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Home My WebLink About0009 BROKEN DIKE WAY - Health 9 BROKEN DIKE WAY Centerville A = 227 - 078 5 S M E A D No.2-153LOR UPC 12534 smead.com • Made in USA "WW SF[SR PAOGRAN pF i10H WWWSWROOPAMANG No................_....._ Fxs............._............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................O F.........................................----.--...............----..._......-----------•• Appliration for Disposal Works Tons rnr#iun Fjormit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /� I •L ation- ddres or Lot o. ....... Owner Address aL......C..--..-: -'..�- ..... Installer Address Type of Building Size Lot_. TQ%Z..__.....sq. feet Dwelling—No. of Bedrooms..........� ------------------------------Expansion Attic ( ) Garbage Grinder (# pa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ..................••----•-----•••-••---------- W Design Flow____________________ �.®..........._.._gallons per person per day. Total daily flow.._...._3__'5_.�..__...._._......__.._.gallons. ` WSeptic Tank—Liquid capacity.pl9P.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 ( ) 3 aPercolation Test Results Performed by..... _?._.. �Qf __r.l1N_Fv.... _bl~Cr Date...N. * /14................... Test Pit No. 1.15 r, ......minutes per inch Depth of Test Pit...f ..e....... Depth to ground water_-N®_ ZR"""y D fs, Test Pit No. 2__�.:�_....minutes per inch Depth of Test Pit---14 fit__....... Depth to ground water._l�f�__�MUM �+ •--------------------------------------------------•----•-•-•--•-------..........-•----------------...---------..............----......-•---------..._.....-- ODescription of Soil.....................................•-•--------------•-----------•----•----•-----------------------•-•-------------•--------•---------------.......................... x 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 TITLZ 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until ertificate of Compliance has been issued by he board o ealth. Signed----- . •. . . .. ........ ....... . .. ............. ..................e ....... Application Approved By.....---- ..................... .. . ...............................10 f---• -•---•--- Date Application Disapproved for the f oll ing reasons----------------•-----------------•---------------------•----------------------------------..Da Date............ -----•••-------•-•--•.......................•--•••-------------•-•-------•----•-----------•••-----------•---------------•--•----•--------------------•-•--•--••------••--•----------- -- Date PermitNo......................................................._ Issued....................................................... 1 No........................ Fxs ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .•....... ................................OF.....................--...._......._...--------------------..........------............... Alip iration for Dispao al Workii Tnnstrurtion thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_......._...................................................................... •-----•-••-•------.........................---•-------•.........