HomeMy WebLinkAbout0291 GREAT MARSH ROAD - Health (2) �� ere
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Not?_ ... ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.._. ter_ Btlt"_ .T .
1 OF...................... �..!r +tee.. ...........................
Appliration for Did atial Works Cnunit`urtiun Punfit
Application is hereby made for a Permit to Construct Repair ( } an Individual Sewage Disposal
I System at: � �
,► �
..........................-........._. •••--••-•--•.-•-- = .. .-- ---_...•� •-•--•..........._.__ o.
Location-Address.,r j� �� � ? or Lot No.
s 6(s CA 0
...................... 11L :'�------- .....9.----•--..............-,•--•----........L _....
-•-•------•-----•--------__--_--___-_
Awd Wv Address
•InstAe Address
Type of Building Size Lot....' ------Sq. feet
Dwelling—No. of Bedrooms...........!1_Oft. ...............Expansion Attic (t-T'� Garbage Grinder (rjb>)
p., Other—Type of Building W.A............... No. of persons.......!t-A/. ............ Showers (WA) — Cafeteria (�,/A)
Otherfixtures . °U�� ----------------------------------------------------- ----------------------------------------- ------------
W Design Flow.......... ....`__-_._._...__gallons per person per day. Total daily flow........3 �.......................gallons.
W Septic Tank—Liquid capacity.Jo5?ogallons-, Width.4`!�;!'"._ Diameter__Hh? ...... Depth_.'?. '"...
x Disposal Trench—No. ...... ..... Widt .....!:-Y%A_,._... Total Length-----hA/ ...... Total leaching area....�+I A.......sq. ft.
3 Seepage Pit No..........1........... Diameter.._... Depth below inlet.._....�;R:._____. Total leaching area...°L _....sq. ft.
Z Other Distribution box Dosing-tank(Nla)
aPercolation Test Results Performed by..... -1 _ !___________________________ Date.....`E.�°�-4:•�•'?..3____._..
a Test Pit No. 1. -__ ------minutes per inch Depth of Test Pit.......!o...... Depth to ground water.....:!-4..............
fT4 Test Pit No. 2__ _2___minutes per inch Depth of Test pit.......1!:...._.. Depth to ground water..!
P -----------------------------•... ......•••••. • -----.....••• -•••-•-•••-•-•----•-•--•••••••---......--••-•••---••••-••--•--•-•-------------___...
C ' Description of Soil......tL =•_•••j 6.n f?:,--L•�13-�--- 'Z- £3'�._a.! .s,-,-®. &' ` t3(3t 5
t --•••- ?-------------
V 8 --tp` ¢.tE-1� SH-� — w Pt-ii"-SR- `� t G�o•�
---`---- �® ��.�..� L•------�-----/--��-� 1 ---).._iU!t=Divan Ss4�.,D. P`- t" t..................................
c_,--r' C-3
-- ---•-
U Nature of Repairs or Alterations—Answer when applicable__--!�A...............................................................................
------------------------------------------------•----------•----------------•----......-----.....•-•--••••••••-----•-----....---••---------••••••--------•--•-•-•-•-•-•......•••••••••......•••--•--•••
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLL 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.
--- -- ----= --
h D
Application Approved By••••-••• ------- - ----- --------------------------------•---•............•••-.......•••--• ........ _
.........
Date
Application Disapproved f o he ollowing reasons:---•-----------------------------------------------------••------•-------••-••-•--- C
.•-••-•-•••-••-•••••••-•••••••••••••--••••....._................................................................•--••--•••••-••••--•------------••-•-••------••••-••-••--•------•-•..............•------
p ^ Date
Permit No. Issued... ------••--
Date-----••-•-•---...-•----.....---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............OF.........F5 t K+.151 ,,
Appliratiun for Biipuual Works Tonui#rurtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
c G Er4. ..::l.A QS �- r P.Cp ct-1 _..-Q. - --- --- .........--
Location-Address or Lot No.
C� v u_
.-------•"'-'--•••----•--........•..-••--•. '" � •----•--•-••"•-•............................•-••---......_..
Wry Owner./��r.J� p j Address ,Y
installer r Address
Type of Building Size Lot....... Sq. feet
Dwelling—No. of Bedrooms.......... ...............Expansion Attic Garbage Grinder (w1A)
PL4 Other—Type of Building ...�1P�41/.'................ No. of persons......! /A............ Showers Cafeteria (wn)
dOther fixtures ...-•----'..jk.........................................................--•--•------- ----•--•-------•-•-••----'-••-•-•••••"•-"'-'"'"'-•""-'-"-"-.
W Design Flow.......... ....!;;'._-+__..........gallons per person per day. Total daily flow........ �.Q.......................gallons.
GG Septic Tank—Liquid capacity. 000gallons Length.��'..�R.... Width.4'.!_�R .. Diameter_ ...... Depth_S el.....
