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Home My WebLink About0429 SAMPSONS MILL ROAD - Health ��,429�Sam �'� pso� Mill Road ��,C O tU It� ',��,,rr��;y��rv�o..' � l 7y°",, x,° 7,{ .f � ' ''��1� �ti � "�039��'�l� ` No. V[ L4 Jae THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH / O F A-1Li✓ L� V APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (� Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System []Individual Components LLocan / Owner's Ame Map/ r�rcel#S2� Address I UZ�T1� 'Lot# elephone# V Installer's Name 41 De' n is Name L7—s dress I, a Telephone# elephone# Type of Building: Lot Size I, V" Sq.feet Dwelling—No.of Bedrooms \J Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required)-,T-fo gpd Calculated design flow J30 gpd Design flow provided 3 7(,gpd Plan: Date VL l/V Number of sheets Revision Date Title —77 C. S_ ,� Description of Soil(s)— Soil Evaluator Form No. Name of Soil Evaluator 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 a?furtheagre s top ce the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Z- FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No.io�P�064 TO THE COMMONWEALTH OF MASSACHUSETTS FEE /1119 BOARD OF HEALTH OF AA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application fora Permit to Construct (� Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components 1 7 ca[iop Owner's 4ame � SY Map/jfarcel# Address ' �' •Lot# Telephone# / '" Installer's Name N De'gn is Name jig ' ^I.p , G ddress I " Telephone# Telephone# Type oftBuilding:_ ' Lot Size Sq.feet ..•+�= Dwelling o.of Bedrooms Garbage Grinder ( ) ` Other—E,Type of Building No.of persons Showers ( ), Cafeteria ( ) t 'Other fixtures Dest n"Flow(min.required)-a-j gpd Calculated design flow �� gpd Design flow provided 3 gpd Plan'13ate -P-Z• Allu Number of sheets Revision Date �✓ /IF" T1t��- .., ! Dscription of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation ' p p �ti• DESCRIPTION OF REPAIRS OR ALTERATIONS x The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further ag s top ce the system in operation until a Certificate of Compliance has been issued by the Board of Health.'- Signed Date /Z�! z� i -FORM 1 - APPLICATION FOR DSCP 4 DEP APPROVED FORM 5/96 ` ~" ,No. THE COMMONWEALTH OF MASSACHUSETTS FEEO�} 9,49 / 4�BOARD OF HEALTH r' CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ]Complete System ` The.6deerrsigned hereby certify that the Sewage Dis�p.-osalSystem;Constructed( ),Repaired( ),Upgraded( ),Abandoned( si ) at /K - to li 1` 7710- �F has been installed in accord nce with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application IV 7,000 " ,ated /j ! Z4%t&Approved Design Flow (gpd) Installer r l i i Designer: Inspector "� V. Date (� +� The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 -CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 -- .-m-_. -- ------ i No. 0¢4Vdd��THE COMMONWEALTH OF MASSACHUSETTS FEE I-e4rx-pt` ) PR N2 Z—" OQ:> Sr BOARD OF HEALTH DISPOSAL SYSTEM^ CONSTRUCTION PERMIT Permission-is-hereby granted to onstruct Repair { ) grade (/ )� nd ) ual sewage disposal system at described in the application for Disposal System Construction Permit No. �` �,dated Provided: Construction shal be completed within three years of the date of this permit.All local conditions must be meth Y, Date 1// r� Board of Health v � FORM 2 - DSCP DEP APPROVED FORM 5/96 .� i i FORM 1255 (REV 5/96) H&W HOBBS&WARREN rM PUBLISHERS-BOSTON TOWN OF BARNSTABLE 9C LOCATION �`�`y//7 >��f�s„ / �/ ,�� SEWAGE #AW4-V_ VILLAGE ASSESSOR'S MAP.& LOT 0P. -A.2 INSTALLER'S.NAME&PHONE NO. 6 i��d�>I, ixso_s n c�ed. 40S-71.74 SEPTIC TANK CAPACITY /scud ell LEACHING FACILITY: (type) Sad? 4f 6) (size) ,V X 3g `X. 1 NO. OF BEDROOMS .