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HomeMy WebLinkAbout0053 CHOPTEAGUE LANE - Health Yl- C-- i I I i i i II i I i S M E A Do"] No.2-153LY UPC 12934 smead.com m Made In USA NABLE FORESTRY INITIATIVE Cortified Fber Sourcing wwwAprogranLorg L G A T IQN S3oVfc_G» 4b�E W �E}, P/j( R M i T NO. - �•� -��� ��1i11V /�/ �C �'�d'i rnnirn . fll'PflQ16�®�� I V I L L A G E PAP, EL ['1'0... INSTA LL R'S NAME 4 ADDRESS a U 1 L D E R OR OWNER �C?r DATE PERMIT ISS Ulf' DATE COMPLIANCE ISSUEDvas A _ U�9 j q zq )v lo� ASSESSORS-MAP-NO- No PARCEL NO.: X �\ THEBOARD C COMMONWEALTH OFMACSSA;H.UrSETTS' - � Appliration for Dig niia1 Works Towitrur#inn ramit Application is hereby made for a Permit to Construct (1,-)"",or Repair ( ) an Individual Sewage Disposal at�System ..., '................... .... _ . -�. r.. ....... ..:.......K�/�... ................. Loatio ddress r Lot . Q Owner Address t Installer Address Q dType of Building Size Lot./I, _' .d0.....Sq. feet U Dwelling—No. of Bedrooms.._...............:....................Expansion Attic (4-1' Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Othe fixtures .................................................. W Design Flow....... .............•.•........gallons.per person per day. Total daily flow............3.2�2...................gallons. W Septic Tank—Liquid capacityb o..gallons Length.............•.. Width................ Diameter------------_--- Depth................ xDisposal Trench—No. .................... Width.................... 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__ �lJGr' e.. .. Cam!-clgDate........................................ Test Pit No. %.....minutes per inch epth of Test Pit................ .. Depth-t� ground water.._ (i, Test Pit No. � minutes per inch Depth of Test Pit.................... Depth to ground water. _� � Ra' -- -------------------•••• . O Description of Soil....��yOy.�rr_s3 r .........._ . '''.__ `- --.s�._�ls�,)�_ .-,SD . V •-----•----------------•---......_5�...[.t .. }�°' - !^4. a lrG!^" 5 o.c•-4f .. - - - .__..... - --- - ---------------- --------------------------•----------------------------•--••---•------.............----------------------------------••----•-•---...------•-----.....------------------• ------••••• U 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'L NLiJ 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 h h. ned- --- --- '-----------------•.----------•--- -_ l ----•_----- ._ D t Application Approved By.. - ................•-•------------....-•-•-•-•-•--•-•— --•---•-•- - ate Application Disapproved for the following reasons:.......................................•---------------•----.....-----•----••---•-----•••-••-•••......-------- I --------------=-------------••---..__................-•-------.... Date /..'.-------•--••---•-----••-•-----•--...-•-----•-------.._..........-•----•---------•-•-----•--•-•----••-•------" -------------- PermitNo... ........`40_ _ Issued....................................................... Date . r No. ra....� O FEa ...- .... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HE, kL.TH 7 r ✓5� .................oF.. ............. .......... ................................... Appliration for Biipoottl Works Tonotriirtion ramit Application is hereby made for a Permit to Construct ( L-Y or Repair ( ) an Individual Sewage Disposal System at �l Locatio ddress Lot N ... . ... ... ....... `.. ✓r �. Eli Owner Address CA.... �. .. ..........`-. � ................................... Installer Address Type of Building Size Lot._ ��` S feet d YP g -•- q U Dwelling—No. of Bedrooms........... ...............................Expansion Attic ( Garbage Grinder ( ) Other—T e of Building ------------- No. of persons....._...._.........._...... Showers — Cafeteria Otherfixtures .-------•-•--.....-•----•-----------------------------.-------•---•-•--•-•--•-••-•••-•-•-••----••••....... - W Design Flow......... . .................:.......gallons per person per day. Total daily flow............................................�• gallons. WSeptic Tank—Liquid capacity!K!Lgallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.................._sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.....................Total leaching area..............::..sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by__ °ref ate......................................... Test Pit No. ...minutes per inch Depth of Test Pit.................. Depth ground water. Test Pit No: ... f rh r, ��'-,minutes per inch Depth of Test Pit.................... Depth to ground water.. ...._......__.. a - Description of Soil x x V .�..'........................................... . . ...................••--........ 1 "' r" _ . W -•••-•-••-•••--------....•--••-••-••-•••--•-•........--•••---•••••••-••--•-••...............•.... _.. -...__ VNature 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 TITL% 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 th board of health. �...........................' t Application Approved By.....