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1
No.--ca _' 2 Z Fxs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
............. ...oF. c-�`fi�/ 1� .
.................................
Appliratiou fear Bi4paga1 ,ark Tututrurtivit amit
Application is hereby made for a Permit to Construct (� Repair ( ) an Individual Sewage Disposal
System at:
=...... ........,b U .---- •---------------------------------------------
- Location•A ress, or Lot No.
Ow Address
a ........... ,Y--.l.�P1 Y. ).Vr" iAAA--------------- �.,./.�.s.............-------._................------........----
� Installer Address ((•�
Type of Building Size Lot._7�_Jf`J_W...._Sq. feet
Dwelling—No. of Bedrooms__________..................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ................ .................
w Design Flow......... _________________________gallons per person per day. Total daily flow.......... _ _.................gallons.
W Septic Tank—Liquid"capacity__Or/Ugallons Length................ Width................ Diameter................ Depth..............
x Disposal Trench—No_____________________ Width.................... Total Length.______..-----
Total leaching area....................sq. ft.
Seepage Pit No..........I-_.__.___. Diameter____._ ._ .__ Depth below inlet___. �.__. Total leaching area. ...sq. ft.
Z Other Distribution box ( ✓� Dosing tank ( ) II
'-' Percolation Test Results Performed by.. -�°. _. � __��_____________ Date__._1_�_l.,_�. �_.___-.
a
,.a Test Pit No. 1.� _minutes per inch Depth of Test Pit_____ 2'_._..___ Depth to ground water________________
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_.........:.......
p---------------- ••--- -••------ -----__ -- -
Description of Soil Sv I(�f...•��-_ �-f----- --�
x ---- --------- -------------- --����---:K i---16. ...-�-- ...............................................
UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
--�-��
Agreement:
�lersigned agrees to install. the aforedescribed Individual Sewage Disposal System in accordance with
the provis ons o4TITLE 5 of the State Sanitary Code— The un ersigned further agrees not to place th system in
until a Certificate of Compliance has been y h of health.
•
Signed........ ----•--...-----•----•-••--•-•-•-•-•-------_.. .._
ate
Application Approved By--•--•-•-•-••-----•--••-••-••--•••••.................•-•--•-----•--•--._._.._...............-••- .....................
-__-...............
Date
Application Disapproved for the following reasons:_..:---•------•••------------------------•-------------•------------•---•-•-•----------•--••••••--•---••--_-----
---•-•--....---•----•-•----•--------••____---•--•-----•-•--....-•-•-•-•---------------------••-•-------...••----•----•---------•-----•--------•-----------------•--------•-•----•-•--•--•------•-•-••----
Date
PermitNo......................................................... Issued.......................................................
Date
No................-....... FE$..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
................. -_ F'.........._.......O .......,��j . .�-�
-
Appliration for Disposal Works TouBtrnrtion Pumit
Application is hereby made for a Permit to Construct (Vill"or Repair ( ) an Individual Sewage Disposal
System at:.
-Address ..........
1�- . Location,, ._-......�- , 4 : _..__�-?_� ._ .... ...... �( 31. t.N��l :. -.....-
` * A j Address
"¢ s6 J
Installer Address
UType of Building Size Lot... ....Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures .----••-----•--
W Design Flow.........?..........................gallons per person per day. Total daily flow.......... _ ..................gallons.
WSeptic Tank—Liquid capacity..1UUllgallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......... .......... Diameter....... .... Depth below inlet.... g _4 ... ft.
.__. Total leaching area_
Z Other Distribution box ( ✓S Dosing tank ( )
~" Percolation Test Results Performed by--- .:^........ .... :--__-- =�.-_......._. Date......+.�_�_9.` ..........
Test Pit No. 1��--..minutes per inch Depth of Test Pit._...'.2......... Depth to ground water_-_ .............
rs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_____-__-•--•---_--___.
94 ---------------G---------------- '•. J. ....... ... 1
0 Description of Soil..........O-.3�... S c� 5u1 l_f a��7..15 A
x .. � 7 i
U ........•-•------•-----••-•----•-••--••----•-•--•--•...-•••-----•------------------�=�- .�--•- .....��-------------------------------•-------------..
w
-------------------------- --------------------------------------------------------------------------------------•....----------------------------------------------------...........................
U Nature of Repairs or Alterations—Answer when applicable......................................................:........................................
--------------------------------------------------------•--•-------------------•-.......-------•-----------------------------------------------------------------------------•-------•-•..__...._...---.
Agreement:
-11TM ',i,di ersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provis�oI•is cot iI=— 5 of the State Sanitary Code— The un,ersigned further agrees not to place the system in
— e�'until a Certificate of Compliance has been ' s d by h b of health.
\ f
Signed f _ s�
.! s bate ....-----••.
ApplicationApproved By..................................................................................................
Date
Application Disapproved for the following reasons:---------•----------••--------------•-------------------------------- ..........................................
------•--•-•...................•--•-----...--••••----------------•-----•--------••-•----------••---•--------•--------••---------•......•----•-•••-•......•----------------------------------------••---
Date
PermitNo......................................................... Issued......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOAR OF HEALTH
. _
........ ...P:.............................
Tntifirab of Tontpfianrr
Tj1W IS TO CERTIFY That the.Individual Sewage ,Disposal System constructed (d or Repaired ( )
y ?I - 1----- ----- --------------------------------- ------ ---- ---------
J nstaller`
- - - •-•-- -------------�-- ------------ ---------------
has been installed in accordance with the provisions of ',!T( : 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No................. ....... dated_____________________________________
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CON TRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. b
=DATE.........................a- - ..........-------•----------... Inspector---.....---` -- .---- ---- ------. ......----•-----•-•.
