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HomeMy WebLinkAbout0110 FOX DEN BLUFF ROAD - Health 110 FOX DEN BLUFF ROAD COTUIT A = 041 - 036 No. ..... FEic ...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............OF............f5A.7—.W.& __.ems .C-% .................. ApplirFation for UispooFal i9orkii Tonotrnr#ion Prrmit Application is hereby made for a +Permit to Construct (5<L or Repair ( ) an Individual Sewage Disposal System........_... -- - ... .....1AA � ..... .--•-••...... • .Lo on-A ess or Lot No. !� Owner Adress W ! •------• -------• --------------•-....:. •---------------..-------.---•----•-•--•--------•--------- --------•--------- ,-� ...................... Installer Address � U Type of Building .............. 3 Size Lot.+ ,l.ZV.......Sq. feet Dwelling—No. of Bedrooms... .......................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Otherfixt res .•-•-••--•-----•---•••--••••••-•-••-••-••-•••---••---•.-----•-•-•------•----•--•---•-•-•-••......---•• ----------------------•---- W Design Flow..........�g......................gallons per person per day. Total daily flow........ . ..' gallons. ... f� Septic Tank—Liquid capacityl'�._•-_gallons Length................ Width................ Diameter................ D•�e�_._..__._._..__. Disposal Trench—No..._....�._....._..__ Width�_®....._._._.. Total Length__ ......... Total leaching area_. 1.__�. .sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet:................... Total leaching area..................sq. ft. Z Other Distribution box (V) Dosing tank Percolation Test Results Performed by._ .t_ kG.................. Date.... ..2......................... �_l Test Pit No. I.....�-_-_minutes per inch Depth of Test Pit.....J2_....... Depth to ground water------ .............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-__--______-___----____. a ----------------------------- 6 .f......... .... Description of Soil.......... '.. !.��......Y-�?fk .... U�l �tV ; Z �w�-- Q - - - U ......................................................GFJ�c � S. 02--------------------------------------- UW ..........................................................---••••--•------•------------....••••-•••--•--•-----------•--•---•------•--•-•----•-••----•-•-----•-------•-------••-•-••--••-•._............ 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'I'LI: 5 of the State Sanitary Code—The undersi n d ther agrees not to place the system in operation until a Certificate of Compliance ha en issued y t boa d ie h. Signed ......• . •--... • ---------- Application Approved By....... f . ............-•-- . . --•-••! ...... D Application Disapproved for the following reasons-------------•--------------------------------------------------------------------------------------------..... c ....... Date Permit No......s✓..2 5,., ------------------------ Date 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....---" OF............ .�_.�.. CL....................... ApptirFation for Bispva al Works Tutu trttrtion Frrutit Application is hereby made for a Permit to Construct (�AL or Repair ( ) an Individual Sewage Disposal System at: ..........:...Z�_...........s.--..........., �I c..._.. ... .......------. ----------- --...---• ------ � Lo on-A ess or Lot \o.Z. Owner A dress Installer Address -��--yy Type of Building Size Lot.... !_ !_l._------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers a� YP g ---------------------------- P ( ) — Cafeteria ( ) Otherfixt res ---•-----------•-------••------•••-•----•---------••-----••------•------------------------------------ ------•-• g ._.