Check# ��% Site Evaluation Forms Included? Yes_AZ No Local.Upgrade Form Included? Yes v--' No Telephone#: q—'19-25Y-22(p 1 Fax#: E-mail: bey i M,)d OSq OOCICCO Y1easl:I)e Homeowner Name: "a.rd OFFICE USE ONLY When the submission is complete(including check): Date stamp plans and letter Complete and attach Receipt Y ' '"'r Copy File;Forward to Consultant Enter on Log Sheet and Database 09/28/2889 22:59 17813340115 TANGARDR PAGE 91` CL w j g { �cl m a . CPI CP1 m O �+{ CD(1 If7 F ' c. ®■ !Y- <A CL 'fF.a .�` r Lil 1 I iTl � � u C cn fA c � r� El ❑ ❑ O Z�, C � �.,11 � tp �s' �f r @ ® ul RU c47 O m vii P W CM .c .. 0 -a R. 9 N 0� uw@i T CL , C =-d o CL v' © tf1 f ■ '... e @ ❑ ❑ Sd �, b oa Bbl cr m G? g � Iii 09/28/2009 22:59 17813310115 TANGAFDR PAGE 02 0 c 4 Gn rr�w moo ZI m N a m to lb p IML v CID a , � N o - (D 3 s < ° ,a fn rlr :r CD y ° m h d m m CL m � ° F r C N A rn rp col ° * CD cu 3 b rD m m Q. > cr CO �. O N Q ❑ ° � I' y m N C17 ❑ cu m R m (R g o a a a > ° N en ii W a d \_ w ^m m m W ch Q cfl 3 U1 � l 0912212009 22:59 17313340115 TAHGARDR PAGE 03 0 4 m { -n 00 r O CO) K Nu cr ° n ( b' cr C` m to Aq en C1 Y 6 ' t�► �a CD xW � a� Q c Yi m m o o a m 09128/2009 22:59 17313340115 TANGARDR PAGE 04 U O 6 p y _ o G) o ® O 3 o Q O a m n w CL o p CL IT co a 5" „ a ,- _ CL m ° c O' C N tb SA L7 N CA © a K rr CD CL • to c ro r- LO) rL �G � i a ro m 4 W m m CD ca El en 9L obi S olp ran Z y g o cn ti N 09!28:'2009 22: 59 17813310115 TANGARDR PAGE 05 c. 0 -� t g Q Q Q {'1 En ws m a LNh C w q cr CL Lo Ilk 0 3 c 9 �s � co a �- � m U th h o � m a cD �m r m � a In "�. _ u' '13• m m 0 CA wo m e � m 2 09/28/2009 22:55 17813340115 TANGARDR PAGE 07 w 0 r_ -n C7 0 b O ro CD m cp m v� ur cn .., N m to O Q © rn CJ a a cn v m o cr � cn m ED N rvii v *Sy,,, _ o �"' a ' o m o p, C' N m o. c�a a L U d1 N m v a y� 7 . ' 7 ,r 3 rd) m (�J lz Y N A R Y m CD 4. m CL co r m Al Q 0 m in a Q � ' 1 N � d � Q 09/28/2009 22:59 17213340115 TAt•-IGARDR PAGE 03 0 { o a z + w M CL Cy O 3 QQw m a 4. N d a 0 CD CL 0 CL 0 (d N co +' c m rn M EL o _ 0 rn +ate (D � � fr 3 a co jm�K� � � Q (D o �m �� �� d 3 � � G � ? ^ 0 all o sa o { 3 g a :-4 Q CD I coo r"F CD rn P_ v = J = — os co a R,%\ N m C m o W A ID Q"^ Z3 a �' C rt �•a � CL os o CD rh m w b O p'3 Q mg °1 -,>, C M _N m @ f) ry J d (11 Vf 5 o Y 09/2 812009 22:59 17013340115 TANGARDR PAGE 09 v, 0 a 6 O �_ W 9 I `, Q . 3 D � o 0 s 0 CD a -« a � � w r CA 1 TI � f C µ OI - `CD 7 U) a v, m 0 m m m m 0 09/28/2009 22:59 17813340115 TAhdGARLR PAGE 06 Commonwealth of Massachusetts City/Town of Percolation Test ForTn 12 Percol;stian fa$t tesults must be submitted with the Sail Suitability Assessment for On-site Sewage C1iSposal, 0? has provided this form for use by local Hoards of Health, tither farms may be used, but the information must be substantially the same as that provfded here. Before using this form,check with the local Soard of Health to determine the form they use, Irnportarrt: ite iriforMatio When filling out forms an the Computer,use only the tab key Owner Name to move your cursor-do not use the return Street Address or l.bt# key. Ci#yiTown state Zip 00do Contact Petspn(ff dWerent from 4wr'ier) Telephone plumber .... B. Test Results f� Mme VE Date Time Observation Hole# —r .- .� r t Depth of Perc – -- Start Pre-Soak .r End Pre-Soak Time at 12" _ Time at 9" Time at 6" Time(9"-6") Pate(Alin./Inch) Test Passed: ] Test Passed: I J ,. Test Failed: (� Test Failed: 1 ( _ . T st rfvrme By: Vlfi(nessed lay: Comments: —r t5forrn12.doo-08/03 Pere test•Page 1 of 1