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KEEPING YOU ORGANIZED
No. 12134
2-153LGN
OREEST FORESTRYRYY MIN.RECYCLED
INITIATIVE CONTENT 10%
C.rcfiod fiber Sourcing PCGT.CONWMM
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GET ORGANIZE AT SMEA ZM
TOWN OF BARNSTABLE 1
LG?CATION 46-11914le /%7// o4ti SEWAGE #
VILLAGE 0 S T nn ASSESSOR'S MAP & LOT 3" O'3_
IN�� NAME&PHONE NO;. e9ld L. /M
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SEPTIC TANK CAPACITY
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{LEACHING FACILITY: (type) (size)
PTO. OF BEDROOMS
BUILDER.OR O WNER / L B' �
' PERMITDATE: COMPLIANCE DATE:
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
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TOWN OF BARNSTABLE
U7CATION ' 1 � � SEWAGE # f
VILLAGE n S VI,1/,140 ASSESSOR'S MAPp�& LOTZ'( 0-,a57
INSTALLER'S NAME&PHONE NO. 7"7S Z '-� C-ow I®
SEPTIC TANK CAPACITY 'I
�/LEACHING FACILITY: (type) C. ,r^�[cxjs (size)L1:�'�
�,,-NO.OF BEDROOMS
BUILDER OR OWNER AP0 '�®r'��
PERMITDATE: 2'r'7'7 COMPLIANCE DATE: 9'
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 'fN�d
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No... 9Z)3 if 'ES.. ....................
THE COMMONWEALTH OF MASSA:^.HUSETTS r '
lq3 BOARD OF HEALTH
.: . - .- .
Sri ApplirFation for Bi_qpnsal Works Tnnitrnr#inn Vamit
Application is hereby made for a Permit to Construct (�or Repair ( ) an Individual Sewage Disposal
System at
. A9.T.. __..- `-.��- ---I��-°��.�.... _... - ---------------------- ................. --..4... ..._....._.. -- -
Loc ion Add or Lot No.
Owner ✓' Address
a .........................
Installer Address
d Type of Bui ng Size Lot.... } _Sq. feet
U Dwelling—No. of Bedrooms_______________.............................Expansion Attic ( ) Garbage Grinder ( )
' PL4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Other,fi tures .
Design Flow_.______.` __________________________gallons per person per day. Total daily flow..__._-_ ____�_� .___._________gallons.
W
R: Septic Tank—Liquid capacity_ ea gallons Length� P___ Width---------------- Diameter------_______--_ Depth................
Disposal Trench—No..........I.......... Width.......0........ Total Length-----:�!�..... Total leaching area3.4?_t o_&___sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below,inlet....._.............. Total leaching area..................sq. ft.
Z Other Distribution box (✓) Dosing tank ( )
~' Percolation Test Results Performed by .................................................. Date....... .......
Z '?W2oj Test Pit No. 1...�.......minutes per inch Depth of Test Pit------ Z_...... Depth to ground
(z, Test Pit No. 2................minutes per inch Depth of Test Pit...._--------------- Depth to ground water........................ .
a ----•- --.._..
Description of Soil-------------------- -•••••--T - ........................tv-•----- I N ..i l..........
x
c,
W ------------------------------------------•----•-•----•-•--------------•-•-•-----•-•-•-•••••••--•••---••-••-•----------•--•---•---••-------•-------•••••--•-•••-••-•--••••••-••-•-•••••-••--•-------•-.
UNature 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 i Ili LZ 5 of the State Sanitary Code—T e undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b iss ed t Board of health.
l y
Signed 'V ------- -------------------•---•------...-------- �(!
Dat
Application Approved BY -----•----- ! -•- -••-• ••-•-•..................•••••-•-••-•-••••-_.. 0 1�
Date
Application Disapproved for the following reasons' __________________________•_______________________._______....................................................
------•-------------•-----••-----•---------------------------......__..••-••-••---••-•-•--••-••-•-_.._.._------•-•-••-•-•-----•----••--••-------••-•--•-•-••-••••-••••--•-•--••-----•-•••--•-•••--------
Date
PermitNo......................................................... Issued.......................................................
t
No................_.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............
.............- v v� - �
OF......... � - ..._........
