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Home My WebLink About0069 CAP'N CROSBY ROAD - Health (2) �9 Cqp�. Cra4bc�- ed , � l `7a i No.- -.......O.J....... Fss...ra...................... THE COMMONWEALTH OF MASSACHUSETTS , ...._- BOAR® QF HEALTH : . ........................... Appliration for Disposal Works Tonstrurtinn Frrmit Application is hereby made for a Permit to Construct•(/) or Repair ( ) an Individual Sewage Disposal System at: �� r .............. ��......-: ,,�`. .. ---•-s------------------ ................................B.• ---•C.-----•--..._._..._----•- --- jc LoE Address W Owner •----------------••-•••-••-••--Address Installer � Address UType of Building Size Lot___/S'� % .......Sq. feet �-, Dwelling—No.. of Bedrooms________________ ____________________Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtur -------•------- ----------------------------------------------------------------------------------------••-----•---------------••--•---------------- W Design Flow.............. ....................gallons per person per day. Total daily flow........33�......................gallons. W Septic Tank—Liquid capacity/5Zallons Length________________ Width................ Diameter.___..._._._____ Depth___________.._-. x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area__.____._____, sq. ft. Seepage Pit No...... ........... Diameter...14......... Depth below inlet.....�.......... Total leaching area _.._.sq. ft. Z Other Distribution box ( ) Dosin 1 k ( ) '~ Percolation Test Results Performed by--- •-- --------------'test to ground water._.A,_/4)______- fs, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 ..--•---_---- -- - ------ -- - --- --- ��...---------------------- Description of Soil --------- UNature 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 Comph ce has been issued by the board of health. Signed----•-•----------•-••-•----------------••----....----------------••---------.._..---- -_- Application Approved y -- ----•----•-•--------------------------••. Date Application Disappro d the following reasons--------------------------------------------------------------------------------------------•--------------=.._. .................................•-------.._..----•------------------------------•------•-••--------------------------------------------•----------------•--------------------------------------•-•-•--- Date PermitNo.......................................................... Issued_....................................................... h Date No.. � &�'' F�s.... �.........._ THE COMMONWEALTH OF MASSACHUSETTS BOARD . F HEALTH ..........A...... . -----------------OF...................-:........... ........ ...................................-•---- Applirafiaan faar'Dhipa sal Works Tnattaifrnrfiaan thrmif Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at q ._...... C s ............................° .. ... ............. --.... ............................................................ 004 ..... ........... ._.... - .. ._..... --.....---- W Owner Address ------------------------------•---- --.------------•---------.------.-----------•---•-----..---------------•--------------•......... Installer Address WO V Type of Building Size Lot... 1 ----------------Sq. feet ., Dwelling—No. of Bedrooms................. ----.____.____--_--Expansion Attic ( ) Garbage Grinder ( ) WOther—Type of Building ...........................m No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfi --------•-•----•----•-••---•---•-------------•---•••-----•--•----------•--------------------•--- .. W Design Flow.............. __..