HomeMy WebLinkAbout0100 ROSEMARY LANE - Health SMEAD
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
wFORESTR MIN.RECYCLED
INITIATIVE CONTENT10.
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MADE IN USA
GAT QRGAW-D AT SMEAn.c am
TOWN OF BARNSTABLE
LOCATION �os?�^�cr y L.G s+ P SEWAGE #
VILLAGE �'p,0.,r il !I.m Y7 ,a 11/
ASSESSORS MAP & LOT
INSTALLER'S.NAME & PHONE NO.
i
SEPTIC TANK CAPACITY /,000
0 LEACHING FACILITY:(type)/ b��o 9,Aft.sao (size) 12 X 33
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
6BUILDER OR OWNER �Gry f�G�ybr�5
DATE PERMIT ISSUED: 5 y
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: , Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
7" TOWN OF BARNSTABLE
ppliration for Diripa!ml Hfur1w Tomitriir#iun ratnit
Application is hereby made for a Permit to Construct (/X) or Repair ( ) an Individual Sewage Disposal
System at_�........... .... T.i /� -�. P .
Location-Address '
---••-•.......................•............ Lot No.
Owner Address
W
Installer Address
UType of Building Size Lot..._5.y:.7._1_.._..Sq. feet
Dwelling—No. of Bedrooms.____-_---!�..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .---••-•---••------------------•--••--•--•----•------......----...----•----••------•--.....---•--------------•-•-----------...........................
W Design Flow..............q_5........................gallons per person per day. Total ally flow...........7_�__1 d......................gallons.
if
WSeptic Tank—Liquid capacity.I,0�_.gallons Lenggth___.�.._�__ Width__-Or.n.0- Diameter................ Depth..S.i.&�.'
x Disposal Trench-- No. .. -..._._.._ �JVidth. r;.._.� � Total Length....13.......... Total leaching area.._++........sq. ft.
3 Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
� Percolation Test Results Performed by j�w#.+_
Cat.. t-rC&:e !' 4!1-S!-+CTDate2 (z
Test Pit No. l..`.Y.___minutes per inch Depth of Test Pit.... `.... Depth to ground water......13ev.".....
44 Test Pit No. 2.... ...v...minutes per inch Depth of Test Pit---- Depth to ground
axW
S --• water__-_.
--------•-lW"-•••-----'-............................................
.....�..OD So ?'y 1.15 P s%
tono t-PA-Y-1---_S-cj.5....'3 ? .. . .............`
..`..._.....
v � S ✓; `�. .. : .... _... .... G_ k . ..5 ! _...__.._... ........................ .....................
---------- ------3en.... 1 _. . `'� ----� � .
.................................•-----------......_......._.....----....-•-•---•--•-
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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has i ued by theboard of bealth.
Signed ........ ...................... ...............
Dace
ApplicationApproved By ............ ...... . .. - -...... . ... ..... ................................................. .....
Application Disapproved for the following reasons: ............ .............................................................................................................. .
.............. ........................................ . ............................... ..................... . .... .. .........................................-- - .........I.... ......... ..
- .......... -Date ............
Permit No. .... ./ .......... Issued ...... "...-Y:.........
Gl
Uace
No.. � i�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applirtt#ion for Diripooul Works Towi#rur#tun 1rruti#
Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal
System at
••---•--------•--�°-T ------------------ ---- Q -..�-E,`- ---......�..._.._..----............ I .
!, Lorition-Address or Lot No.
L� .-.r._�z.F2 i 5-------------------------- ----------------------------------------------------------------------•------------------.........
O�ner Address
W
•-----------------------•-- --•----------•----------------•----•----------•-----------..._.....- ----------------------------------------------._...........__._..-----------------•--
Installer Address
UType of Building Size Lot.... 15�_'_.._..Sq. feet
�-t Dwelling—No. of Bedrooms._-•-----_�J__--•___________________________Expansion Attic ( ) Garbage Grinder ( )
-
04 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ____________________________
Design Flow.............455________-___-_._.--_____gallons per person per day. Total daily flow........... ......................gallons.
9 Septic Tank—Liquid capacity..9O.!-,?__gallons Length._._O.V. Width---'�.�.�_rt Diameter................ Depth_.'S. 6
W Disposal Trench-- No. 4.. .:.!�: Width_ ...�.? Total Length.-_ '......... Total leaching area...`4 4 z.......sq. ft.
x
Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by..__:n17 ......
`.l Test Pit No. l._,Lk...__minutes per inch Depth of Test Pit----I__1-.V....... Depth to ground water...... .:..'..._.
f= Test Pit No. 2....k..''...minutes per inch Depth of Test Pit----!_.7.9_".... Depth to ground
a -- water....._...
T f.(rrt Y L � 1 ' �1c`.'- ••---•--------•-----••.............•...-••••---- ?..:. :: L
O Description '_...
of Soil.�2•.'`?�'._-....1_ r� a �� `- - ------:"O' ) t `_ n ty ^ ` �i'` � "
w _._...0 ...- . ••..... .............................
_37- n-- (Mo.............�^'� -...... - t_n t-r •-----------•
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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance hasWr
sued by the board of health.
