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HomeMy WebLinkAbout0250 CAP'N LIJAH'S ROAD - Health (2) 1a3- it �t - e� .V� THE COMMONWEALTH OF MASSACHUSETTS ® BOAR® OF HEALTH 1, .....OF............ Appliration for Dispati al Works Tunstrnrtann ramit Application is hereby made for a Permits to Construct ( ) or Repair ( ) an Individual Sewage Disposal ,.,.System at: C... .. ...... --•--------� .._ ---.....•........ ... Loc ddr ° or Lo - .. • ..... ....._ .. ... ... ......... -• C '�I ..... ............................ W a,__ &er Address ........... ........ Installer Address UType of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grinder (�, PLO Other—Type of Building ............................ No. of persons............................ Showers (=) — Cafeteria ( ) G4 Other fixtures •-------------- - d •---------------------------------------------------"---------•-- ............................................. Design Flow.....__:._..... .........._..gallons per person per day. Total daily flow----- -..__ gal W �'� ` = -- loos. WSeptic Tank ©_gallons 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 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......................... a . --•--- ............................................................ ODescription of Soil - �} -•--•- -- ............................................................. j. ----------------------•---------------------------•-----------...•-••••-----------------------•---•-----••-------•-•-----------...... .............. U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ----------------------------•-----------------------------------------------------------------.....-----.....---------------------------------------------------------------------------•-•-•••••••_- Agreement The undersigned agrees to install the aforedescribed Individual Se3Rge Disposal System in accordance with , the provisions of TI'i 1Z 5 of the State Sanitary C — The un ig further agrees not to place the system in operation until a Certificate of Compliance has b ed by Si --- ----- �. - ---•.................... f......_.i -- - -- - Date Application Approved By......... •... ..... -- .. .................................... Date Application Disapproved for the following reasons:----............................................................................................................ , --------------------------------------------------------------•---------------------.........---------------••-•-••---••-•------••-----------------•--•-------------------------•-------------•----•--- Date Permit No..................... Issued..'2 . -- -•-•----•---------- Date j ..,.. ,k.ley-.. � J 'I�c9"'x.��-� � _� 5 rip �_.Y-__ ° 4.,;•. ,,,.�,.,...'. _ ,/ .►� _'.'lam � 12 THE COMMONWEALTH OF.MASSACHUSETTS BOARD OE �'HEALTH _, -- -1 .....OF...-:....... r r� rtt tan for Bispnlital Ivork11 Tun un rx_�mi� ♦^ :.A Application is h eby;made for a Permit to Construct ( ') or&Repair ( ). an Individual Sewage Disposal. system t 181----- -'------------- -------------- . .... ......4LA..............................;.. ddr �• ........... F } w w er fi�* Address r� . . ..Ins€alley _'ri It c .$ ••--- ---•--. ...................................................AddreessO ........... . Typ D f Buildingq! i Size t- Sq. feet awelling—No: of.:Bedrooms ........_..__..Expansion Attic ( ) +garbage Grinder ( 1� :gib p-I O I e'—;Type of Building 1 No. of persons Showers ( -) — Cafeteria d `Other fixtures _1 v --} ----- 'l ) �, ---- - Desi n ,Flow__ T � gallons er:person per day. Total daily flow_.._. g --------•-----------� g P 1? P Y• Y ��� ' --gallons. g ` Se tici T;:iik e:c c' p Liquid capacityi' gallons Length Width................ Diameter ........... Depth_.`*.,,L Ll so 1...Trench— _____________ Width° Dept Total elowninlet_______ _.-____ Total leachigeach 'a- _--_________-___ sq ft. ' Seepage Pit No..........'._:._. Diameter g area.,................sq. ff. z Other Distribution box ( ) '' :Dosing;tank ( -) '-' Percolation Test Results Performed by.- ,,a ..... Date____ Y Test Pit No 1 .. __.___.._.rminutes per inch ,"Depth of Test),Pit Depth,to ground watt w Test Pit No�2 ............minutes Per inch i Depth of Test Pit ........ >Depth toigzound watetx f -) -- .... Description of Soil . `-- k � ".�. ............................. t W `---- - ---- .--- ------. ..................................... aPPlivable -- ' ___.. --U' Natuitof Re airoAlterations—`Answer when '� ------ Agreement Th6—undersigned'agrees;'to install 'the,{aforedescribed Individual Sew 0 Disposal System in'accordance with , :. ,. the provisions of TITLE 5 of the State Sanitary C — The un g further agrees riot'#o place the system in operation until a Certificate of ComP liance has b i Date .,Application Approved BY........ :.. . r'1.! `. u ! Date- Application Disapproved fgt the following reasons.: ----- ------- -----------............................................................ --• •-- ...- -- ....................... ................ 4. ; P i No ........................................._ ,_ Issued �j/J� -- Date Date r £b :j — 'F`' -m_„�7 h 1i'^-r.,_ m� ..:..-�� a :.:r•� _,c_; t-'�.'. '�� 'zl "'" �'tY��,.�;_',�,` w '':"'-^•!`".a'' r -,y,.. �,r-� .�-,�,.,r- . TOE COMMONWEALTH OF MASSAI HUSETTS r K § _ 'BOARD HEALTH , , { ...• .. ............... .. ........ ....... .................. ._. y. Tntiflptle of T�ntjlfi T 'S TO C Y, at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ..........._.. by /--een _ ----- s 1 - at. ns "-- -- ! r. .hasstalled'in accord: nce•with tliovi$ions o T L� 5 of The,State Sanitary Code�a "`described�In he application for'Disposal Works Coristructio�-l'ermrt No:: .;. _: ... dated. .- �.,_.. _:_: _ i THE ISSUANCE,OF Ti IS` CEk*1FICATE,S-HAL OT BE CONS RUED A G RANTEE TIiA THE SYSXIVI W LL FUNCTION SATISFACTORY. Af DATE__ .`. , . ,9' _.. <In°spector �'t: 4.4 ,� . �` THE COMMONWEALTH OF ASSACHUSET 'S c r ` �i BQARD '®Fr -ALTH �t �' r Pertxiission' s hereby granted to Const�uc or pair ( n idu�I Sew ge sposal st', », as sho':n on the application for Disposal'�i�orks Construction P t N ' r___.,_ _ Dated _ "+ _._.... e_71_ s .r DAT 4 ." xn a alth �r w j: '" --------------- of e y FORM '1255 HOBBS'& WARREN ONC PUBLISHERS •. , �� �ri .a: .�, �. A C �� 5� i '�t'1� f _ V+�j .Alt 4 #: n. K j i 441i99II ... -...d -. ..`.,x ....... �:. tA'3�... �;�d .. re. ,F i ..s ;• „t i. ,. �a- t- .�f.�,�?:. ..._v°.. ?�.. I w t Z.7 r N r i N/ U/ zz"r Ax N w o N o ° °_ �10 9 � 64 Ilk ,.. y /41. 7CP' tN OF OF 'f ap O� THOMAS yG THOMAS �Gd, = L T4oMAS E.KELLEY CO. L a ENOJNFXRS—SURVEYORS KS f/ 4260 346)-,( G POND DRIVE O G/STEQ $OU-11A yAr.MOUTH,MASS. 4,yD P v�p8' ��' ONAL 6\� 02664 CERTIFIED PLOT PLAN LOCATION 4,q �8�.Cpt:Lea�. .zl: a4rns tle. SCALE —( `3Q : . . . DATE . . . PLAN REFERENCE Chszr(eS. F SLa.zL�y 6Y Ckar/e$. . . . t.41, 1174 . . .'. plc►n 13aQ1� .277 czoe 98 . . CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCA - ND AS SHOWN HEREON AND TkV# TO THE SETBACK REQUIREE% T�! OWN OF G{tcti-(ems F, Sft�nLe� WHEN CONSTRUCTED. CR�t�� �ja/z roc�al DATE PETITIONER: REGISTERED LAND SURVEYOR ` r TOP OF FOUNDATION CONCRETE COVER O Z CONCRETE COVERS CAST IRON 12"MAX. rrmr PI PE (OR 12"MAX. EQUIV.)- MIN. 4"ORANGEBURG(OR EQUIV) PITCH 1/4'PER. PIPE- MIN. LEACH PITCH 1/4"PER.FT PIT PRECAST o'o -INVERT o Q ;•�;.: LEACHING ` e EL 46-00 IN V T INVERT w PIT OR SEPTIC TANK , ��' DIST. E EQUIV. e INVERT EL.. BOX 1• � � •�. e; EL. 7'19.. a�I . .. GAL. IEL IN T ;:' w w ::�: 3/4"TO I I/2 � EL �. WASHED ' 0 0 / w STONE 10 —� �-- 10 ... �Z— -6-D I A. IA. wo PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE .:'Z.'! / 7... TIME.9136g.M, T v�.. M. URROV . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 1 NOM�$ �� ENGINEER ELEV. - . . . . . . . . . ELEV. .. .. . . . . . . A.A- �u6p— . . . . . . cj►A'TbR. weap Lb" c t. / Ue50a. DESIGN DATA e Z4!• NUMBER OF BEDROOMSIr t� Fq �,gV TOTAL ESTIMATED FLOW . .3. V . GALLONS/DAY; tD BOTTOM LEACHING AREA 749rS>. SQ.FT. /PIT v SIDE LEACHING AREA . . ►. . �. �� SQ.FT./ PIT- GARBAGE DISPOSAL . .N. �j. . (50 % AREA INCREASE) TOTAL LEACHING AREA SQ.FT DPERCOLATION RATE ,D'�? TA MIN/INCH LEACHING .AREA PER PERCOLATION RATE SQ.FT. d.WATER ENCOUNTERED NUMBER OF LEACHING PITS . _ p� — APPROVED '. . . . . . BOARD OF HEALTH ^^ ml.174y Ire, ;rcwj DATE . . . AGENT OR INSPECTOR '(H OF p� THO yG j� THOMAS E.KELLEY CO. v 24266 O y •. LOW ENGINEERS—SURVEYORS G/STEa� � OPI V!94 `T .r.�► 346 LONG POND DRIVE f ONALEa�\� PETITIONER SOUTH YARMOUTH,MASS.