HomeMy WebLinkAbout0042 DOLAR DAVIS ROAD - Health CtAlt rVPtJe,
17 ! 2°6
LOCATION SEWAGE PERMIT NO.
YIILAGE
0 L <s M X51, �-
INSTA LLER'S NAME j ADDRESS
k, H e-K-5,�
B U I L D E R OR OWN ER
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ,�/A
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
OF........TJ.! ..1>-�..5- -�-L
App iratiou for Binpugal Works Tontitrurtiuu lirrutit
Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal
System at:
...................•----•-•-•-•••--.....----------.... ......•••---.......•----••-------•------••------•--..........--- .........--•-
Location-Address or Lot No
.
-- ner
� .... .........�.......----•-..
Insta er t 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 f xtures -------------•---••-----•----------......---•------•-.-••---••-••--------••-••---------...---._...-•--•-•-•---•-•--------•-•••-----••-•.........---•--
w Design Flow......... `.............................gallons per person per day. Total daily flow-----------
�J r�...................gallons.
W Septic Tank—Liquid'capacity.�U. W-gallons Length.�D)... Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No...... Diameter........... D____ Depth below inlet_._..�.......... Total leaching areal .......sq. ft.
Z Other Distribution box (./ ) Dosing tank ( )
Percolation Test Results Performed by �C(lCr ... 1�? .................. 1 - ........
a Date i
Test Pit No. i................minutes per inch Depth of Test Pit.....J_7...i....__.. Depth to ground water_._:..--'--_-_-..__-._-
Gtq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...............-........
Ix --•----•-----------------------•---------------•-•----•....--•------••...•• ...................
O ..� J C r.............. !...C�. IY _... �.::�.:. t.�_ ._
Description of Soil......... " - f' ..���L.� t��t? �',1' �rtv 17 G�= g✓ �•-----•----------
w
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
------------------------------------------------------------------------•-----•••-••....----------•-----••-----------------------•------•-------••----••-•---•-•---•••---••-------•--....------••..•----
Agreement:
The undersigned agrees to install the aforedescribed Indivi ial Sewage Disposal System in accordance with
the Provisions of'ITI.L 5 of the State Sanitary e— T e un rsi ned further agrees not to place the system in
- 1 op tion til Cert�te of Compliance has b n sed o health.
Signed---- .....• b
` / Date
AlWication Approved By............................. --•--••-- ... •. .....(�
Date
Application Disapproved for the following reasons--------------------------------------------------------•-----•-----------.....................................
•••-••--••••--•--------•-----•-----------•-•--•••---------•------••-••--•••---••-------••--•-••-••-----•----••--•-•---•---••------------••---•--•--•----•---------•••----•-----•-----•-•--•.............
Date
PermitNo......................................................... Issued.......................................................
Date
No................_....... FEs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L�( .+J...........OF...... f�c. .►�-�.. --l.-a I�.��- ...
Appliration for Uiipu,ial Works Cilowitrurtiun rrutit
Application is hereby made for a Permit to Construct (vl) or Repair ( ) an Individual Sewage Disposal
System at:
k
... ...................................... ......
Location-Address or Lot No.
- -- ....................................
nstalrer .....A_.., j6'9-1.F//V...............1 •- -f•- .!___._ .......-�.......__•----
�....__..._
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 ( )
P4Other fxtures ...............••-••-•-•----------•-•••--...-•--•-•....••--•---•--••-•--•-•------------------.._..•---•••-----••-•-------••--••--••--•--••--•-••-•----
W Design Flow......... `?............................gallons per person per day. Total daily flow...........��_�J ..................gallons.
WSeptic Tank—Liquid capacity.j."..&gallons Length.�19.. Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No ----- __--_-___-_ Diameter------------Lo.'. Depth below inlet......k5'_......... Total leaching areal ? Gs it
Z Other Distribution box (J) Dosing tank ( ) q
Percolation Test Results Performed ........................... Date..... ' .........
Test Pit No. 1.___. '.._..Minutes per inch Depth of Test Pit......t.:?._'....... Depth to ground water--_--""--------------
fsr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a --••----••-------- ------------•--••-------•-----•---•••••---.....-•-••-•...••-•--•........._--.•----.....-•-•---•--•-------••--•-••--..........-----•....•.
D Description of Soil..........6:- ----------------
tA
.1:?..� _C-a.�A���.-.r
w r'- -------p----
S `-'vim i- -- 2--- .t, ! ►�
--------------------- -------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
------------------------------------------....................................-........................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individ al Sewage Disposal System in accordance with
the provisions of TITS 5 of-the State Sanitary Code— The unsi ne further agrees not to place the system in
operation until a Certificate of Compliance has b n ' ded o health.
Signed.._.:{ ......,t:.............
-•-- ............................. / !,t
Date
f
ApplicationApproved By................................................................................................ ...............
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------------------..................
---------------------------------------------••••-•-•---.•----•-•---••-••-••--•-•---•-•--•---•------•---•---------•--••.
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
J.. l.:.............OF.......... .... l�J��1!. .....................
wrtifiratr of Toutpliattre
THIS ISo T(� CE IF , Th�,the Indiyid _al Sewa e Disposal System constructed ( or Repaired ( )
�—F --r ' /oar`
r-
by %. - ...(... >_. ,'�___'. ..-•-- �, ------ -------
v,.; Installers^' """
at.'_"' Y �lr ._f.._.. � . _`"., J!. .1�...........F --Y (^ - t f
-4. ' f........................
has been installed in accordance with the provisions of TIT r.. . 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL UNCTION SATISFACTORY.
p.
