HomeMy WebLinkAbout0042 PEEP TOAD ROAD - Health (2) �� ����� ��a�
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No.._--•...................
THE COMMONWEALTH OF MASSACHUSETTS
d BOAR® OF HEALTH
ApplirFatiun for Ui£puuaal World Towitrartiun ramit
Application is hereby made for a Permit to Construct A) or Repair ( ) an Individual Sewage Disposal
$ stein.at
-. ........ ---------------- --- �'............................._-- ......................
Location-Ad ess or Lot No.
s
Owner ��j ��q� ��q �dd/ress/ G��
a .. .. 3l.L'..A................ �Xd. K.� .....................l__............-•-•----
/Installer Address
Type of Building Size Lot_R'7t -=__Sq. feet
U Dwelling—No. of Bedrooms------_��................................Expansion Attic (Po Garbage Grinder (�
Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures ._.._..
�•—� -••-------------------------------
W Design Flow........................: 5..........gallons per person per day. Total daily flow................. ..............gallons.
WSeptic Tank—Liquid capacity/0.00gallons Length................ Width--.............. Diameter................ Depth................
Disposal Trench—No...... ___. Width...... .,..__.. Total Length...... Total leaching area......YK�..sq. ft.
Seepage Pit No------------------— Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (. Dosing"tank ( ) ( f �_� ,7
Percolation Test Results \ Performed by...........................F...�.1 ! -_.:._. _._ Date........
!/_,..._..._ _..
�a Test Pit No. 1...............minutes per inch Depth of Test Pit.....J..�._.. Depth to ground water........ .........
fi Test Pit No. 2.....�........minutes per inch Depth of Test Pit................... Depth to ground water------------------------
---------------- --------• -------• --•
Descriptionof Soil------------------------------- ....Z............L................... ................................---
x
-•--•-------------------------------•---------------------------------------•----------------------------------------------------------------------------------------------- ....._.........
U Nature of Repairs or Alterations—Answer when applicable....................................................................................._..........
L
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 Compliance has been issued y the board f health.
•---•---•.....--•-_ti?� . . --•
Sig ..... ----�=-------•-•-•- -
// a
ApplicationApproved By......---- • ••-••-. ..--•--•-----•--•--.....••--------••------•--•-•---•....................... ...�-/ .........................
Date
Application Disapprove for the following reasons----------------------------•----------------------..._.....-----------------•--•-----•••-------•--•------._...
••------------•---....--••------------•--•-•-•---------------------------•--------....-•------------••--.-•-----•---•---------•-•••-•------•-----••••-•-••------•-------------------------•-•-------•---
Date
PermitNo........................................................ Issued.......................................................
Date
No..- .................. Finc ..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............." ...............
........OF.................... .....P..P4 .........
Appliration for Disposal Works Tontitrurtion rumit
Application is hereby made for a Permit to Construct (sit) or Repair an Individual Sewage Disposal
System at: _r 'It
................... L " .t.............-.---------.-.-
.----------------. ...........
.......................... --- -- -- ...... .. ...7........................................�.. ....
. ..................—...4...-.
on AddesbvIe/ ..
................ ......... . A........ ...... ............................ . ............. .. ..... .. .
caner Address
Installer Address ..A.f......
Size
Type of Building, Lot__.n. ----- Sq. feet
U No, -7
0 1 Dwelling— of Bedrooms_____ .................................Expansion Attic ( A-10 Garbage Grinder ( 6
�4
Other—Type of Building ............................ No. of persons._______________________.___ Showers Cafeteria (
Otherfixtures...... ............................................................................................................?............................
Design Flow.......................... ..gallons per person per day. Total daily flow_.__._.________.3.16.)............4allons.
Ix Septic Tank—Liquid capacity./tkNkallons Length________________ Width... Diameter_.._.._ Depth................
Disposal Trench No. ..... .......... Width..:.:_. Total Length.......3... ..... Total leaching area.`..L� --. -sq. ft.