------•----••-• -•-•-•------•--•-•-•...................•--.............••----•-- bate Application Disapproved for the following reasons:_..--•--•--------•------•--.......---•-------------------•---•-••---•-------•--...._.........•-•..._----------- ....................................................... •-••------••------------------•-••-•----•--••--••.................••----•--••-••......-••...-••-•-•••---•-•----•••••-••...---•-•......---•-•-•--- Date �1Permit No.......... ------ --..... Issued-------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEA TH, - Gs. ........,oF....: .. ......... ....................•••-•.............. Trrtif irair of Toutplinurr TIJIS IS TO C-E TIFY, Tha the Individual Sewage Disposal System'constructed (L'"or Repaired ( ) jInstailer has been installed in accordance with the p`'• sions of'TITI,r. 5 of The State Sanitary Codas described in the application for Disposal Works Construction Permit Nor" ._?.... _,e:2Z,_4. J....... dated------ _.__ ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION FACTORY. DATE..... , ------------------------• Inspector... ..........--------...:-------------------------.._........ THE COMMONWEALTH OF MASSACHUSETTS Q U BOARD OF. HEA T ..... .�,1 s`7..............oF...-- - ...................................... N ....� FEE... ......�.... ... 13hiponal Works fanstruAijon,fermit Permission <s hereby.granted:.. t: a :. ' `c _ :5 . .............................................................. :.._... to Cons ( repair � ) an Individual Sewage Dispopel System .+�`~ r at No.• . ......... ...•••-; ... . t�... `. _ . ..... . .__. S••-- ............................. -------•--•-.••... . ........ Street c" � as shown on the application for Disposal Works Construction Permit N6 .2 . -----/Dated----.—.—*. .......... ...............................................-.......................................................- �, y � Board of Health DATE............ ........... •••------••..............:...........•...•-•------ FORM 1255 A. M. SULKIN, INC., BOSTON ln\ 4 Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT rY WELL LOCATION �7 Address / �) / ��C C. "/'?� lY�/1l f N• City/Towne G.S.Quadrangle Map Grid Location Owner.—a>/7 r t°r.i � 1yY�1n Address /n 6 /) i ► I , a✓� _s/. 7W'//r/�/��� //� WELL USE CONSOLIDATED WELL Domestic U/Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled 1) From To r7 2).From To Date Drilled 3) From Tc 4) From To CASING Depth to Bedrock /i Length (1 I Diameter_ Type. � <;J;r UNCONSOLIDATED WELL STATIC,WATER LEVEL Water-bearing Materials Feet below land surface Sand: fige Q/mediumv© coarse❑ Date measured /,_I - + Gravel: fine❑ medium❑ coarse[] � � v GRAVEL PACK WELL Screen: JQlength 13 1 from—to- Yes ❑ No Q Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slot length from to Chemical Q� Biological ❑ Depth To Bedrock PUMP TEST a � Drawdown 0 _feet after pumping days hours at. AQ GPM, How measured a/I(P4l- M t!N Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 m //D�RILLER Firm f " ' iY_ 0 tIll, hr, n Address ��( Qf U \ City A Registration No. t'4 . a operator's Signature Please print fir y BOARD OF HEALTH COPY 2501•10.85-807101 t I t T dRR ICA BOARD OF H1iJ:i I-I fO'v'JN OF BAD P.O. 30X 531: /Ak S HYANNIS, HASS. 02601 $Ac?JA�iU 57-4 B 4-4 V q O.E&GNING ENGINEER MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING THE SYSTEM WAS INSTALLED IN STRICT ACCOADANCE•TO PLAN. A cl _ �; •� ,C,oT l 47-Alp to _ _1 -- o h VRCRNT 410 j , 3 a �3t D Rem 11 4 i hQoposE2 i vleA CA10.4)7ZA No.814 UPPERCAPE ENGINEERING P.O. BOX 616 WE H° E.' SANDWICH, MA 025 7 362-6281 I L TOP OF FOUNDATION • CONCRETE .COVER CONCRETE COVERS "R�sFR 4'CAST IRON 12"MAX. OR SCHEDULE 40 12"MAX. ' P.V.C. PIPE 4°SCHEDULE 40 P.V.C.(ONLY) PITCH I/4"PER.FT. PIPE- MIN. LEACH PITCH.I/4'PER.FT. e � PIT_.. Fi ELY. X�.�...INVERT �a" iy 0 .'. SEPTIC TANK INVERT G DIST, INVERT �� w EL.YX.�. .. BOX EL... . ,.INVERT � _�.. ... GAL. •. .INVERTINVERT v ;u-a w r �Ao 6 DIA. y . . DIA. PROFI LE OF il/p GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM �- 457,2 NO SCALE S 1 L LOG WITNESSED BY : DATE A , TIME... . .. .... • UP.PERCARE-ENGINEERINGBOARD OF HEALTH TEST �64zq OLE 1. TESfi HOLE .2 .P.O.. BOX,616, , . , ENGINEER ECFV,.`,�•::�'P, ELEV .fS °... , E. SAt�1DWICH, MA 62537 . . . . . . .322 •1. . . . . . . -3 7_1 a DESIGN DATA : NUMBER OF BEDROOMS , . . . . .; . . . . . . . . , TOTAL ESTIMATED, FLOW �. ,Q , , , GALLONS/DAY BOTTOM LEACHING AREA :��3 . , . , SQ.FT../PIT SIDE LEACHING AREA . . . . . . SQ.FT/ PIT GARBAGE DISPOSAL . . : '. .:.(50% AREA INCREASE) 3 l7E-D .t/D TOTAL LEACHING AREA , a:G . . . . . SQ.FT PERCOLATION RATE r( Ss . . . . MIN/INCH LEACHING AREA PER PERCOLATION RATE .. SQ.FT. -.WATER. ENCOUNTERED NUMBER OF LEACHING PITS . .O�f Z-- . . . . . . . { APPROVED . .. . . . . . . . . . . BOARD OF HEALTH 2: •`�'(Y -•G�•_ ��.3 `�F, ! : :��3 ./g7f0�! A :!sos� s)=,3?s ,six- DATE. . . . . . H T .AGEN T 'OR INSPECTOR a A9tAL4, OF M,q ffgy , v p - lw l ~ J. JACOBI ("fXQ� � 814 PETITIONERS: q ATAM., Iry Ids r+