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HomeMy WebLinkAbout0107 WINTERGREEN CIRCLE - Health Y14 e/ C,,ev LO C AIJON �E0 IP SEWAGE PERMIT N . � l VILLAGE I N S T A LLER'S NA E b • ADDRESS ------------ B U I L D E R OR OWN ER I '! DATE PERMIT ISSUED DATE COMPLIANCE ISSUED <:' ,-, .,� •� �l � � � ,-C °;�� B .:� f • ��� �I �" _ i� �� � V R Fx$.. .............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH O.t,J.V�.........OF......... .�`-. .!^ 5 = Applira#ion for Disposal Murks Tonstrurtion Prrmit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: l,67r l t>.I Kj.... �ii� .0 f�J. G) ram" 0 �'l=v.....� �.:..l Location Address or Lot No. ��.�............. ........................L�..>S 1.. 4. .... ET ........... =)..--.....4 A.IJ .�. ^� !'`5.s..........•-- O n- r` s� Addretss Installer Address d Type of Build7g,, Size Lot z_69_A q.16....Sq. feet Dwelling—No. of Bedrooms...............3......__......____.._._.Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .----_-----_---------------------------------------------------------- •--------------------------------------------------------------- ........__.. W Design Flow.........._.r5.........................gallons per person per day. Total daily flow_--____---3 p__.................gallons. WSeptic Tank—Liquid capacityA64W..gallons Length Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. r Seepage Pit No..................... Diameter.......IR_i..... Depth below inlet...... _......... Total leaching area?.—�_ f-4...sq. ft. Z Other Distribution box (,./) Dosing tank ( ) Percolation Test Results Performed by.W1AxW.j#,ZUA lam.._ h��U..f lJL.... Date-------o _.1 ....... Test Pit No. 1._2�___--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........................ �+ -•-•--•----•-----------•......................................... ............... .....-••......--••------•---••-•-----------..........•••------ 1 O Description of Soil............�.���._...'T"�_� ._ :.�_i 14 y 3 ' .......r.A Jam.---.t 1tJ.P.............. W U •-•--------------------------------•--•---------------•---------------------------••-----.-------- --------------------------•-----•--------------- W . UNature of Repairs or Alterations—Answer when applicable--------------------------:-____-__------..-•__---__--_--_--_____-_____- __-----:----------. ---------------------------•-------------------------------------•-----------------............--------•---------------------------•------------------•-------------------------------------•......•--- Agreement: The undersigned agrees to install the aforedescribed, Individup Sewage Disposal System in accordance with the provisions of TIT % 5 of the State Sanitary C e—The unde ig d further agrees not to place the system in operation until a Certificate of Compliance has bee i t ar ealth. Signo ................ ---- •-•--------••-••----•-•------------------ ..... ... D Application Approved By..... ---------------•-•------- /.. f+ i Date Application Disapproved for the following reasons-------- -------•--•••--•--••----•----------------------------•-----------•------•-------- ................. Permit No....1 1--fay.--.- . ............................... Issued................................... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Dhipasal Works Touritrurtion Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ` -m � V ' � � GI I_`:.. ._.. ..... ..� _ :. _-r-...... C.....................................................i/ �. Location-Address E or Lot No. ^l 1! _ jam' t_..L_ �j i 1 �7 �� 1 ? . . C.