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i T4E COMMONWEALTH OF MASSACH SETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Migpogai *pgtem Cougtruction permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. r 61441 1� Owner's Name,Address and Tel.No.
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a� �y ove o.16ss
Installer's Name,Address,and Tel.;No. ,4/�/�— Designer's Name,Address and�el.No.
JIP
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )n
Other Type of Building No.of Persons oC Showers Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this B Heal
Signed A Date 7- 9—
Application Approved by
Application Disapproved for the following reasons
c
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( )on
by for
as construced in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. " dated °'Ax—
Use of this system is conditioned on compliance with the provisions set forth bel w:
7S �TSTHE COMMONWEALTH OF MASSACH — s
PUBLIC HEALTH DIVISION -TOWN OFIBARNSTABLE., MASSACHUSETTS Rz
0(ppricatiott for )DigpogaY *pgtent Congtruction Permit ,
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No.. Q � Owner's Name,Address and Tel.No. o /l
Installer's Name,Address,and Tel.;No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other , Type of Building No.of Persons o? Showers(.,) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in,accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this B Heal r
Signed 4_ n Date 7 1` !Fc
Application Approved by
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE-,-MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( )on
by for
as construed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. '"' dated G'-l—. 6'
Use of this system is conditioned on compliance with the provisions set forth bel w:
00
AYRNo. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
wigogar 6pgfem Congtruction Permit
Permission is hereby granted to V)fllf A 4,, `
to construct( )repair( )an On-site Sewage System located at
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within two yeaYs of the date below.
Date: 7 Approved by
GENERAL NOT=5: n ! -1
;�q` ACCESS COVERS MUST BE WITHIN /NVER T E_EVAT I0NS: DES I GN CR.' �R.l A:
1. THIS PLAN IS FOR TH• DESIGN AND CONSTRUCTION J. e•OF FINISH GRADE k R•MINI.". INVERT AT BUILJl NG: 105 -D_ DESIGN FLOW:
J'MAXIwUII COVER INVERT IN SEPTIC TANK: 104 50 _3 aEDRooMs AT I LO-o.P,D. PER
� THE SEMI#'Dl dro$AL SYSTEM ONLY. � - ��i/R$i 2' 10 __
BE LEVEL MIN z• of vEASTONE INVERT OUT SEPTIC TANKL 104 25 BEDROOM EOU'.:LSv.G P.D.
2. AU CONSTRUCTION METHODS AND MATERIALS AND -- -
COWORMATO OF THE SEPTIC SYSTEM dDALO EO PVC - }� INVERT IN DIST. BOX: I04.00 BOA"
TO LIN RE ULA T/7CE 3 AND COGC SCHEDUL �' (--- WASH- / //2'DIA. ` _!!O GARBAGE GRINDER
BOARD OF NF4TN REGULATIONS. I - .j5 lOJ�3 T2— I_ WASHED STONE - INVERT OUT DIST. BOX: .�OJ:BO__ ..
:! ?1dLtRilR}yd. INVERT IN LEACH CHAMBE .10J.50 .
�.__.—
L_—_ SEPTIC TANK REOUL45U:
J. ALL SEPTIC SYSTEM COMPONENTS COCA TED UNDER rL DMRET J-1'X'e'FLOWOlFFUJOR9 BOTTOM OF LEACH CHAMBE L_ -
1RRMidR --.A_--. _I"_G.P.D. .t' 200x - 660
AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER !O'Y/N. 1500 D-BOX W/J' dTONE AROUND. ."UNDER GAL.
GAL \ ADJUSTED GROUND WA TER: N/A
TIAAN J• IN DEPTH SHALL BE CAPABLE OF WITH- SEPTIC TANK d'CRUSHED$TONE BASE --- SEPTIC TANK PROVIDED: lS00 GAL.
STANDING H-20 RHEEL CORDS. £ OBSERVED GROUND WATER: N/A_-
w. _ BOTTOM OF TEST HOLE: 96 5_ SOIL ABSORPTION SYSTEM REQUIRED:
4, ALL OVEER PIPE SHALL BE SCHEDULE 40 OR PROF I :NOT TO SCALE ' DESIGN PERC .RATE -_+-_ __MIN/INCH
APPROVED EQUAL. .' `
SOIL TEXTURAL C,'ASS -_L
3. BEFORE CONSTRUCTION CALL 'D/O-SAFE•. - EFFLUENT LOADING RATE -0.74 GPD/SF
/-C�0-J22-b41 AND THE LOCAL WATER DEPT. - .�330 GPD /-0-7'Q GP:.'SF -4_S.F.
folP�.KAT/ON OF UNDERGROUND UTILITIES.
�. ,�-`• cry? E� N ;�:
6. VERTICAL OAFLW.IJ: ASSUMED w i. • :. PROVIDED: 3-4'x &!_F;owQLEF_f=RS W/.7__
STONE AROUND. I' UYDER. A-460 s F.
' •7. FOR BEND/MARKS SET. SEE SITE PLAN. (
1
S. -NO DETERM/NAT/ON IHAS BEEN MADE AS TO - �I Fj
COYPUTANCE w/IN DEED.RESTRICTIONS OR ZONING O.-T/1 LANE 'r, - SOIL TEST -! T DATA
REGULATIONS. IT$HALL REMAIN THE CLIENTS
RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL 4 n; - - G,3 INDICATES - IND/UTES
_ _ ? (Op; PERCOLATION OBSERVED
PERMITS. VARIANCES ETC. FOR THIS PROJECT. •' +' S6 TEST - GROUNDWATER
9. EXISTING CESSPOOL TO BE PUMPED DRY AND �,.y,4 ' �' •'PA/
BACKF/LLED.. $ - T�. ,DP WAtt o m-aLL I : GRND EL.
G.W.EL A:'A
$89.45-50-E I /00 00 •.4
0. HORIZON TExrIRE 106.5
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16021i1 S.F. ,I ]-�- . 106.J
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. - W I 'n. / I: -..� ;, ;a� ,, 4'•L I DATE:DECEMBER 21.
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TEST 3Y,STEPH6H HAA S_ _
WITNESSED BY:ED B.,RRY
o I Mwe,cd O +r` PERC .RATE: C 2 L..N/UICH
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LOCUS MAP e Io z0 4n JBNO: 95-J5B FIELD:RVB,•PDR CALL SAH/CFwj
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