.
Seepage Pit No________ ___ ____ Diameter,.......... ......... Depth below,inlet..................... Total leaching area___ sq. f t.
Z Other Distribution box Dosing tank,
Date.............
Percolation Test Results Performed by:.______. ' '....................................................... ..................../Z
al
Test Pit.No I minutes per inch Depth of Test Pit-_"J'_?....... Depth toground water_,___:__..-
ater-------- ...... .
' t �...
Test Pit No. 2..... ________minutes per inch Depth of Test Pit..... w, Depth to ground water..._.._.._____._:_._.
P4 .......................
.........;�... .c.............................................S
Soil................................A— 5 ot
0 Description of . .................I................. .............................................................................................
................................................................ ................... .............. ..........................
U
----------------------7---------------------------------------------................................................................................................................................
U Nature of Rep-airs or Alterations—Answer when applicable.________ .......................... ............................................................
.......................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'T T 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.
SigI................................ ......................
e
Application Approved By........ ....................................................................................
p ........ ... .........................
Date
.1
Application Disapproved or the following reasons:--................................................................................................................
................... ............................................................................-----------------------------------------..............................................................
Date
PermitNo........................................................ Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF. ................................................../
T-5rdifiratr of Tompliaurr
THIS IS TQ-CERTIFY, That the 19,6vidual Sew age Disposal System constructed or Repaired
by--------------------_------- -_----------- --- ................................................................ ....................
.. Installer
at.............................................. ............................. .._.......... ....... .......... .. ........
;----------07-----------------
has been in I stalled in accordance with the provisions of T171 5p le Statp.eSan, itary Codp/a s ri_ ed in the
� r7 -
application for Disposal Works Construction Permit No_____---------I
........................... d--,]. ................................................
----------------- ('-IT
THE ISSUjANCE1,OF THIS CERTIFICATE SHALL NOT BE CONST ED S A GUARANTEE THAT THE
SYSTEM WI,1LV)XL F/UT.I..O. N.. SATISFACTORY.
DATE.... ... .... . . ............. Inspector_.. A.
..................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH'.
0 F................................................. .................. ..............
er
N ............. ............... ;4 FE . .................
• Mit
Permission J§-hereby granted..................... ......
......XV, ............ ��...............................I.
to Construct,(' ) or Repair an-Indi Individual Sewage isposal Syster/n
at No.......................................... ------- -------
......... .......7�u ....
Street
age?
as shown on the application for Disposal Works Construction Permit Nd . ....D
ve ...........................
.................. ......................................
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
13e77,1LC Pt!. �joJNDS \ Q Q
OF mASs1`/y
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No.10951 Q ,r
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LEQEN CERTIFIED PLOT PLAN
EXISTING SPOT R VATION 0A. /*�
EXISTING CONTOUR �®.� �, � ... Lv-r 7 r r.,
77
FINISHED SPOT ELEVATION';,,,� V � },
V .
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FINISHED CONTOUR 0 A k 1'4a IN
1
APROVED , BOARD OF H E A 14,
'toy .�
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a °nr37
t374,
0 AGENT SCALE, / �..4'0 DATE /♦ z
REDOE ENGINEERINS IN C+R �,•�,,�
= C1.I;L�1?' .I* CERTIFY THAT THE PROPOSED F
fi �-� Q BUILDING SHOWN ON THIS PLAN
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EAISTERE REGISTERED ;� 108 t�[tr. ....._..---r .�aNFORM3 TO THE ZONING LAWS
CIVIL LAND'-�fk wry _ =x x'a
EN'AINEER UR E �. "OF BARNSTABL MASS
„ As
f
712 MAIN STREET`,' � CH, ��
H YA K MH S. M A$$ -.x gN SOP 1NATF , a� ��n citRuF,
20 F`77 MIN. NOTE /F THE SEPT/G 7Awk /S MORF
TH.4,V /2 /NChfES QELOi•V 4AAP,E=, A 24
/O FT. M/N. //VCH .D/A/".ETFrR Gon/c rCT6 CovBR SI++.e#LL
4'PVG P/PE De aR(3U6H7' TO GiRAOF, �.4IV EXTi!/1 /`/EAYY �1�'
CONCRETE M/N. PI TCH 4CA3 T IRON COVER 5Hi4 L L 46,6 US�O /F /N
ELry' L�z.s' CO y X •-
M JN. 4RAL7E 4"oou9LE
PERFi�Rr4TFrd
b:'• PvC P/PE
_ upv/D LEVEL • ems- CLEAN SAND —Z� • S m QO5
-.a 4'CA5T -
JRON PJPE / 0 0 t� GAL.