��! .t`�_ — .d........._. ............._ ............._ ........ ._..............•..... ......--•--•-- Owne i Address - staller Address Type of Building Size Lot_ _ ....Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pP.l Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -•----------------•-----•--------•---- ----=----------- W Design Flow............``�5.........................gallons per person per day. Total daily flow.........._.2 �,�...................gallons. WSeptic Tank—Liquid capacityjeI k.4_.gallons Length Width................ Diameter___-___.._______ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------ __.. Diameter.......L2........ Depth below inlet__--__-6�......... Total leaching areaZ,�-.7 ...sq. ft. Z Other Distribution box ( Dosing tank ( ) aPercolation Test Results Performed ...... .__A_`?`��G---LN4._.. Date......�.2./_Z..,/tom_ _-._.. Test Pit No. 1...�n __._.minutes per inch Depth of Test Pit......L:5........ Depth to ground 'water-__3�K1CL% .._.- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --••---------------------------------------------------•---•---------•...._..-•--•------------••...........-------------------------•--•---------------...... O Description of Soil.............��•-'" T?.F_ -s _ _v t y 3 ....... ! P x W ------•----------------• ------------------------------------------................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable..._............................................................................................ -----••--------------•---•-----•----------•-----------------------------••--•-------------------------••-•------------------------------•---------•--•----•----••---•---------------.........---- Agreement: The undersigned agrees to install the aforedescribed Ind id Sewage Disposal System in accordance with the provisions of iIT 5 of the State Sanitary e— The unde ign d further agrees not to place the system in operation until a Certificate of Compliance has bee, i )t ar ealth. Signed----. . ................. ----- -- ----------•--•----------•-----•----- I D Application Approved By---------------- ..... �l - /', Date Application Disapproved for the following reasons:----•-%Z"- -----------------------------------------------------------------•-----------•--•---------------- .................•--.......---------------------------••---••------------------••----------------•------------------------------•---------•------------------•---••-•--------------•------•------------- A Date Permit No.---- = .......................... Issued........ -�-`_-�le Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH P ( f.....:...............OF.....Ona ): :................. f�ler�ifirtt� ,af �u�t�li�a�crr b THIS IS T CERT Y, Th or e Individual Sewage Disposal System constructed <' Repaired ( ) at - - �� e----------------------------•--------------- 6� 1 has been installed in accordance with the provisions of TITS; j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------. .___-20......... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CO STRUED AS A GUARANTEE THAT THE SYSTEM WILL UNCTIO SATISFACTORY. DATE..... -�1---------------------------- Inspector..... . THE COMMONWEALTH OF MASSACHUSETTS - � BOARD F HEALTH �/ ............................' Y .......OF.......:...... .(..��. �.�f- ............... o No.4.�...............r FEE.... ................ Disposal k� ��ir trrn rr tt Permission is he,eby granted....-------- ; < :....4�` ----••- � � 1 to Construct Repair ( �rn Ii�dividu _Sewag Disposal Syst at No....................... .. 