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Home My WebLink About0564 OLD STAGE ROAD - Health 564 Old Stage Road Centerville A = 191 — 020 —002 b No. 42101/3 ORA Q ESSELTE 0 10/o 0 O D O e a Noel....._....._ �- THE COMMONWEALTH OMA SACHUSETTS r(2etA�re�l BOARD OF HEALTH T:v+1AI.....:....OF......,1� -s - ... Appliratiun for M-4paottl Works Tonotrurtiun ramit Application is hereby made for a Permit to Construct (rj or Repair ( ) an Individual Sewage Disposal i System at: -•- -..----•-.......................................... Location-Address —� or Lot No. ...................................... .................. •--..............---•--.............................. Owner Address W Installer Address Type of Building Size Lot._ 1°. .......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ s3� W Design Flow...........................................gallons per person per day. Total daily flow.._.........°:.............•............_..gallons. W Septic Tank—Liquid capacity_Z4�ia..gallons Length_G'�' _�'__. Width-�`. `/.._ Diameter................ Depth.�'g'F.- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......... ........ Diameter._.....Zi?..._..... Depth below inlet.j..!............ Total leaching area._:z.E....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by 4...c _... �' Date__.al _Y-- �.`............ a _--- a 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........................ GG -- -----------------------------------• -- ------- •---------.------------------ •-----•-----••-•-------------......----------- o Description of Soil-----�� = `' off c ------2-�..•_ fo ..._� _:s� ......--�a--='. ......................... -.. ►�+ /®8."-.1 .... E .......:...r ??_'......---•---•-•-•--••-•---...-•-------------•-------•------...... •-•-----•---------- --- --------------------------------------------••-----••----.....•....--•---------------•------------•-----•------•--•-••---•---....................-----•----•----••••-----.•..... 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 TLITLIE 5 of the State Sanitary Code—.The undersigned'further agrees not to place the system in operation until a Certificate of Compliance hasdbeen d by o d of h. i �_ •-----•-•-•..............••.... /� �� Application Approved BY = •• • • _. .... Date Application Disapproved for the following reasons: ---•-----------------------------------•--•-•------- s .................................•--------•-.......................------------..------------------r----...................._---•-----------------------------•---------------•--------------------•--- Permit No..................� i:-.-11!i.�....... Issued....................................................... ...... ,. Date t z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ..........OF....... 4' k Appliration for Disposal arks Tonotrurtion Permit z Application is hereby made for a Permit to Construct (r/) or Repair ( ) an Individual Sewage Disposal System at: .: : .............. ........................ Z................................................. Location-Address or Lot No. ----•---•----•-... . ....... ......•--•-•---- .............................................. •••. W Owner .Address Installer Address Type of Building Size Lot..... .......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers W YP g -•------•------------------- P ( �) — Cafeteria ( ) QIOther fixtures -----•--•-----•-••-•------••---•----•---....-•--------.-------------------•--•--•----•---.........--•---•-----•-•--:...--------•------.....-------•-•• d W Design Flow..................-�3 ........--..........gallons per person per day. Total daily flow.............53p....................gallons, WSeptic Tank—Liquid capacity.lsvp.gallons Length..B.G.:�-._ Width..�.�� .... Diameter'.—............. Depth.. 5'8°! x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..........Z....... Diameter.......Zo.. ...__:_ Depth below inlet..... l........ Total leaching area._2 S ..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......IJZ-L.... 6?�:........ Vi z.................... Date.... ✓:..!� `�y`�� ................... Test Pit No. 1.... :._..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........................ Pi ...................•---•-----••-••-•••---.....................---...............---.................--•-•-•------•-........•-----•-••-•---.........---...... -S O Description of Soil...... .".