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HomeMy WebLinkAbout0102 SUOMI ROAD - Health (2) 32 BLUE JAY DRIVE Hyannis A = 269 - 161 TOWN OF BARNSTABLE LOCATION �:L��u�.ic��r����� SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL oL&8 QLJ INSTALLER'S NAME&PHONE NO!70c; ,% AL I�rcwS�.9Mroc v SEPTIC TANK CAPACITY xc�rLAtA to 00 LEACHING FACILITY.(type) Mo 5-pocino t C� fs (size) (:Z,S K MS ,! NO.OF BEDROOMS 3 OWNER %, ► s5Ur D PERMIT DATE: COMPLIANCE DATE: ` ` Separation Distance Between the: N da a CNcwN++red Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 436 Per( Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ' e � d � Q ri � No. � /J ^� �Q J�! .� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN.OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for disposal 6pstem Construction i3ermit Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 32'ZIYc'3c y 'Pr,v Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ;L C,$ - , S V Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. `1uos)&r A 4/00--71 S`5 IUey e r cwc) Sates TNc St�'j-}CaZ..-2qr Z Type of Building: Dwelling No.of Bedrooms 3 Lot Size /D S Z 7 sq.ft. Garbage Grinder( ) Other Type of Building )(,aQg,,e_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 0 gpd Design flow provided 3 gpd Plan Date �T� /`�, Number of sheets 2— Revision Date Title Size of Septic Tank / � sy;,,, Type of S.A.S. 1. 5-CO yt alk.J Description of Soil Nature of Repairs or Alterations(Answer when applicable) . ,LStli II %1/rw p `T�C7X Gc�(J 2 /7�'�O S"Ob g4��w✓ -5 c�J Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 1 CL Date �+ -/ Application Approved by Date (9 �0/4 Application Disapproved by Date for the following reasons l Permit No. p.) ^ `off-® Date Issued ----- n No. �CI L` UG� rX ;, Fee �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppflcatlon for Disposal *pstem (Construction permit " ,i + Application for a Permit to Construct( ) Repair(�Upgrad e ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2 '111 yc SQ Y `'� 1�- •,•J Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2 C,8 2 1 % �!`�S V Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. L�,JsIG s A 13 rvw J r c SC j``/00—7/5 5 JlJ1 �� P r cvV C) SONS Z rJC 5-ce,-36Z.-2yZ Type of Building: Dwelling No.of Bedrooms 3 Lot Size /q 5 2 7 sq.ft. Garbage Grinder Other Type of Building env„s.¢ No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow(min.required) gpd Design flow provided 3-1-2, 2 r gpd r Plan Date��- /� Number of sheets 2-- s;Revision Date Title t Size of Septic Tank /Gy,v I:.--x,y f r� . Type of S.,°.S. ;L SOD '10 ck nib SX/2`S'jl'Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) %.,,fG�� �1/r�J P -13M ewe) 2 !/•10 <LQ JA-u Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compiiance has been issued by this Board of Health. igne &e- Date -2 d—/1 Application Approved by Date �) G Application Disapproved by Date for the following reasons Permit No. '�-©r)L-� " �' Date Issued D 0 / L ThE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired�1< Upgraded( ) Abandoned( )by<:a:,1 c c, A 1 b(M J—3 T nl c_ at '�2 1 1 , 'S c�•i `�t• ,v� CSyJ N(r-, has been constructed in accordance with the provisions of Title the for Disposal System Construction Permit No?�'�e-i -�k �datted Installer-_T-,>—,,-. G5, A R7t ,,.j a SIUc Designer-eyyr A,✓d SwyS .7n1c #bedrooms 'Z Approved d sign ow 3 _ gpd The issuance of this permit sh �Il n(?t be const ed as a guarantee that the system iion as designed. U Date Inspector /, R /VZ-----"_"----.-_ --- ----------Z___- No. �—�-- CJ Fee ` O C) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem onstructlon Permit Permission is hereby granted to Construct( ) Repair(Ip� Upgrade( ) Abandon( ) System located at 3.2- Z hlr -TGY Tf kie 141 e N A)►C and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc//tio must b fe com leted within three years of the date of this permit. Date (rj J 1�7 Approved by t I LEGEND HYANNIS PROPOSED CONTOUR Mq� EXIST. I ,000G c ® PROPOSED SPOT GRADE ti S�FFT LEACH PIT 41'4�,HYD --gg -- EXISTING CONTOUR LOT 13 + 96.52 EXISTING SPOT GRADE Q-OPO LOCUS W— EXISTING WATER SERVICE _ EXIST. 1,000f_ S8 00'• � TEST PIT P p TO L-Li41.4I ,`SEPTIC TANK ® G� � N D 41.6 '� , pR `t_ x OHO 0qp y I ol CH ROAD CRAIGNMA4 BEA LOT 12 F4 >-- 41.4 O M N4-c- ' LOCUS MAP 00 ycso 42.8 LOCUS INFORMATION Z 41.9\ PLAN REF: 182/121 TBM =TOP OF TITLE REF: 2698/258 Z FND=44.00 PARCEL ID: MAP 268 PAR. 21 ZONING: "RB" aC 41.7 FLOOD ZONE: "C" #3 2 ' 4 COMMUNITY PANEL: 250001-0008—D DATED:07/02/92 `a ' LA ` 21 SEPTIC SYSTEM 16.,3 1 O o 41.5 T 2 2 �, REPAIR PLAN p LOCATED AT: i ` 32 BLUE JAY DRIVE . 