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HomeMy WebLinkAbout0120 CROCKER ROAD - Health 1 20 Crocker Road -West Barristable J 'A=`l 10 - 023 ,t /�a L"DC` �TION�/ � / SEWAGE PERMIT . VILLAGE Ix"� INSTA L�LE� N A ME & ADDRESS B U I L D E R OR OWN ER nSDATE PERMIT ISSUED DATE COMPLIANCE ISSUED FRo,, , n 0 `l , v� 936 L O C-A T ION SEWAGE PERMIT NO. VILLACE INSTALLER'S NAME & ADDRESS V-Ll�, 1-9 rull� CD 0 U I L D E R OR OWNER DATE PERMIT ISSUED t-/ 3a DATE COMPLIANCE ISSUED (O/ 5/ r i ro wcc� TD A M&AI O&YAK/ - No.....�.r�_�=_a- � , ............ BOARD OF HEALTH- '- �� AA � f 116 -b� �dW .....................�....................OF Appliratiun for Mqvuual Mork.5 Tonutrnr#iun Famit � �S�aApplication is hereby made for a Permit to Construct or Re Individual Sewage System at: * (� pair ( ) an ewa g Disposal �; •............... LOT ...�o©........e:ReetGF� -IZnAC > C ;_Ci2YySbL - ►- 5.... ................. Location-Address .or Lot No. ................_..._-------- ----------........_._._...... ..._...__ ...._.... •-•-•-.._.....__---- ...._ WOwner Address •-----•----•---•-----••-----•-•...... .............................................••--•.............•••.........•-•••-••--.....---..... Installer Address Type of Building Size Lot_..4_&�. --- q. f U Dwelling—No. of Bedrooms___._._.....��__..........................Expansion Attic ( ) Garbage Grinder aa Other—T e of Building No. of persons......:................. Showers YP g -------------•----...------- P ---- ( ) — Cafeteria ( ) Otherfixtures .----•------------------•-----.._...---.......-•--•-•-.----...••------------••--••••-•-----•••----•--••---...------------•••--••...----•.....•-_••---- WDesign Flow................... ..................gallons per person per day. Total dai!flow.___________._. ................gallons. WSeptic Tank—Liquid capacity19�__gallons Length---��5�__ Width_`E.S....... Diameter________________ Depth.._g_e�__. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..___._,/-_.......... Diameter......C0......... Depth below inlet.......:_Lo........ Total leaching area._.24.z'.......sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...... e4 C1�9�......................................... Date.:...__zAt'. �'�...___.__.. Test Pit No. 1._..__.�___minutes per inch Depth of Test Pit____________________ Depth to ground water.... N6^...F.._ . 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------- ••••--•------------- ...._........ ........... _------------- ------- ... ......_............._.....__........-- O Description of Soil..........��__k.Lq:�......Ag. �___.-is9N15�z x V ....•--•----•...--------•--•------•-------------•------••-------------..._•-•__----- ..-•----------•-••.----..__.........._...----- . •--------------..._•------------ ...----.....-•-•---...... W •---•-----------------------------------------------------------------•------------••--...---------•----•---------------------•------------......-..................................................... 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 TLITL; 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. gned...................................................................................... •• ....... ApplicationApproved By--••• --•- -------------•-•-•-••-----.........---•-----.._......_...---•••-•-••-...._..__.._ !'_.. ..- Date Application Disapproved for the ollowing reasons_________________________________________________________________________________________________________________ ..............................•••-------......--••-•------------....-•---••-----•---•---•---•----•--.......--=-----•----......._.....--•-----•----••---•----...._..-------•••--••----•--..._•-----•_-•--- Date PermitNo.......................................................... Issued..................................•-•--................. Date Massachusetts;Water Resources Commission/Division of Water Resources WATER WELL COMPLETION REPORT Address R �� 0 E ,`� F F t; ` •"� City/Town W 4 G.S.Quadrangle Map Grid Location Owner / /W OJ©0 Address 1616190 1211 W, &2�v ca, WELL USE CONSOLIDATED WELL Domestic] Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From To Rotary(type) CablvRl 2) From To Other 3) From To 4) From To CASING Depth to Bedrock Length D" meter Type UNCONSOLIDATED WELL STATIC WATER L E,L� Water-bearing Materials Feet below land surfa S�J Sand: fine❑ medium❑ coarse❑ Date measured � 7" Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot�O lengthYLfrom�7 toy Yes ❑ No Split-Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot# engrrr--,Fa *� Chemical Biological Depth To Bedrock PUMP TEST /� c Drawdown �� feet after pumping daysc hours at 33 GPM. How measure ours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To a m RI ER Firm 0 d -6M 6.6l(/ as Address GAIJO tAl City ILA! AW6 a Registration No. 'to ignature Please print firmiy 10M-8181-1 6 4 8 4 3 FEs... �............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH UF Appliration for Disposal Works 01nim. rurtion "p.erutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: t^6 T_--- a v.,--_-• C R c�E 1?- Q.o R L� t�a CS A 2 NS_1 A�c 4 w/ASS ....................... ' i ................»»... ......._............._................. ......... ........_ __ Location-Address - -� -or Lot No. ................ - -... WO.. --------_---•---•-- -------•• --•-----.» --.--•••---.----------•-•-..- .. WOwner Address Installer Address Type of Building _ Size Lot._�_�a AR....S feet Dwelling—No. of Bedrooms------------=3-----_---_-___-___-______-Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building a Other—Type g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures ... 3 3 v � Septic Tank—Liquid capacity.!��__gallons per L Length �.S�... Width.�._Sy..... Diameter._............. Depth..4 lions. Design Flow...................�"6.....____......_..gallons person per day. Total daily flow.............._.....__.______.._._......._._ c� x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./----------- Diameter.....1v......... Depth below inlet.........In........ Total leaching area.A!9GZ.......sq. ft. z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by....... ........................................ Date......?� 5! $�/- Test Pit No. 1___.... :...minutes per inch Depth of Test Pit.................... Depth to ground water.."A.!On/ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 --------------•-----_____---------------••---------•--------.---------_-_------..----------------------------•------------•-•-------•-•------------• -_- O Description of Soil.......... - 1_......Ai1 /2---BA N,O-------------------------•------------------......------••--------•- V ........-•-------------•--------•-•---------••-•...-•----------•....._..------....._ ...----------•-••----....--•------•----•--•--•-•-•----•-•-------- --__--.e. --••-••------••---------. z ..........................................................................................................................................................F ......................................... U Nature of Repairs or Alterations—Answer when applicable._.............................:.................t f.............................................. ....................................................-............................................................................................................................................. .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I TIL 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. gnd .................. ........................................ ---------- Application Approved BY --- 1._.." � �/ J, D ......._.. Application Disapproved for the ollowing reasons:..............•--•-`•-- - -—rf-. ----------------...-----------.._....-_--------.----.._...........-------- t��� ---•-•-•--•-.....---•-•----...