Q•. .SEPT/C 'TANK .. • ::'.:::.:': ::... ;.-.-.• =::j.•=•'�' •• g7.z..
%4 PER FT. DIST. .... . . .. �. . •... - - .•.,;.. .•. E i: '
PDX �sEE
C T.4 BY.L..4 T/ON�
_ a. 9S LEACIVIV6 FIELD $
3
SECTION OF GROUND WATER TABL£ QY o rtM z
vz• A
SEf� AGE DISPOSAL SYSTEM TABI/LAT/ON
• EACNIMO F/ELD X` 0/w4ff#VjI0l r A -5'FT
3 FT. FT. O.C. 8CI1tt .` a !�- C" D/I+I!°NS/ON 8O FT.
p/MJ=NS/ON C l•
r'�.+yER +~oouetE SO/ -TL�St SOIL LDG
y f 3/2 PFRI�ONCATED
Dby43,1 - ~
HEOw 4SOIL TEST ! SOILTES02
'NT G -1Y-7& ELC .S R DAT OFJOL EST `I 9•/
orrFs JeV
MON/1Ts JVMVESSEO BY �J O _
CLLCAN. ' PERCOLAT/QN R4Tdr A6I �M/N�JNCp p L
:SAND. ; . ': 'r' ' • '. PERCOLAT/ON Ri rw 0-2 6
o Svf3
•. _. •,,; ••: •: :s: -:. DESIGN CRITERIA
J'ERFDI�ATMO JVASJ4IFD,1T0/✓E WOOD 57AXES NUM6�ER Of aEaRooMs I� T
SET a FT GARBS D/.S�AQSrAL llldlT �oT/E S ANp
PVC p/P� ON CAWTER ETI SMATED'PA.0W 3 3 " GALI Y DA ���uV/✓A
u/A-7E2 -.
LEACHING AREA O SO. r 9z.
SECTION X—X R.ESER✓E AREA gZg S4.,p7r EC j I
SCALE : �.F� I -O•# Fi �U CA 71ACl-rl x 40 � NOGROuND YVATER E/VCOU/VTE�ED
4zo Gft L,/ P A y 0 GROV VP JVATER AT ELEY. 9 z�
, •� INVERT ELEYAWDNS
MSS L O T.7 PEE/� TO 1> �.
INVERT AT Bt//4PI Vd9 /l L._L �.
ROBER7 ALBS �G y
tucE f INLET ,SEPT/G TANK 9 8.9 FT.
�7fORSE 01M.A7 SEPT/G TANK'; 98.7 .=y
No.10951 Q INLET DJsTRiBuTioIV BOX 9�s FT. EL.DREDGE ENGINEERING CO,/NC.o A 712 MA/N ST. HrAN/V/S /►SASS_
/STEgy�Q 9oFFG/STEQ \�� OUTLET D/STR OLMON BOX 4 F7'
ND su Fri f FSS/ONAL�a� ENO OF LEACNJN6 FIELD q'7.7 FT CG/ENT: o s� DATE: ;9
U^�Ll M l.•rr-.-P
S�rn� s 9 �8z isi� JOB Mo. S v SHEET- 0
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