1 5.1 � r �N o !� 3PREPARED GLOT 15NNIS, FOR 41.7i � OQ LOT14 FCk o AREA=10,527t S.F. j j DENNIS VI N S U N CO), DECEMBER 27, 2013 PO / j iG 41.6 ! NO 1 I S68 S8,41.4 W OF Mgss 0� I / -'1140 �' Vl� >t � R NITA01'� 0� O \rob UPOLE !`~ MEYER AND SONS INC. a h' GRAPHIC SCALE j P.O. BOX 981 r 20 ° '° 20 40 s° ! EAST SANDWICH, MA.. 02537 (508)362-2922 ( IN FEET ) 1 inch = 20 ft. `' SHEET 1 OF 2 J#1575 1 '1 ELEV. TOP FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS (Existing) NOTE: PLACE METAL RINGS AND COVERS TO GRADE OVER D-BOX AND LEACH CHAMBERS FINISHED GRADE 42.1) = 44.0 F.G.EL: 42.5 F.G.EL: 42.0 0 F.G. EL: 42;,1 VENT t MAINTAIN 2% MIN SLOPE OVER LEACHING AREA7 2" OF 3/8" DOUBLE -WASHED TOP TANK=EL. 41.04 3/4" - 1-1/2" STONE OR FILTER FABRIC DOUBLE WASHED STONE 4 i_�� 6" 4" SCH 40 PVC LLL, I r 6 (MIN. ®®®®®®®®®®® A' TEE'S ARE TO BE 14 5= 1% ) ®®®®0ERE3 ® 4" SCH 40 PVC INV.39 35 2 EFF. DEPTH ®®®®E3E3E3 ® a: INV.39.75 �' INV.39.15 4' 2 X 8.5' 4' GAS PROPOSED DB-3 = EXISTING OUTLET BAFFLE `DISTRIBUTION EFFECTIVE LENGTH 25' BOX INV. 40.0 '� I (H20 LOADING) INV. ELEV.= 38.50 EXISTING 1 ,000 GALLON SEPTIC TANK ' GAS BAFFLE TO BE INSTALLED ON �����' OF ss9� ' BREAKOUT OUTLET TEE AS MANUFACTURED BY o DARKEN M. ti TOP CONC. ELEV.= 39.5 ELEV.= 39.50 TUF-TITE, ZABEL, OR EQUAL o M YE r0EM NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 140 " INV. ELEV.= 38.5 E3PIPE INVERTS PRIOR TO CONSTRUCTION ®®® .2) D-BOX SHALL BE SET LEVEL AND TRUE TO ®®®GRADE ON A MECHANICALL COMPACTED SIXNITAR�P BOTTOM EL.= 36.5 ®®®INCH CRUSHED STONE BASE, AS SPECIFIED IN J 3.75' T. 3.75' 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK r. SEPARATION 6.0 FT. EFFECTIVE WIDTH = 12.5' WITH GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGEDED,, OR UNDERSIZED. SOIL ABSORPTION SYSTEM SECTION 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 30.5 ( GAS BAFFLE AS REQUIRED (500 GALLON H2O LEACH CHAMBER) GENERAL NOTES: SOIL LOGS P/� DESIGN CRITERIA 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL #: 14142 BOARD of HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOOM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: SEPTEMBER 5, 2013 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, CSE 1614 DESIGN PERCOLATION RATE: <2 MIN/IN - 310 CMR 15.405 (1) (A&B): WITNESS: DONNA MIORANDI, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. 1) A 4.9 FT. VARIANCE FROM 310CMR15.211 TO ALLOW LEACHING t TO BE 5.1 FT FROM PROP. LINE VS REQ'D 10 FT. GARBAGE GRINDER: NO (not designed for garbage grinder) 2) A 10 FT. VARIANCE FROM 310CMR15.211 TO ALLOW LEACHING Elev. TP-1 Depth Elev. TP-2 Depth SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,000 GAL. SEPTIC TANK TO BE 10 FT FROM DWELLING VS REQ'D 20 FT. 42.0 0" 42.0 0" 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILL.ED PRIOR FILL FILL LEACHING AREA REQUIRED: (330) = 445.94 S.F. TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 41.17 10" 41.17 10" .74 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING A A FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN LOAMY SAND ' LOAMY SAND USE TWO (2) 500 GALLON PRECAST (H20) LEACH CHAMBERS W/ 4 ENGINEER BEFORE CONSTRUCTION CONTINUES. 40.17 10YR 3/2 22" 40.17 10YR 3/2 22" ' + ' + 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B B STONE ON ENDS & 3.75 STONE ON SIDES: 25 L x 12.5 W x 2 D 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF LOAMY SAND LOAMY SAND BOTTOM AREA: 25' x 12.5'= 312.50 SF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 10YR 5/8 10YR 5/8 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 7. WATER SUPPLY PROVIDED BY PRIVATE DRINKING WATER WELL 38.50 C 42" 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 38.50 C 42" TOTAL SQUARE FEET PROVIDED 462.50 vs. 445.94 REQ'D = TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. PERC 0 EL. 37.25 2.5 SAND MED SAND DESIGN FLOW PROVIDED: 0.74(462.50 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 2. Y 7/4 2.5Y 7/4 THE LOCATION OF ALL. UNDERGROUND UTILITIES, PRIOR TO BEGINNING PROPOSED SEPTIC SYSTEM UPGRADE PLAN ! CONSTRUCTION. 30.50 138" 30.50 138" 110. EXISTING LEACHING TO BE 1 PUMPED, �D FILLED PER TITLE 5. . 