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HomeMy WebLinkAbout0054 FRAZIER WAY - Health (3) 54 FRAZIER WAY, COTUIT 4 No. - THE COMMONWEALTH OF MASSACHUSETTS FEE P 90 —y BOARD OF HEALTH 41urL OF N LMJJIJLL&�� Z/ a APPLICATION FOR VISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( Repair ( ) Upgrade ( ) Abandon ( ) [complete System [:]Individual Components �� Ir ; dno-a L i 1 0—D Cffm4/1 A C-1-1 m Luc:jinn O Nam. �� 5���l 1n--� i�© Po�c_wners Map/Parcel# m Tc'ephonc# �.5 v� l a� ,_lastaller's Na Designers Name O 0 B �e�- �QAa,RA CQ 6 (5:b A rcss Address � Y33��� 9 Telephone# Telephone# Type of Building: Lot Size 61 63G1Crw_�Sq-.irrt- Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) gpd Calculated design flow 3.3CD gpd Design flow provided :�pd Plan: Date O Number of sheets �_ Revision Date Title I �- Descriptio of Soil(s)O'- �~ 3ln" o�vt t c t s s� , to"- t". 0,La 13Zh Soil Evaluator Form No. Name of Soil Evaluato P S p rl Date of Evaluation 11-7,5—OQ -�jo51 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of r not to lace the system in operation until a Certificate of Compliance has been issued b the Board of Health. TITLE 5 and further agrees p y p p y Signed C- Date la- 16-_! Inspections '' da— /7�4?7 FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 as " TOWN OF BA.RNSTABLE LOCATION �ncra .&zze Wla-t4_ SEWAGE # VILLAGE [� ASSESSOR'S MAP & LOT 37- 06 - qC INSTALLER'S NAME&PHONE NO. .�C SEPTIC TANK CAPACITY 0 0 11 LEACHING FACILITY: (type) 40,u (size) J-/ST-*y, NO. OF BEDROOMS 3 BUILDER OR OWNER J^ - 17 C 14,4 4;L PERMITDATE: Z -It,- COMPLIANCE DATE: $ L 29 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 No.� �—t� 3 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH V/ OF i4 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( Rcpair ( ) Upgrade ( ) Abandon ( ) - Complete System ❑Individual Components v � �L-i m eo 66 cr's Name r _r Map/Parcel# Iles � .��Vtt# � " � " rc4'�p oh nc# IQcQv� r Inf l ue P i o n V C9,o IN rLnstarllers• cNai Designer's Name ail.©. 6 B o c1a INIQ �C06V 4`tj � Vres' Address�Idepphone# Telephone# Type of Building: _ 4�`"* . Lot Size 1),153aera-S Sq Dwelling—No.of Bedrooms 3 Garbage Grinder ( ) ' Other—Type of Building , No.of persons Le Showers ( ), Cafeteria ( ) Other fixtures 1 f Design Flow(min. required) 55 gpd Calculated design flow _3_3®gpd Design.flow provided - pd Plan: Date D Number of sheets —1 Revision Date ,, Titl Descriptio of Soil(s)O`- D;• `"' `;=s3lp" civL,c.� Srrc+�� "- u 9 (6M' �3Zn 5 �-- Soil Evaluator Form No.' Name of Soil Evaluato , & ' '`y Cvw�-G. Date of Evaluation 11-ZS-CIj DESCRIPTION:OF REPAIRS OR ALTERATIONS` f 4 v The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of -'4 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. i 4 Signed V0 Date ID '- IIL-7 7 _ / Inspections - .� 1 a- /� Nf . y FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 `No.97- 7/ THE COMMONWEALTH OF MASSACHUSETTS FEE / O a BOARD OF .HEALTHv�" X CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage D sposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: 1 at t has been installed in accordance with the provisions of 310 CMR'J5.