HomeMy WebLinkAbout1221 OLD STAGE ROAD - Health T
1?21 Old Stage Road
Marstons Mills
A= 173 — 00 ', 005
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•• THE COMMONW A-LTl--', OF MASSAQ&USETTS
BOAR® OF HEALTH /
Applirtt#ion for MspaoFal i9orkii Toustrurtion ramit
Application is hereby made for a Permit to Construct (Y,,) or Repair ( ) an Individual Sewage Disposal
System at:
- ��•--� - -� -.........................-•-•--------
Location-Add ess ----- or Lot No.
.... rz.. ._..r.......C) h �w.i........ c�, 1.1........... ...... ------......------.........................._.....
Owner A ess
an .. ...........................................
Installer Address �{
Type of Building Size Lot._1.LgaA........Sq. ieet
Dwelling—No. of Bedrooms........_�...................•......___.___Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
ad Other fixtures ..........................
--2N.--_t.
W Design Flow..........1.10--.-.-.--_--_-------gallons per peseu.per ay. Total daily flow..............�ZC>......--......gallons.
WSeptic Tank—Liquid capacity.l .gallons Length_n(o.`.`_.. Width4-;-A0_'' Diameter................ Depth._5._. 4'`
x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No........I----------- Diameter........U0_-.._. Depth below inlet......�p......... Total leaching area.g��.7....sq. ft.
z Other Distribution box ( ) Dosintank )
Percolation Test Results Performed by... _ `--....-..- •--
__.__ M..........:........................... Date.... .......
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---------- -------._
Test Pit No. 2.��_...minutesper inch Depth of Test Pit._ °j___.. Depth to ground water.ao.
.......
as ._,,.................��......._..........._......--
O Des 'ption of Soil r..�`�c .---. `' .e..� z' �' -"' 1- `-�.�-----
. .......
vi_x�.. ..----SA.MI =----...• � ��'••... _._.L�f - 4` ................................................
----------------------•----•-------•----------•---•-•-----•---------•---•-•-••--•-•-......-•......----•-------------••-•--•----•---•------•----•-----------------.........---•-----------------•-_.....
UNature 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 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 by the board of health.
Si e ............. ----�-��"---------•--------. --•IaI
Date
Application Approved By..- E `-----•...._... --•--,�. _- -- ....
4Date.
Application Disapproved for the following reasons----------------------•----------------------•-•-=------•------•------------------------------...--------------
----------•---------------------------•--..._........••--......_.........---•-•--•------•--------------•.•--•-••.....-•---•----------•------•--•...••-•---•-----••-•-•--••------................._._....
Date
PermitNo....................................................... Issued.....................................................
Date
L �
No.... -Fim
. ...........Z......
THE COMMONWEALTH.OF MASSACHUSETTS
BOARD OF HEALTH
...........104 ......... OF......7. ".ms'A .6ig. ................................
.........
Appliration for Uhipoiial 1V11rk,5 Tomitrurtion Prrutit
Application is hereby made for a Permit to Construct or Repair an individual Sewage Disposal
System at:
... ...................................... ........ . ..........................................................................
Location-Address or Lot No.
...... -------- ..........0......A4.....................................................
ik ress
..............
...........................
Witei Address
< Type o-f.Buildine Size Lot...6.99A.......sq"4eet
U
Dwelling—No. of Bedrooms._._....._.5.............................Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons.........._.........._...... Showers Cafeteria
Other fixtures ........................... ...............................................................
yn------------------------------
Design Flow...........D.0.......................gallons per =per ay. Total d4ily flow ....gallons.
...........
-4
9 Septic Tank—Liquid capacity.tPKIDgallons Length.6.-(Lo'... Width.4f..Ld'Diameter................ Depth..........-
Disposal Trench No. .................... Width..�........... ..... Total Length.....................Total leaching area...................sq. f t.
Seepage Pit No. . ..",,See . .....I.......... Diameter.........W..... Depth be"' inlet......4....... Total leaching area..9!4�.7...sq. f t.
'. ".
Z O
therDistribution box Dosing tankercolation,Test Results Performed by... VY)...................................... Date..... .......
Test;Pit No. I :.::.........minutes per inch Depth of Test Pit..._................ Depth to ground.... water..._..._._.
%# 0 i.-t.
-eA Pit No. 2...43--- _._minutes per inch Depth of Test Pit...1.44---- Depth to ground water.-a .....r .0
P4
.4. ................................ .....t......
.Z -------------- . ........... ................---------- -------------------
scfv of .0. .......Z! .......kTp 4 vi
---i. Bt
9 -A D t' ;Oil r----�; ..6. ...
7 -----?---!tn_J.A. ....... .......
I I la
.... .....
U e......... ..........n.0----- ..............................................
...................... .............................................................................................................................................................................
UNature of Repairs or '6erations—Answer when applicable.-_...........................................................................................
........................................................................................................................................................................................................
Agreement:,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisiotis:.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 be ssued by the board of health.
. ... .... ......................................... ..........................
•
Application Approved By......_ te.A /N9 .................................. ... ......................... ........................ .....7.......
Date
Application Disapproved for the folilowing reasons:.............................................................................................................I-
..................................................................................................................................................................................................Date
PermitNo.......................................................... Issued._.._.._.__..__._____.____.-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
...................................... 0 F.....................................................................................
