HomeMy WebLinkAbout0185 OLD POST ROAD (CENT.) - Health (2) 185 Old Post Road
Centerville
A= 209—052—003
N SMEAD
No.2.153LOR
UPC 12534
smaad.com • Made In USA
�.CYC�
....L//7 .Fizz.. ...�..
THE COMMONWEALTH OF MASSACHUSETTS
s�
BOARD OF.1 HEALTH
..... ..............
�i
r 87 ApPrFatinn for UiipnnFal Works Tnnitrnr#inn Errant
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
....Lo. - -®C=v-� .. ex.
................ c - .............. ...
lrC� ..LL =
er .Address
a •------------- ..... ._ '��. ................. •-••..._._........--------•....._.......--••------•---•-•---------.......--•-•••-•----------
Installer� •' Address
Type of Building - Size Lot.. _ _®® .......Sq. feet
Dwelling—No. of Bedrooms ..................................Expansion Attic ( ) Garbage Grinder ( )
pa., Other—Type of Building ............................ No. of persons.....................--.---. Showers (?.)---Cafeteria ( )
Other fixtures ....................... . .
Design Flow--------..g V P P P Y Y � �.
W .....--gallons per person per da Total dail flow.........., 0...............gallons.
W Septic Tank—Liquid capacity.112 allons 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 7— 1-9— 7/"
a Percolation Test Results Performed by....... -------- --------------
•................. Date........................................
a Test Pit No. 1................minutes per inch Depth of Test Pit.--.--.............. Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit..--........--...... Depth to ground water........................
;4 .................--------------------- .._._ ............--•Z.......
O Description of Soil....................
�_ __.:.. ! '�� t�!- �r'- ' �-t _ _. �z�.�
x z,
V ..............................................•-----------------------------•-----.......-••--............------•---•-......--••-----•-•--••-•----•----------........-----•._.....--•---.
----------------------------------------------------------------------------------------------•---••----.----------------------•------•------------•---------------••--------•-•-......-••----•••.-----
V 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 iITL U 5 of the State Sanitary Co e— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee 's ed by t board of health.
l Sign - --. :/. - ...........................................................
ace7E/x
Application Approved By....._ � . !+_.. .._ /✓/%� !� -(� ' ��
Date
Application Disapproved for the following reasons:...............................................................................................................
.........-•---•------------------------------•--•-----------....------------------.......--------....._..I....-•-----•--•-•-•-• ---•--•-----•-----•--•-----------•-•------••--•--------•----•-•--•.....
QG Date
Permit No.......................................................... Issued---&-�Zf -7•�•f....--------.....---
Date
No..-• •-7� -- F�s...,t�t �...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.�
................... ... F................ .... tom_ -�
Y.
Appliration for Disposal Works Tonsirurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal:
Sys 9m a - [ �" rbl I_ .
... . _....----____ ...... ........ ................. - ---- -------------• ---
._ _...."ca....&a_.5 .............................. � .0..... - .._..._._ _.._.l Y_:_�._.. .....�' •
Address
Installer Address
dType of Building Size Lot... -------Sq. feet
U Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building ____________________________. of persons............. Showers (' — Cafeteria ( )
P4Other ures -------------------------------------------------------------------------------------------------------- ----
d allons per person per day. Total daily flow__________-
W
Design Flow--------- P P P Y Y gallons.
1:4 Septic Tank—Liquid capacity_____ :_ allons Length................ Width................ Diameter---------------- Depth................
Disposal;Trench—No..................... Width.................... Total Length............._...... Total leaching area....................sq. ft.
Seepage Pit No......._............. Diameter.............:...... Depth below inleg................... Total leaching area..................sq. ft.
z ; Other Distribution box ( ) Dosing tank ( ) O/V— '7- 7 7
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................
(�. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •-•--- .._••----_--- -
O Description of Soil-----••-•-•--•-••-•. �....--�-- ` ----- '" ------� .- - . ..--
v ------------------------------•-
UW Nature of Repairs or Alterations—Answer when applicable
P PP
r..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 5 of the State Sanitary Co e— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be ied by F boo d; f health. -
Signe .:•••= - ......................................... - f-
�I ate
Application Approved By...... ............ .... ...............7.
