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HomeMy WebLinkAbout0177 CAP'N SAMADRUS ROAD - Health 177 CAPtJ P. SAMADRAS A�6- --- A= 038.050 i i No. THE COMMONWEALTH OF MASSACHUSETTS Fee BOARD OF HEALTH nXM - OF f2 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (-1/Repair ( ) Upgrade ( ) Abandon ( ) - [�Complcte System ❑Individual Components Location Owners Name Map/Parcel# Address Lot# Tcicphon Cobs?G P-AX�-J Insta r'. r me Designer's Name N�V174' ASSESS R d t„ Address fr PARCH, TJ phone# Telephone# Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms _.,!S Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow( in.re uired) P:D gpd Calculated design flower gpd Design flow provided gpd Plan: Date Number of sheets Revision Date Title 6 Description Soil(s)0i4/`—�ci o�--Zc� �t " to t 12" t��' �a�-(�u.. a(�w�, T Soil Evaluator Form No. Name of Soil EvaluatoFD, Sty Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. rees Signed Date Inspections94_1z�4 - FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 TOWN OF BARNSTABLE SEWAGE # '' LOCATION j ASSESSOR'S MAP & LOT 3 .�j VILLAGE INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �[ Z LEACHING FACILITY: (type) C l � A- (size) / %Z NO."OF BEDROOMS BUILDER OWNER COMPLIANCE DATE: PERMITDATE: ,�--- Separation Distance Between the: Feet j Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) exist Edge of Wetland and Leaching Facility (If any Feet within 300 feet of leaching facip3)-� Furnished by s' i I S,Jcr ka 00 $ r �0 o �.;,^ .- .. ,..-o..—,...•. ..4c:war.—..,_ ter`., .-.-�r ... :'�.._•.•. � ...�.-, ...?1,...^- ...��.. .<�. ;.- •v •. - ,.., . - No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH l�bt�YL OF APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (./Repair ( ) Upgrade ( ) Abandon ( ) - Complete System ❑Individual Components Location Owner's Name Map/Parcel# '� Address �" / /� Lot# Tclephon Iv; i C 6V Co��Ca D�o f Ill 1 It�/� Installer's Name J/ Designer's Name T/ NAltr r Addres: - Address Telephone# , Telephone# _ Type of of Building: - "'' -: Lot Size (0 _Sq.feet Dwellirrg No.of Bedrooms a' Garbage Grinder ( ) Other—Type of Building No.of persons (�� Showers ( ), Cafeteria ( ) Other fixtures Design Flow(f irr.re wired) gpd* Calculated design flow —3 gpd Design flow provided gpd Plane Date" Number of sheets Revision Date Title ©;; -vvt.e C e .�c.�z ✓� Descriptiot Soil(s)�=l "-B o..�•mac. lob " I o " �' uw 4 "-i o+ti`�--- Soil Evaluator Fd'rm No. Name of Soil EValuatorC>. 5&u.r c It Z- Date of f Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of - TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board Of.Health. Signed O.�'ri Date Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ..,>.� - ti � ✓y No. "� � THE COMMONWEALTH OF MASSACHUSETTSf FEE -✓ ..iy r BOARD OF HEALTH R CERTIFICATE OF COMPLIANCE/l Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned'hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded1(°'),«A6andoned( ) by: at has been installed in accordance witthe provisions of 310 CMR 15.00,(Title 5) and the approved design—plans/as—built plans relating to application No� dated ^ !Approved Design Flow (gpd) Installer Designer: / Inspector Date - v , The issuance of this certificate shall not be construed as a guaraneeth at the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED..F4DRM 5/96 ..+ k No. � THE COMMONWEALTH OF M4SSACHUSETTS FEE J .fo, q BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct (: Repair ( ) Upgrade ( ) Abandon ) an individual sewage disposal system at / 'g� �A.