__gallons per person per day. Total daily flow..........______________.........gallons. -- 1:4 Design W n Flow----•-------�`�--'----------------------- Septic Tank—Liquid capacity_�?�- gallons Length................ Width................ Diameter..._.....___.... �g t13 Disposal Trench—No.......A............ Width••.©............ Total Length..3 V..._._... Total leaching area-.�/_G-.�-sq. ft. Seepage Pit No._.---•-__._----_--•- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosin tank ( aPercolation Test Results Performed by._�IkiC-,Ml)... `.N�f_ _f. �"_�.................. Date.... ..2' S Test Pit No. 1.....Z/....minutes per inch Depth of Test Pit...... ....... Depth to ground water_____ ............. fq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................... O Description of Soil.........d ��' �3-----k ..... ........L) 0 r-t' ,`3_.�j + �➢t v,t/j' �U •--------•---------------------------•--•- U ....................................................... SA-_--C.-_..SA-N.).;A-N.).2......................................................................................................... UW --------------------------------------------•------.._....-•-----------•-•----......-•-----•-----------•-------•------------•._....---••----------•---••--------------•----••--•--------............... 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 iIT1E 5 of the State Sanitary Code—The undersi n d ther agrees not to place the system in operation until a Certificate of Compliance ha en issued y t boa d h. C \ Signed -- 11 11......... . ........t -----•--•-------------- ---•----------... - Date Application Approved By.... r'C 7` :- , �1::P �...... ----G - „ ------- /' II-- ' / pt Application Disapproved for the following reasons:..............................................................•..----------! -• -( -�j . ... ...__ ..-•..................•--•-•-•----•----......•---------------------�----•---•-------......------••--••---•-------•----------•------•-----•-•-••----------------•------------------------------....... Or? Permit No...... ---•-------- Issued. ... Date _ �? ,� Date THE COMMONWEALTH OF MASSACHUSETTS �-)� ��>> OAR OF HEALTH ...... .�,/.11..V..... .OF... Z6 . ............. /" Tnrtif iratle of TontlrliFanrr THg IS TO RTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by._...._..f)6 ------------ . Installer J"} / ' has been installed in accordance witn t t�prbvi�t''1'1T of heC e'S ii >ay Code as described in the application for Disposal Works Construction Permit No_______________ ____�__ ...... ��,�pp_2 / THE ISSUANCE OF THIS CERTIFICATE SHALf61 iT BE RITE® AS A G47 a4 AMHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..........••Y'D ----------------------•--------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH VVV v 1�'.J FEE...... No:. ....... ..... �io�ro��a1 ork� Cnon,�trttrtion rrutit Permissionis hereby granted-------------•--------------------------•-•--.•----------•------------------•----•---...--------.................---................-•-...... to Construct ( ) �o!r�yRepair ( ) an Individual Sewage Disposal S stem at No. ---- / stree °- as shown on the application for Disposal Works Construction r it Nod ___ ..... ..... ... ..� ........... . ..•-• ................... ----------- --- ---- ..............----•--•.-- Board of He th DATE-------------------= -- •-�------••--- .. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS I TOWN OF $A.RNSTABLE y` LOCATION T r �SSEWAGE #� VILLAGE ASSESSOR'S MAP Sk LOTJ� 3�0. INSTALLER'S NAME f PHONE NO. SEPTIC TANK CAPACITY �C - L,� LEACHING FACILITY:(type) � (size) NO. OF BEDROOMS_-PRIVATE WELL OR PUBLIC WATERz,1 �c BUILDER OR OWNER -Tf� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �; s. �.