Loading...
HomeMy WebLinkAbout5012 FALMOUTH ROAD/RTE 28 ,56 l a qW601, �Q-A it f 1 Appliadon Number......KAS& -...1.. :.-...` .. C� • g , • ! Perm Fee.J........ a....... .:Q.. ..Othea Fee........................ TotalFee Paid........................ ........................................... TOWN OF BARNST LA& Pm:mitAPmv9bY•• ••• r� BUILDINO PERMIT ...........Pam............._..�........... APPLICATION Section I— Owner's Information and Project Location �. Project Address Fl�-6 41 w Vf71age <fc- /— t _ Owners Name �G!,!/}� /LQ Gri I � L Owners Legal Address 12 W 6,4 State WS.T -- zipCity _ Owners Cell# � �^�l4 -Rf 3. E-mail �Ct w� G�j/�C�N / /�02� • �m Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under-35,000 cubic feet Single/Two Family Dwelling Section 3—Type of Permit F- R New Conshaction , ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structare) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alamo Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation , Other—Specify Section 4-Work Description 6 Aes ��vf° 1::�y CLCIT Ikk -7 ,4.(e ! LDS s L.v T ACt flMdAnd--nt201 S Application Number.................................................... Section 5—Detail Cost of Proposed Construction 2,GG o Square Footage of Project /1( Age of Structure 4h u ) Dig Safe Number . #Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ' Design Section 6—Project Specifics ❑ Wuing ❑ Oil Tank Storage. ❑ Smoke Detectors � ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑' Masonry Chimney ❑^Add/relocate bedroom Water Supply, ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: b(S p 054.(, I am using a crane ❑ Yes No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. ' 3 S - Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required �tit Proposed Rear Yard Required f Proposed y Side Yard Required e C*' Proposed Has this property had relief from the Zoning Board in the past? El Yes No Last imams 2mr2018 Town d Barnstable P# ' Department of Regulatory Services o a Public Health Division Date lg Meer: r t-6.1 A� 2200 Main Street,Hyannis MA 02601 yi • Date Scheduled h "3• Time__�'t.� Fee Pd._ < �� n Soil Suitability Assessment for S e Disposal { Performed-By: �� STD ov G-� Witnessed By: Locedon Address LOCATIO INFOR N&/.GRAL MA N r 0( j`T� O(� (j/ (`t6Z Z$, Owner's Name Address Assessor's Map/Parcel: 2 e �d U�� Engineer's Name G�i S — 7 — QD NEW CONSTRUCTIO d N REPAIR Telephone# v `S 2 / G Land Use- Sr / Slopes(% / f f Sur�fa 5toncs/ �✓G� Distances from: Open Water Bodyft Possible Wet-Area ft Drinking Water Well ft Dral'nage Way A ft 'Property Line 6� ft Other l `C 7p {) SKETCH.(Street name,dimensions of lot,exact lace ona of test holes&pare tests,locate wetlands n roximlty to holes) c Parent material(geologic) GJsry Depth to 13 edrock Nl Depth to Groundwater. Standing Water in Hole: �'� Weeping tYan Pit Pnea � Estimated Seasonal High Oroundwatcr 2 DETERMINATION FOR SEASONALMIGII WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles. DclIth to weeping Lfrom side of obs.hole: in, Groundwater Adjustment Z it. ax Weil- Reading Datot Index Well lavol,� Adj.-factor, ,. _ Adj.droundwaterIeval,. PERCOLATION TEST bikill V 's Ti.Q </'g M Observation 2 Hole# ¢ Time at 9" // yi r7 epth of Pero bv11v1" �� d� �4, Time at 6" Start Pro-soak Time @ , l0 Time(9"41 Ld Pro-soak !/•.OS !