48 HOUR NOTICE FOR ENGINEER CERTIFICATION r IJ 32 BLUE JAY DRIVE, HYANNIS, MA �+a 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PERC RATE <2 MIN/IN. (-Cl- HORIZON) - Prepared for: Vinsun NO GROUNDWATER OBSERVED AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY I Engineering and Surveying by: SCALE DRAWN 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. N.T.S. DMM 14. NO WETLANDS WITHIN 100. OF PROPOSED LEACHING. to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX9i81 15. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED) requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Eval. Exam in October, 1999. E41STSANDWICH,MA 02537 DATE CHECKED SHEET NO. 508.?622s22 12/27/13 DMM 2 Of 2 16. PLACE 40 ml POLY LINER AS SHOWN FROM ELEV. 39.50-34.50 TO PREVENT INFILTRATION. 6/28/2021 ShowAsbuilt(1700x2200) TOWN OF BARNSTABLE LOCATION S;Li3lue`i� l�rta� SEWAGE# / VILLAGE_ y � ASSESSOR'S MAP&PARCEL a(?S t INSTALLER'S NAME&PHONE NO.I)aA % 570gt-410-YS'3zj SEPTIC TANK CAPACITY .�tct Sri ttT y`C7 R a� LEACHING FACILITY:(type) Hop Sm ot2l Ap doers (size) 12,5-1C ?S 7C 2- NO.OF BEDROOMS 3 OWNER \tt,v 5,J�,1 PERMIT DATE: ) COMPLIANCE DATE: Separation Distance Between the: &J000-i•►ere) Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility CtV f?e f C Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY�c Isn"/') 1 14 2-G CC20r" 6 �- t1 I I https://itsgldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=268021&sq=2 1/1 '16/28/2021 ShowAsbuilt(1700x2800) LOCATION SEWAGE PERMIT NO. VILLAGE /-�zz!�r!a.-.,f.S A- I N S T A LLER'S NAME & AOORES c cIo I. C tA1G PAEDE .OS 142 Carperation Street l'Yannls, r„ass. / o- 9R OWNE' (� S'sT 1,7s 7 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 11-6 � il9 j �p 2) https://itsgldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=268021&sq=1 1/1 Town of Barnstable Regulatory Services Richard V.Scali,Interim Director '"`NMe, ' Public Health Division Ada Thomas McKean,Director ` I 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form a i Date: p t " l Sewage Permit#r 20? — 2 09 Assessor's Map\ParceI �I Designer: g M �1� � `5fc�e��cJ NC Installer: ' � Address: �� T,J1�1 i Address: \ Al On CP ® go was issued a permit to install a (date) installer) septic system at 115111 �J i° 40 based on a design drawn by p (address) VA i w C, dated (designer)ir��,�� I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if'required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the AA approval letters(if applicable) OF o D N (Installers Signature) t 140 "' I } �0V' (Designer's Signature) 410ITAa,Or��� 9 • PLEASE RETURN TO BAYATABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- j 1 BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. . THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc I • I Town of$ah-astable P# °� Department of Regulatory Services �ARHKrABM Public Health Division Date z- 3 ,6sy ,b 200 Main Street,Hyannis MA 02601 Date Scheduled Time / Fee Pd. oil Staitabrlity Assess�ner�t for Sewage Disposal Performed By: p'" '�✓� ` �^ ' Witnessed By: LOCATION& GENERAL INFOPWATION Location Address .3 U� v Owner's Name; .�.6 �Lt poa C:1 / l� I Address Assessor's Map/P4rcel: a / 0' 0 I Engineer's Name J -IG NEW CONSIRUtj0N REPAIR p- Telephone# S�EJ '3 0 Land Use tZl 1��II�� Slopes(�'o) J •�• Surface Stones N&IV t_r- Distances from: Open Water Body ft Possible Wee Area f 7V ft Drinking Water We prainage Way 00 -ft Property Line 9/0 ft Other f[ i SKETCH:(Street name,dimensiods'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Pao Y J,/JA-7 13 I la a lti I • , r j t I i Parent material(geologic) ��SL+ Depth to Bedrock Depth to Groundwater. Standing Water in Hole:, I Weeping from Pit Face ^J Estimated Seasonal iEligh Groundwater i DtT- E j'TION FOR SEASONAL HICK WA' TADLE Method Used: ! In. Depth Observed standing in obs.hale: to. Depth to sgll m9ttles: $. I in. . ©roundwnter Ad)usttnent Depth tojweeping from side of obs.hole: ; _ A' ,f7ctor, , Adj.d�uBdwflteY level Index Well# Reading Date Index Well level i -- PERCOLATION TEST . Date. TI11e Observation I Time flt 9" � s Hole# It Time at V ' ----- Depth of Pere 1 Dt' ` . Time(V-0) Start Pre-soak Time.@ i End Pre-soak Rate MinJInch p/ F Site Suitability Assessment: Site Pas /� Site Failed: — Additional Testing Needed(YIN) sed Hole Data To Be Completed on Back Original:.Public kle'�lth Division Observation -- -- `**If percola�ibn testis to be conducted within 100' of wetland,you must first notify the Barnstable C4#servation Division at least one (1)week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel ot)_ lC;1 6 11 .