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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...........OF:....... �d. -�✓.l�-...........
ApplirFatinn for Disposal Works Tonstrnrtion ramit
Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal
System at• DDi�
............ �� - -----Ia-�B.A.J.....`,-°--------- ......2.�__...-•-•------------------ ......................
-..
L c ddress
-►' -� ............. ..,� f.x fit. --. .... .�7__ A467
0
.� O Address +
a ` - ----------------------------------------------------------•- . . -- q
Installer Address
U Type of Building Size Lot... .CP.32--5 feet
Dwelling—No. of Bedrooms..............................•.._........._Expansion Attic ( ) Garbage_ Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ..-----•-------------------------------------------•---•--•-------......----------------•-......-
W Design Flow________________,, ...............gallons per person per day. Total daily flow------------_ . .._.._...................gallons.
WSeptic Tank—Liquid capacity] allons Length................ Width................ Diameter................ Depth...._..._....__.
x Disposal Trench=No..................... Width..I--•-•------- Total Length.....:__{....... Total leaching area....................sq. ft.
Seepage Pit No-------I-__--____-- Diameter.......'.........--- Depth below inlet......_..:.......... Total leaching area�'�.450...�s .wft.
Z Other Distribution box ( ) Dosing. ) - $6 I�
a Percolation Test Results Performed by.__.__.�-.� ( lam? ______________________________________ Date...... �� _�__--.•---------
,� Test Pit No. 1......�...minutes per inch ;,Depth of Test it____________________ Depth to ground water..__ .6___._.
fZ4 Test Pit No. 2...........:....minutes per inch 'i Depth of Test Pit.................... Depth to ground water........................
a of n
O Description of Soil
----- :' - +__
Urz r:
W
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 iITI1Z 5 of the State Sanitary Code—The undersigned f rther agrees not to place the system in
operation until a Certificate of Compliance has been i e by the boa f eal h
Signed'_"i ! -.1 -
- Date
Application Approve t_
Date
Application Disapprov f o the following reasons:------•----------------•----•-•-------------•-------------------------. ........................................
Date
PermitNo......................................................... Issued-----------------------------•------••-------•-•--••---
Date
X/y!
v
! THE COMMONWEALTH OF MASSACHUSETTS
t .
BOARD OF HEALTH
s�
;� r r�irtt#iaan -far Disp.aii al Works Tonstrn.rtinn ramit
{
Application-is hereby made for a Permit to Construct X.) or Repair ( ) an Individual Sewage Disposal
System at
.......... — . ..1.�.- .... '? .., . ............... . -----------• -----a -
ca;� n Address
r - -
W Address
- — ..
Installe Address
ZYp g Size. Lot___
x •'�'-� T a of Building 1-r 337 Sq. feet
�'
a
"welling—No. of Bedrooms____----------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtur
DesignFlow_.__.._ _.._______ __gallons per erson per day. Total daily flow_..._.._--- --- --- -- - - g P person P Y• Y ------------------------------dons.
Septic Tank Liquid capacit _gallons Length................ Width................ Diameter._._.:_________. Depth................
. . W
x" Disposal Trench No ____________________ W>d h (............. Total Length_.___ _..i Total:.leaching area - * ft.
Seepage'•Pit No. __ .._.._..____ Diameter ... _._____._ Depth below inlet_.__. ._.....__ Total leachin ��•: # -
Z Other Distribution box ( ) Dosing
—Percolation Test Results Performed by.. "`"_.. ________________________ Date... f0
" Test `Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to,ground wate ........................
G4 Test Pit No. 2................minutes per inch Depth of Test Pit....................jDepth to ground water.........................
04
O
Description of Soil..'" 2►l•_ ` __ ...
- ------- ---
x - .........
rm
V -----------------------
•--- _ -_---- -------------••--------•---•------•---------•------------•------------------------
W . .;- .
"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 TITIS 5 of the State Sanitary Code—The undersigne urther agrees not to place the system i
operation.until a Certificate of Compliance has been/1% d b he. r
r Signed -- -•----... :
Date
Application APprov. - ..........................
............................- ------•-• .......... -- ............
Date
Application Disappro d r the following reasons:------- -•--------- - ---- •-------•--------•------------•------------•••--- -------....-••-
Date
PermitNo.......................................................... Issued.........
Date
THE COMMONWEALTH OF MASSACHUSETTS,
BOARD OF HEALTH`
:- ..........................................OF.........................................
err ifir a e of T.amptianrr
T IFY, That the Individual Sewage Disposal System constructed or Repaired ( )
----- ---- ----- - "
. --
at. e! ----------------------•---------•-----------------•-•-- ---------
has been ' e in accordance with ie pro visin. of T TIZ r of T tate Sanitary Co . as ri ed in the
application for Disposal Works C uction Per t No _ - _� ._____ date .- --- ____-_ '
.THE ISSUANCE OF"`THIS CERTIF,IC?aTE SHALL NOT BE CONSTRUED AS A UARA TEE THAT THE
SYSTEM WILL FUNCTION SATISFACT RY.