(9rdifiratr of Toutplitturr
Z:H* �the Individual Sewage Dispo I S, em constructed, or Repaired
byall ................ .... .... ............. .. .... .... .. .....................
at.._......... ...V..... .. .................h........ -----------------------------
----------------------". ..............has been installed in accordance with the provisions of #4g:he State C T Sanitaryje.�Ls'WVcr' in the�W
application for Disposal Works Construction Permit No. ..................................... dated._...._.._........._-.--_---`--._'_---_.__----._-
THE-.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
-7
DATE...................5:n Z,-Z_Z........................................ Inspecton." ..................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD H=EALT
W)I 4� 1
740 ;r ..........................................OF..........&Z..........................!!�................................ ..................
No........................ FEE........................
Mop ion r mit
Permission ereby granted... ... .................. ... . ..... ... ......... .....................
kNFr
r
....... ....
to Cont L a;eWo is tem
at No...._... n I-1V * % 6 e v f mi
............................................................................... ................................................................................
Street
as shown on the application for Disposal Works Construction Permit No
Date ------------------------------------------
// __ I ----------------------------------------------
oard of Health
DATE_---•-•-•-•-••. ------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
„
, .
SOIL TEST INVERT ELEVATIONS NOTES:'
DATE 'OF -SOIL TEST 2' IZ 8p INVERT AT BUILDING 99.5 FT. ALL WORKMANSHIP AND MATERIALS
WITNESSED BY x2•�--
M, INLET SEPTIC TANK S'P, 2 FT.' SHALL CONFORM. ` TO D.E.Q.E. 'TITLE' ' 5
PERCOLATION RATE G z MIN./INCH ' OUTLET SEPTIC TANK 98. 9 FT. AND THE TOWN OFfQenS'[ R =RULES
INLET DISTRIBUTION BOX �.�—FT. � .
AND REGULATIONS FOR SUBSURFACE
±. :. - ; `�8 3 FT. .,_ DISPOSAL OF SANITARY SEWAGE
OBSERVATION HOLE I OBSERVATION HOLE OUTLET DISTRIBUTION Box
ELEVATION=.1 o ELEVATION= fao•a
Orr, _b„ ! INLET, LEACHING PIT` F T.,
�llIl SV �' BOTTOM LEACHING . PIT 9Lr y FT.
DESIGN CALCUL_ATIONS a
NUMBER OF BEDROOMS
. .
3
4learl I GARBAGE DISPOSAL .; UNIT:.
c earl . : . . . . . . . . •. . • I"l D it> '
!n TOTAL ESTIMATED FLOW (.110 GAL./BR /DAYx BR ) 0 GAL./DAY
e- Fine REQUIRED. SEPTIC TANK . CAPACITY. : .. . GAL.
5an� Sanol ACTUAL: SIZE OF SEPTIC TANK TO BE . INSTALLED... . 12,00 GAL,
LEACHING AREA . REQUIREMENTS ,
�l.-.bB,o' r Gl.=$A,•a' SIDE WALL . AREA2 GAL./S.F.
—144' 144 o GAL./S.F. S
BOTTOM AREA 1•
LEACHING CAPACITY (BOTTOM SIDEWALL ):.
n� � no {�z°p 54,
GAL.
RESERVE LEACHING CAPACITY. . . GAL.
TOP OF Zo rnirl
FOUND..
ELEV.=IoZ.d �D� 1 CONCRETE 4rr SCH. 40 CLEAN :,SAND
COVERS PVC PIPE
MI PITCH CONCRETE
+, 1/8N� PER. FT. COVER o`'�/ �i ° p`�HOFMgsq
+N. rr 2 /o MIN. PITCH � N ��E RIGiARD:��yG
12 MAX.. o , rv'
-. JAMES
Z N ,r ro N n ti O•HEARN
FLOW LINE 2 LAYER OF 1/8- i/2 r Q. No.,694 Q y
�. a WASHED STONE ��� �FGISTE`��
o ' /4rr i /2r`
• 4rr CAST IRON 6' _ STONE
"� - s iaa�a�
D.• '•.,.� O
PIPE-`MIN. PITCH , , i,i
3 D ONE
r
I/4 PER FT. DIST. o ��-- o PRECAST LEACHING
. BOX �D c�°- n o BASIN OR. ..EQUIV. ,
�� b • D
It
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IODG7 CAL _ CEn��{z� ILL-� MASS
SEPTIC
x ,f TANK R. J. �0' HEARN, INC.; RLS, RS
E � .1348 ROUTE 134 . . _
.EAST DENNIS, MASS.
` .� •° :GROUND ;.WATER -TABLE ,
r`= ,. J08:.N0.8o�8t� C.LIENT. ,
i•'. e
:StW ►Gt' QUA ry DISP �.. SYSTEM i
t - NOT` T,0 -SCALE g . DATE 1 t Zag,.BU SHEET Z OF:• Z. , ..
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4-o ' APPROVED BY DRAWN BY ROVE
Ev-li5Tin,:::4 conTz)Jw- T,�) THE zonin�/-,, SCALE:
DATE:
EAR
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inc DRAWING NUMBER
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