- . . .. :a E. 0 s 7: DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gra el oil- I0t, DEEP OBSERVATION HOLE LOG Hole# WA Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra I .t I Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No 1// Yes Within 100 year flood boundary No!r Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe 'ious material? Certification I certify that on C) TC1 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required rn expertise'and experience described in 3:10 CMR 15.017 Signature Date 1 1 Q:VSEPrIMERCFORM.DOC J } LOCATION - SEWAGE PERMIT NO. i Y'1 L L AG E 1 H S T A L L E R'S NAME S A D D RI S AID MEDEIR®S Own 14.2 Cofrpor.ition 'Street $R O qER i'yannis, t ass. / .j- y SST' /9 r-7 13 lv a � :E l/►� L (Ts v-` DA T E P ERIIT I S S 0 E D2 , DATE C 0 MPLIAHC.E ISSUED t a o O y` c 2i �© No.- 3---�......•- F�$ •• .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �y„___•. :.... .........._....... ..........OF... ...................................----------------- b rpfir�atilan for Uh4paii al ,arks C�nntrnrtion irmi# Application is hereby made for a Permit to Construct ( . ) or Repair ( ) an Individual Sewage Disposal Systemat N� �rx •............ ...... .. ......................... .. ............R-•-••----------•------------ j atio - ddress or IVo.���' Ow er - •ess Installer Address Type Buildi Size Lot...:........................Sq. feet a V Dwelling—No. of Bedrooms............. .......................Expansion Attie ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) ------------------------=--•-•------•-•••••--••-••..---------•-•------ Other fixtures ........................ .... W Design Flow............................................gallons per person per day. Total daily flow._..:; .___._._..gallons. f: Septic Tank—Liquid capacity...........gallons Length................ Width....._.__._..__. Diameter................ Depth................ x` Disposal Trench—No. ............... ... Width......_�,�t._...... 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........•............................... aTest Pit No. 1................minutes per inch Depth, of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ O - •----- ----------- ........................................................Description p U •-•..................••---•••••••-•........•••...... --•-•----•--.....----•-......--••••-••-••---••-......--•-•---.............-•--••••--•...............-•-•-•----•-- W •-•--------•-----------------------•-------------•-••--------------•-------•-------•••••-•--•----•----•------•---------•------------•--•--•---------•-•••--•-•-------------•----••-••••.............••. UNature of Repairs or terations—Answer when a plicable_:...._. . ��_ -tip --.............. .................... .•.._ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Hi'I IL4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance s been issued. the board of health. igned--- . ... - ............................. ..--•--- ........ ae Application Approved By........... ........•....... ........... ...::_'........:_. - =_... �- Date Application Disapproved for following.reasons:--••----•----------•-•-••-••--......--•--•--•--.......-----••-..............•........................... . ............................................ -• ••••••-•---•---•---•--••-••--•-•---•......_..--•----•----••-•---••-•--•--. Date PermitNo......................................................... Issued_....................................................... Date 41) Fizz.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ......................OF.......................................................................................... Appliration for Disposal Works Tonstrurtion lbrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at, ............. .. ......... .... ........................................ 1:.................................................................... ocati ddress or Lat-N 0............ . ................................................................. .3. . . .....1... .....�J.. �t................... 0 ner ess.......... .... .............. .... .............. .... ......................... . ........................... ..... ... ................... .............. -_- '?