� ,2�'A�' &Z �a� If'E 77as described ' t in the application for Disposal System Construction Permit No. � dated Provided: Construction shall be completled within three years of the date of this per 't.All localetsjn itions must be met. Date !3�!d�1n I Board of Health c �CJp FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON /l r�po VAN OF BARNSTABLE TI LOCAON // SEWAGE # 9ff" VILLAGE L Ulf I2 J 7 ASSESSOR'S MAP & LOT 19 -:Z INSTALLER'S NAME&PHONE NO. I-A,e K-vv s r SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Gl l -Tu (size) NO.OF BEDROOMS BUILDER t� C` �� t V`'��ce.� ►1 PERMITDATE: COMPLIANCE DATE: .:s 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 existY)JC� 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 facgq),� Feet Furnished by z *'_ \ s. . i I I I 3 I i 4 { 4 r i 3 � i i i f I j I 1 � }" I 3 , 5 E 7 } t i t I r i 1 I 4 �• ' I e Nj ! f i t p I c , I F � rs �,- q SYSTE -PROFILE t i NOT TO SCALE TOP FNDN. FINISH FINISH GRADE EL . �G,a �-s% DIST BOX DE OVER 4 ,o p e; FINISH GRADE FINISH GRADE OVER 7 OVER TRENCHES 73 •4•'o° SEPTIC TANK �. !o i"° pA6 12" MAX. n777/7 p�40' �4. p :i'� .O�'nA::J� O'::Q.a�DOPp .I•'Pb' Qp.ld P b' o ct OUTLET PIPE LEVEL TOTAL LENGTH OF TRENCH 2 3 QUO may d FOR 2 FT. MIN. $oil A,O�Q• Q D .Q VU V -01.%-Ei I. OR PVC TEES , tea. . �o 0 o a ,. 6 no V p .0D'Oe�. 06 !! BSMT FL . 1500 GALLON a DISTRIBUTION B® y y , o..o.0 b C. .a o PAECA S T CONCRETE 9a INSTALL ON LEVEL BASE. 11500 GALLON DR YWEL L S + p4oa.e . I di , �do:oii0 0,e:6 0 ti :a•vA.Q• 0 :P '..A Ob H_ 0. REINFORCED 0• °Savinelle �Q�ode� e6 7ub' Pd o �s �.d:bo.Op'C'nob::Ob.:te a �ti•O.��Pri'bQ �4a'�p�4:0 v ► -o o• v, D, O Ceda' _ SEPTIC TANK TRENCH SEC TION �� ° , c3 �' ^ o A � INSTALL ON LEVEL BASE NO TE.- EXCA VA TE TO ELEV. OR z Q of Puna S„ °W / 7 LOh�ER TO REMOVE ALL IMPERVIOUS gan a ` < s- " p '�" v °dam FOs t MA TERIA L BENEA TH THE LEACHING AREA 4" DIAM. 12" MIN. Z. REPLACE EXCA VA TED MA TERIAL NI TH 3" OF ?/B yoG "nct".y^ � CLEAN, CLAY FREE SAND b '�rti: I✓ASHED PEA STONE " 3/4 - 1-1/2 WASHED �;�t'ai Old �) r_andiri CRUSHED STONE q /o -y z �o GENERAL ._ O TES TRENCH WIDTH 1. ALL EL EVA 7 IONS SHOWN ARE BASED ON ASSUMED MUMBER OF TRENCHES � 2. ALL PIPES IN THE G. 2 SYSTEM MUST BE CAST IRON NUMBER OF DRYYEL L S, 2 , I � OR SCHEDULE 40 PVC. u.- BSEP VA TION PIT 3. : THE BOARD OF H _AL TH JS `NOTIFIED WHEN CONSTRUCTION IS COMPLETE PRIOR P-8889 T -_i TO BA CKFIL L NG PERCOL A TION RATE: 4 _ 4. ANY CHANGES 'IN '-IIS PLAN MUST BE APPROVED <2 MIN./IN. 1-9 Y - BY THE BOARCs OF [)EAL TH AND CAPE 6 ISLANDS XI TNESSED BY.• v SURVEYING CO., INC. GERRY DUNNING 5. MA TERIALS AND INS TALLA TION SHALL BE IN ,h ` COMPL LANCE III TH THE STA TE SA NI TARP BARNS. BRD. OF HEAL TH DESIGN DA TA o 0 -� - CODE - TITLE V - AND LOCAL APPLICABLE DA TE.- MAR. 11,1997 / 7c -5'a ---- RULES AND REGUL'A T IONS a 7-1-1z- ._-- 3 61, v L= O r n , y 2 2jZ NUMBER OF BEDROOMS S. NORTH ARROY IS FROM RECORD PLANS AND ,Z" A �L oQ ,o Y2 s/Q --.—. rry __ IS NOT TO BE USED FOR SOLAR PURPOSES G Sa��I _- G/ GARBAGE DISPOSAL \ NO r o N 7. FLOOD HAZARD ZONE C (NON-HAZARD) a y 2 '� DA IL Y FL Old 330 GAL . ` .�, +-- _._...--------,.�;' • ` • o � � B. RA TER SUPPLY TDNN YA TER 3G" 1500 7.v__ c SEPTIC TANK REO 'D. —_____ GAL . `1 'SEPTIC TANK PROVIDED 1500 GAL . LEA CHING REOUIRED 330 GPO. Mac! !v M-t i S a v, SIDEVALL AREA 152 S.F. Iy, _ 152S.F.X O. 74G/S. .F 112 GPO. \ ' LEGEND Y R BOTTOM AREA = 329 S.F. 329 S. F. 74 GIS.F. HT. 243 GPD � LEACHING PROVIDED 355 GPD L J c>T � /yy' iYo__. li•-.,!/�N fir. � .4 -e PROPOSED EL EVA TION 7'7-- EXISTING CONTOUR OBSERVA TION PIT SINGLE FA MIL Y RESIDENCE C �• 0 DISTRIBUTION BOX � PROPOSED SERA GE DISPOSAL SYSTEM t PREPARED FOR f� o�' o o SEPTIC TANK F' �. ._ 1° CHA RL ES MA CCINI LOT � T z3 _._� RESERVE AREA 30 CA P `N SA MA DRA S RD. 1T �lii Of � BA RNS TA BL E CO TUI T -- MASS. op" PIPE .INVERT ELEVA T70 = F)AVID-LES j DA TE.'M�'-�h ��; /'9�r CAPE 6 ISLAN 2 2 �4 OS ENGINEERING PLOT PLAN � ``'yF' SCALE AS NOTED .t SCALE.• 1 "= 20 ' 3z3 c .�o . �FcrsrE�Eo %1 - 133 FALMOUTH ROAD - SUITE RE sy t'+r^s rn k Ax,w! f r^,^r• a r— } A3 I p±{ V Q a / PLAN NO MASHPEE, MASS. -