HomeMy WebLinkAbout0064 NYES NECK ROAD EAST - Health (2) NgCS NCM �' nu4--
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH A
Appliration for Dispoiial Works Tnnitrurtion rrrntd
Application is hereby made for a Permit to &onstruct ( ) or Repair ( � an Individual Sewage Disposal
System at:
�..1...� y�S ,U�............................................................i ( �L � G .��L ✓! C.c.s �� ......
a lion.•Ad s• y r Lot o.
...............
Owne Address
PQ Installer < Address
t
d Type of Building Size Lot..... .....Sq. feet -
U o-- Z
Dwelling=No. of Bedrooms............................................Expansion Attic (PO) Garbage Grinder (t-30)
a`4 Other—T e of Building No, of persons............................ Showers
YP g ---------------------------- --------P--- ( ) — Cafeteria ( )
Otherfixtures ----------- --•-•-------------------•- --•------•---------------=-------•----••-----•-----•-•-•-----•--•-----•-------------------
W Design Flow....................... ..........gallons per person per day. Total daily flow---Z?c_111U..=..?�..._gallons.
C4 Septic Tank—Liquid capacity) gallons Length---:7........ Width-----7....... Diameter----.-"-----
Disposal Trench=No. ........I.......... Width......�.-`.._._.. Total Length......�-�._.. .... Total leaching area--_Z1_(_.....--sq. ft.
3 Seepage Pit No------------------ Diameter.................... Depth below inlet.................... Totaf leaching area..................sq. ft.
Z Other Distribution box (✓) Dosing tank (PO) _
'-' Percolation Test Results Performed by STD' _tt-&-'-D...... ......_.... Date._.......5__-.Z _ .........
a
Test Pit No. 1---_...Z....minutes per inch Depth of Test Pit-----1-3Z-___--- Depth to ground water... Z_...._....
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Oa' -----•-•••--••--------•--•--•---•-------------•-••--•------••----------...----------•-...-------•-----•••----------••-......••----------...------------.----
Description of Soil...... ` `t�l ................ = __... 'S c G.............................., m-r- 3�Ze 5v�5o�c_
.
-8 .. -•Elm, .. ----�.... im -- ej �. z'..........................................................r
U `� --------------
......... _--------......../LA vet.. .
U Nature of Repairs or Alterations—Answer when applicable.__e� ...........:�Y� 53t7-`sue(
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'I I'L l : 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be n issued by the board of health. /
Si ned_ ••--( •---'1� �' =-....... •. ...
Application Approved BY----... - ------• -•.....
__.. ate
Application Disapproved for the following reasons:...............................................................................................................
------------------------------•-----••-•-------....-------••-------•---------•------•-•---.....-------------•••------•------•--•......--------•---••---- -----•--•----------•--•-----------•-••-------
Date
Permit No. n... �----•--•------•-------- Issued_---------..- .....�--.... .
Date
Now-••-!.. a.. Fx$� 7X_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. ......oF........7 'S"'�'::. ..r .C-
...........................
Appliration for Dhgpos al Works Tonstratrtinn ramit '
Application is hereby made for a Permit to Construct ( ) or Repair ( \) an Individual Sewage Disposal
System at:
..••---...:?�- t � ... /, c �, 2....! r c ,c- C/
c ation-Addr �o
........�.I ` ...... .%�.................... /...y c./-t Lot / .,...........................................
/ ._.....
f/ZGl/,A6 Crd tz
Addre�sl �t
Installer ........................ .... �(/L.9...... /J ' ........R! ...-. 1!t!jcr/. ..�y17!1i....
Address
Q Type of Building - -�
U Z Size Lot-----�-�-'�-°'--•------------
Sq. feet
Dwelling—No. of Bedrooms.................................•...__.__..Expansion Attic (00) Garbage Grinder (t-)-)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q Other fixtures
W Design Flow......................... 5.......____gallons per person per day. Total daily flow... _x._f_��'. ... ....---_`.- ..__gallons.
WSeptic Tank—Liquid capacity.s 92?gallons Length....---_---- Width......7�_..... Diameter.... ----- Depth_..r�.'
x Disposal Trench—No.........I_.......... Width......A!Z......... Total Length.....!........ Total leaching area....1LO........sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank (PO) _
'-' Percolation Test Results Performed by...-,,', `7 ~'...... .`.c 5 a .......... Date.........
a Test Pit No. 1.......Zr-....minutes per inch Depth of Test Pit...../?6'. ... Depth to ground water---- I--•-__-
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_.................
Ri .---•------------------------------•---......---------...-----....-------•----......---•-------•--..........-----............----...........................
0 Description of Soil...--P. `/ Z c>-&" .c - �.z:'�'�`' _5u j5�,L
................................................
(xj ---BK.„.......!`•./�.0.. .. �..._..'4!.................... ..............................v� �_ _ /}'c? �� N f. �. 40A 1 7 r-
U Nature of Repairs or Alterations—Answer when applicable..v''`"' ''_ .......... .___._..:5E 2�T�r.
Yf4 Is ,_!- e 5 4?Cv(l? _...1`-f-�-M -r7T -E. "
...................... ----------------------------------------- ----------••••-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TI'7-E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance haVbDe n issued by the board of health.