/' ----- InstallIer Address Z Tytpef Buildi Size Lot............................Sq. feet Dwelling—No. of Bedrooms. ___.__________________________Expansion......._....................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ------------------------------------------------------------------------------------------------------------------------------------------------------ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. � Septic Tank—Liquid capacity........7---gallons Length................ Width................ Diameter...__.....__..__ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No..................... Diameter.__......__..._.._._ Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ �-4 Test Pit No. 1................minutes per inch Depth of Test Pit...._......._...._._ Depth to ground water..__.._................. rzq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..._._........_......... 9 ...... ........................................................................................................................... ............................................................................ ............................. .................. 0 Description of Soil....... �4 ............................................................. ------------------------------------------------------------------------------------------------------------------------------------ U ............................................I............................................................................................. ........................................................ U Nature of Repairs or,1 7teratons—Answer when.app x ........... ......................................A ---------------- .. ................... ...... ---I-A.... Z ------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT 1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ids beenassut the board of health. ..... .. igned.A .......... ........ .. ....... ............... . ApplicationApproved By....... ..... ..... ........ .................. ............................... ......... Date Application Disapproved to following reasons:............................................................................................................... ............................................ .......................................................................................................................................................... Date PermitNo......................................................... Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................OF. . ................ ........................................................... (Intifiratr of Toutpliattrr HIS 0 CE�TIRY,.,TjVat thV Individlial-Sewage Disposal System constructed or Repaired .......... b ......... ...... ------- -- ........................................... ................................................................................................................ tall S 7 A4 at........................ .... ................. .. ........................... .................... has been installed in accordance with the provisions of f) of T ate Sanitary 0,k1w as abed in the application for Disposal Works Construction Permit No....... ......29!........•....... dated..... ... ........ ........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED/AS A,�ZZUAARANTEE THAT THE SYSTEM WIL�/FU"CTION SATISFACTORY. DATE......I!Y.l V................................................. Inspector....................... ......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9 0 F............................................ ...e---;.............. ---------- ------------ No.. . ........... FEE........................ v at Morks (guns M on Vvrrmit I W_ 9 Permission is hereby gran ted.. ....... ------------------------------------------------------------------ -------- --------- V. V, to Construct Rkq air I ix e age poVAyste atNo..:,..24:t ..... ........ ... ................................ .. ................................. ....... ..................................... Street C as shown on the ap h do for Di osal Works Construction Permit Now,__ -A... Dated.......................................... ............................ .......................................................................... Board of Health DATE... ............................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS