HomeMy WebLinkAbout1279 MARY DUNN ROAD - Health 1279,.Mary Dunn:Road
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Barristable
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L O C AT ION SEWAGE PERMIT NO.
Lo Am&Y VVA or., �ff
VILLAGE
I N S T A LLER'S NAME i ADDRESS
BUILDER OR OWNER
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DATE PERMIT ISSUED `,72-Cf ` 7%
DATE COMPLIANCE ISSUED �-
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THE COMMONWEALTH OF MASSACHUSETTS
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BOARD OF HEALTH
�33 �l�dc1 ................OF....... � .� .�. L .....................
AvOrta#ion for Uiivnsal Works Tonstrurtinn Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
------ ............... Lam"
Location-Address or Lot No.
_O. ....................
Owner d
ress
a LKSIsr!sdC1 i!lC. _.....sJ- ---------------------------------- ...................................................
Installer Addressj �
Q Type of Buildi ., Size Lot___ ---
Dwelling No. of Bedrooms...................._...............____.__.Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ............................ No. of persons___.-_--_-__-___----________ Showers ( ) — Cafeteria ( )
Q' Other fixtures
Q ----------------------------------------- -------------•--••......_----•-
W Design Flow...........3.�Q....................gallons per person per day. Total daily flow__._.._.____.__._____...__.._...............gallons.
WSeptic Tank—Liquid capacityt�..gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width Total Total Length........ _-__- Total leaching area........... _sq. ft.
Seepage Pit No....___�....._..._.. Diameter-__---l---� --__ Depth below inlet___.. ... Total leaching area._ l� rsq. ft.
Z Other Distribution box ( ) Dosing tank ( ) ° ��Ll` 1-2
Percolation Test Results rformed by._.Cg�.�--�--- ------7� ............................. Date__ 2=..'50'!-!-'2........
aTest Pit No. ..minutes per inch Depth of Test Pit.l ..... Depth to ground water. �✓r�_-___..
Test Pit No. 2................minute nch epth of Test Pit..................... Depth to ground water........................
/� / .f- par 1 •------y 1�� .............................................
OF
Descriptioh of{�oil_./zaz 1. .0 .-----.52.......E --•-•---------•------------------•------------------------------------------------..........------
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W -----------•------....••-•==----------------------•-..._...--------------------------------•-••---------•--•••---------------------•--•-•-----•-------------•-••----------------
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 TI'i 1Z 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 boar f health.
,
Si d ,4 t3lld. -- --CYs-.e,.,Q-'�-..
Date
Application Approved By..... i ... -�y 7-
Date
Application Disapproved for the following reasons:......................................................................................... -•----•-•-----------•-
-•------------------------------------------•-----------•----•-••----•---...-------------------•--•....._..
Date
Permit No. Issued_....��'aL g-7
........ Date ._..
No............... ...... Fxs.... d............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ,OF HEALTH
..................OF....... _-
Appliration for Bispos al Works Tonatrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
/�
- Locon Address or Lot No.
.••-•
Owner 'Address
................................ '' 'r4, a `'._____-____________________ _________--__-•-•----
Installer Address Z
Type of Build Size Lot__/./ .: ....:..
U
Dwelling' No ipf. Bedrooms___________________............... _Expansion Attic ( ) Garbage Grinder •
Other—Type of Building No. of persons____________________________ Showers — Cafeteria
r. Other"fixtures ------•--- ---------------•---------------•••----•-••----•------------•---------...-•-------••--•••--•--•--•-----•-•---•-•...._.....__......•--•
W Design„ Flow__._.._____33
Design, per person per day., Total daily flow............................................gallons.
04 Septic Tank—Liquid capacity/ 1-.gallons Length................ Width................ Diameter................ Depth.............
W Disposal Trench o............. Width_ Total Length.......... Total leaching area.. .... __ sq. ft.
x
Seepage Pit No. ----------- Diameter _ Depth below inlet....._ ._. Total leachingarea.. 00,_sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) ° " '- y` '•
'_4 ' Percolation Test Results l_ �erfo�med by._ --- •---�w , ...................._________ Date__ .2.f�`'*"' ,1-____.__..
Faj Test Pit No. L_ _.!._y_miinuutes per inch Depth of Test Pit.l$.."_`V...... Depth to ground waterA..Af_._._..
Test Pit No. 2........ ___.___niinytes pff inch epth of Test Pit_______________:"'_:_. Depth to ground water_______....._______._._.
�-- S` ----------------------------------------
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Description of Soil__l7 ] _ d5. ...--- Ak! --`-""=------------------------------------------- -•-----------------------------------------•---------
x
W ----••-------------------- ------------------------=--•------------=---------•--•----:----------•-----•--•--•------•----------_•------•-----.........................................................
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 boardof health.