0 cSigned ' ?...R--' •------------------- --
. ,
r y..
Z. �, .. / to
A lication A roved B _.._e y" ` __. ':� ��,r,,. %�� /-
D
PP PP y --s .. .......:.:.. r- � 5 `I------...
ate
Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------------•---
....••••---•--•-••••-•-•••••................•---••••------....---•--•••------ ----------•---------
Permit No. ............................................. Issued------. � ...Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
__- BOARD OF HEALTH
......�...Uw ti!...............0F...... '.n►.:= ..4..!' .L. ...................
(9rrtifiratr of Toutplianrr
TH S IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
/_ / Installletr �}
has been installed accordance with the provisions of TITLF, 5 of The State Sanitary Codq as de cribed in the
application for Disposal Works Construction Permit No.___� _-,._--'.................... dated_....___ _
THE ISSUANCE OF THI �-�-----------------S CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................L................................................... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
�c:'1G!"EN;G ENGINEER KV1 —T
BOARD F HEALTH'STALLA T ION AND
2 w -(7�5.��i YSTi:M WAS INSTALLER i
OL
o ..........................................oF.................---•-----------.........__... .r.�.-.�nr:. c�PLAN. diCT
.� rtiu�yl�l,�
- FEE........... ,
Permissionis hereby granted --------------Y...--.•-----•--•••-•-•--.............................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Dispgsal System
at No....4 Q.....1-Q__ s M::Z-0_G1C. AlJ.
Street
as shown on the application for Disposal Works Construction Permit No.F.`?.....__: .. D ted..__.._l -----.--_----
J _ , -----•-•--...------•----•...............•-- ,---------------------.-•
pp o rd of Health
DATE. ------------ --`-•••-r------ .........---------....................
FORM 1255 HOBBS,& WARREN, INC., RPUBLISHERS
SOIL TEST PIT DATA, SEPTIC TANK DETAIL DISTRIBUTION BOX DETAIL:
TEST WtOU%4N Vk TrE R NOT TO SCALE NOT TO SCALE LEACHING FACILITY DETAIL: N,0. DATE
TP TP TP TP NOTES, I SEPTIC TAM SMALL BE STEEIL 4 MILEr AIAC C1U'v_fT' 'EES TO 91E CAST RON, NO OF OUTLETS: NOT TO SCALE 7- -,4.L
eiE 414M"GLE :OAR NOTES
JkLESS UNDER PAVE ME INT, DRIVES CW I DIST BO)( TO WITHSTAND H-10 LOADING
7 RAVELED WAYS, WHE RE Ik H-?0 LOADMG UNLESS UNDER PAVEMENT, DRIVES OR
SMALL APPL ! TRAVELED WAYS WHERE-IN H-20 LOADING
PRECAST SHALL APPLY.
DIST
3 ALL PIPE CONNEC_TIONS AND CONCRETE
CONSTRUCT10% TO BE WATERT*#4T
F11100ft GRACE BOX 2 PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF
FRE V
'
PUMPED SYSTEM.
-70 3 FIRST TWO FEET OF PIPE OUT OF DIST
71r 77- BOX 70 BE LAID LEVEL
A PLAN VIEW
+ REMOVEABLE - 1. THIS PLAN IS FOR DESIGN AND
T COVER
CONSTRUCTION OF THE SEWAGE
PROVIDE DISPOSAL FACILI`TY ONLY.
SEPTIC -7 r* ow OUTLET F-1 SEE
L BOARD OF HEALTH REGULATIONS.
PLAN VIEW CROSS-SECTION BASE
DATE: DATE-. DATE� DATE:
INVERT ELEVATIONS:
TEST BY: TEST BY TEST BY: TEST BY:
4" INVERT AT BUILDING
WITNESSED BY: WITNESSED BY. WITNESSED BY: WITNESSED BY: 4" INVERT AT SEPTIC TANK(m) -44. ,
4" INVERT AT SEPTIC TANK(out) 44-
CONSTRUCTION NOTES:
DATUM: INVERTS AT LEACHING FACILITY
VERTICAL DATUM.-
BENCH MARK USED:
. INLET PIPE EXCEEDS 0.08 FT/FT OR IN
/q ~/ OBSERVED GROUNDWATER
ELEVATION
DESIGN CRITERIA:
TA DESIGN FLOW�
00" REQUIRED SEPTIC TANK. CAPE COD SURVEY
100
J CONSULTANTS
SEPTIC TANK PROVIDED- GAL.
BARNSTABLE VILLAGE. MA 02630
.__e---A gwv Lx_w-Z) SIZE OF LEACHING FACILITY REQUIRED (617) 362-8133
DIVISION OF
BOSTON SURVEY CONSULTANTS INC
PLAN
SEWAGE DISPOSAL
0 PO
7-1
Aj
4(Dx3 LOCUS PLAN:
/xi� S PREPARED FOR:
<23
z DATE.
ON 01
CHECK
DRAWN
PLAN VIEW /z/1 FIELD
DWG NO- JOBNO
IE i
SHEET OF.
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