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HomeMy WebLinkAbout0069 ROSEMARY LANE - Health "41 (, (P va S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR F�ORRESTRY�� MIN.RECYCLED INITIATIVE CONTENT104 CerrifiedRberSourcing POST-CONSUMER® wwwdiproammorp SWI29D MADE IN USA GET ORGANIZEn AT SMEAD.00M ©F lolslg0 4Tf F BARNSTABLE LOCATION� SEWAGE # 'TILLAGE C�e,� ��v�`/� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. J' >X- S-J/.f SEPTIC TANK CAPACITY %o a o LEACHING FACILITY:(type) r"i (size) � NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER P,161,� BUILDER OR OWNER DATE PERMIT ISSUED: DAT..: COMPLIANCE ISSUED: vAV VARIA:'ICE GRANTED: Yes No i `T v 4 ' O JAI 5�5 Cc- No.....as---------•---7 F�$....7.,a7.._.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - A < .../J-....".."".."".................OF..............---.. . .--"---_--_----_-------- Appliration for Disposal Works Toustrurtion rrmi# .Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at � ~................. % C .._..--•- ... .Location- de , or Lot V ................... / 7?j---------- �f/`� 9.:5!!�. .. //Owner Address I taller Address dType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) Q, Other—Type of Building ___________________________ No. of persons............................ Showers ( ) — Cafeteria (. ) a � Other fixtures ................................-...................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow................ _______________gallons. 04 Septic Tank—Liquid capacity/151Q.Cn__gallons Length................ Width................ Diameter________________ Depth................ Disposal Trench—N __________________ Width.................... Total Length.................... Total leaching are .�' ..--sq. ft. Seepage Pit No-----------_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) /' "'aPercolation Test Results Performed by___.__.....G?�6......(� .����_-------------- Date__.__2/ ,-a Ili Test Pit No. 1-,t. ._minutes per inch Depth of Test Pit__ fir______ Depth to ground water_._;,,d Li, Test Pit No. 2________________minutes per Inch Depth of Test Pit�__._..._______.. Depth to ground water___.____._�_.__U____.._... R+ .....................................................-...................................................................................................... 0 Description of Soil______________________________ V .....................•-............................ --- ...............Z,,....... -6V_ _C_.:. . ........ --- ---- ... ---••••--•-•-------------------•-••_._...--•••••-•••---•••-•--------••--•------------•-••-•-•--•_-----•-•--•---------------•-•-----•---•-•••-------•----•••--•---•-•-•-.....------••-•-••----•....._... 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 Tl ITLL y g g p y S of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Signed---- ..... �'. 2--------------------- ,................................ Date Application Approved By......... _�� --••�--•-- _---•--• �-1 ---=- Date Application Disapproved for the following reasons:................................................... ----------•-----------------------••---••-••------••-•------ ................••---•--------•-•-----------•------•-•-----....-----•---------•--•--••-•-....•--•-....-•--•-----------•-----•-•••-•-•-••----••-•-----------------•-•-•---•-----•---•------•-•••••------- �a �- Date Permit . ..�,,T--------------------- Issued.._._!-."'��P " ��_---------------- l t; 7 THE COMMONWEALTH OF MASSACHUSETTS BARD ®F HE LTH Appfiratiou ivr Uiip.viial Worko C atv r c ivat �ernti Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ............... t - a� -- -- _.Lot-------•• ................................ f -------- _- Location E�ddres `" ozr 6`<..�j. .. ._. ,!.k._ ...4!f z. ......._ ' f� .... a.....-- C`.+.._ .�/' ••-- ,.. Owner �� Address ...........................t.. .(`..F 3_?'W."'1 .__.. -••_- -•_•-•-_.... ......................................................•...._........_......_._....•...._..._. Faller Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ................:........... No. of persons............................ Showers ( ) — Cafeteria ( } Other fixtures ------------ wDesign Flow............................................gallons per person per day. Total daily flow.............. 7-C................ W Septic Tank—Liquid capacity ..�' �..gallons Length................ Width................ Diameter---------------- Depth............... - x Disposal Trench—No.................... Width.................... Total Length.................... Total leaching area. -__t-sq. ft. F� Seepage Pit No--------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ) '- Percolation Test Results Performed by......... ....... vz~"" ............... Date__ Test Pit No. L. .-,rq-----minutes per inch Depth of Test Pit.__._ dam_.___ Depth to ground water____ -i_rZ. -� w Test Pit No. 2. ...._...._minutesper inch Depth of Test Pits __.....__.r. Depth to ground water............. ' Ix --••----•-••-------- ._. •---• ............................................. x Description of Soil K --- ' w 71 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'T'Ll, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... .......................... Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•----------.........---...._..... ----------------•---------•------------.---------------•-------•---------------------------------------------------- ------------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA T ..........................................OF �pr�ifirtt��e n� �IIMt�t�tvatr.� i THIS ISJ tiCg,R�TIFYJAhp,taWe' "vidual Sewage Disposal System constructed (�) or Repaired ( ) by----------- --. ---•-•........................ Ze �-----•-� ----------••-•--------------------� ��� c��=� ,�� ; at..................... ---------••--•-•-•--.................. ----- has been installed in accordance with the provisions of TITgES .5V751T,e State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_--.------.----------------_.................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONS UE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. oe DATE..........IV..:..•-•--•� ...-...-...--••----•--•--���-.�:���:y �� specto ....._. - ----��`�- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA S ..........................................OF............---.-.............................. ..............-....................... .F No......................... FEE........................ .Dblpvsq��( W�111L Permissic,r,is hereby granted.........------------•----------.....----...... (... -e......... ' ............................................ to Construct (L)or Repair ( I i '.dual age Dist?@#, t p atNo-...................................... -... .. ........................................ o Street , . "7 as shown on the application for Disposal � orks Construction r t No.._.UU................./ ted--_.------:�___rr �....... C7l -------••----...----•-•-------•-•--•-•--. Board of it jC e DATE----•-------------- --- � - ------•-•----------- _ r FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ------------ SECTION - SEWAGE F, zo. � Rvse*�.a•4`•( mot•./. EI_ .gz Cq SEPTIC TANK — 1 I — "D"BOX — 9 — LEACH P I T TOP OF FDN 4`✓:C3? (MSL)M "2"OF 11eTO 42" WASHED STONE CEO S Et,AARY LANE r_ IN- OUT 1?t- OUT- IN. I C cc, 4 I.C,11 I I.Z� I SEPTICG TANK ELEV. ELEV. ELEV. ELEV. I i \ 40.8 4o.�io 3q.53 6 .I pr�P ELEV. ELEV. C•,� - \ �. .`rn. LB .,GATz-- we 1t. 1 OF V4"•1V2" QI WASHEDSTONE LOT S zOf o G LOT 6 TEST HOLE LOG P 4�3 G ry s'� �.; TEST BY R-l't' t=, T. CON L-O N TESTDATE 2T12��5 WITNESS 3 BEDROOM HOUSE r�: W_ f DESIGN T.H. « 1 T.H. +► 2 \ _ �� LoT ELEV. i ELEV. NO DISPOSER DISPOSER 4�.2 PERC RATE MIN/IN. FLOW RATE 330(GAL./DAY) SEPTIC TANKS 30 Y, 05)= 49S r,E REO'D SEPTIC TANK SIZE CC.' - LEACH FACILITY 101r6 = I�SjJ.� !i )y,L e SIDE WALL (•Z• �) G/D. tt r BOTTOM lcs S' /4 = '75.5 � 4I, �1 ti� I I SILTY 3✓'Z TOTAL Z�'1.0 .2 Gar' SAND 150" �"' BEAN N E%: :f.rlp t6F" ZU USE: C71`{6. LEACHING PIT N O WATER ENCOUNTERED r0'`! 20 NOTES: (UNLESS OTHERWISE NOTED) 1.DATUM(MSL) TAKEN F�M-„-bY�N tJlS—_.QUADRANGLE MAPS 2.MUNICIPAL WATER----__L —-------AVAILABLE �j� OF 3.PIPE PITCH:1/4"PER FOOT 'e 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- 1C , -44 � S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1) FT. �U ARNE H. `� O) �SSq� -�-DISTANCE AS CERTIFIED 6 P. IPE JOINTS SHALL BE MADE WATER TIGHT 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. C a I�Oa ARNE y��, SITE PLAN STATE ENVIRONMENTAL CODE TITLE 5H.- LOCUS: ��SEMAf�Y �-AtJE �0 2 as �+i`' GENTE�V IEEE M SS• AL PROF kie.-,L A;--r�'� REF: �--So-1 � ,- 4V`Ir� PREPARED FOR: CIVIL ENGINEERS __----_----- ` BOARD OF HEALTH LAND SURVEYORS J 9" main st� REG.LAND SURVEYOR wOI CONTOURS (EXISTING)----- --- APPROVED DATE BAf2 NSTf�ESLE�MA t tJ Y� SCAL -T (PROPOSED)-O-O-O-O- - �y. I(� DATE 8?„��2