DATE....................................................... Inspector.................. = --•-•- "
THE
COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF..................................................................................... �"�U
NPf.._./.. ............... FEE^'.-...---....---.......
i a1 ark, T�anstr ion rrmit
PermissionT hereby grante ........z----------------------------------------------------------------------------------------------------------=............
to Construct ) or,,,Repair ( ) an Individual Sewage Disposal System
at�No.....................................-......==----=-----------------------------•-----••--•---.---------
street
as shown on the app 'cation dl'Disposal Works Construction ' - ..................... Dated..........................................
-•--•- ....... --......................
Board of Health
------------
(/ f
A'
FOR:FORM �f,255 /{• M. SULKIN, INC., BOSTON -
t
SF.E L OI=
E
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o r�
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AVA TER
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1
SM OF
o THOMAS
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v '
ISTtP�O� ,
� D SUR��yO
SEWAGE DEAIGN PLAN
~ LOCATION � 1171�� .r. t'�•
.a SCALE /. .':� . ?.' DATE
PLAN REFERENCE . L .T..��.. . : ... . .... .
MIL ENGINES
41.
PETITIONER
�T •. �0? THO
�n�' d./..}. ..7�..p. ..... THOMAS E.KELLEY CO. o K Y
../`���'�la-.�F.n✓.,��C 11.�.vva. . !�A �LL. . :.. IINOINEERS-SURVEYOR$
"6 LONG POND DP"B �QIST6Q
.� / _ 90tnH YAItMOU Ws UAM ONAt��
� -
--SHEET T O 2 SHEE
TOP OF FOUND�ION '
. , CONCRETE COVER:
�,• CONCRETE COVERS +
• ,
4, CAST IRON 2��MAX. 12"MAX.
OR SCHEDULE 4 ..4°SCHEDULE 40 P.V.C.(ONLY)
P.V.C. PIPE PIPE- MINIMUM LEACH „ :.
' PITCH i14"PER: PITCH 1/4 PER.FT. PIT CIRCULAR
PRECAST
-� ' • LEACHINNIJG
•FEL F'�.00.. INVE INVERT � �� PIT .tz
SEPTIC TANK DI ST. W
e . EL..,ft4-* EL p.2� ' ; >=
INV,�� GAL. INVET BOX ��� •� ,.
EL.. q.. ELYfoi.. . INVERT ;.� � w o (1 :;i: 3/4"TO I I&
e WASHED
W STONE
Ao
.' Id MINIMUM I2 6'DIA. �- `
DIA
e o' 20 MINIMUM !O
PROR LE OF GRouND WATER TABLE
SEWAGE DISPOSAL SYSTEM `
x
NO SCALE
it-
SOIL LOG .j WITNESSED BY
DATE .f/�.84t. .... TIME.4.P,. . . . . . I. . . BOARD OF HEALTH
TEST HOLE I TEST HOLE 2,t J °L�• , C,Lf� , ENGINEER
ELEV. : . . . . . . . : : ELEV. .
. . .•. . �-��?, . . . . . . MCA Ia4Tv� - ,
uQ S4luo DESIGN DATA
0 GQ�VE[ DTP r
50/4- ;Dar, )
Ot�OJ NUMBER OF BEDROOMS .
V TOTAL ESTIMATED FLOW3.Q. GALLONS/DAY
BOTTOM LEACHING AREA 7 �0 SQ.FT./PIT
SIDE LEACHING AREA . SQ.FT./•PIT ':
GARBA'SPE DISPOSAL AID :(50% AREA. INCREASE)
�- TOTAL LEACHING AREA : 2��.•On : SQ.FT :r
-O ocnn w .. T
_ ...MON RAT _ MIN/INCH I ,
LEACHING AREA PER PERCOLATION RATE Jr,SO SQ.FT. x `
- D WATER ENCOUNTERED n
NUMBER OF LEACHING PITS Q/��. la�o?'.���
APPROVED . . . . . . BOARD OF HEALTH •A Q T o..�'! �y �� r�te..�}
i ✓S64-Ttis a .
DATE.
OTC _ . .1 L' CM INEER•
AGENT OR. INSPECTOR 22. A P7` •4 �,�/�• k
n IF
PETITIONER cTHOMM :,.
p� L
('•' % + ��` THOMAIS E. KELLEY 9 '`
ENGINEER— SURVEY T
OR
3" LONG POND DRIVE ONAL� F;
CJ °2 I'*er"fjl o0or• SOUTH YARMOUTH, MASS.
. 02664 / :+
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