":. Date
Application Disapproved for the following reasons:----•---------•---------•--••-----------•---•---------------------------------------•--••-• --•-----......-•---
Date
PermitNo......................................................... Issued.............,=-----------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ALTH
............: ...........................oF......:.......... ..•• )ee%- 1....-.......__..................
�rrtifirair of f omplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Pepaird ( )
by '
.........n.6_ 11..
a
-----------
at
•- c J
has been installed in accordance with the provisions of T � 5J� The State Sanitary Code as described in the
application,for'Disposal Works Construction Permit No. 7 �.--___________ dated........ 7___77.........
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT,11i CONSTRUED AS A GUARANTEE THAT. THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. 'l.y Inspector $.` /..._
.......` -••••-•---• a,
THE COMMONWEALTH OF ,MASSACHUSETTS
'''''" BOARD O HEALTH
.............0 /
No.............. Fj
,. Disposal Works onotrudiun rrmit
Perm'issioq ia,,hereby granted_--=----------------•-------------••-•------•-------•------•--....................-................................ .........
3.
to Constr t ) or Re .•r ) n . i idual �a Is sal S t .�,
at
Street
as shown on the application for Disposal=VVorks Construction Permit q
Dated ' � ` ......
,.w;^ 2- 7
DATE--•_... .' Board of Health
---_----
FORM 1255 HOSES & WARREN, INC., PUBLISHERS
PIE 6A5/I/ aQ r,q �
rN<L,E /-,,4/Y?/L�� - ,3
2732 '
s�rlC 7",eJr✓K = 3-:�30 /-40 4?5 spa
/50 SF ,e 15 = 375 6F'Ia f Fury•
—66r7'a,t4 AV6-1
50
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82.o GEtZTI>rtEt� pt..bT" PL./�l�.l
uo u/�test FED F«
12 o .sc 7�� l d GA Y i o tit
cc �- tiL �o 7l�T`l= _ +7/tq b-7
i GMRTtt=Y T"A-r TtaF-- �UV7�D(JT1�iJ Sttcv�.v�.! PLA�1 TZ�F"cRc►.1G
t- T-jZ j=nc.l f oAA L_s-eG vl/MA TI-AG: 51 D E Ll► G=
A wr-> SETtaACK RE-QuicemakiTS OF THE
-TowU OV7 t= s
A PPt��
vA'TG
tZEGISt'I�..I:�D t_.AIJp 5u2vE.YoIzS
TNtS Of At-1 tS E•_.tO-r r6ASFt> v4.t Act oSTFr�vi�.t.G o ArCASS.
ttJ�t-E'�r��t•1 i 'Su�vt��{ TUC-. o �, rS 5►tc•wu� APPL-I ca ""V- /
u c r r_e m t W& L >r LI Wi,:s _._
LOCATION SEWAGE PERMIT NO.
1rILLAGE
CC,
INSTA LLER'S NAME & aADDRESS i
7 c a -� 3 i '7 7S —t3 z._
B Uf'L D E R OR OWN/ER
G` U !..-e
DATE PERMIT ISSUED �-
DATE COMPLIANCE ISSUED
!oL
tVk
711
............
THE COMMONWEALTH OF MASSACHUSETTS
BP ARD OF FIEALTH
._... .:. ..OF. .....................
Appliration for Biiivviial •Yorks umitrudiun rcprrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at 2 �_� �c� � "
..'l.�Q.0 _.....--. ..............
Location•Address or Lot No.
caner Add ess
Installer -
s Addie ?�} QQ��
Type of Building Size Lot__I_..1.j,-,?_.LJ.b...Sq.`fee�t
Dwelling No. of Bedrooms....:.......... Expansion Attic ( ) Garbage Grinder -1
`4 Other—Type of BuildingY ______________ No. of. ersons__....._._.__:_ ........... Showers — Cafeteria
W Other fixtures ---------------------------...____.__----- .._......_ .
W Design Flow........ -_i_::0......................gallons per person p�r'day. Total daJ�Y Qow............. - -- .-•------ r lon�
WSeptic Tank-Liquid capacitygallons Length. _.___ Width:__. _-_. _. Diameter................ DepthA0..
x. Disposal Trench-No.................... Width___._._.._.___.._.. Total Length_.....__:_..f__:... Total leaching area................ ft.
3 Seepage Pit No-------.,_._....._._ D meter_.._....Lo_.__ Depth below inlet_..._,.......... Total leaching ar ___ ... .....sq. ft.
Z Other Distribution box (^� Dosingauk ) I
a Percolation Test Results Performed by-----Ni A ._ ......._.°... Date___ �. .
Test Pit No. 1....... _ _
minutes per inch Depth of Test Pit Depth to ground water..]1'
_ %.
(Z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x v :....._..... -- - ----
,,
O Description of Soil_. �P c �C�� <- h•1,�- ! �..........
- b
c, •........------------------ ...................
_..._ --------------•--W -__
.
U ' Nature of+Repairs or Alterations—Answer hen applicable.._. �_. p,& a.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of L I L L; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
-operation until a Cer icate of om e has been iss the bo f healtil>
Signed..............
............................ .. .:. i.......f..... ....
�> Daye
Application Approved By.................................. .......
:.vr,.?• f:`?....
.
Date
Application Disapproved for the following reasons:..........................................:.........................'__.._.._..__.___________.................
...................................•---...._..__......-•-••-------•-_._-•-•---._,..•----......-•-----._-..._....._..........._.._....__...---._............_...____---_____.------ - .._._....-•---
Date
PermitNo.......................................................... Issued......:...:..................................-...........
Date
No...................... FEz...........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF FJEALTH
T- 'O ................OF. .
Xpliftration for Mqpviial Works C owitrartion rumit
Application is hereby made for a Permit to ConstructRepair an Individual Sewage Disposal
System at:
........ ...........LLII �LT t J_
........................... ....... ...............................
Location-Address or Lot No.
A- :::(.I...............77
11.....
Owner
aAddress
0 "ZI(i C_ ............. 7T I
...................................................................7i W.................... .... . .......P��j LCE
--- .......*
Installer Addrest....*------ -----------------
Type of Building Size Lot_11 ...Sq. feel/
U —No. of Bedrooms________________ Gart'a"g,e"
Dwelling ..............5.....................Expansion Attic ( ) Grinder
Other—Type of Building r.............................. No. of persons............................ Showers Cafeteria
Otherfixtures .....................................................................................................................................................
Design Flow........VA....(D......................gallons per person p�r day. Total daily flow..................1-n-R. .........zallons.
'I ' 7 it
C4 Septic Tank—Liquid*capacity100.0gallons Length.E)110 . Width... Diameter________________ DepthA�.I.d.
Disposal Trench—No..................... Width...._.._ __._._____ Total Length._...._____.__.... Total leaching area............I........sq. f t.
7 Seepage Pit No........X........... Diameter_.._.._.10. Depth below inlet.....(,-.%.......... Total leaching ar sq. ft.
Z n box O' k Other Distribution Dosing ta
04 ei I Percolation Test Results Performed by .... ............. Date...
Test Pit No. I.....<Zrninutes per inch Depth of Test Pit... Depth to ground watr
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.____.__...._.__.... Depth to ground water.-__.__..._.____._.._...
9 ..................................................I...............................................
0 Description of Soil. . ...................
0 �Pm. ............t.k.........VAE-OXD�A....!�k.
..?'�
�4 ..............................................................
............................................................
----------- --------*---------------- -------*........ ........**..........*----------------11--------
................................................. .............................................................................
U Nature of Repairs or Alterations—Answer when applicable..,-P,----------------- ............7;�;�....
77,
...................................................................F4�k.... ...........b�A... .........
.................
Agreement:
The -undersigned agrees to install the'aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TAI TALZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complia ce has been issue� I the bo allh,
0
Signed....._.__. /
...................................................................... ........1.....................
Date
ApplicationApproved By................................... f. ............................................. .............. .
Date
Application Disapproved for the following reasons:..........................................................I.....................................................
........................................................................................................................................................................................................
Date
Perm' it No......................................................... IssuedL.......................................................
Due
------------ .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
........7 k)........OF.......... ........................................................................
Tprtifirate of Tomptiatta
THIS IS TO CER&FY, That the Individua) Sewage Disposal System constructed w),or Repaired
170 Al
by....... .................... .... ......................*.......------------- ------------"':......"....... .............................
Installer '?)
............... ............................
at.. L q, , "0'*-
....................................... ..............
has been installed in accordance with the provisions of TITLE- 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.......