(; /J 4 Rate Miu./Inch Sm'�� LZn t LZ.a l `Jrna�/1.F j Site Suitability Assessment: Site Passed Sitp Palled:_w(s_ Additional Testing Needed(Y/N) o Original: Public Health Division Observation Holt...tata To Be Completed on Back-------- t � ***If percolation test is to be conducted within 100' , gyetland,you must first notify the Barnstable Conseirvation Division at least one(I) we irlor to beginning. Q:\SEPTIMHRCF6RM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Shcl Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o lsistency.%'Gravel) CJV �t124c L •s io'�y� � •• • c 40/9"C/ p. C/ 7e✓ —5eG 2rAC' DEEP OBSERVATION HOLE LOG Hole# �- Depth from Soil Horizon Soil Texture Soil Color Sail Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. v? .� L•S; �6 2 Gl� �x � • /4�A Go�Sr.�C✓ Z•SY7 4 /1'b � er'�� DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency, 24'- 4r C � o end DEEP OBSERVATION HOLE LOG Hole#- - Depth from Soil Horizon Soil Texture Solt Color Soil Other Surface(in.) (USDA) (Munsell) Mottling. (Structure,Slopes;Boulder;, Consistency, OMM011 - U r L-.S • �z% � s ZSye s t • � � .. Flood Insurance Rate Map: / Above 500 year flood boundary No— Yes Withln 500 year boundary No Yes Within 100 year flood boundary No,—_ Yes_:,_.._. Death of Naturally Occurring Pervious Material Does at least four feat of naturally occurring pervl material exist in all areas observed thrpughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe vious material? Certification r v I certify that on 9. (date)I have passed the soil evaluator examination approved by the Department of vironmental Protection and that the above analysis was performed by me consistent with . the required tralnin 'se le cc described in 10 CMR 15.017. Signature Datb Q:WEPTICkPHRCPORM.DOC TRANS.NO.: CITY/TOWN: / APPLICANT: 4 ► fe- ADDRESS: /2 t 2v DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO wa . rg� Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious.surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] " Location and dimensions of system components and reserve areas. / [310 CMR 15.220(4)(e)] V System Calculations [310 CMR 15.220(4)(0] daily flow septic tank capacity(required andprovided) soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15:220(4)(g)] Location and log of deep observation holes (existing grade el. on / each test) [310 CMR 15.220(4)(h)] �/ Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] V Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment' / given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address J U/Z Ar Z R, Sheet 1 of 7 A j N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply' within 250 feet of the proposed system location in the case ✓ within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins ✓ located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR ✓ 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system ✓ components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as ✓ approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? ✓ [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? ✓ [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] ✓ Materials specifications noted? [various sections of 310 CMR 15.000] System components not>36" deep (unless Local Upgrade Approval or 1 UA requested) [310 CMR 15.405(1(b)] Address S° Z Rr ZS Sheet 2 of 7 I I 4 N/A OK NO SEPTIG �TANK n ; , Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [31.0 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] ✓ Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for ✓ upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 V CMR 15.232(3)(0] Three access covers (inlet and outlet must be 20" or greater) - ✓ middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1 000gpd, ✓ . two'for systems >1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [3.10 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] ,/ Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% ` daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address ���Z /�F 28 Sheet 3 of 7 ,j N/A OK NO BUILDING SEWEZANI3 OTHER PIPING„ t, . Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and ✓ sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable 310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed tre nches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/(leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller /. than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) ' Stable compacted base.[310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] ✓ Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] " ;1' P CHAl�'I I �h48 Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats- alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] . Stable,Com acted Base [310 CMR 15.221(2)] Buoyancy calculations needed?Provided? [310 CMR 15.221(8)] Address �°�� ?s �' Sheet 4 of 7 1 N/A OK NO Calculations correct? ✓ 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] v Required separation to groundwater? [310 CMR 15.212)] ✓ Aggregate specified as double washed [310 CMR 15.247(2)] ✓ System Venting required/provided? (system under driveway or >3 6" deep) [310 CMR 15.241] ✓ Inspection ports,specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] ALEStixxC ERAS3 GVIR1S25 �� ff r v. f ra*,xrx.•t rrlas<x�✓ � xc.,�K.»ra 4rn..✓.tJ^^m! . Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I' minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] �­ � minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only[310 CMR 15.252(2)(i)] Address fv`L- 2T Lg Sheet 5 of 7 } N/A OK NO 77 DID THE PLAN YNyOLYE„ ¢ . 5 Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems >2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan[310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by . designer [310 CMR 15.255(2)(b)] V Retaining wall must be designed by Registered Professional V/ Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) 310 CMR 15.255 (2)(e)] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface ?x�r srw ewe t. xz ✓ m ,.3� '�`�' ,�, '� 'r"{� '�rr �zix °``S �r � as t�c�i'3«�,sa� za z�,'SD� ay;° .a. Was DEP Approval Letter provided and/or have you reviewed the letter for onditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on.the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance 3 4 ��415 a '�11�'ILifiC ff +' i Are the variances listed on the plan? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five f feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address U 2 �� Z Sheet 6 of 7 N/A OK` NO ltYOg211�eIZSZLVe Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and ✓ 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] ,f,-r 01sScellar�ae0us Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address 5 a/ z A Lc Sheet 7 of 7 _ ^ Approved by:--w- j4�--- LLJ T. CD ~'.... \ 06 __.... cc Applicable Massachusetts Buildin LL Codes&Zoninci Code TV 0 Residential I&2 Family SI:j.SITE PLAN 1.11 t-,ol—1 INDALL SIT(.11RA-)1111-11A11— c(i LL aiog IRC with Stale Amendments SEE FIA1,11NO,PTA""10-11-1-1 � ! � | Al1 � | ] ' ` ' ' ' | � ] ...... � —/ �— ---- | --_�__-___ S_____ _____ _______------'----------------------'------------�--------�-----�-----�---� i .. ....... -- ...._..