A VIir ��a :G" �a ° n �a �k Cnxnstnnf enti
Application is hereby'made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at
..... _ — ............. ...................... ••-•--••--••-••.......-•------•---••••-•-•--••••-•--...-----•••-•-
/� / Lo ion-Addr or Lot No. p/�
���• Owner Address
WAm ...tF.................................................................... •-•-•-•-•----------••-•---••••--•-•-•-••------•---•-•-•-•-........._..................._^_'_..---
,'' Installer Address �i..
Type of Building Size Lot... j S_----------
Dwelling feet
V Dwelling—No. of Bedrooms.............................: ............Expansion Attic ( } Garbage Grinder ( )
`4 Other—T e of BuildingNo. of persons............................ Showers — Cafeteria
a Other.fjxtures -------------------------------- -
Design Flow......... ---- ----- _"':.gallons per person per day. Total daily flow............... �'� .................gallons.
W -------------
':
1:4 Septic Tank—Liquid capacity,.('v?.gallons Length`?T�"'--... Width_-------------- Diameter.___-__--____ Depth................
Disposal Trench—l�?o.---------�___.._..._ Width_.__:.` ......... Total Length.................... Total leaching area.�01'6...sq. ft.
Seepage Pit No---_--------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Other Distribution box { ) Dosing tank ( )
t
t-� e ._ Date------. `� q(�
Percolation,Test Results Performed by.........---'------------------------------------•-;-----•------------- - �--------------•-••-------
Zc�z, Test Pit No. 1...v____-__minutes per inch Depth of Test Pit------t�a.....__. Depth to ground waten-N)- ?.t�-C..__.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil '. i h-/......•>... `a`-!-l"----------...-- -- ---L----------....-.....`"-----...-� .... 1�---
x
W ----•••••-----------------------------`........-•------•------------•--•••.._..-•--••••-••••••-•---•----•----••------------•-•-•-- .......................................
UNature 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'i T r.-'p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certincate of Compliance has been issued by the board of health.
Sin -----------------------
-------------------------------------- --------•--•--------•----•------
p D
Application Approved By-•••••-- ----•--•-• ............................................... T .....---------
Date
Application Disapproved for the following reason . ------------------------------------------------------------------------------•---
Date
PermitNo. :............••--•---•--------•-•-•-•-••-•--•••--••--- Issued.................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....................................O F.....................................................................................
THIS 04*1 ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby
( )
-----------------------------------------•..........-•-----•-•---------------•--•-....--••--..--•-•.....
staller'4
has been installed in accordance with the provisions of TI 'T'' 1 j f The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._Q_f_.���9............. dated_--._-_-__-_-_.____--_-_____-_____-_-_-_--_-----
THE ISSUANCE OF THIS CERTIFICATE„,,SHALL N.OT;,BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SA ISF ,CTORY. �; ':
DATE...................................../, -�+� .............4, Inspector......./ ......................................................................
3
THE COMMONWEALTH OF MASSACHUSETTS
s ,
BOARD OF HEALTH
it
....••••....------•................... FEEV................
i
Permission is hereby granted.......... ----- ---••• •-•--• ........................ .......
to Construc or Repair ( an Individu e , Disposal Sys emj/at No. �I��-----••-------jam------ •••- ----••••-.. =
Street
as shown on the application for Disposal Works Construction Pe it No.__. �._.......... Dated..........................................
! x - ------... •---•••-•......----••......_...
2W Board of Health f
DATE................................................................................
,
FORM 1?55 HOBBS & WARREN, INC.. PUBLISHERS
SITE PLAN SNEE r I OF 2
SCALE:
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✓�F_PT/C TiCNK � � I' - - � � �I I li
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o .v Sow/4 '/3"� 20¢•50'
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" . N�F U,9/E',By ,e.E.4LTY C'aRP
Of
o WARWICK
U No: 19771
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S U R,iy�.`�,
�lp�►rm
FOR
REGISTERED LAND SURVEYOR ,La T /5 Z��e/, R P.4 rc�Z .ea ao
ZONE P- C
' TER V/G G E f3/9�f✓�7'.4.ei'E /�1.�1
PLAN REF.
DATE .Qf'�'/1 /R /�-��¢ ►:�./. �/1 ly
51=NCH MARK Dn J /=2` n {'ter H'M• M. YIARWIC. S AS,'OC. , INC.