�� / f W ,� � ,� �� J S/TE PL A N sHEE r / of 2 SCALE: I _ k?' ` Y ' m :,i'i ;. ca!d: �f� 9 % , 41 s 777 \ 6 t 1 V � N Aiz, �. n. _U .�.:. y.....� is REGISTERED LAND SURVEYOR FOR ZONE F u. PLAN .REF. DATE _ Iz/Zzo BENCH MARK DATUM 1V�lf. At. t4IARWICK 8 ASSOC, , INC. IN >_ N DOMESTIC WATER SOURCE BOX 80/ - NOR TN FA L MOUTH FLOOD ZONE. �`� AIASS. 02556 - (6I7) 563 - 2638 St t�j71T ��j., -TO tT YJr i T SHEET 2 OF z TYPICAL SYSTEM PROFILE ,11 tt �5�•`l 1ST F . 21''CONC. MAN11OLE COVFR WAMRA61IT OR G1. FRAME A: crVER IF PAVED FG. BY TANK RISER(S) OP B41CK&MORTAR }1 • COURSES AS ROV. TO BRING TO GRADE. 'y f s''q' O ram• 1. p �I• 9 nN1SH MADE tl{ 00 40 I; t+ — — Ftow uNE _ Sch-40 4PVC TFE 40 sch, �7G R90. 1FE 4 PVC LOADING G — nOW LINE — 1 o3 .......... :. GAL. 4b•Zo 47.70..::':. ' SEPTIC TANK .••• .••... LOADING ':......... ' - NOTE. FOUNDATION TO OF - ..... ••.•••.•. �' C'AL. '::......... DESIGNED BY OTHERS. SEPTIC TANK &D-BOY 7D Bt •..'::;;;;; .......... INSTALLED ON A LEM. STABLE SASE '.......... •••....... 21'CONC. MANNOI E COVER WATERTIGHT •.......... ••••••;••• LEACH BASIN OR Cl. FRAME& COVER IF PAVED F:C. •... •••••�.... LEACH BASIN SECTION BY TANK RISER(5) OR BRICK &MORTAR �': • • .i•.•... COURSES AS POD. 70 BRING TO GRADE. • NOTE. MUST BE TO GRADE IF DESIGN "•••• �•�;'�' EFFLUENT 15 > T1IAN 2000 G.P.D. - LEVEL BASE .••...:: 17N.'SH GRADE � I¢ _ now LINE 2" OF 1/8' TO 112" `'O WASHED PEASTONE, _ • FREE OF IRONS, FINES, & ••.':. DUST IN PLACE. 7I •:.: ....�• ....:.. TO 1 "SPECIAL NOTES"••• •'�• / � /2'• CLEAN .. • WASHED CRUSHED STONE, •'••••"•• FREE OF IRONS. FINES, & ""•'••" - - ........... " LEVEL BASE "•"' DUST /N PLACE. 4 FT. 6 FT. 4- FT. 14 FT. Errrt:nvE DIAMETER - GENERAL CONSTRUCTION NOTES SEPTIC TANK, DISTRIBUTION BOX, & LEACH BASIN TO BE "ACME" STD. PRECAST REINFORCED CONCRETE UNITS OR EQUAL. CONCRETE: .5000 P.I.S. 28 DAYS, STEEL: ASTM—A-615-68 GRADE 60. H-10 LOADING UNLESS NOTED. ALL SEWER LINES TO BE 4" P. V.C. SC:H. 40 PIPES, GLUED JOINTS., INVERTS TO CONCRETE TO BE PARGED && WATER TIGHT. MINIMUM PIPE PITCH TO LEACHING UNIT: 1/4"/FT. UNLESS INDICATED OTHERWISE, ALL SYSTEM COMPONEN`FS SHALL BE INSTALLED IN ACCORDANCE TO THE STATE ENVIRONMENTAL CODE,, TITLE V, THE MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE EFFECTIVE ON JULY 1, 1977. ' AT COMPLETION OF CONSTRUCTION, PRIOR To BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR AN INSPECTION. ( WM. M. W.ARWICK & ASSOC. INC. TO BE NOTIFIED IN SOME TOWNS.) ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEAL TH & WM. M. WARWICK & AS.SOC. INC. _ SOIL & PERCOLATION DATA TEST PIT # 1 TEST PIT ,# 2 S 0' EL. 01 EL. PERC. RA TE•: IN./IN. ` Lc�,o.n/� *� Sugs��L f. �•3, i { TEST PIT ELEV.: ��'' PERC. DEPTH, DATE.• 7-.. z - �� JVl E D��1 M -j--�, - '• .TEST BY.• WI TNESSED B Y.• IT. h U_j 0 ki &4 _ HEALTH AGENT R.0,H. EL. EC. DESIGN DA TA GROUND WA TER WAS ��ENCOUN TERED A T A DEPTH OFz FT. NUMBER OF BEDROOMS: ,4 GARBAGE DISPOSAL: ►j0 rl L`-•;.;' f O �� lot EST. TOTAL DAILY EFFLUENT GPO. SITE & SETffR PLAN I o�® SEPTIC TANK REQUIREQ- GAL, f'0 ' C. SEPTIC TANK PROVIDED �'�'�' GAL. SIDEWALL AREA 2 r,AFT rC U Kj _FOdk .1 C5U L BOTTOM AREA GAL.ISO.FT. n[` LEACH REQUIRED L- COT't� L'C'� M ASS LEACH PROVIDEDA + '�� ��• L:. �►�� o% Scale: As Shown Da t.e: T T.. (v vi. Wm. M. Warwick & Assoc. Inc,. 21.3 Old Main Road Box 801 �. North Falmouth., Mass 02556 • �1 i ' (617) 563 - 2638 ROFESSIOIVAL SANITARIAN '`