Si ed___ -
Date
Application Approved BY--- . �' `
Date
Application Disapproved for the following reasons:..............................................................................................................
_
Date
Permit No......................................
= Issued_ ...............................
� Date
R
k' "s
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF............. ................. ........
Trrtifiratr of Tomplianrr
TH CERT Y, That the Individual Sewage Disposal System constructed (�br Repaired ( )
by -• ................. (,!"'✓- I---a --- -------•---. -----
7
has been installed in accordance h the provisions- of::.TI 5 of The_.St to Sanitary Code as described in the
application for Disposal Works Construction Permit No -----___ _. . dated_-_ .................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THATTHE
SYSTEM, WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....---_-__----•---------------------------__.__-___---••-•-------------•---------- "
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
�" .........OF...... .............................................. ... 1,
No.....:... ........... FEE. �............-.
-
Permissio ereby granted_.'...........�---± 7144AJ. C`�------------------------------------------•-----......._.._._.._.....---------
to Constr t r R r ) a In ual Sewage D* p°�al Sy em
at No t°I .......... �-�-- �'2'•7 C�r-------------------------
. ... -
Street
as shown on the application for D sposal Works Construction "it No. _.. Dated.. '7_7............
Q . .. ..........I...T..............................
Board of Health
DATE _1:=--- -----•-=........................................................'
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - . -
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EIr►wARt� K .t.0 CERTIFIED PLOT PLAN
^CUMII AOU'D. ;4.4" `1)A"77 LOCATION 89,�!?-sT446.4Ft 4�1A5S.
SCALE . . DATE
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PLAN REFERENCE .84h 0- gr `'`17 .
-Si WV ON !aZA-A-J. CT2le . . . . .
AL.844C. 33s-
I CERTIFY.THAT THE
SHOWN ON THIS PLAN 1S LOCATED ON THE GROUND
//�� AS SHOWN HEREON AND THAT IT CONFORMS TO THE
j5K/E 6ri D/Ve SETBACK REQUIREMENTS OF THE :TOWN .OF
/? . .!9?tF'ua'7 '4'4!C . .. . . . . WHEN CONSTRUCTED.
DATE A. �t�G:.
PETITIONER: /A,v,t//5 ��Ss", C.REGISTERED LAND SURVE R
N59345 `
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TOP OF FOUNDATION
CONCRETE COVER
CONCRETE COVERS
•'; 4"CAST IRON "MAX' -�rss,7
PIPE (OR 12 MAX. 12"MAX.
4 ORANGEBURG(OR EQUIV.)
EQUIV.)— MIN. PIPE- MIN. LEACH
PITCH I/4"PER. PITCH 1/4-PER.FT. PIT
PRECAST
e . -� LEACHING
N V R� Q
INV T INVERT a . '� e•; PIT OR
° o EL.`s`1n... SEPTIC TANK DIST. �a w EQUIV.
o INVERT EL... . '7`.. . BOX ELA3./B ' : >x
/0'0 GAL. INVERT ~ 0:
e; EL.�¢9/.... ' . ' ' . ' ' ' ' '' INVERT v a o' :;i: 3/4"TO I I/2
.� EL�s'l� w w
EL6Z,/o U-o �. p. WASHED
w STONE
vo
PROFI LE OF GROUND WATER TABLE .
SEWAGE DISPOSAL SYSTEM
NO SCALE
PQL�d���C�aQ�
SOIL LOG WITNESSED BY :
DATE 'T Y .Z¢079 TIME. �o:'oo Atl �.q`C. Mc✓,�2A'/ BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 , L�424eY P4- ENGINEER
ELEV. . 70, Zo. . ELEV. .�L, Za /
eez ey
Lolly¢ 4vA-"
ME"
S,,a_Sp,L DESIGN DATA '
4z„ 3
48" NUMBER OF BEDROOMS
TOTAL ESTIMATED FLOW . .30 . . . GALLONS/DAY
P42C BOTTOM LEACHING AREA 78 So . . SO.FT. /PIT
H 7FI,ve- Nice / . Sv
SAID r/n�t SIDE LEACHING AREA . . . . . SO.FT./ PIT
S � GARBAGE DISPOSAL -!�awE� (50% AREA INCREASE)
TOTAL LEACHING AREA . SO.FT
PERCOLATION RATE . MIN/INCH
LEACHING AREA PER PERCOLATION RATE .44Z. SO.FT.
No .WATER ENCOUNTERED
NUMBER OF LEACHING .PITS
APPROVED . . . . . . . . . . . BOARD OF HEALTH G�! �2,�, Sift . - /.fC 7DA.JZ
DATE. . . . . THOMAS E.KELLEY CO.
AGENT OR INSPECTOR ENGINEERS—SURVEYORS
346 LONG POND DRIVE
OF
SOU,-TH YARMOUTH,MASS.
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PETITIONER