- --........ ....... - --._.._._..._....._._.----- --..-......__.._..._.._._----_ - -----------..._..-.- _.....- -- Arch. Lu ®, - - LLJ ^I ` I 11111 - III I I 111 w I CE� t ..�.c -•I$$I ` " Ir-ly�ll l� l III III���I if u�u III II, III III III III III111 II111111111 II' Illli 11111 II III HL11 �, ,; ,,,. ILI. ill il__LI_III lll- N n �11111LIrl iI1111 ��1j o � rt ,� II TII�III LL c F;R -111 111 III ,.. -In_M --- o a , Il�lll�r ,,,a ,,,,> � 111J o, _ III IM i Vn �II�� IIIii� ITIIiLilnl nllllilll,11 L� I„�II�111n1�11� TouII1111I�jnI111nW1 I� .111 IIII_ni�lil�llllllll-llj�, — --— _-- / i tQ A1 .2 Y .........._._..-__......_......_..._...-_..-._-..._.._._.__-...--._.-_.. MRVI 31 ,�� s hii !!.k r l4+F k�M a i ,� ! yy t ��x rid n ttC •j4 1ti��3 '� ! t s • �n�' iS'�� ��i'fat ti��d�'� � • ` °�4�ur ���5���4St�;, ` :tom s, �a��^}• r rrt st AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 01/10/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT NAME: Erica Morin SULLIVAN GARRITY&DONNELLY INSURANCE AGENCY INC a"CONE No,Exf: (508)453-2514 FAX No: E-MAIL ADDRESS: erica.morin@sgdins.com ` 10INSTITUTE RD INSURERS AFFORDING COVERAGE NAIC# WORCESTER MA 01609 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B BOYSON STEPHEN INSURERC: INSURER D: 15 WINDMILL WAY INSURERE: SOUTH DENNIS MA 02660 INSURER F: COVERAGES CERTIFICATE NUMBER: 228643 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEINSD WVDPOLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S • DAMACE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence S MED EXP(Any one person) s N/A PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIESIS PER: GENERAL AGGREGATE SPRO- F POLICY u ECT u LOC PRODUCTS-COMP/OP AGG S, OTHER: $ AUTOMOBILE LIABILITY ., COMBINED SINGLE LIMIT IF. $ accidentl ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED N/A BODILY INJURY Per accident S AUTOS AUTOS ( ) - NON-OWNED PROPERTY DAMAGE HIRED AUTOS I AUTOS Per acc+dent $ UMBRELLA LIAB OCCUR I - EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STER ATUTE EORH AND EMPLOYERS'LIABILITY YIN - ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500,000 A OFFICER/MEMBEREXCLUDED? NIA N/A NIA 6HUB2E92415117 10/29/2017 10/29/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensationlinvestigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION' DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Dennis ACCORDANCE WITH THE POLICY PROVISIONS. Po Box 2060 AUTHORIZED /p REPRESENTATIVE South Dennis MA 02660 X Daniel M.Crouvyey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i� Subject: ..._—_----- From: sobrien8@babson.edu To: shawnobrien4ll@yahoo.com Date: Thursday, September 27, 2018 12 06 39 PM EDT a s d y / a �« w 0� �. -- Shawna O'Brien Babson College I Class of 2019 Campus Box _#4 1473 (508) 269-0305 J sobrien8r!babson.eclu Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurmce coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts 4 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE , Revised 4-24-07 Fax#617-727-7749 www,mass.govfdia The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): s f j�'E �Y S U i� Address: W/AA 44 ' C"Y City/State/Zip: Phone#: -�r7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees . These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' Y aP n'• $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 131-1 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. !