DO' L.STIC WATER SOURCE "^''U BOX 80I NOR TN FA [ AlOU7h'
I n NE /� •.. 1!['i=f�_L' C /l�!SS. 0 S56 - (6/7) SC� - .6 .5S
i -+_(�D, 70 - --
Pl N v/t 1•v F1_0W CHAMBER
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"FLOWDIFFUSOR' 'A4MERATIOLN., CH.AaHER OR EQUAL
___' NOr r,O SCALE I"
�i^ I�71-
��REAKOUT FOR ADDITIONAL
FLOW IF REQUIRED
A--� � =' --,r= I-�= r _ INSPECTION COVER DETAIL
_ _I =
a a° NOrt I. 5000 PSI CONC® 28 RAYS
2. DESIGN LOADING 600 PSF AASHO H-20
_ %4.r SLorso 24"O/ IWEIGHT 2400 LBS.
REINf. RIO
SNC TION A A AL V LIFTING HOOKS SECTION OB '
4ALE KEY FEMALE KEY
MALE
® �-6 CONNECT/ON ® KNOCKOUT FOR TRENCH
FEMALE INSTAL L AT/ON
CONNECT/ON KNOCKOUT FOR BED EARTH BACKFILL-2 Ygoro;
3l, 1NSTALLATION _' WASHED PEASTONE FRE
l3„ r Of IRONS,FINE
S AND
. 2 � I 4"CLEAR 4T' DUST /N PLACE.
7S%29 -Y4"ro 1%2"WASHED CRUSHFD
O !•61 O 1�l FLOWLIN£ C3 C3 ' STONE FREE OF IRONS,
g�{ 12„ alb q 0" ,�� FINES AND OUS 1/N
5`2 T�, PLACE.
T, dE 1/VSTALLED ON STABLE .BASE MIN.
EFFECTIVE WIDTH
-GROUND WATER-�`--1-
T YP/CA L PROFI L E
�L• ZI CJ /ON STD. LL WGT. C/ MH COVER
ZO-o ZD•v
ZO•�7 '.
g
"c.1.PIPE NB/T. f/B£R PIPE
OWELLlNG !` 1,•l
T/GHT JOINT$
fLOW
IOT 14
17.78 C.
TEE 17.3 I a o p p
NC. ONC. F W HA Ib•OD
17-A ; STD, PRECAST CO STD. DREGS C
't GAL.SEPTIC TA TYPE OF/NSTALLAT/ON T«NL
a" NO. UNI TS REQ D. ->
SFPT/C TANK TO BE INSTALLED ON /�G �L ID,O
ON Lf,YEL, $rAoLf*ISf 1.
SOIL AND PERC. DATA ;'_$ = TEST PIT NO. I O�� TEST PIT NO: 2
PERC.RATF_ -- MIN. /IN. di
TEST BYRv��
2
' �a�1� J,a�o�l rrlNt% 5s1�1p
WITNESSED BY
TEST•PIT GR. EL.
DATE I o /I`� ', ,�._..�..�.� 1 Z o Ot P�aJ¢Jat� zo
GENERAL NOTES 'Vora: bite. wArE.eG-' • ¢.0
DESIGN DATA sAE
BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM.
DISPOSAL SEPTIC TANK AND FLOW CHAMBERS TO BE STANDARD PRECAST
R£INFQRCED C014CRETE UN
EST. TOTAL DAILY EFFL.�L"GPD ALL SYSTEM COPONE:NTS SHALL BE INSTALLED IN ACCORDANCE
SEPTIC TANK I�a�'---GAL• ..TO .REVISED TITLE' 5 OF THE STATE ENVIRONMENTAL CODE,
SIOEWALL AREAL—1 GAL./SQ.FT, I:NIIIRUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF
BOTTOM AREA GALJSOYT, SANITARY SEWAGE EFFECTIVE ON JULY 1 ;�197T• BOARD
LEACHING REQUIREOZ6�O' SQ.FT: ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE B4
OF HEALTH.
ACTUAL I.FACHNG AREA.
3o1,$cO;FT AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE
BOARD. OF HEALTH SHALL BE NOTIFIED FOR INSPECTION.
PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED OTHERWISE.
uk9:^ asp SAL SYSTE'
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SCALE' AS 1NDICATE'o
- INC.
w Al,,WARWICK d ASSOC.
. C RDA.. R:OI NORTH fiOL AIIOUTN
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I PRoFESSIONAL
ENGINEER MASS. 02556 .(6/?l g 63