HomeMy WebLinkAbout0032 MARIE-ANN TERRACE - Health (2) 32 MARIE ANN TERR., CENTERVILLE
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UPC 12543
Now LOR .coNs�
HASTINGS. MN
No. (� THE COMMONWEALTH,OF MASSACHUSETTS FEE /V�t
BOARD OF HEALTH
OF A_ 1AC
APPLICATION FOR DISPOSAL SYSTEM C7mpleteSystern
STRUCTION PERMIT
Application for a Permit to Construct ( '(Repair ( ) Upgrade ( ) Abandon ( ) ❑Individual Components
m '
Location Owner's Name
Map/Parccl7 Address
Lot# A, Telephone
Installer's Nance Designer's Name
Address _ Ajdgss
Telephone# Telephone#
Type of Building: Lot Size�2 0 Sq.feet
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building No.of persons UJ Showers ( ), Cafeteria ( )
Other fixtures
Design Flow( in. required) 5 S gpd Calculated design flow 3; gpd Design flow provided-5 gpd
Plan: Date '1.2 Number of sheets Revision Date
Title S II' p I - iQ f ly - 6_-4 �
Description f Soil(s)O"%_h a"- ' �0 `-J n " al�n _ �
Soil Evaluator Form No. Name of Soil E aluator el�,A O' D to of Evaluation -
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigne agr es t sto t abo a described dividual Sewage Disposal System in accordance with the provisions of
TITLE 5 and furth agr s no pl ce e s _ m in opera until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
TOWN OF BARNSTABLE
1
LOCATION ald -a-.-TV 7 s�E # '
VILLAGE D,��t .t9'�a�Arr`O.C� _ ASSESSOR'S MAP&LOT - 3
INSTALLER'S NAME&PHONE NO. _ ; C A g . flle T'ivu.c
j SEPTIC TANK CAPACITY ,f .r� C�C�
LEACHING FACELI TY: (type) 7 (size) 5 Q y Qa&1M Q,C-tt
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: I0 -1U' 91S COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
,t
A 33 `
AD
A.r-- --37€5
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BIB = 34`
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No. O THE COMMONWEALTH OF MASSACHUSETTS FEE Vre),
(�prnSf BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) P&M-plete System
The undersigned hereby certify that the Sewage Disposal System;Constructed(V�,Repaired( ),Upgraded( ),Abandoned( )
by:
at '
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved designs s/as-built
plans relating to application No. 1 '47 dated '70 2Y-9J Approved Design Flow gpd)
Installer
Designer: ,L Inspector t1 Date�/� F {�
The issuance othis ertificate shall not be construed as a guaran that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE ~DEP APPROVED FORM 5/96
------------
No. / lJ 'y7� THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct (✓Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage
disposal system at ? 2 /l'9&'L-k —,4-"h Tie cAA 6f as described
� p
in the application for Disposal System Construction Permit No. / //78 dated
Provided: Construction shall be completed within three years of the date of this permit.All(l`oc co itiions ust be, et.
Date Z Board of Health
FORM 2 - DSCP DEP APPROVED FORM 5/96
. f
FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- B OSTON
j ,
No.` � i THE COMMONWEALTH OF MASSACHUSETTIS FEE 16 ,
4 '-'+� .
BOARD OFH� _EA�LTH
OF a � R
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( i(Repair ( ) Upgrade ( ) Abandon ( ) - [ Complete System ❑Individual Components
Low M14A I crh
Localion Owner's Name
L�OA I t r 9 :!�?
Map/Parcel# Address
�o}3
Lot Telephone
Installer's Name Designers Name
Address 4—n--n dr7
Telephone# Telephone#
..Type of Building: Lot Size Sq.feet
Dwelling—No.of Bedrooms a+ Garbage Grinder ( )
Other—Type of Building No.of persons LJ Showers ( ), Cafeteria ( )
Other fixtures '
Design Flow( in.required) gpd Calculated design flow gpd Design flow provided3 �-r-�gpd
Plan: Date ')Ls!) Number of sheets Revision Date
Title'�S '
Description f Soil(s)
Soil Evaluator Form No. Name of Soil E aluatorWdl� b'�ean,t D to of Evaluation `I —� � --
I
DESCRIPTION OF REPAIRS OR ALTERATIONS ?,
The undersign agr es to sto t abo a describedllpdividual Sewage Disposal System in accordance with the provisions of
TITLE 5 and furth agr s no pl•ce a syj m in opera until a Certificate of Compliance has been issued by theBoard df Health.
Signed A
Date
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
rc. 4.I�
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/ TOWN OF BARNSTABLE
L
OCAT0N Yy.3- C, 3 maid -CZn.ry
SEWAGE #
VILLAGEI r(I.- ASSESSOR'S MAP& LOT 4
INSTALLER'S NAME&PHONE NO. " t, 1
SEPTIC TANK CAPACITY l 5 D p yp-3 V 33
LEACHING FACILITY: (type) t (size) )
NO.OF BEDROOMS ll
BUILDER OR OWNER !"71; ��[ ,)_(,>.t t rnti, .I
PERMTTDATE: BCD -,4h COMPLIANCE DATE: �o�z��?�
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
YS T M _PPOFIL.
NOT TO SCALE
TOP FNON. FINISH GRADE
�-2, FINISH GRADE OVER
EL . FINISH GRADE - �, FINISH GRADE OVER DIS T. BOX .�^M�', OVER TRENCHES
a•,° SEPTIC TANK s�.
i QYp0
o,a.Q pRpl�
12"' MAX. �1\�\ ..'r/`a\��� I� J 79M�7Tf
:4 Q• ,p....e;., p'• ,0, .,p.>�' .Q • •.A •: .®.ta .p,�';.."^. .8'�'•4.•.i gip;
:ay.o• . 4 "
0 „ OUTLET PIPE LEVEL TOTAL LENGTH OF TRENCH es '
�3 v
FOR 2 FT. MIN.