- Insurance Company Name�C 16,1) ��� '� �o,/✓-P�/� � `��P Policy#or Self-ins.Lic.#: -2 �+��/3 Expiration Date: Job Site Address: -�&17, r`7 Gt Al/7/e City/State/Zip:6 f l 7//AS r Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pa'ins and lies ofperjury that the information provided above is true and correct. Signafore: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#' / N Poky/ IOm pVa P . � M -�` SIE rttL:ii E4R[i pRe 1l MnBHPEE `� - .. • L OGq T/ON MAP ^ FOR REo.STRY USG V, Z I`009� 44, -os I t�r ooV mro •. ti��f•, aeg^w�c.sy r op' 5 P oa�''y� e�✓ V � i pima i � p°?N kYLgb IIp 58. / C� om • v i. m2 -v, d J p;DIY°. � 1�3 s°�•"$:'m oa 1m`a Ap P,p 3p�1 eim \ AIpei' ady6 B HL I $" P• - - 3 e n5 z pasb Y'e.w�d� • �, j30.lo N{N Z n 'Ate i6 —SUBO/V/S/ON PL/9N of L/9N0 — /A/ Bq,E NST,9BLE- (Sq NTV/T) , MFI SS. BE/N6 q S✓BO/V/S/ON OF. THG PARCeL OP GANG AS SHOWN ON THE PLgN RGGOROEO qT THE BRR NBTRBLG GOVNTY .EGG/STRY OF OEEOS/:/N PLAN BOOK .35• PgGG 39 P.EEPA.eEO FO.E: O,E'OE.E SONS OF I7-.9L7' 6GALG: fkF SEPTEMBE.0 /y80 o So ree Sao gap REV/8E0 SEPT.P/•/98/ ' gPPR_OVRL NOT REQV/R EO VNOE,e SVg O/V/S/ON GOA/T.EOL LAw.. A NST BLE P RN / G O NOTe: Pe RIMeTBR /NFOR MqT/ON COMP/LEO FROM PLRN.PREPAReO ' FOR PEMBERTON WH/TGOMg BY GHAR L ES N.SAVERY /NC. OATEO JAN /S /970 RNO REGORGE./N PLRN gooK 238• PG.39 LgPE GOO - / caeT/FY THAT THIS PLgN LO"FORMS IN/TH THE RVLES r•° TE GHN/GqL PLgNN/NG qlo REGULAT/ONS OF THE 0,"°M`p" • - U /9SSOG/gTES /NO. - ,EEGISTERS OF OEeos, ERST OENN/S MASS. ,�z e veR a r�A'��t REG LAND SURVEYOR Y .. t � • Application Number........................................... Section 9—Construction Supervisor Name:�57"h",i ,0 Z4,rSp,� Telephone Number '7-7�-( Address l57 &01414 c.G dA+ _qtyS PAmS State�Tip. d Ic er 6-A.-S KIT License Number C S �� 1 Y S License Type,u� s of Expiration Date Contractors Email S rRv-k Am kjVenj @ e.e�� CAS • c Cell# ? 3 _ SS"7 I understand my re onsibilities under the rules and regulations for Licensed Consfruction Supervisor in accordance with 780 CMR the Massac etts State Building Code. I understand the construction inspection procedures,specific inspections and documentation by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section-10—Home Improvement Contractor Name c� ���w C�ct �'cJ✓ Telephone Number • 77�� �3 — S�,� Address C� QIjLg4 Z—& ra-( city _ ty s. QeW/4 s State�_Zip 62 GO Registration Number l�� ?I Expiration Date r Z 2 Q l� I understand my responsibilities under es and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Buul ' Code. I understand the construction inspection procedures,specific inspections and documentation reqlored by 78t) and the Town of Bainsstable.Attach a copy of your H.I.C... Signature Date J Z 4 Section 11—Home Owners License Exemption Home Owners ame• G{. Telephone N ber d Cell o Work N er I understand my ilities undei the rules d regulations or Lic ed On Supervisor in accordance with 780 CMR the Mass State Buildm Code I understand the •on• ce msp on pro dares,specific inspections and documentation by 780 CMR own of Barnstab Signature f _ Date 26//W- APPLJtANT SIGNATURE Signature Date l � C Print Name Telephone Number s f E-mail permit to: ,,j o4ztew VieLf T