THE ISSUANCE OF THIS CERTIFICATE S14ALL NOT BEL'CO;' I STRUED AS GUARANTEE THAT THE
SYSTEM WILLFUNCTION SATISF'AGTORY.
PDATE........................4-A-25. ............................... Inspector.... .....x�o .................................
4. ............. .....
etas
............................. a. ........
f_1 I . THE COMMONWEALTH OF MASSACHUSETTS
BOARD-'20F A"
HEALTH
................OF.�......................................................................................kwd 1-ftZA). �T�%( E/ 1 1
'�S r_7 r7 ..... _5bz��
No......................... FEE........................
Disposal Varks Tanstrurtion famit
Permission is.hereby granted..........P P��f:�............................*-------------------------- ----------------- ............
to 'Construct ( Vl� or Repair (,,.Lan Individual Sew.age Disposal System..
at No.......Lv.�....1_?....... r,_-t:Z-I-,
.............................................. . ......... ............................................................................
Street J
as shown on the application for Disposal Works Construction Permit No7._S._-S.-'27Dated....�_46?1��
...........
------------- ...............
Board of healthDATE....... ......................
..............
U-0 CAT ION r � SEWAGE PERMIT NO.
Zco r ---) oW/ 6-sir 0� 5 - --
IILLAGE
I N S T A LCER'S NAME i ADDRESS
—7?
BUILDER OR OWNER
DATE PERMIT ISSUED
DA;T:'E CO�M.PLIANCE ISSUED
k�O
SECTION - SELVAGE {`
--
uM
-SEPTIC TANK - ' to LEACH"D"BOX - -
_(D - _�
TOP OF FDN,
-S���-(MSL) "2"OF i/STO 42'
WASHED STONE , \
,l
IN OUT• :: r Scr✓�c-
IN OUT. I
l ti `_.moo G I N..
SEPTIC
TANK 'S5 /
ELEV. ELEV. ELEV. Ele) CE V. riz.
ELEV. E EV
o
WASHED.STONE �'. .. -
TEST HOLE LOG
TEST BY.rt.r( . t-1S�ya,�..t�,yi-{. .�• C.yw--t i..c,�--! lyao;l-1 . -
W I TN ESS } T.`_i' �f
rY' Z� es- _ DESIGN - BEDROOM HOUSE
TEST DATE - � \
T.H. * 1 T.H. # 2
t Xc.i, ELEV.A ELEV. -
`f PERC RATE G z- MIN/IN. DISPOSER DISPOSER 2-11 4�
„ - FLOW RATE (GAL./DAY), SEPTIC TANK 4't-5 "
(�
REO'D•SEPTIC TANK SIZE d
LEACH FACILITY �-----
�,u�l•.� SIDE WALL `�-`i I •Z
BOTTOM Ira rr¢/ c lg.'�. ( I c,) s "tg5 G/D.TOTAL
2r
USE: �-�—'� LEACHING '�` `
_
WATER ENCOUNTERED -
NOTES: (UNLESS OTHERWISE NOTED)
f � I
1.DATUM(MSL)+TAKEN FROM____HY` !`� QUADRANGLE MAP �7
2.MUNICIPAL WATER I .____-_---____AVAILABLE Vil OF 1 `
3.PIPE PITCH:44"PER FOOT / v
4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- -44 C'y
S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. ARNE H. C>—DISTANCE AS CERTIFIED -
6.PIPE JOINTS SHALL BE MADE WATERTIGHT OJALA y ��� 0( k4SS7
1
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. VIL STATE ENVIRONMENTAL CODE TITLE 5 . 3079 ti 'Z
o ARNE SITE PLAN
sJ,
'$ p K. LOCUS:
o T
OJALA
,4v R26346
REG.P A ENGINEER
I\9�`,�.rs�p tgaS4 REF: Lo -Z
down Cape en�ineerin� PREPARED FOR:
CIVIL ENGINEERS l . r�� Lam`Ste-I
LAND SURVEYOR --------- --
f (EXISTING)------------- BOARD OF HEALTH REG.LANDSURVE R
CONTOURS (PROPOSED)—O-0—O-0— APPROVED —DATE +'��`ST 9� � • SCALE
i-G MA . �.CV i 8/23f S� DATE
`
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