•••----•-•-•----.............---•- Location-Address or Lot No. ......................_.......................................................................... ..........-•............................................... :..._......._------------ Owner Address W ` ---••-- - Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------------------------------------------------------------------------------•--•-•....._.......... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic 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.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p+' --------------------------------------------------•---•------------•___---------------•-------•-------------------- •....... .-------------------------------- - Description of Soil..........•----•-•---•---•- -----•-•-=•----•---•..................•••--••--•---•--•---••••-•--•--•-••-----•---•••-•-•••---•---------------••-------•-•..........------ x 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 TITRE 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 E� �S A; o ed By-•••••-•---••--•• -- --•-••• -----------------•-•-. •--••-----------•--•--------••----•-. ------ Date Application Disapproved for the f of ing reasons-.............................................----............................................................... ......................................................................................................................................................................................................... Date PermitNo......................... ------ - Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................... ......................................... Tntif irate of Tuntplitanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b .......................... / ` Installer -----l l!I........,_.r; ______._. v.1•T. :_.4-l ram._=-1_____:_`*_—.......L.—_M.=________________�.__._.._____.____________..._..____________________ has been installedin accordance with the provisions of TITLE 5,_of The State S -tary Code as,descr'bed/in he �a d } — ram,/ ; ' „ application for Disposal Works Construction Permit No..................C.___�__.__.._r_ d lted--_.-_____-_.-._.....__�___.___--.-...____.____ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL CTION S TISFACTORY. _ _ DATE - 9- ._.��.......................... Inspector......----�------------•••-•---•--•-•-•----•------•--•...-----•---•-•-----•••. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1........................ . . ' .. �... ..E� fi......... . �tk._._t...................... .. No............:-.r.:... �1E� 7 II FEE........................ 'r Disposal Works T41ntrnrtilan rrntit Permission is hereby granted...................... - ..I....... to Construct ( ) or Repair ( ) an Individual Sewage(Disposal Syslient. M at No.................... 1. Street ] I as shown on the application for Disposal Works Construction Permit No...........G-�__ a e .......................................... ---------- ................... ---•--------•-••---------•------------ { � Board of ealth DATE.- ------------ •s P"V ►. ri✓?