e..r.....i..a-A.mmPim o Section 12 —Department Sign-Offs Health Department © Zoning Board(if required) F I-Fistoric District ❑ Site Plan Review Of required) 0 Fire Department ❑, Conservation ❑ For commercial work,please take your plans directly to the fire deparbnent for approval Section 13—Owner's Authorization as Owner of the-subject property hereby authorize - �' ��cam/ S`h/ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner, date Print Name . a i l j I I Last undated:2J92018 e i 1 � � N U Llu / I LOCUS / / N ° S a i '2s'S3h w 349 8 C LOT 4 a iiiiiiiiiiiiiiii�iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiI 28 / cn \. 24.4' m LOCUS MAP z NOT TO SCALE: 0 30 45 60 \\ 1 � 1 +' i rri 1 -0112-8 J� I 66 / PROPOSE GRAPHIC SCALE: / GARAGE I 1 INCH = 30 FEET ' � � '1 � I � SLAB=71. I , G G G' J / � G D.T.H. 4 m / rn / #5012 SITE & SEWAGE J PROPOSED 1 P- SERV \ 1 3 BEDROOM DESIGN PLAN . \ WELLING, 5 � \ D.T.''m,, CELLAR . #3 1.45..D0 12 FLOOR=64.0 . # a IIII I -Tl\ FA L MOU TH ROAD / i SEE SEPTIC (� D � *� DETAIL � N �" SHEET 3 a J I C 0 TU I T, MASS , S °°0°3 22.2' PTSAS o— � I; 0 0 w/ 4- — o II --I DATE: SEPTEMBER 6, 2018 — 1/- \moo a� \I M = D.T.H. #1 OWNER/APPLICANT: LOCUS DATA F 340.89. � I O0 HMAK SHAWN O.BRIENNAILF / I BENC SET RN ' D i o 1243 MAIN STREET E E 1 E,EV MAPLE9.4 II CURRENT OWNER FRED P. F LOT 5 l COTU I T, MA 02635 PAGNATO 43,561t 508- 840-8883 PLAN REFERENCE 3583 - 5 ` I a I SHEET 1 OF 3 PROP. DEED REFERENCE 359-64 UTILITYPOLE I II PREPARED BY: ZONING DISTRICT RF I - _ — J 1 EAS SURVEY, INC. " �. �� TM � I FLOOD ZONE X 7/16/14 �� - EDWARD P. O. BOX 1729 A N ASSESSORS MAP 002 N�sT N .I SANDWICH , MA 02563 PARCEL 006 PH. (508) 888-3619 • OVERLAY DISTRICT WP / ZONE II o CELL (508) 527-3600 LOT AREA 43,561f S.F. / EAS.SURVEY@YAHOO.COM I RAISE COVERS TO WITHIN 6" DESIGN 6" OF FINISH GRADE ? CENTER CHAMBER RISER DESIGN FLOW TCF = 71.67 FINISH GRADE RAISE TO WITHIN 6" GRADE 71.00 ELEV. 70.5 FINISH GRADE OF FINISH GRADE 3 BEDROOMS AT 110 GPB/D AN- GPD ELEV. 7( ELEV. 70.0 `� ELEVATION 69.70 REQUIRED SEPTIC TANK T = 68 3 /� a�///ate a� �� //�� /�� /��///ate 36'®S=0.02 TOP ELEV;67.00 1' MIN.-3' MAX. COVER ___330 X 2 = _ _ _66AL. EXISTING 4" PVC 20'OS=0.02SEPTIC TANK PROVIDED4 PVC SCH 40 6' ®S= 0.04SCH 40 MI-+�x 000000 0 00000 o REMOVE Ill= 7.72 INV.= o o i UNSUITABLE 67.00 10"TEE 14"TEE INV.= 0 O O O O O SIZE OF LEACHING FACILITY REQUIRED O O O O MATERIAL TO f 5'-7" GAS BAFFLE 66.81ZNV.= O 00 00 0 00000 C2 HORIZON DESIGN PERC RATE __«____MIN./INCH 4'-61/2 4'-1" LIQUID LEVEL OUTLET TWO 5'-0"x8'-6"x3'-O" H-20 CHAMBERS LONG TERM All RATE-0.74-GPD/S.F. S.A.S. (13.0' x 25.0') > 66.41 o w SIZE OF LEACHING SYSTEM PROVIDED: INV.=66.00 ix BOT. .=66.24 ° 64.00 DATUM: a o 330 _ 0.74 SF/GPD = 446 S.F. MIN. REQ. 62.55 ui ui VERTICAL DATUM: PROPOSED 1,500 GALLON ELEV, 57.7 MSL± / BARNSTABLE GIS SEPTIC TANK SET ON LEVEL USING H-20 CONCRETE LEACHING CHAMBERS BENCH MARK USED: STABLE BASE WITH 4' OF STONE ALL AROUND 8" MAPLE ON PROPERTY LINE BOTTOM (13.0' x 25.0') = 325 S.F. ELEVATION 69.4oil SIDE WALL (13.0' + 25.0') 2x2 = 152-,.E, 18-0112-B 00000 0 0 00000 477 S.F. 000001 o o 0000 477 S.F.x 0.74 G/SF 353 GPD SITE & SEWAGE °°°°° o 0 0 0 0 0 0 353 GPD PROV > 330 GPD REQ. = 23 GPD RES. DESIGN PLAN f--4.0' 5.0' ---� 4.0---� P- 1 5 6 9 0 NO (GARBAGE DISPOSAL / GRINDER ALLOWED) , 50�2 �- 1 SIDE VIEW D.T.H. #1 > } D.T.H. #2 > D.T.H. #3 D.T.H. #4 ib DATE: 6-19-18 DATE: 6-19-18 DATE: 6-19-18 