.� /� , ( Gem .Signed .................. ...................................................... ........................................
Application Approved By .............1 -t�t� �.-. �✓ '..................... '....................... ..... ...^.....11� `�'.
Application Disapproved for the following reasons: .. . ..................... ........................ ..-- ...._..... .. ..............�1e`.................
.................................. . ............................ . . ......................... ... ........... .. ................................................ ....................................
Permit No. ...., `/�------..... -(�- t�----------------------- Issued ...... .`"....�1.. "�^`��...........
Dare �
i
THE COMMONWEALTH OF MASSACHUSETTS 4'
t.'l
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( l/) or Repaired ( )
by ... .. ............. . .d...:.. -.. y'J....... `ram......--- ---........ ------ ----- -------------------------------......--------.-...._......--------------------------------------------
at ... ....... �1. ,�... _. �ff -p '�� G'.................. .. . ..._.............
/ f' '. -
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..�.*, --- dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BFICONSTRUEA AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
r.� z ...------ �- �' ...........
•-•� �_v-_.. ....._... -�. Inspector_.:.---......�,.�.. � -
DATE......�.......'�".....fG.�....... ... � �............
__-e®_______--__,_,_.__-_>_-_.-_----.-_-------_-__-____>_,-._____ ��,-- --__
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE FEE
3�io�us�t1 urko �un,�#r�r#iun �rruti#
Permission is hereby granted...... ---------------•-------------..._..------------------•----•---......-•-•---
to Construct (40_�or Repair ( ) an Individual Sewage Disposal, System,
at No....../......O��v f���� '�/���r .... ='��- ..............................................................
street
as shown on the application for Disposal Works Construction Permit
L /�J 7 -
Boar"d of Health
DATE..................... / -----.---•__••-
FORM 36508 HOBBS A WARREN,INC..PUBLISHERS -
J
� Aaw/Or s
/ \ � ,•' `' �-- y�_, TEST HOLE LOGS �
- LOCATION MAP (NOT TO SCALE)
ENGINEER: Me A-, PE,
Y1 � WITNESS:
BUILDING ZONE:
�l DA7 E: 2--}2-_435 ___�--�f .
\ \P ` PERC. RATE: 1-= SETBACKS:
'E'�p ` M�k.�i�. 3 FRONT = „
1 �, -- - _
WPt i- � wT l R � _ �,34T' SIDE _
". ; -rap s REAR
�. 39.3 Q 3D ' . ASSESSORS MAP = PARCEL
n, - t
1i Y FLOOD ZONE
c;,�+a � �1.. 30.E
V
O E G, ,Vale. 40.v c
of Ei.2(l.7AM
L.Au.
-
__ NOTES
l x _ JIhA��7 3o.2
Iv1 1. DATUM NGVD TAKEN FROM
2. MUNICIPAL WATER IS -
\'`" 3. PIPE PITCH TO BE 1',4"/ff UNLESS OTHERWISE NOTED.
- 1 2� ^- K �:"/ _ L`x; �� ZA►lE::. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO-H)
5. PIPE JOINTS TO BE MADE WATERTIGHT.
A0.1. 32' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANC MASS.
7. THIS PLAN FOR PROPOSED WORK ONLY AND NOT TO BE USED
Y
��EI TIC I R OF ILE FOR LOT LINE STAKING.
(NOT TO SCALE) F,8. SCH 40-4" PVC TO B USED THROUGHOUT SEPTIC SYSTEM.
s �/ MINIMUM I' OF COVER OVER PRBCdST ------37. ID
LD
-----
�� (
-� f1
3'-3S - DEPTH OF FLOW=)i Igo
TEE SIZES: ,, / l=i �. ��� --- ' �•-
INLET DEPTH = 10 MIN. 6" CRUSHED
OUTLET DEPTH = Mq1{ STONE UNDER
D' BOX
- -- ---
.Js FOUNDATION
- - -- SEPTIC TANK---- 3� D' BOX - -— - -- — LEACHING
r FACILITY
SEPTIC DESIGN:
DESIGN FLOW: =1_ BDAMS ® I_D__ GPD/BR = __ 1_ GPD--)
PD -- SITE AND S'E WA GE PLAN--- -----
SEPTIC TANK: __ GPD X (' S) _ __`t"' __ GALLONS
d wn cape engineering, inc. \ - - USE A __ _ GALLON TANK IN THE TOWN OF:
1 ►�AFK Gl;TL�% LEACHING:
,r s t / _ 4 0 SF — sr _t✓
CIVIL ENGINEERS
LAND SURVEYORS F + o Nt F t.o , �� = BOTTOM: _ � + i =+_;�__ _ � (. '� _ •!2 PREPARED FOR:
s' L 2-'M� TOTAL:
Rte 6a, YARMOUTH, MA USF: j-,
BOARD OF EW TS r
,. 2
?j ✓A �' SCALE. DA TF. L - -
AR1VE H. OJALA, P.E., R.L.S. DATE APPROVED DATE Ns++
.... .., r_.....M. _ _._ . ._.. ...-. ..j