;p ..o. , � .� :r ,!t,, off." • : v.• •.., ...�. .-'D:. .q• ..Q, 'b, .P , .e ,v• e6;'Qe U
'.. '0.. D• /pp .y �.�' �p m �j d° \T, P• 44� Ap Y n .! 'a•. OOp�.
.p •Oq "
'�•o yc ;0 O 0 p P W:n•:'a:.ar:m^:e:c.: O It CAP END
e;da Q C.. I. OR P VC `TEES A -� P 7 ,,, o° :° �y ® ® ® o °FL
b o b pbA Ev
2G5 e
1 500 GALLON DISTRIBUTION BOX
BSMT FL .
EL . f f, �+ /'+ INSTALL ON LEVEL BASE "SIL�0 +Gi4 L L®I�✓ OR Yh/EL L S "
PAECA J T C,ONCPE TE
H ..10 . REINFORCED
A• `p
o••
~ I>n:mo.d'Q •.C• G'!n•'6;:0 .:+ •A'- •'�a" ' D rr.�• p•,.®. ,. A
'V:•1►••O..q`,°•p.p�D' .•o.•o :d'• .P..p::o. .G•igy �"rr,!p b•f"o .,4.�•.4p7a4:
SEE'TIC T,4 NK TRENCH SECTION
INS TA L L ON L E VEL BA SE NOTE': EXCA VA TE TO EL E V. OR
L OBER TO REMO VE A L L IMPER VIOUS \
MA TERIA L BENEA TH THE LEACHING AREA 4" DPAM. 12" MIN.
" - -- REPL A CE EXCA VA TED MA TERIAL WI Th4 3" OF 1/8"--1/2"
�c. .39 , "' ---•.._, o' �o a•a:d.�,p'„.v o:gA•p b"•; ;b.:a;• •A j;`},
o. CLEAN, CLAY FREE SAND af1
1.'b.•.j . •a WA SHED PEASTONE
oe ,'q; 1'.. .. pe�a
` 314," _ 1-1/2" WASHED
.:RUSHED STONE q: ®�
sox 3GENERAL NO TfE TRENCH WIDTH
1. ALL EL EVA TIONS SHO N ARE BASED ON TOPO B Y O THERS NUMBE14 0)7 TRENCHES 1
2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON NUMBER OF DR'11YEL L S 2
OR SCHEDULE 40 PVC. �
M .3. THE BOARD OF HEALTH MUST BE NOTIFIED
O A710I P.
WHEN CON S TRUCTION-IS COMPLETE PRIOR P-8452
•y' TO BA CKFIL L INS PERCOL A TION RATE.
z • 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED <5 MIN./IN.
N
s/xs , ,o , BY THE BOARD OF HEALTH AND CAPE C ISLANDS WI TNESSED B Y.'
h,o aye �� ox� SURVEYING CO., INC. i ED�IARD BERRY
'` 5. MA TERIALS ANf.J INSTALLATION SHALL BE IN COMPL IANCE ;WI TH THE S TA TE SA NI TARY BARN BRO. OF HEAL TH
S DESIGN DA TA`
q CODE - TITLE V - AND LOCAL APPLICABLE DATE.- MAR_17, 1995
_lv f z Q) \, Lam// �srr'� I 77e.s� rio /-t
RULES AND REGULATIONS 3
- - NUMBER OF BEDROOMS
G. NORTH ARRON IS FROM RECORD PLANS AND �� �c,-,.� N NO
IS NOT TO BE USED FOR SOLAR PURPOSES W a A 7 S „.l i p v rz 9/4 GAB RBA GE DISPOSAL
7. .FLOOD HAZARD ZONLE' NON—HAZARD DA.IL Y FLOW 330 GAL .
B. )VA TER SUPPLY TOWN YA TER _5"or e� v� SEPTIC TANK REO D. 1500 GAL .
o Y /G SEPTIC TANK PROVIDED 1500 GAL .
330 GPD
LEA CHINS REOUIRED
o
v
\ M Gtl 4-o 4:1'', a SIOEYALL AREA = 152 S.F.
152S. F. .i' ®�74G/S. F. _ 112 GPD.
2,5 Y R 4/11/
BOTTOM AREA = 329 S.F.
i L 329 S. F. X O. 74G/S. F. = 243 GPD
` I L EA CHING PRO VIDED = 355 GPD
PROPOSED EL EVA TION
�� -- r- -- EXISTING CONTOUR SI �IGL E FA MIL Y RESIDENCE dr
OBSERVA TION PI T
DISTRIBUTION BOX PROPOSED SERA GE DISPOSAL SYSTEM
f «tip t ;r PREPARED FOR
L OHR CONSTRUCTION
O G SEPTIC TANK f
HSE. 32 (L O T 3) MAPIE—ANN TERRA CE
_B RESERVE AREA '-
IA CEN TER VIL L E—SA RNS TA BL E—MA SS.
PIPE INVERT EL EVA TION /U DVII.1
CHARL
-�
-' DA TE.' ✓�/y , i �8
PLOT PLAN CAPE 6 ISLANDS ENGINEERING
_ _ _. _
ri, sz, o SCALE.' ? " 20 9s 3 13:z � `� •:FOSTEz�o ��� SCALE AS NOTED 133 FALMOUTH ROAD — SUI TE 2E
"d ' PLAN NO.,�o�r 3 9 MASH MASS. �'9