DATE: 6-19-18 F-A L MOU TH ROAD GROUND ELEV. 69.7 GROUND ELEV. 70.2 GROUND ELEV. 70.3 GROUND ELEV. 70.8 N I CERTIFY THAT I AM CURRENTLY APPROVED BY THE NO GROUNDWATER NO GROUNDWATER NO GROUNDWATER NO GROUNDWATER DEPARTMENT OF ENVIRONMENTAL PROTECTION TO CONDUCT C 0 TU I T MASS SOIL EVALUATIONS AND THAT THE RESULTS OF MY SOIL OAE OAE CAE OAE EVALUATION ARE ACCURATE AND IN ACCORDANCE WITH 310 LOAMY SAND LOAMY SAND LOAMY SAND LOAMY SAND 3 3 10YR 3 3 10YR 3 DATE: SEPTEMBER 6, 2018 CMR 15.100 T H 1 10YR 3/3 6„ / 8„ / s" 10YR 3/ 8" B B B B EDWA S ONE, ERTIFIED OIL EVALUATOR LOAMY SAND LOAMY SAND LOAMY SAND LOAMY SAND OWNER/APPLICANT: 10YR 6/6 10YR 6/6 7.5YR 5/6 7.5YR 5/6 S H A WN O.B R I E N Ell = 66 9 42 EL. = 66.2 48' 24 22 DTH #1 INDICATES LOAMY SAND LOAMY SAND 1243 MAIN STREET 10YR 6/6 10YR 6/6 C 0 TU I T, MA 02635 ZHOP INDICATES 60" EL. = 66.3 48" EL. = 66.3 54" 508-840-8883 ��� DA P-1 54" PERC TEST C-1 C-1 D I MEDIUM MEDIUM SHEET 2 OF 3 NO MOTTLING SAND SAND MEDIUM / MEDIUM / 66" 0 1 NO WEEPING 2.5Y 7/4 2.5Y 7/4 COARSE SAND COARSE SAND 2.5Y 7/4 2.5Y 7/4 PREPARED BY: NO G.WATER " NO G.WATER NO G.WATER „ ' NO G.WATER r EL. = 57.7 144 EL. = 58.2 144 EL = 58.3 144 EL EAS SURVEY, INC. - - B.O.H. P. O. B 0 X 1729 DON DESMARAIS 144" INDICATES ADJ. GROUNDWATER SOIL EVALUATOR SANDWICH , MA 02563 ED. STONE NO OBS. GROUNDWATER VARIANCES REQUESTED BACKHOE OPERATOR. ELLIS BROTHERS PH. (508) 888-361 g NONE SOIL TYPE: 1 NO OBSERVED GROUNDWATER CELL (508) 527-3600 PERC RATE: <2 MIN. PER INCH EAS.SURVEY©YAHOO.COM LOADING RATE: _0_74 GAL/SF/MIN DEPTH TO BOTTOM OF HOLE 12' CONSTRUCTION NOTES: GENERAL NOTES: 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND 1. ALL WORKMANSHIP AND MATERIALS; SHALL CONFORM TO D.E.P. 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT WORK ON THE SITE. FOR SUBSURFACE DISPOSAL OF SEWERAGE. ELEVATION OF THE OUTLET PIPE. 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. ACCESS-PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX CAPABLE OF WITHSTANDING H-10 LOADING UNLESS SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE S.A.S. AREA IS PROHIBITED �' OTHERWISE SPECIFIED. FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL TM� 'u9 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION BE LEVEL DAVID OF ALL UTILITIES PRIOR TO ANY EXCAVATION. 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW FLA T OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. AND APPROVAL. F FEET PER 13. MAGNETIC TAPE ON ALL COMPONENTS. No. 21 6. FINISH GRADE SHALL HAVE A MINIMUM 0 0.02 EE . 0 10 15 20 ,p FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. 6 7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF N R� SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE THE FLOW LINE AND SHALL BE OW THE CENTERLINE AND GRAPHIC SCALE: LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. 1 INCH = -10 FEET , X 70.5 18-0112-B Q� PROPOSED SITE OC, SEWAGE PROPOSED DRIVEWAY RESERVE DESIGN PLAN x 13'x25' 69.6 ; 50 12 70.3 X i D.T.H. #3 FA L MOU TH ROA D IN COTU I T, MASS DATE: . SEPTEMBER 6, 2018 OWNER/APPLICANT: PROPOSED S H A WN 0.B R I E N 61.8' PROPOSED S,A.S 1243 MAIN STREET ,SEPTIC IC TANK GALLON T.H. (2) 500 GALLON COTUIT, MA 02635 35.8' 0 LEACHING 508-840- 8883 SHEET 3 OF 3 25.0. PROPOSED 3 OUTLET PREPARED BY: D-Box EAS SURVEY, INC. P. O. BOX 1729 N x 69 SANDWICH 7 MA 02563 I, —13.0' D.T.H. #1 PH. (508) 888-3619 CELL (508) 527-3600 EAS.SU RVEY@YAH 00.COM