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date ' 2' 7 The issuance of this certificate shall not be construed as a guarante that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 -----o-u- °-- ------® a No. THE COMMONWEALTH OF MASSA U- SETTS FEE DO BOARD OF U1EALTW DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an indiviabal sewage disposal system at q as described in the application for Disposal System Construction Permit No. / Z- 7 f dated Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met. Date Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARREN rM PUBLISHERS- BOSTON SYSTEJ P a FILE NOT TO SCALE TOP FNDN. FINISH GRADE OVER FINISH GRADE EL . o ry FINISH ,GRADE FINISH GRADE OVER DIST, BOA' OVER TRENCHES ''�� W poa fi"r .- %'?, o SEPTIC TANK ai, 12" MAX. 'I 4:0 0 .4 vQ d c44. w �.i,� :O�.'16 4'::Q.o�ti�n a:/nI>.p+�4C+w►.�•. ! .'8'ti4. r aQ :a a.o'• . d �' °•P. ___ a 6- OUTLET PIPE LEVEL TOTAL LENGTH OF TRENCH z �' 3 ° FOR 2 FT. MIN. DODO ' ''p :D ® ® Osa + •w. •: -D.. .e •:v• :b' n •o .o• y ��� 00 ,0 o•q�' �!�� 6" � 00_ op. eY o• •,p,4, •.*, •p�•e�o$p :e°dad: D C. I. OR PVC TEES b° �7`' f6 g4o00 • ,o�• •p � Gi f ..- 0�80 0 .1500 GALLON b4: DISTRIBUTION0 ' BSM T FL . e °'v o !. p %- ' dN S TAL L ON LEVEL BASE �� EL . _ o a'Q. 500 GA L L ON DR YNEL L S PRECAST CONCRETE 70. ob H-1. 0 REINFORCED a a: ao 4.OID'o.,•ov,:yo•.bd'�'•n 'd•;:O:b.:tx•�'�':4b.b' D�:A'p'�o'0'' °.4 Flp' •d.e A••o,.'v • .p•° .p° •D..o:s. .Q' ri;Ob. :9'A' p.4: SEP TIC TANK TRENCH SEC TION INSTALL ON LEVEL BASE NOTE: EXCAVATE TO ELEV. 1114 OR L OWER TO REMOVE ALL IMPERVIOUS MA TERIAL BENEA TH THE LEACHING AREA 4" DIAM. 12" MIN. REPLA CE EXCA VA TED MA TERIAL WI TH 3" OF 1/9"-1/2" CLEAN, CLAY FREE SAND a.: A: b o:6, •�. � } 0 ., ,o,r °•° WA SHED PEA STONE .0'• 0• 41'• i 3/4" _ `1-1/2" WASHED CRUSHED STONE13, �� ��, (A• r�,,,.:.,� GE ERA L NOTES TRENCH WID TH 1. ALL EL EVA TIONS SHOW ARE BASED ON ASSUMED NUMBER OF TRENCHES •,,1 2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON NUMBER OF DRYWEL L S 2 FRA ZIER WAY OR SCHEDULE 40 •PVC. OBSER VA TION PIT .3 THE BOARD OF HEAL TH MUST BE NOTIFIED P-9057 -- N 12.45'00" !y d WHEN CONSTRUCTION IS COMPLETE PRIOR &pA 12 .oo TO BACKFILLING PERr,O,A ,IG,'V RA TC-.• 4. ANY CHANGES IN `THIS PLAN MUST BE APPROVED <2 MIN./IN. BY THE BOARD OF HEALTH AND CAPE 6 ISLANDS WITNESSED B Y.• SURVEYING CO.. INC. GERRY DUNNING 5. MA TERIAL.S AND INS TALLA TION SHALL BE IN COMPL IANC8 WI TH THE STA TE SA NI TARY BARNS. BRO. OF HEALTH DESIGN DATA _ \ CODE - TITLE V - AND LOCAL APPLICABLE ry.�� DATE.• NOV 25, 1997 Z 3 - ' _ o�' RULES ANO REGUL A TIONS — — — — —'•� �a 6. NORTH ARROW IS '"ROM RECORD PLANS AND y - _ __ __ y NUMBER OF BEDROOMS 3 IS NOT TO BE USED FOR SOLAR PURPOSES NO r �^ s�n s GARBAGE DISPOSAL C (NON-HAZARD) d , �. r� 330 GAL .' 7. FLOOD HAZARD 'ONE. DAILY FL Ol�✓ � B. WA TER SUPPLY7 OWN _ _.____ �y 1500 GAL ; w SEPTIC TANK PEG D. _ «k �. .4500 GAL . • • ���I SEPTIC TANK ,PROVIDED LEACHING REGUIRED 330 GPD. rr N G 152 WALL AREA 152 S.F. S.F.X G/S.F. = 112 GPD. B 7 S.F.GE �OM AREd 243 S.F.X ' G/S.F. GPD LEACHING PRO VIDEO —`�5 GPO PROPOSED EL EVA TION —— 7 —— EXISTING CONTOUR SINGLE FA MIL Y RESIDENCE csr A OB SERVA TION PIT ci DISTRIBUTION BOX PROPOSED SENA GEDISPOSAL SYSTEM yF r f^ sN \ \ 3$ e"E f,rh PREPARED FOR 1,33 298 .20 5 16 ® o SEPTIC TANK F� t ° x �a � � 5—D CONSTRUCTION M>f s �' LOT 5 (HOUSE 54) FPA ZIER WAY RESE,A'VE AREA d °F ' CO TUI T — BA RNS TA BL•E — MASS Ix DAVID �^1 r` PIPE INVERT EL EVA TION CH � A., SANICKI DA TE:_�,. ; i 7 PLOT PLAN �0� I CAPE 6 , ISLANDS ENGINEERING SCALE.• 1clar���° ��G, ' SCALE AS NOTED 133 FALMOUTH ROAD — SUITE 2E MAMASS. ..... MAP SEC PCL v EE, L OT HSE ' �o P. . v. _.,.,.. LAN NO � 97 - I