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Home My WebLink About0369 CAP'N LIJAH'S ROAD - Health 369 Cap'n Lijdli Rd Centerville A= 193 - 104' oyaro UPC 12534 No.2 153 OR +uaruioa.us s o.. .. ..... ...... Fx$ s THE COMMONWEALTH OF MASSACHUSETTS ,x BOAR® OF 6Li -I ALTH �/� l q3 a pfirati an for Ba-qVniiFal larks Tonstrnrttnn umit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System • _ ...... ls� -• -- ------------- n•Addres ' or Lot No. Owner Address W Installer Address UType of Building Size Lot............_.......-....Sq.,fee Dwelling—No. of Bedrooms......;.Z1............................Expansion Attic ( ) Garbage Grinder Other—Type T e of Buildill p., yp g ............................ No. of ersons.___.___._.__........._._... Showers — Cafeteria y* • --------P ( ) ( .. � Other fixtures ----------------------------------- -- -- ---------------------------------------------------------------.......---------•----------- `- W Design Flow....L_;�o...._.' ....... .._gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity.//•-gallons Length................. Width................ Diameter----------------- Depth......t....... Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..........�:_L,__sq.ft. /3 Seepage Pit No.__ -------------- Diameter.._ 2-•--_________ Depth below inlet........!(0........ Total leaching area_'-,,,,-.-.------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground.water---__-_.-____-___.__---. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground watex ............... a '" k -------------------------------------------------------------- ••--............... ... .. Deyiptior�o, il._---------•-•----------------•••-•-----•------------..........---•----------•••-•-------------------•••-------------......•-----•-•••--••••-•-•--------•--------------- c.� -------------•--------•----------------•------------•-••-•-----•-•---------------------•-•---•------•------------•---------•-----------------•--------------........................................... W UNature of Repairs or Alterations—Answer when applicable.----------------------------------------.:.........___.__._____....___.__...___................ ------------------------•-------•---------------------------------------•-----------.....-•--•--------------•-- ......................................I................................................. Agieement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL 1Z 5 of the State Sanitary Code—The undersigned furth agrees not to place the system in operation until a Certificate of Compliance has been issA and of igned --------•---------•---•-• ... -----•-----•-- •---------- -- ............ ApplicationApproved By....... ------ = - ------ .......................................................... ---1 � -' 3I)ijE Application Disapproved fr th ollowing reasons:................................................................................ .........": %= .----------- ..------••••-••----•--•-•-----••---------•--••-------------•------------....---•-------•-•-••--•---.......-----------------------------------•---- ........... PermitNo................................-•--•-------------------- (r No... r.3 a.. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................O F........................................----.---------------............................. a Appliration for Uhipaii al lgorkii Tomitrurtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System 4,t ...........: - ----• ••.... .. .. ................. .......•••---••-•-•-•--....._.......••--•-•••--•••••--•------••-•--•-----•--•--••----------•-•---- n-Address or Lot No. ............ ---......... .... .. ... ................................. ......................... ...-----.............................................. Owner Address W Installer Address Type of Building Size Lot.... ._._._:.............Sq. fee Dwelling—No. of Bedrooms...__._'.............................Expansion Attic ( ) Garbage Grinder ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' O he fixtures ---------------------- -- <11 W Design Flow....:.....:..0...... ._.___. 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...4......_..... Depth below inlet........-fir.-........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------------------------------- ---------------------------------------*........•...•------------------•...•----------------------------------------..