�riW Disposal Trench—No. ......!-'�!�_.___ Width.._�1A_._._.. Total Length-----�/!�....... Total leaching area....!-�! .......sq. ft.
Seepage Pit No.---_____�._________ Diameter.._...!.o Depth below.inlet......2�R........ Total leaching area...2 .....sq. ft.
Z Other Distribution box (%-I' Dosing tank (•,06
`-' Percolation Test Results Performed by..... ........................... Date.....5124�_P�.3........
W -
a Test Pit No. L�-._ '_._.minutes per inch Depth of Test Pit _-__-! ...... Depth to ground water........................
Grq Test Pit No. 2..:�:... "._-_minutes per inch Depth of Test Pit------- Depth to ground water..!:'Q � -----
P4 •-'••-••"-••••-•-•--•-••-••---•---••----•••-----•-••--••--'-----'--'......---'-'-''""•......••'•-'•----------------------------------------------------------
D Description of Soil... --'- ; - L + (.2:. ti.c D_sn�r q...�...�-�'t33Lc..S.."I-------------
.
C`j ..!O ) Mew
W ' �'-•L! �d.-:. .�..1 L T�j •r am`' 12.' KA E`Ol vm S A.so � �e2/t 1�L.. e s—v e.w A-rc-�
x ... •- ------- ................................................ .......................t--------------------•••--•-.---•--
U Nature of Repairs or Alterations—Answer when applicable----!-r.IA..............................................................................
---------------------------------------•---•--•-•-------•--•-----------------•-'-••--"'.._.........._......'-'••--•-•----••----•.•-----•--•----•--•--•-•----•----•--•----•----•----•---................
Agreement: . I
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL L 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.
�n
ApplicationApproved By......... --_•-----------•----._...--•-----'---------•--••---'-"------"---•- ....� •-- ..........
ate
Application Disapproved f oeasons-----------------------------•---------------------------------•----------------------"•---•-'-•'•----.........--
.............................................................................................................................................................--------------------------
Date
PermitNo.-'-""""""""'-"""•""'"-""'•'-'""-•---••-"•-""•----••.. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. +!J. ....................OF..... i C! ►T(......C9r............................
Ourrtifiratr of Tomplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (✓) or Repaired ( )
....................................... •--'--• ..............•--• •" .--
�+�I,nstaller
at _.CC'4---"- ------'11A Cn__-"- `" M O "`I"� '
has been installed in accordance with the provisions of TI"' 5 of The State Sanitary Code a/des ' in the
application for Disposal Works Construction Permit No..�.�-----n. Y................. dated_.-.li_ ...._......
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARAT THE
SYSTEM WILL FUNCTION NCTIO SATISFACTORY.
DATE--•••''•-. ---....._..~..--- .....--•----•--------••----•-•---. Inspector.--•
---------------------------- `1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD pOF HEALTH { i
OS64.!' ................. OF........... ................... ,�
No.........................J FEE. ..............
Diupoua1 Warks Tunotnul r �rrm
Permission is hereby granted..k9V.y.1 .. Cr = ---•-••----•-•--•- ..............
------•---•. .........................................
to Constru. t (v� or Repair ( ) an Individual Sewagebisposal System ,
at No..l.o qF �`�`r�...... c +"�........nQ_. --.-•' :4..--- Cq.,04CC%Jkkkc M ..............
Stre
mit - - ................
as shown on the appli on for Disposal Works Construction Per NoY.. �-. 7-- D 1; ',
Bo o ealth
DATE. ... ......--•-------•-'-"---......"'-•'-"•--•-••.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -^
Y 6 -
Comp l e t ed by f: i✓LL��E bG�i= .►b=`2
Hit dAQUNp=WATER LEVEL COMPUTATIONS _;
site Location: � ��MPvOEcr+EE /GQaT titAQsrl ��tCSs Lot No.aA
2�0/130
/— I Address,. ,.,%A w...:" • ,, `
a Owner: ti►�F �CG6 -�Prl '
f Cont.ractor: M� � D>~s.���r -Address -
J
Nofes: Q-EF 3c�iL-rESr +� P- ln-�4
s
t{
k yt i
2
I k •,
STEP.'. 1 Measure. depth toFwater table = a
83-[
to nearest: l/10 ft. . . .
rdate�-
STEP': 2 Using ,Wa.ter-Level . Ran e: Zone
c and Index We11, Map locate
site and determine:
A 14i
k
A) Appropriate index we • :• ,
„i 3
B) .Water-level:..range 'Zone �` p
t' f fi h
STEP' 3 Using monthly report"Current '
Wafer Resources Cond t ions"
determine. current depth
water 1eve1 for .index"•well •. /83� ,,
�--- -
Y S moyrr• -
if,4x }
t x
�
STEP 4 Bin"gja.ble of :Water, level ;
Adjustments for index we91
c STEP:- ZA current depth' toia a s°
:water 1eve;l for index we) 1
and jwater l eve.l
f Zone'•`(5TEP,' 21j) -'determine.