DATE........ 7 l Z )5 Inspector..... /
THE COMMONWEALTH OF MASSACHUSETTS
BOARD FAH' EALTH�y
................OF... /�. .. 7_e. _. 1 :.
No......................... FEE........................
Dispoind Fvg.,g Tonotr tion rr�tit
Permission is he by granted•-- ... ................................................
to Construct ( /or Repair ( an Individual ewage Disposal S
at No................. l ' r 2 Street- t �z�.------I ��..................
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
-------------------------------•-------- -------•-------------..----------------•-----•.---••--
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
SITE PL A lV 'SHEET I OF 2';
SCAL E:
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Q; WAtaMCCt h Z
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FOR
REGISTERED LAND SURVEYOR L to &?P47. D a L.A rZ PA\/1 5 r?4eA p
ZONE G' L, N 1' (z v l L.L.< h At . ,
PLAN REF. DATE Z 7- 1 �(
1
' BENCH MARK DATUM '- wm11 } WM: M..WARW/.CK 8 ASSOC., INC. .
DOMESTIC WATER SOURCE '�t"da,r rJ wAT - BOX 80/ NORTH FA4MOUTN. ::
FLOOD ZONE. 1�D reJ-� aA 7- 7 :�- MASS:*0'2556 (6/7) ,5$3.-c�6 3B
_ LEACNINOG 8ASIN SECTION NOT TO SCALE Shecv1 of z
EARTH FILL BRICK AND MORTAR COURSES AS R£0'0• TO BRING
i. _ ,-. _ _ COVER TO GRADE
? INLET' 8 FLOW LINE -_ y, p"_%"TO " WASHED PEASTONE fR££'Of IRONS,
PIPE �' T FINES AND DUST /N PLACE
`- /q To...I/2 WASHED CRUSHED STONE FREE OF
OPENING WITH 4%g" IRONS, FINES AND DUST /N PLACE
7 OUTER.DIAMETER ;
AND 13/q„INS/DE
0/AMETEK . I. CONCRETE TO BE 4000 PSI 28 'DAYS
r 3 r
2. REINFORCED WITH 6"x61' NO. 6 GA. W.W.M.'
3. 2'AND 4' SECTIONS ARE AVAILABLE FOR
GREATER DEPTH REQUIREMENTS
so" I zI —{ 4. NUMBER OF PITS REQUIRED fkJa
MIN. .. �o ; NOTE: EXCAVATE TO ELEVATION .o OR
EFFECTIVE DIAMETER
(NOT TD ExcEEo 3 TIMES EFF£Cr/VE oEPrH) LOWER AS REQUIRED TO REMOVE ALL
WATER,TABLE - LOAM AND CLAY BENEATH PIT. REPLACE
EXCAVATED MATERIAL WITH CLEAN
rYP/CAL PROF/LE GRAVEL TO DESIGNED GRADE.
58,5 /B"STD. Lr wGr c. my CovER
5�.5 ., d•5 6,2 6..o
4"C.L PIPE 4'BI r F/B£R PIPE
r/GNT ✓DINT OUTLET LEVEL
DWELL/NG FLOW LlN£ TO FIRST ✓OINr
53. i4,, �� 110 ou ► 1
cI. TEE _53,t5 1 II OOOI00 91 I
bfl ' rD, PRECAST cONC. 53.3Z 0/ST. 9oX 0 BE 53,00 ' 11600 00 to i i
GAL.SEPr/C )rANK INS A�ON LEVEL, 11000 00 01 I I
STABLE BASE i it 000 00 0•1
.•_:.L:
11 000 00 o
NSEPr/C TANK ro•BE 1 if 00.0 6 0
/HST LL D LEVEL, 111 p 00 t 0 0 I I
STABLE BASE. i 1 1 0 0 0 O 0
1 100o 0 0 1 1 „
LEACH/NG BASIN , i 1 A p O 0 0 0 I ;
BASE To BE L EVEL i 1 8 0100
1 1 ,
SOIL AND PERC. DATA
t�. O TEST PIT NO. P- 370o O TEST PIT NO. 2
PERC. RATE MIN. /IN.
-Top le.oo,5c, lL
1 TEST BY
5
WITNESSED. BY: nnSP. san.iD
TEST PIT GR. EL. GL,EA,v r- tiE
DATE: �► %�� s ,p
11
DES16N DATA GENERAL NOTES
BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM.
DISPOSAL SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD
EST, TOTAL DAILY EFFL� GPD. PRECAST REINFORCED ,CONCRETE UNITS.
SEPTIC TANK GAL. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE
TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE,
SIDEWALL AREA 2- SGAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF
BOTTOM AREA 1- 0 GAL./SQ.FT. SANITARY SEWAGE EFFECTIVE ON JULY 1 , 1977.
LEACHIRG REQUIRED 179'1 SQ.FT., ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
ACTUAL LEACHING AREA OF HEALTH.
Q.FT. : AT COMPLETION-OF CONSTRUCTION, PRIOR TO BACKFILLING, THE
BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION.
PITCH ALL SEWER LINES I/q / FT. UNLESS INDICATED OTHERWISE.
�'-"°F '�� SEWAGE DISPOSAL SYSTEM
4� MA ETIN
f034 N LoT l03� D®Lf�fL Z�/�►V I�j �oa�
L 1.1 t M f c 5 S .
ASS/OI Al ECG\
SCALE AS /ND/GATED DATE I z /a
• WX M. WARW/CK 8 A$50C•, /NC.
BOX 801 .-. •NORTH FAL MOUTH
` MASS. 02556 - (6I7) 563 -26'38
PROFESSIONAL EN6/NEER