-•--••---•----•----••-----------------•-••..... ..-----....•..-- .. ... .. •.... ....-------------------.....-•---••---------- ------............------... ......------ Date PermitNo..................................----------------------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS � BOARD OF HEALTH Oi tw .......>:.................................OF..................................................................................... - (Intifiratr of Toutphattre THIS That the Individual Sewage Disposal System constructed ( or Repaired ( ) by..........U... .. --------------- ---............................................... -•----.....-•--•----•..._..--••----......-• - -- --.. .r Installer at._........:_�:' .......� .--_......-:_ ' `'°� ----------•-------------••----....-•---•-•----•---------------•--•----.....-•---•-••-------•-. has been installed in accordance with the provisions of T ,, Ke State Sanitary Code as described in the application for Disposal Works Construction Permit No.-".................................... o............:.......................... dated-............................................... THE ISSUA CEO OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®,AS A GUARANTEE THAT THE SYSTEM WILY FUNCTION SATISFACTORY. DATE.. - Inspector .. ....... � A _..�.__�,� - _______..�...._ -.._.__...._..._.._w....._.....r._._ �.....�._... —— —_---.-- THE COMMONWEALTH OF MASSACHUSETTS L/ BOARD OF HEALTH ...........................................OF. �-d No.....................•••• FEE........................ Moro �ono�rttr#ion rrutit PermissioY gra ••.. ......... ...... ..7------------------------....-----.._..........-----------..................:__............ to Constr opt�2ep "�-( a �I'n/�di'vl r 11 eve age Disposal System /OQziGC �� C/ at No. .................................. ...-- ............ ............................................................ Stteet as shown on the application for Disposal Works Construction er -o.................... Dated.......................................... �+ ........... •-•------ ............................... .............................................. �. ^ ✓l� Board of Health DATE.. l._... SECTION - SEWAGE _ Z -SEPTIC TANK - - "D" BOX - - LEACH 1 TOP OF FON i =� (MSL)* "2"OF 4BTO 1/2" WASHED STONE Pr' _ L OUT- IN —� OUT- ;[ 16 O C? G L�---- I N/r• •TANIK 1C9.Q17 / ELEV. ELEV. ELEV. ELEV. ELEV. ELEV. _ �Z.o'Imo-- --�•{Z.c m l/."- Vh" WASHED STONE ( 1 UQ — TEST MOLE LOG - 1)0S ` ' 4g, c le,' , TEST BY �Ip.KMb.�► �oN�.� �ACoT'�1 ►t•$.c�.y, // TEST OAT, WITNESS WITNESS DESIGN —� BEDROOM HOUSE T.H. 1 T.H. 2 OGa'4 -1 CA.o T ` ELEV. ELEV. NO oA/ PERC RAT MIN/IN. DISPOSER DISPOSER E MNIN / FLOW RATE 334;> (GAL./DAY ) SEPTIC TANK 330 (t.Sl= 4cl 5 Y/ l00� At REQ'D SEPTIC TANK SIZE -7 g Map LEACH FACILITY90, / ��~ y30 SIDE WALL G/D. BOTTOM lo'-C`r/4� _ �� -( ,.o ) _ ,� G/D. `.:. �� '77 TOTAL 7-`.'c� = S45 .-I IV F1 Srs D PIT _ �. A / a o USE: G�►.�G LEACHING *;�a � ? `` N\� '1/ 1rp8 c.5 Co e fir !(- x �c> -fit. e tip WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) SAta CavJ E C-14 1. DATUM(MSL): TAKEN FROM QUADRANGLE MAP 2. MUNICIPAL.WATER_. tr{O� ------......-AVAILABLE !'��� i� .441, ' �L �' �' � � � � O 3. PIPE PITCH: Y4"PER FOOT _ j/ter // 4. DESIGN LOADING FOR ALL PRECAST UNITS: AASHO- •(� 44 '�( 5. MIN-GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. CJ� At? fir. ARNE H DISTA E AS CERTIFIED'\i,, �D 6.PIPE JOINTS SHALL BE MADE WATER TIGHT �a r.CONSTRUCTION Or-TAILS TO BE ACCORDANCE WITH COMM.OF MASS. n�aL cr CIVIL! SITE FLAN STATE ENVIRONMENTAL CODE TITLE 5 n v t2.6348 Ct, 307 ry \ LOCUS: uG ---- - AL -•�'� EG.PROFES EER REF: . 43k.. 301 t.. c c� (��Wd CflPe en�'iaeer.�a � PREPARED FOR:�IM4t CIVIL SURVEY iRS ------------ BOARD OF HEALTH LAND SURVEYORS REG.LAND SURVEYOR CONTOURS (EXISTING)•- ----- ��� SCALE f C �y (PROPOSED)--O--O-O--O- APPROVED DATE MA Yarmouth MA GATE 4 4- ©cslg