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Home My WebLink About0055 OXNER ROAD - Health (2) N IsMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED WITIATIVE CONTENT10% CerttiedF6erSourcinp POST-CONSUMER www-Apropre v SH0lm MADE W USA GET ORGANIZED AT SMEAMOM I LOCATION �/ � SEWAGE PERMIT NO. L®t-39 o eve I r" /U � � V L L A G E C e. i Ae,*,w, Ile INSTALLER'S NAME A ADDRESS Y&A;4& 9-f b 1� Acy- Ce0'0v 0 U 1 L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED Lot t7 411 r red. 1� 20 �1� 3V 1 �118 3� No?/-24........ .............................. THE COMMONWEALTH OF MASSACKF*ETTS BOARD OF HEALTH ......................I...........----.....OF...............----.---... ................................................. Appliration for Uiiiposal Works Toustrurtion "ermit V Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal sy :_ �(- 1?d 11............................................Ll--- ............................. ............................................ �ation-Address dr Lot;jo. ............. . . .. XAddress ner /f . .. .... ....................................................................... ..................C ;K a ...--------------------- ------- ...... .....................Install r Address Type of Building Size Lotlid,—,P.M.e. Sq' feet U S.�w . ............................Exp Dwelling—No. of Bedrooms ansio Attic Garbage Grinder P4 Other—Type of Building No. of p ................. Showers Cafeteria Otherfixtures ......................... ............................................................................................. Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width-------------- Diameter_____.__........ Depth...._...._...... W x Disposal Trench—No..................... Width.................... Total Length___._...-__......... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter..._____._.......... Depth below inlet........_........... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date..................................... Test Pit No. I................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_._......_...__......... ............................................................................................................................................................. 0 Description of Soil...................................................................................................................................................................... X ......................................................................................................................................................................................................... U W x ...................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable....-__............ ............. .............................................................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the afo d d Individual Sewage Disposal System in accordance with ., ;eCeyibe 5 of the State San the provisions of'I'LL Sanitary The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee i b th board of�ho6lth. Y Signed ............... .................. ........... ApplicationApproved y--------- . ............................................................................. ...d. ............ Da e s bee neld - ---------------- -- Sig �y - ------- - ---- a e Application Disapproved or e following reasons:.......................................................................... .................................. .................................................................................................................................. .................................................................. Date PermitNo--------------------------------------------------------- Issued-------------------------------------------------------- Date ------------------- ----------------- ------------ ...... THE COMMONWEALTH OF MASSACHWSETTS BOARD OF HEALTH ...........................................OF.............................. 4 Appliration for %Vaoal Works Tonotratrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at• � � , �O : (" e Ex -• .. .... ..........: :1.. ...... �......�-^^ L• ation-Address F............ 1/ _.....n�.......................................... c7t�..::..b..._1'_':. :P.. ...........i. _. o.f.+�---5.."':L........ � W �� /�Address a .............. =;'� :to_�tr .:..... ......_..................--•---....----- i Instal er Address /,�-- Type of Building Size Lot.!_t�t_d-Mi:......_Sq. feet Dwelling—No. of Bedrooms........... ...............................Expansion} Attic ( ) Garbage Grinder 04 Other—Type of Building�lG�trt�r�✓�C�'�.. No. of persons............................. Showers ( ) — Cafeteria ( ) QIOther fixtures',, -----------------------------------=----------•- -•-------'---•------------'-'.....•----•-•'.............•'.............._. W Design Flow............................................gallons.per person per day. Total daily flow--------------------------.................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal 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 ( ) Percolation Test Results Performed by------------------------ - = Date 04 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..........._............ LT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ---••--'-- - -------------- ----------------------------- -" --• '-......-...------ --------- -------------------------------------- ._...---------- 0 Description of Soil...•-'....-•--•-•--'--•---......-•---••'-"----'.............................••••'-'---------'•-•-•••'----•••-•---'-.....••---•--'-•-'-'----'-'•-•-••--'--.........--•-- x U -'--..'••••'-•-.__..•...............'••---......................-""------......... ._.....•••.._.......-••---•...'•"-'•..........•"•---••"-•••...•••""-•"-'-'•'-•--•'••••-'..._.__....-'-•-- W UNature of Repairs or Alterations—Answer when applicable................................................................................................ --•---•-----•------------•----------•••-•----------'•-•--'-.......---'-'--'-------------------•-•-----------'-•--•---•----•---•-•-•----•-•-•--•-••-•--•""........._. Agreement: The undersigned agrees to install the aforedesfribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary C de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee i u d by t E boar, lth. /�' Signed-•. ..................7:t/ _t^iY�t%1�. a Application Approved y.. •'• '- = `=..---•............................................•......_......__... •-•••-....... Date Application Disapproved f o 'he following reasons----------------•------------------------------------------------•-------_--..................................... ......................................................•._._.'-•-•••••-•'-•'---------.............-'-•---•••--•••--..............•-'•--•-•-••-•-""••••••-----'--•'•'•"------......-'---•.._.......... Date PermitNo................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............:.............................OF............................................................................. Trrtif iratr of Tontpliatta TV31EA, CERTIFY, That the Individ 1 Sewage Disposal System constructed ( ) or Repairedby ,. r, } !� Installer ata� c = '-- / y -..---••------------------•--------------------------------•----------------------••----------------------- has been insta led in accordance ith the provisions of YT, F 5 of TheState Sanitary Code as described in the application for Disposal Wj s Construction Permit No .___(__._=_ '_ -...`>-....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI FAC O Y. DATE................................................I............... --• Inspector...................... �•--........••"'-'••'•........---......'-'"•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No .....................OF.............................................................•....................... FEE ...'w .. .... �i��ro �tt� � o �onotrttrttion rrmit Permission is hereby granted�''.• 'w° ... . ._...."•'-'' .---'•"••'•'...--.................................•'•••..........•-•-•........._......---...... to Construct (✓) or e a>r ( ) an Individ e1& g. isposal System at No........ -•-•'-.... '� �" .............� ------ -- ----------------------------------- Street as shown on the a plicati for Disposal Works Construction Permit No..... .... Dated.......................................... ............................... ••. •---•••-•••-••-------•'•••••-•....."-'-•-•......_•-•"..... -..-•-•. Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON • SHEET OF dX /VE Ra 4Z,5' 40—"� Tapzp S. I. jI h l I '' I ` I ( IN I 3 — 38 o i TOP = Fou,,JDA 1 cod I . jai. OF Mgss �� I✓` D/ 1 �o�� THOMAS +I U �7 (p III /4¢;03 FeI:Te��o� �su� SEWAGE- DESIGN PLAN j , 9 - LOCATION C6A).7_4/2 t/.i 44,01.. ..!?` s... SCALE . 30'} . DATE . . 7-84 . PLAN REFERENCE . 4.0.7 43 9. . ... . .... . . ; .+ 5�"`�.._ . . : . . . ._ CIVIL XUQJNEER. ��a�'(M OF Mess PETITIONER > THOMA� THOMAS E.KELLEY CO.5.1". -S . 0 K N BNIINEERS—SURVEYORS _ 1 A"LONG POND DRIVE fs ISTE ' 3 ;SOtT H YARMOv oNAL E , Z7.84. SHEET Z OF 2✓ SHEETS p TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 1 •'0 4"CAST IRON 12 MAX, 12"MAX. ` OR SCHEDULE 40 4"SCHEDULE 40 P.V.C.(ONLY) P.V.C.. PIPE PIPE-MINIMUM _T LEACH CIRCULAR ' PITCH 1/4"PER.FT. PITCH 1/4*PER.FT. PIT PRECAST 0 0 - LEACHING INVERT Q.� PIT . o EL..S/.`6- INVE DIST. INVERT °� w SEPTIC TANK ¢n EL.,//3 }� �,c INVERT EL... �•. . BOX ' ' V o' EL.,S� fJ��'• GAL. INVERL, INVERT va 4 %:►. 3/4��T011/2� GJ� •• ELSI•.3.Q �o0 Q WASHED ' EL,SQ•.SF U- w STONE. • 10 MINIMUM 1z,-- —6�DIA. --+1 � DIA--+� A/O 20' MINIMUM _ __ PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE i SOIL LOG' -�- WITNESSED -BY ' DATE . '• TIME. �. . . �U.-°�•• al • - . BOARD OF HEALTH TEST HOLE 2 /+ G � � . . ! TEST HOLE I . . . .�•E-NGINEER ( ELEV. . . . . . . . . . . ELEV. .. . . . . . . . . i DESIGN DATA ' t NUMBER OF BEDROOMS f1 i /2 TOTAL ESTIMATED FLOW 33Q . . GALLONS/DAY BOTTOM LEACHING AREA �P':5D. . SQ.FT. /PIT 5� SIDE LEACHING AREA . .�88'S�. SOFT/ PIT j GARBAGE DISPOSAL ./YQ. . .(50%AREA INCREASE) Z�. OO TOTAL LEACHING AREA 1.�. . SQ.FT !• PERCOLATION RATE . •. . .�!Q. . . ._._MIN/INCH- i —— — LEACHING AREA PER PERCOLATION RATE 5.50 SQ.FT. /V..f�.WATER ENCOUNTERED NUMBER OF LEACHING PITS . O�- R/.T.�US�' APPROVED . .. . . . BOARD OF HEALTH I. DATE . . . . . . . . . . . . . . . . . . . . . . CIVIL NGINEER ' AGENT OR INSPECTOR 1N OF M4S r Q.-PETITIONER �� THOMAS t 45 i -I Q tuc-e n`.�.!1 E. if O KEl •�� — N� N O�JA�, THOMAS E. KELLEY -o9 Nc 4; i C �.a�* ENGINEER— SURVEYOR o ST 346 LONG POND DRIVE TONAL SOUTH YARMOUTH, MASS. / E b02664 a