•••- 0 Description of Soil......................................................................................................................................................................... x •••••--------------•----•------•----•---•--••---•-•-•----•---- 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 TITIZ 5 of the State Sanitary Code—The undersigned furth agrees not to place the system in operation until a Certificate of Compliance has been iss the b aW f agned -----• ••..••--- -----•••-- ------------ Application Approved BYlthf' ` �ff_ ` _ .� Date Application Disapproved fwing reasons:----•••-••----••••••••••••-•-••---•••--•-•--••-••••••--•••-•-•••-----•••••••-•••••--......-••---•-•••........_ --------------------------•----------------------------------.....------....------...........-------------•---•--•--•-•••-•--•••--•-••---•-•----••••------•--.......................................... Date PermitNo--------------------------------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tpr#if irtttr of Tompliana T is CPrrdance 1 hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ... ...... .... .....- .......... 0 at ...... r - ... ----------- has been installed in ace w tl, ie provisions of TI 5 The State Sanitary Cod _as (abed in the application for Disposal Works Co ruction Permit No......................�............... dated_... :_ .______-�''___.__..._.______... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® S A GUARANTEE THAT THE SYSTEHA�L NCTION SATISFACTORY. DATE. ..f�0 3........... Inspector........ •--;------•--•--••--••••----••••-•.........................•--•.......•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,, � .................................OF..................................................................................... � No.••--.....•.............. FEE...••--............... irrjar ttrirrn anti Permission is hereby granted................. ----------. •--------------- .'.�.. .:.. to Const uc ( or a' In i al S gag is sal System �°�`� �'�` at No.. '...! .. ............. . ............•• ....... ..... ...........Street---------•. .._.fir.............. .................... _ � as shown on the application fo Disposal rks Construction Permit No ._. Da d. �._.!�-E°....•............... ............••-•-•••... .....-%--...E..'.'-----------------------------•------.....---- Board of Health DATE................................................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS p=�%�EViI�AGE DESIGN PLAN SHEET OF Z LOCATION � 1? li� .! �' •S,... ... DATE . �Z•z7e�. PLAN REFERENCE 77 L CIVIL ENGINEER - i�, OF lyq s CtJ r - •Z THO \ THOMAS E.KELLEY CO. j ENGINEERS—SURVEYORS 24260 O �' >i4f LONG POND DRIVE �G�STEQ�'��i``' , •Ot?=YARMOLTM MMS. PETITIONER °' TH ouit'�� \V ' .01 44. y , '� r •' '.NAY d 9 n C ' � 3 Z GiYI5 7 ZOO L So�a�Ci�S�v�E�✓i9TurN> , , TOP OF FOUNDA TION • CONCRETE COVER ` CONCRETE COVERS •'; 4• CAST IRO?SEPTIC . 12"MAX. "' '"r'• ,•; PIPE (OR 4"ORANGEBURG(OR EQUIV.) EOUIV.)� MIN PIPE- MIN. LEACH ' PITCH 1/4"PER PITCH 1/4"PER.FT. PIT PRECAST °• , LEACH I N G o J o, NV PIT OR .e EL; T4D. \—INVE INVERT Q't TANK •p DIST. W EOUIV. 'o IN ERT EL... 3 BOX EL415, >x • • •e; EL4`V(p.�.�.�. /�iQ• GAL. INVERT INVE�gT :• /w :'i; 3/4'.TOIV2" EL4S7. EL4�,,sb :• u. 0' WASHED •STONE t 0.0 ru D a ; o.,-.. PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO , SCALE SOIL LOG WITNESSED BY DATE .� ?D� 6.2—TI ME J1. `• • • �• •�,�✓ � BOARD OF HEALTH TEST HOLE I TEST HOLE 2 1140AI 6 ENGINEER � ELEV. Qcg•'.�. . ELEV. .. .. . . . . . . C..C. G(L t .d Fitz A> S DESIGN DATA : F QED- / ` A _1A NUMBER OF�BEDROOMS : .`. TOTAL ESTIMATED FLOW Zp�. . . GALLONS/DAY M et). sD BOTTOM LEACHING AREA ; 78,s.4. . SO.FT. /PIT SIDE LEACHING AREA . . �88! . SQ.FT./ PIT GARBAGE DISPOSAL . D. . .(50% AREA INCREASE_ ) TOTAL LEACHING AREA . . ��c` SQ.FT /^4 '1 Ll PERCOLATION RATE ZZvS.Tl Al v MIN/INCH -- - LEACHING AREA PER PERCOLATION RATE : 43. SQ.FT: WATER ENCOUNTERED n NUMBER OF• LEACHING PITS APPROVED . . . . . . BOARD OF HEALTH p . . 00C?uAl.s .DATE . . . AGENT OR INSPECTOR �cH oFMgs ?� THOMA G K H �` '�T-iOMAS E.KELLEY Co' � � 210 O dgf $NGINEERS SURVEYORS /ST�a� ' 346 TONG POND DRIVE sYpNA'�& 'j 4 * .' ai.�� PETITIONER f� g01�THYAAMOUTH�MASS L0C TION / G SEWAGE PERMIT NO. VILLAGE 3� INSTA LLE 'S NAME i DONE S BUILDER OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 3�� ^\ „ "000"PO .