_ �_... FORM 1255 HOBBS & WARREN. INC.:—PUBLISHERS �,� (� /0CAT10N � SEWAGE PERMIT NO. TO 7 V I-1 l A G E NS� I:NSTA LLER'S !LAME i ADDRESS R U I L D E R OR OWNER DATE PERMIT ISSUEDb � � DATE C0MPLIANCE ISSUED /icy I �Qc/�C U 0 Vi --� G y/ 20 FT. MIN. . ` TOP OF FOUND. \` a�? EL. = 2q•5 10 FT MIN __. CONCRETE PVC CLEAN SAND COVERSPIPE C MIN.H. 40PITCH CONCRETE � 1/8 PER FT. COVER 2" LAYER OF ° 4" CAST IRON ! , nU � PIPE - MIN. PITCF' 112 MAX. I/8 - I/2 WASHED • �.0 " STONE G I/4 PER FT +• . o , o ti f LOW LINE ` .. t 1. = 2�.2_ _..� 10 '� ._.__ ---..`` a MIN EL L_`l.°1 EL = 27.0 ' DI ST. EL= 2 .*.0; w LOCATION MAP �'� = BOX ° ° - P_.1^ v 3/4% 1 1/2" -- � e'�° w a o WASHED STONE 'O�° o °d O o . 0 LL O , :Ic''C7 p GAL. PRECAST LEACHING w 'd" ,. BASIN OR EQUIV. �_ SEPT I C 6.0 .; TANK 4y5j,0721 _ _, M* L__ BOTTOM OF TEST HOLE f E L. �� _ �_.�J _ PROFILE OF GROUND WATER TABLE( / / ) EL. _ _ SEWA(� DISPOSAL SYSTEM NOT TO SCALE DEIGN CALCULATIONS ._ _ A NUMBER Or BEDROOMS . . � �j r. SOIL TES �- ,� r �_ _ t7or e DATE OF SOIL TEST GAPBAGE f POSAL UNIT. L - ,� �.�. _ _ w R - ,... _ � 4 , � .. :, _ ., r r � � At L MIN / I N C H r t4Y -C� ._ J 'ERC0LA1 10N N y ,_.. •_. ._ .__ _. _..;,. ".�;"` -- . _ � ,: • � I'�_ . .SAL /f3R.� DAY x 9 BR . . . � --GAL I D.,� --==-- -., IcoA (✓{aIri HFOUIRE:D ` ,:PTIC TANK CAPACITY.... . '"' . 49� GAL, OBSERVATION HOLE I OBScr�Y'AT3CIr ,.... ACTUAL ;17'` C. SEPTIC TANK..... . .. . . . . ... . .�^ j ----GAL. ELE.ATION = 21_� 4 �ELEVATION ' _IA LEACHING 1PEA REQUIREMENTS i x,._,_ •- _ �- _. SIDEWAL'_ AREA _2.,5 GAL S.F. 1 BOTTOM AREA _� T�O GAL./S.F. { $ LEACHING CAPACITY ( BOTTOM + SIDEWALL) . '0 GAL, v,! r w;.,`+c I ,• �1� -} n I'Nl ► , ' I,o A r ='t;t j .. p,x•,) t 2,�78d%JF�to '�!. K,�1 � �j•� W f 1 ' RESERVE 6q9 O GAL 1 ; ( LI:ACNIN6 CAPACITY . i C;tec'�rl . r11,.'..J� urri `��r14 --' �� • j !44 Ei, 16,4 4 E I Ili '� NOTES VIC I LL'k RK MANSHIP AND MATERIALS SHALL C NFORM ( p :E T I T L E 5 AND THE T O W N OF r,bl G T REGULATIONS FOR SUB5URFE' t5P1�SAL s l e qc> r U L E ;~ r �i Y SE WAGE . . 2 ALL C 'EkS TO SANITARY`'-UNITS SHALL OL-rBROU614T TO j+. + �.t WIT'HINJ 12" OF �INIS►-E D GRADE. 3. LXISI 'm FINAL GRADES SHALL REMAIN ESSENTIALLY ' N tL PAT U — �,^ MIN. FRONT SETBACK m THF_ .r �a R MIN REAR . SETBACK 1r' 4. NO- 0EP:..,,:ATION HAS BEEN MADE BY THIS OFFICE d5 1'0 ISIDE SETBACK I y root-, t COMP-1 'N(il WITH TOWN ZONING REGULATIONS. 01h ER, ar'PLICANI� ✓ '':�� 80Ar20 OF HEALTH u ? / \\ IS�}aT :le SI�C�H IDETERMI �TION FROM APPROPRItORITY. t"�(r( i Ili!)t DATE AGENT PROJECT LOCATION: 1 �� •: A. \ \ . .wM +.. el`r _'► ✓} fiV .. Cv I C/' `� ,t' sue' I, i I ur�e b: .;� o !� �i u -o. ("r1�} ��rt— ) j �r y ,i �� a 1 ter, rt, an for J. APPLICANT: re �`A OF ,yqs NaF� fi 'f !� ! LEGEND EP�S SCALE GATE ..._� y. l'y RICHARD t /r EXISTING `;POT ELEVATIONS 000 �e� RICHARD G -x J. (, _ �' PO , .4 - __ _ - - __ X _ S JAMES c�� + �0B N '! AP PE). REV: aA LXISTiNG ;ONTOUR 00 CYHEA�RN Co. 278N a� �4 "Gg2.�? +�i l`�f'JG.•-" FINAL SFOT ELEVATIONS w a 4 FI�(AL Cc� TOUR rM, F��sT s oSJQ R. �/ O LEARN, /NC, DRAWING j l l&N SGI T E S f LOCATION - SA �a� REG. LAND SURVEYORS- REIi SAN?AR/ALAS NO I 41 Ll SITE PLAN 3,5 ROUTE 134 — UNIT 2 5CV7'H DE-NNI S , MA SS. O F I 4......