THE COMMONWEALTH OF MASSAC SETTS
BOARD OF HEALTH
OF,! % ;/ _'?fi, ,..........................
No......................... FEE---.
-- -•-. .....
Disposal Works Tonotrudion Vrrmit
Permission is hereby granted------.�-)- k '` - �'
to Construct (�r Repair, ( ) an Indivi/ al Sewage Disp�Casal stem --�-
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated............................................
r •----------------•--•-------------------•- ..........................................................
- �„j f/ Board of Health
DATE ..........................................
l FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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SITE PLAN SHEET I of z
SCALE: 1"z Z '
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M. i
WARWIC
o NO. 18771 0
S�Oy L LA10 S`
�Q/Zt cJ L.r FL-1 f lM �, L,L. .
REGISTERED LAND SURVEYOR FOR
e.? ., C� 15 D42 L.,
ZONE G (5�yr,Q_r F v►L.L jq�
PLAN REF. DATE —
BENCH MARK DATUM '' rE 1—2 '� 0- WM. M. WARWICK 8 ASSOC., INC.
DOMESTIC WATER SOURCE VJlw,7— BOX 80I - NORTH FALMOUTH
FLOOD ZONE. 0 "-� ��� "��r� r r MASS. 02556 - (6/7) 563 -26 38
LEACHING QASIN SECTION NOT TO SCALE Shc-c
24 C.I.MH COVER
EARTH FILL BRICK AND MORTAR COURSES'AS REO'D• TO BRING
-4 _,r•,, COVER TO GRADE
4 8 FLOW L/NE
INLET i_ _ __ _ _•_; 2 TO%" WASHED PEAS TONE FREE Of IRONS,
P/PE FINES AND DUST /N PLACE
• 314" TO l%2 WAS.YED CRUSHED STONE FREE OF
�n.'. OPENING WITH 4!18
� OUTER DIAMETER
IRONS, FINES AND OUST /N PLACE
" % • 4
AND 13/4„INS/DE
DIAMETER is CONCRETE TO BE 4000 PSI 28 DAYS
t 2. REINFORCED WITH 6"x 6" NO. 6 GA. W.W.M.
3. 2'AND 4' SECTIONS ARE AVAILABLE FOR
I\" GREATER DEPTH REQUIREMENTS
40 31� 60' 4. NUMBER OF PITS REQUIRED o0e
MIN. 1 Is' NOTE: EXCAVATE TO ELEVATION A-1•0 OR
' EFFECTIVE DIAMETER
(NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL
—WATER TABLE - LOAM AND CLAY BENEATH PIT. REPLACE
EXCAVATED MATERIAL WITH CLEAN
TYPICAL PROFILE GRAVEL TO DESIGNED GRADE.
S4• /8 ST0 LT. WGT. C.I.MH COVER
53•0 92.7, g2.2
4"C.I.PIPE 4"8/T.FIBER PIPE OUTLET LEVEL
DWELLING FLOW_L/N£ TIGHT JOINT
TO FIRST JOINT
/4 O 00 1 IU 00 1
q°).b� C.I. TEE 19 0�0 0 1 1
G " 1 11000 00 1 1 I I
STD. PRECAST CONC. �}�•�l D/ST. BOX TO BE ' 1 f 0 00 00 1 1 1 1 .
1000GAL.SEPTIC TANK �'O I I 1 100 00 0 1 1 1
INSTALLED ON LEVEL, 1 1 1 p 00 00
STABLE BASE 1 11 1Q0 O 0 1 1 ' 1: ::• .•.
SEPTIC TANK TO BE 1 if 000 O 0 1 1 1
INSTALLED 0 LEVEL 1 11 IOO 10 0 1 1
STABLE BASE. 1 1 1 0 0 0 000 0 01 1 1 1
� 1110p010 0 1 1 i 1
LEACHING BASIN ' 1 1 1 b 00 I 1 '
BASE TO BE LEVEL i i 1 f5�_,
SOIL ANO PERC. DATA
PERC. RATE �'z MIN. /IN. O,� TEST PIT NO. P377-+ O�� TEST PIT NO. 2
TEST BY: �RuL3: I-I�LD 3' -I"o '�/Sv t�yo1L
WITNESSED BY: 9 o IzD 7' y�N p Izav aGt,
TEST PIT GR. EL. sue' `+ Gf.re,A Q AA
DATE: ► III ��'�' ska►JS7
DESIGN 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 l ao o GAL ALL -SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE
TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE
SIDEWALL AREA?S GAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF
BOTTOM AREA GAL./SQ.FT. SANITARY SEWAGE EFFECTIVE ON JULY 1 , 1977.
LEACHING REQUIRED zoa SQ.FT.. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
ACTUAL LEACHING AREA , OF HEALTH.
;-±2-SQ.FT, AT -COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE
BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION.
PITCH ALL SEWER LINES 1/41 / FT. UNLESS INDICATED OTHERWISE.
" 017'9'� SEWAGE DISPOSAL SYSTEM
or MARETIN
FOR.; �✓J5-: L_ -
v MORAN
J23417�Q � l0 I � L,� � D AEU L 5 P..c:)
L_L�
�PSc;OUAL
'J�lyrii� SCALE AS INDICATED DATE 7-a 4�
WM. M. WARWICK 8 ASSOC., INC.
8OX 801 - NORTH ML MOUTH
` MASS. 02556 - (617) 56.3 -26.38
PROFESSIONAL ENGINEER