- Z 4' 7v _= ' .c. c� "- /o as3" ��a ��sc- f/ &O 1V V '�1a ...... -------------•--•-•--•-----•-••----........................... ---I——------- 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 TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss a by t Vboaof 1 Signed_.__ fir:.. .. ............. t _ ................................ xs Application Approved BY -=== •.............. ===-`............................................. •- •--••----•---.. Application Disapproved for the following reasons:............................................................................................Date..............--- ......-•--•..............•-----••-----••----•--....--••---•--•------------........---•------....--------.........................................................................................------ Date Permit No.............. ': ,Zl.'/.� �'__.... Issued........................................................ Date y' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ste'.t!Ie, ..OF........... ...:�........................ ..... .. .... Tntifutttr of Tomplianrr THIS ISM �RT�FY,,.T.laat(the Individual Sewage Disposal System constructed ( �''or Repaired ( ) by................... :�. :...... `` : . ..............---••-•-------•--•---•----••-- --)--- =.............. - ..............................._...... ••- c1t 'ZIPS Istaller � at... 1.......-•-------•-...--•-------•-••-•---•- .....- ..... •------� ......---`.... .-......--- .------{'----•-..... ...-•............... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code s de ribed in the application for Disposal Works Construction Permit No....`�Ll.-_/r .......... dated------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... .. L ................................. Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH E f_ 1/ !.......O F. ..f�� LsvS !3G E. �' No .. .... ............. Fss........:-I�).......... Disposal Works To , o#rurtiort Permit Permission is hereby granted....... . t=�� ...:... to Construct ( wr or Fepair ( ) an Individual Sewage Disposal System at No........ --•--•--- =�---•--...----�----- � '•--�_...-..---�� ram' .....�� :....�'::^:..__.". ............ �.. . .... Street as shown on the application for Disposal Works Construction Permit Nori- ..:±:13 Dated.......��'.�_ .............. .................................... . ..--•••-•••-•-•--------.....-----....-----•-------_---•-- J Board of Health // ' DATE..... _ . ..-•-�----�.............................•----•---=---•--•---- FORM 1255 A. M. SULKIN, INC.. BOSTON a h /Sa;o0 �T�1. .S&ppc Zoe DtST. 00 i 0\ 8 33/ o AIN 10� TCST LOTS' Jj 0 n /l/cTLs- 6Z4FV, 7'7 o N.s B,�S&Z b.V /3ss��s� Dfrrvy . ;I LOCATION SCALE . ./''= v'. . . DATE se-yr. z!/CBS PLAN REFERENCE .1&7!1!C ED' t D o ELLEY H No. 26100 c ass/ s7 4 CERTIFY THAT THE ....... ........ SHOWN ON THIS PLAN IS LOCATED ON THE AROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE . . . . . . . F. PC.-Ao-9S, -7.-e. -- P&E77T7aN6"7Z . REGISTERED LAND SURVEYOR 1l c` TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS e e 4' CAST IRON II2"MAX. ' OR SCHEDULE40 12"MAX. • P.V.C. PIPE 4��SCHEDULE 40 PVC.(ONLY) PITCH 1/4"PER. PIPE- MIN. LEACH PITCH 1/4"PER.FT. PIT PRECAST INVERT e 0 a LEACHING EL. �'��••• \—INVERT INVERT n . h PIT OR o , SEPTIC TANK 3i oS DIST. g 6 W !,. EQUIV. ° INVERT EL... .r. :' ' ' BOX EL..P•.. >s 30.. / GAL. INVERTINVERT 6 w w d: ::�: 3/4"TO I V2' ELF. u-o �. WASHED I ' W .;'• STONE ' ;�qLnvcou yr PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE P- 38z9 SOIL LOG WITNESSED BY : DATE .^!��! i iy8� TIME. . ... . . . . .. '!+. G!�.�02/� . e:S'. BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ENGINEER ELEV. . -3?•.To. . . ELEV. .. .. . . . 7,727 rbp-Snit. ze DESIGN DATA : G-2.Z8•Sv NUMBER OF BEDROOMS 3. . . . . . . . . . . . . . . . . . Co�rza6' 3 30 TOTAL ESTIMATED FLOW . . GALLONS/DAY BOTTOM LEACHING AREA 7.8.So SQ.FT /PIT/C,,Q D, rl • eZ. SIDE LEACHING AREA . . .��7.-.�. . . . SQ.FT./ PIT/3i9 e:P,D• Z/.S � NGrD GARBAGE DISPOSAL .!Y?' .(50% AREA INCREASE) fi TOTAL LEACHING AREA . .Z-'S�. . SQ.FT i ! / PERCOLATION RATE 3S .7.71-9.�v 7Nq MIN/INCH W-P.WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .¢11 SQ.FT/C,f?D, NUMBER OF LEACHING PITS APPROVED . .. . . . . . BOARD OF HEALTH 7Wo AZ- Sia�=s DATE . . . . . . . . . . AGENT OR INSPECTOR Of 11 OF �o ED R GJ o 5sbM T trZ �' ELLEY N o sii No. 28100 . /G6 ��c1sl iNa Sp s�prraa ��,"N Y . . . PETITIONER �,1o",D !9A.5 �2