'•° .e' i n 16
V
water-leve''1 adjustment -•� • • • • • • •
4
' STEP 5 ` Est crate tdepth �to h: gh water
� by subtracting the`.water=
2 3 ;J evel. add ustment
measured iepth -tt.
o water 4
r
level at s;i to (STEP 1)
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ND su. Sg\q6 $•.Ali °
LEG ND CERTIFIED PLOT PLAN
F EXISTING SPOT ELEVATION OxO'`
EXISTING CONTOUR .= 0 LoT �t r'�p,1r. /'��tP ,4 ,et,.
FfNt`SHED..SPOT ( o s c�+ E��.a��
ELEVATION /11P OP
' FINI.SHED'.-CONTOU`R 0 E : ." ;�, �f �?�t
n ORSe s
o ,` No 10951 O :N I N
i APPROVED BOARD : OF HEALTH A ��
_ FSSI0 0-
DATE AGENT. -SCALE S / =40, DATE77
L•D RED GE EN_G/NEfR/NG CO.IN ;. ; , ' : _ '
i� CLIENT. .I CERTIFY THAT .T.HE ,PROPOSED'
y EGISTERE REOISTERE'D JOB, N0 $ oS BUILDING "SHOWN: .ON;:THIS,
: PLAN
rt ` CIVIL LAND 3' , CONFORMS;' TO` THE .ZONING ._LAWS'
?, DR"BY*"t �:
ENGINEER SURVEYOR OF HARNSTABLE MASS
7I "� M.A1 N .STR:EET
NYaNNIS:r MASS ^F j gNET_. :,�Of DAZE E:O LAND . SURVE.YOR
i
'E TIE.SEPT/G TAN!�C OR
�, „ , :_PAGH/ivG P/7• AR.te MORE' Tslfl.`/ /ZBELOK/.
`rRAOE, A'-24'VIAM ETER CONyCRETE COP Z-AP
Io Ps' SNALL 9E BaOUGsrr' To G�rAoE'.
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1iE,4VY CAST./RON GOi/ER Sh+AL.L 3c' USEJ
EL- 't06 .S . COYER.S I®Al. T FT' F/N DR%VEN/AY
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CONCRTE
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SO/L T�
LEV. '�3�•n t�Y
SIDEACHIN6,PER oiT 2 RFSL/LTS iV1TNzsSED BY
00TT'OM'L6+9 X/NG PER P/ 7 8' SCE FT 4 r�'�° M '0e'gCOLA7'I0W RAT F,
L r,�'c AERCOLAT/D/1/RATF2 Ta,.g.`i MIN /IVCM
TOTAL. LFACN//VG AREA �b SAP 'F T• _ry 17S 0 t l's c_ 2::0
'RES�Ri!ELEACXI/V6AREA -SQ. FT. o & 2►_ /
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TER' 6eL�i/. ., �3 US;•t "SH ET OF 3:'
• ' DAP b- ESN 69u 6.,jA,T=�. a:P 5 ✓OD �`
` Lomp eted bye i (�QE®az,S_- b (`
Ib
H,IGH .GROUND-WATER
LEVEL CQMRUTATION �>
G P�✓1 Ll�
Site Local ion: lv _AP,o�
e+E �CT NIA2si-1 Qt� bS x NO. ! "-=S0QS 2 icy�.i3
lot
Owner' CIF GoGGESr4,41r1_. Addressi tiifA
Contractor: iU1 Address. �=-
j Notes:. mil: r�sr u'p P'- 'Lc74 k F
STEP 1 Measure depth to water table • • • •
r 5/'14/83 � 1O .C�
to nearest. 00 ft. • • •• • • •> • • _ _ --
" " date
t
STEP= 2 Using Water Level Range ,Zone
and Index WeIT Hap ocate
' site and.determine
} i A IOW .., . .
` A) Appropriate i ndex: well . . . .
230
B) Water-level.';range'aone .;. . D:.
Using monthly r:eport"Cuerent F
y
Water Resources. Gond i t ions"
determine current depth to '.r" 2� 5a
water level fog �64ex We
f
Using' Table Yof 'Water level°
1 A,d j ustments for_ Index wel
:STEP.' 2A ;': current dtepth; to k k
water level.rfor index well fi
' (STEP- 3) ,.Nand water-- evel r
r zon:e :(STEP 28) ;;<dete'rmine.
tt water-level adjustment :{ •
{
` STEP S: Estinate 'depth°to�high water
by subtract ing; the water"-
� : level adjustment .,(STEP :4.) *R
A C� 4
from measured depth':to water 3;
( )
= Y jevel at..< s.ito . STEP 1 • •
r
zl
F'
s