+...,..».+...+-.«...._..._._..._......._......_..rr.r.w......•_.+w4.«.a..:.._._w.....:..f...,......_._._•.._...._..,.._._.J ,.:C,Y. ,_.. ..............._........- ...... ._ ,—..... ...._._...........-.._.....-..__.__._........_...._...__. .._a......... ._...-__-'_'.a...,.w_.._.-_._.r__. 9. X 4 `41y .... Mr..:.9..+G."'^fS.a.1,M)!.dM+m.d+-f'.^Hi. ` _.Wr,wM'"r"M"'^,...'M^"-ram._,. _ ..,.....,,♦ ... a rlllu. iiMv.BR ( T �• 10 FT MIN TOP OF FOUND 4 SCH 40 T`JN -- - CLE-A .: AN_,' . t Pi (, -� rCNCR'E.T1=' iy ----- T C . - _ , 1 OVE R n , 4i CAST I R O N � � � MAX t { v PIPE MAIN PITCH 1 _ 1 , ,- / - ---- I"LOW LINE � !,4�� PER F T 4 �3 , A' 1 fr t r - - _L_ MN I Ll i5;� T I EL = 1 —1 — H i I -- -- - - �-_ D1 ST L LCICATION MAP BOX y . 4 - � ° � ' z n 3/4 ! WASHCD STnNE f) 00 GAL PRECAS LEACHING LEAHING 1 �. •- _ — BASIN OR EOIiIV. �. �► ° r SEPT 1 C TANK A gr--A�, S3 D7�+ S.F. I f GROUND WATFR TABLE EL. = r a PROFI L_E 01 - / 3EWA' . G DISPOSAL. SYSTEM . i . L0 T. � Dc SIGN CALC'UL AT IONS I,-- oo \ SOIL TEST ' NUMBS` .Qi CMS . - - - TEST [ J 6 - C 'T O F S C)!! L S T APBAGC UNIT �C SF LOW V"ri i!UESSED BY J I .. h �lr'_ vai F ,Y x BY C[.1 _2__-GAL i . 4 A-� ':0 RAT E. aE4�T! TANK CA'r" - / y..IT +-- OBSERVATION HOLE I OBSERVA 1O N�)� 2ION N .� _. G4L TsF_F_.__�'FMO�AL Pf ACTUAL Tip: OF r C TANK --�'-JcJ_ GAL. !- .'�r.:Vµ' lON :: �l3. - I a . _ r w. ACHI s i 4PEA R� i ENTS � r SIVEWP-iL L. is Kr :-i —. JA�.f Sj ._. -,•� • .. T f � BOTTOM AREA ____�� __ rAL /S fi • 3. 3 / l+IA 1'r,:ACHING CAPACITY ( BOTTOM S1DE' '. fG A L �. �t (.' s �.�� RFc :y� �� 1 ct�A� -r ` `, =�> �a r1>✓�Iu ��ht; c-t. ri, Mob �µ(.Xl 2U f f NOTES b 4' i' r� � Z2 1 ALL WORKMAN$H!P AND MATERIALS SHALL COI'F6R M TO D F 0.E TITLE, 5 AND THE TOWN OF RULES AND REGULATIONS FOR S )BSURC7AC•> DISPOSAL t ; "' v OF SANITARY SEWAGE ` 2 CC, PL iANCE f T H ON E 10 - .- 7 F �• �0, � G R GUL AT NS SHALL B - ., - r, .,,. y ,• .. M \n �; DETtRMINEJ BY B lLDING INSPECTOR OR BUILDING BUILDING SETBACK REGIJLA IONS PER 181.t1L.!NG" 2 �� r()MN'ISS+CNER 1 INSPECTOR OR BUILDING COMMISSIONER: i CNl+ r �7- MIN FRONT SETBACK 4' J 5z 3.EXSTING AND FINLv L ' GRADES SHALL REMAIN ESSENTIALLY ! ' TtaE SAME MIN REAR SETBACK �s2 �9 i-}t�Y t-�AJ LS `Z;� p..A�...V_�V ASS 5N-%4N MD MIN SIDE SETBACK vi:�:;=- `� � ' `.�I-I•f�'t 1�D-r �R 7;:_ �-`D `�'YO!•�D �S,�•:1 �>��:y`, '�h.l i..`� ! APPROVED = BOARD OF HEALTH !fv `�'t..h.�.E.- U+ T 4.� •'.� T r- "6`••''.::.a 4-JTJ L..a i...- 1 ^ ?' A.NPT s'. _._. ... ..—...__—,—._ — I DATE - - AGENT - - I �•` PROJECT LOCAT10 I T,• !L TE S • M -,4t. � h ( .:Jk '. FROM O =r/V F4�2 i L . -tt(yv AJ !_7filF_ w,*y RAY.�t n:D �AT/<ovy Sh'/ CA7—ED 0410 2 :r 1p + APPLICANT : c iti --�1 ,:.�4 it3 Rx YA•.,-^ea I 7 I i , �'._/•}�f y, f-,. ,�� + /h Y--=� .s 1 GEND � SCALE �o s1R BY _ I EXISTING)ING SPOT LLB .ATlC)NS OOx0 y JOB N ID B _ . cXiS . 'wCi CONTOUR - - - OC - - r r FIN',, Gi l�T t4 _� `rA iJ�IS Lil �1 r n. �/ J G � kPP Y R�'ti : FA R t NFL �.� , 1 RAw N s t 27x¢ SO! �E T - CCATION RE A Yu - R ' 1 V V �7 �!V+L� G 1 SITE P LA 1 r � _ T G. t wf7 SURVEYORS EG. SANirAR<ANS G 1 I - _ _ _ - P. 12 �✓''� � � t r �B ROUTE r3� BOX 63 ; E $c A EAST Er✓N S , MASS. O�' ' O 7 -7 4 _