______. gallons per person per day. Total daily flow........ ...... .......................gallons. WSeptic Tank—Liquid capacityallons Length..........:..... Width.__.__.......... Diameter---------------- Depth................ x Disposal Trelich—.. o................ .... Width _.._.............. Total Length.......... ._._._....Total,leaching area..... sq. ft. Seepage Pit No_____ _________•- Diameter.. ._ .. . ._....... Depth below inlet.... .:--...... Total leaching area ....sq. ft. Z Other Distribution box ( ) Dosin Percolation Test Result Performed by- _______ ________: .................. Date..... :. /.... . Test Pit No. 1.... ':._...minutes per inch Depth of Test-Pit.......... : Depth to ground water... -___-. µ, Test Pit No. 2-,...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ t¢ 2.------•------------•-•--•----------------•-•-----•---.•••-- Description of So11..__ ... .._...._ .. _ '�'�"' t ................................... UNature of Repairs or Alterations—Answer when applicable._.............................................................................................. Agreement The, undersigned agrees to install the aforedescribed-Individual Sewage Disposal System in accordance with the provi"sions of TITLi� , 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..................................................................................... XDrt Application Approved•�y~�. . . ------ ----• •---- ----------------------••---•--.........--••-----• ��,Application Disappro d r the following reasons:- e ---------------------------•-•----...----••-•---•------•--------------•----------._..._......-----........ Date PermitNo........................................................ Issued...........:.:.........---------•------------•-•------- Date :THE COMMONWEALTH-OF MASSACHUSETTS BOARD OF HEALTH OF...... ...................... Trrflfiratr of Taautplianr>e T;,r4,1��A'Z 6.ERTIFY,That the Individual Sewage Disposal System constructed (' °j or Repairedby---- ----- •-- ........... .................. •---- -----•-----•-----------------------------------------•--------•----••--------•--•------------ .01 Installer at ------ ------r---------------------------------------------- --•------------------------------- r�G"' L cordce with the pr ons of TITI,r, >of The State Sanitary Cod as de gibed in the has been installed-in ac application for Disposal Works Construction Permit No.jk.4:...-. .............. dated 0,e. . ._. THE ISSUANCE OF THIS CERTIFICATE .SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. - ........_--•-•-••-----•-••-.....--�==-�......---� Inspector ------......-.....^--------------•----------•---••---------------••----•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD—OF HEALTH ' ..............O F....... . .---•................ ...... FEarf_-l�iP................ �ia��taa , -1 �aan�frnrfi><tn a�rmtf Permission is hereby+granted.., .............. ...................... to Construct O4orolak'ir j an w 1 ew a pos ystemat N��wnon -----------------------------------•-------------------------------------•----- ✓ reet as sh the application for Disposal orks Construction Ait No•,_.:r............... Dated.......................................... .: - .,....:F Board of Health DATE................................................................................ FORM 1255 A. M:,SULKIN;A-NC.,-`BOSTON I SHEET OF { JOT B -�-- 43-11- -� Uzez A i r 36;o iLo 547i U� ion t 20 o o 431 i SIEWAGE DESIGN PLAN UWATIM DATE .,pukm S _ . . .4.4 . .. . . . . _... . . . . . . ._ CNIL E jH OF M4SS PETITIONER . . . _ o? THO THOMAS 8 KELLEY CO. o /�.4l. .4+/.`dY�7• s� .� BN�INEERB—SURVEYORS w� z !K LONG POND DRIVE CIS ��•Z`� 80V=yARMOUTH.MAN& FSS�ONAL i SHEET 2 OF 2 SHEETS fr TOP OF FOUNDATION CONCRETE COVER ° CONCRETE COVERS e 4��CAST IRON " X. ` ' " TO OR SCHEDULE 40 MAX. 12 MAX. 4°SCHEDULE 40 P.V.C.(ONLY) P.V.C. PIPE PIPE MINIMUM LEACHARPITCHPER. PITCH I/4"PER.FT pITSTaINGEL. S.-50... INVERT INVERT aw .SEPTIC TANKEL. DIST.'INVERT BOXGAL. INVERT " 29 INVERTww 1 I/2EL... ' , oQEDEL.i7--W :. w.4wEMINIMUM6�DI J:o' •°; 20 MINIMUM }_ PROR LE OF GROUND WATER—TABLE— SEWAGE DISPOSAL SYSTEM NO SCALE P- 305 SOIL LOG WITNESSED BY : DATE . .. TIME. . .2.P. . . . t ..JCLa •I. BOARD OF HEALTH TEST HOLE 1 TEST HOLE 2 X'JP ,, ' ' E N G I N E E R ELEV. .Z7.0 . . . ELEV. .. . . . . . . . . DESIGN DATA : r tZt\ NUMBER OF BEDROOMS . . . TOTAL ESTIMATED FLAW l /Q . . GALLONS/DAY BOTTOM LEACHING AREA �-14A! . SO.FT. /PIT � SIDE LEACHING AREA . ZZ4 !� . SO.FT./ PIT '•f'b G&RBAGE DISPOSAL p(50% AREA INCREASE) LlTOTAL LEACHING AREA SO.FT PERCOLATION' RATE . . 4. . . . . . . . MIN/INCH �/ .,..:LEACHING AREA PER PERCOLATION RATE 33;6..2 SQ.FT. .WATER ENCOUNTERED NUMBER OF LEACHING PITS . QAeir A37- .4VV' - APPROVED . . . . . . . . . . . BOARD OF HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE. . . . . . . . � '� CIVIL NGINEE �/ ' AGENT OR INSPECTOR I , PETITIONER C WQXM & , o s T as THOW S E. KEL L EY ! • �Ji ENGINEER— SURVEYOR GISTEa 346 LONG POND DRIVE �FSS1ONAt�a� f SOUTH YARMOUTH, MASS. 14 Zoo . . . . . . 02664 if, [ 5,- I SHEET .,;� OF 10T B 44,* t�i �� Q 2a o 0 ' - Z -VA4( 2M `- 1 t Z�S"-- - — -- 27.0. SEWAGE DESIGN PLAN uD"TM Gcmx .;T-;Rp.ot DATE PLAN REFEREI�ICE y -: . 9%5 . . . 9FGISTEQ� - _•.. . : ._ CIVIL ENGINEER suRV .4 OFMgs PETITIONER _ ��, s ��s� ��/�i•�+r• _ p? THO �� THomAS E.KELLEY CO. K /��l/. .�:✓.Ky��N .�Y$ ENGINEERS—SURVEYORS . . Mr �f�� . . . iK LONG POND DRIVE �STE ab�� SCVIH YARMOLrM KAM& SSIONAI.� SHEET Z OF 2 SHEETS TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS •. r e 4"CAST IRON 12,,MAX. �r � 7 1 12"MAX. """"' ° �► ° OR SCHEDULE 40 4 SCHEDULE 40 P.V.C.(ONLY) P.V.C. PIPE PIPE- MINIMUM LEACH CIRCULAR ' PITCH .. . PER. PITCH 1/4"PER.FT PIT PRECAST n • LEACHING o' NVETT a ` o EL. �/.51�.. INVERT INVERT : W PIT . SEPTIC TANK DIST. e INVERT LSD BOX Q. .. GAL. INVERT :.•• •• e' EL.30r5o.. INVERT-;' wW •�. 3/4 TOIt/2 ELF• ► EI-27-0 Q: WASHED W STONE .' Id MINIM /Z' 6'DIP. _t • o' •e 20' MINIMUM — PROFILE OF GRouND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE P- 3ds7 SOI L LOG' .WITNESSED BY : DATE . i. 08�¢,.- TIME. . .2.P. . . . `��lfr�GL� .�...--'�- -,�. �. BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ELEV. ELEV. .. .. . . . . . . &gm 4 DESIGN DATA ' NUMBER OF BEDROOMS . . . . TOTAL ESTIMATED FLOW �/ Q . . GALLONS/DAY BOTTOM LEACHING AREA SQ.FT /PIT �e SIDE LEACHING AREA . Z44 ! SQ.FT./ PIT GARBAGE DISPOSAL . 0. .(50% AREA INCREASE) TOTAL LEACHING AREA .3 01 30 . SQ.FT PERCOLATION RATE . 4. . . . . . . . MIN/INCH .LEACHING AREA PER PERCOLATION RATE3W. ...2 SQ.FT. Ar4 .WATER ENCOUNTERED NUMBER OF LEACHING PITS . 6/.Zer I-,T. .4V6rW- - -- . APPROVED . . . . . . . . . . . . BOARD OF HEALTH •�� d . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE . . . . . . . . . . / _ •/ C AGENT OR INSPECTOR 7 .. IVIEE PETITIONER 6 03 'HO" 5 12 o K E'!@ N 80 �' THOMAS E. KELLEY issE�`��``� ENGINEER— SURVEYOR F �V SSIONAL 346 LONG POND DRIVE i'� r SOUTH YARMOUTH, MASS.