� BUILDER O OWNER a V PERMITDATE: . - COMPLIANCE DATE: �6 1 0 ,21-I 00 Separation Distance Between e: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S� 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 -);60+J 4,?,f /Ear „r aLit" 3, JOB •` a /sue TOWN OF BARNSTABLE 9C LOCATION ✓d7 ��a�n/&�h ,�� SEWAGE # 20W-(�5�6 i L VILLAGE ASSESSOR'S MAP & LOT 039-1f.2 INSTALLER'S NAME&PHONE NO. ".;4 SEPTIC TANK CAPACITY /sad G-1 L LEACHING FACILITY: (type,) r-V Cw e,WA-! (size) oV X 3d 40 NO. OF BEDROOMS BUILDER O OWNER E V PERMIT DATE: - COMPLIANCE DATE: 6 l o ,1'I 00 Separation Distance Between e: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility =S� 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 -/,6wj 4 -e -------------- Roar do 6.. 3' ,b 40'' i TOP FNDN = 43,25' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO - ENGINEER: A.H, OJALA, PE R�tE as 42�MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE DONNA MIORANDI, RS 2% SLOPE REQUIRED OVER SYSTEM 42.i) ] WITNESS: I RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 5/9/2000 40.C - FOR FIRST 2' / PROPOSED 1500 PERC. RATE = < 2 MIN/INCH AMA 3' MAX. 0 GALLON SEPTIC 39.5' 39.0' CLASS I SOILS p# 9743 39.75' TANK (H- 10 ) GAS �38.BAFFLE 39.0 �� - o en a a 0 a o r 1 o y SIN a 38.17' M [O 171 CO CO F--I = COO o t2.25'TOLNDS � LOCUS 2 % SLOPE) 6" CRUSHED STONE OR MECHANICAL Cl = = Cl (� M � O [� ""IDESELEV, Q ELEV. COMPACTION. {15.221 [2]) �8 2' 0 0 0 0 M � � M 00 36.17' 2 DEPTH OF FLOW = 4 ( % SLOPE) 0 Q 4Z.Z 0 41.5 TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE 0/A/E 0/A/E INLET DEPTH = 10" LS/MS LS/MS / OUTLET DEPTH = LOCATION MAP NO TO AL 14" 10YR 22 10YR 2/2 5•97' 5" 10YR 5/2 4" 10YR 5/2 FOUNDATION- 10' SEPTIC TANK 15' D' BOX - 12' LEACHING BS B ASSESSORS MAP 39 PARCEL 152 FACILITY LS 28" 7.5YR 4/6 39.87' 24" 7.5YR 4/6 39.5' ZONING DISTRICT: RF +38.02 Cl YARD SETBACKS: Cl i FLEV. 30.2' M/COS & M/COS & FRONT = 30' 39 GRAVEL GRAVEL SIDE = 15' CATV PEDESTAL 40 72" 1OYR 6/6 72" 10YR 6/6 REAR = 15' ' - 00 +40.79 CONTRACTOR TO CONFIRM SUITABLE SOILS IN PLAN REF. LCP 36608 C o � AREA OF LEACH FACILITY PRIOR TO C2 C2 FLOOD ZONE: C 39.16 A1' LOT 61 CONSTRUCTION OF ANY PORTION OF SEPTIC SYSTEM AND DWELLING M/COS M/COS M �-42,02 -_�_ 2.5Y 6/4 �6p 2.5Y 6/4 40.1 .52 37. C) M Q� TH2 ® � �`� 144" 1 30.2' 132" 30.5' NO WATER ENCOUNTERED NOTES: IT +44.38 SEPTIC DESIGN: - E NO Y ALwv;E- A.PPROVIMATEn FROM OUAD MAP 3 .38 8.92 op I f 1 (GA for •c vISPOx? I� i)A(lily: _- 110 330 AVAILABLE ( ) 2. MUNICIPAL WATER IS i �• �.32. ► I +o.00 DESIGN FLOW: 3 _ BEDROOMS GPD GPD +41.41 USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o +40.87 0.00 SEPTIC TANKL 330 GPD ( 2 ) = 660 4, DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 5. PIPE JOINTS TO BE MADE WATERTIGHT. PROP 3 BR TH1 w USE A 1500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 0 57 38.06 W i ! DWELLING 42 LEACHING: - ENVIRONMENTAL CODE TITLE V. i SIDES: 2(30 + 9,83) 2 (.74) - 118 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE +41.05 +4 10 b 30 x 9.83 74 - 218 USED FOR LOT LINE STAKING, BOTTOM: (' ) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. TOTAL: 454 S.F. 336 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT +40.13 �, �.` DECK USE (3) 500 GAL. CHAMBERS (ACME OR EQUAL) INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. WITH 2.5' STONE AT SIDES AND 2.25' AT ENDS 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE +44.45 LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR 37.0 54 ` ,� ,� TO COMMENCEMENT OF WORK. +40.54 ° LEGEND TITLE 5 SITE PLAN UT ITY CLUS R ' ELE TEL +4 ,51 100.0 PROPOSED SPOT ELEVATION OF -}-38.86 � 100x0 EXISTING SPOT ELEVATION 429 SAMPSON S MILL ROAD IN THE TOWN OF: 0 0�, LOT 50 LOT 35 100 PROPOSED CONTOUR 20,000 SF (COTUIT) BA RNS T A BLE ' + 84 \ \ -- 100 EXISTING CONTOUR PREPARED FOR: ELAINE 11lUZYK +41.73 +37.6 20 0 20 40 60 B� 'M OF HEAT +39.12 MA = AUGUST 22, 2000 APPROVED _ DA`. SGALE: 1' 20 DATE: .40.00 LOT 51 BENCHMARK: CONCRETE BOUND ELEV = 40.00' o(1 508-362-4541 g fox 508 362-9880 +39.88 �OF M tH I OF . .P` SS ` MqI J9C down cape engineering, Inc. / � ARNE H. J, �` AHNE 1 OJALA OJALA CIVIL ENGINEERS CIVIL ^ No. 263 ,..,. LAND SURVEYORS A�oF q£ Ro " s��f ST0k � 939 main st. yarmou , ma P.E. P.L.S. DATE --08 1 Ath 02675 7 s H.^OJALA, ,