1 Street as shown on the application for Disposal Works Construction Permit No..................... Dat.d------------------------------------------ /�.- /1 / �4 4 joa a of Health I DATE---------------- ....................... .�_......---...._......•---...---•.. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS SITE PL jV ,SNEE r I OF� ' y �n {ir ` ............ ' �'_ > �-,'':/�\ �, Pam• L �! � Y P2 4eaT caa.JG.; z(pg,� - 3 A. 04 4.,IN/ fir c r m y`v ILUAM l �„ WAIiiNICk' I i,' ' t da G No. 1977.1 111 4N � - .cJ FOR 1. � i_ = �ja -Low REGISTERED LAND SURVEYOR s• , (^:p"j'. .3 1`cJ t cV'4' f��..�,.r�.f: Div G r ZONE IzG ©ter-�•' f� v 1 LA,0 . M PLAN REF. , DATE �� t► 3o j �� BENCH MARK DATUM WM .M. WARWICK a ASSOC, INC. DOMESTIC WATER SOURCE `�'� w/'^`� BO.Y`` 80/ FOR TN fA L MOUTH FLOOD ZONE. ►-)o►:� - t� /+` .b.i� © MASS, 02556 - (6/7) :563 -2638 L f--ACHiNG `9.451N SECT/ON NOT TO SCALE shed 24"C.1.MY COVER EARTH FILL. —BRICK AND MORTAR COURSES.AS Rf'0.'0, TO IBR/NG COVER TO GRADE. . FLOw LINE iNL Er .i,: �.•:.;,,. „ 2'-. ",To ".WASHEO PEAS.TONE FREE OF?BONS, ' P/PE FlN S ANQ.DUST/N PLACE. 6 e { / OPEN/NG W/TH 4�g y �, 0/4" TO /Ip~wAslic0 CRUSHED STONE FREE OF ri 7 DOTER 0/AMETER IRONS, FINES ANO DUS r./N PLACE AND /S/4"INSIDE • I. 'CONCRETE TO BE 4000 PSI 2$ DAYS r .2•.REINFORCED WITH 6"x C NO;.6 .GA.:�l W.M. 3. 2�AND 4' SECTIONS ARE AVAILAB F LE OR ,;. __Fq GREATER DEPTH REQUIREMENTS � � z a'o" s �'�'--- 'o�� 4.; NUMBER OF PITS REQUIRED oiu6• MIN, lo' NOTE: EXCAVATE .TO ELEVATION1�0,EFFECT/VE DIAMETER 1 r„!_QR (NOT ro EXCEED s TIMES 4FFEcrIVE DEPrHI LOWER AS.REQUIRED TO REMOVE . ALL . --� wArER rAaLE LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN TYPICAL PROF/LE GRAVEL 70 DESIGNED GRADE., JB"STD. LT. A(//COVER :f 4"a 4 P/PE 4"B/T•f%BER PIPE 014EL41NG . , FLOOY L/NE' T TLE� fVEL IGNr roiw I ,�.,.�. o f/Rr✓om; I ,-,�. . .. � _ "'T.." p 0 4�0o sl-csi. TEE �$'47 �,15 1 10 . i o :1 1 45.0 : :too 00 aI 1 c., 4S To. PAECAsrcoac ' 4f : :o oo$ 00 go I'i ' ( 'GAL,SEPT/C TAN lNS L EV j 1 0 D/SZ BOX ro BE 0 O 00 0 1 I ; 4ON ESE , S74®4E ,9ASE 11000 00 6) I.l , � ie100 OO.D1i SEPT/ C TA ro ®E 1 O o o O 0'It INS T L LEVY[, I tI 100100 1 1 STABLE BASE,'' i �8800 IN / 11100 001ofI 4 CHIa.4SETOBE4EV .L 10 , 0D - 50/L AND PERC. DATA n PERC. RATE - MIN.'/IN. oil TEST-PIT NO P.3�3o TEST PIT N0. 2 O TEST BY ; . Wa>✓wiGt� PSS�oG � ' Ta1�/Sv�Sc�L WITNESSED. BY: >z. tFs.ag_VP TE$T PIT GR. EL.._ DATE DESIGN DATA w ,:GENERAL NOTES BEDROOMS � >.NO .4-AVY _EOGIPMENT TO RUN OVER SYSTEM. DISPOSAL "��"�E SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD EST. TOTAL DAILY EFFL.22� GPD• fi PRECAST REINFORCED CONCRETE UNITS. 1 oov ALL'SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE SEPTIC TANK GAL. SIDEWALL AREA S GAL./SQ.FT. TO; REVISED TITLE `.5 OF THE STATE 'ENVIRONMENTAL CODE, NI.INIMUM REQUIREMENT$ FOR.THE SUBSURFACE DISPOSAL OF { BOTTOM AREA._I--, _CAL•/&QFT. SA�6tTAR'/, SEYYAG,E EFFECTIVE ON JULY I , 1977. LEACHING REQUIRED SQ FT.' ANYCHANGES TO THIS PLAN.:MUST BE APPROVED BY THE'BAARp ACTUAL LEACHING AREA OF ALTH, 2 �.o --- Q FT. r :AT •COMPLETION. OF CONSTRUCTION, PRIOR TO.BACKFILLING, THE, BOARD OF HEALTH SHALL BE NOTIFIED FOR -INSPECTION. PITCH ALL SEWER LINES I/A" / FT. UNLESS INDICATED OTHERMSE. . I"OFSEW o�y� cry S L SYS T� MARTIN G E. v MORAN m #23.417 VdT � �cJ � t.t T E 1ZGc���N GI [Z-LL'1' " g,�yypp.// '. A��;// /�1,y .. w r/,/�_ �/^ „ 6Y"li�. N. WA/7.WI /Y ® ASWNM., //i o o_ a �f F 80ar� 0e , N�Rfwv. ra , FRCFFSS/ONAL ENG//VEER f x <