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I� , , - , ­ , V 1,101, `11 o, . skof"-� , ­­ -: ,, -1:,-�� ,­,�,'4� §7 1 - �_- _1� .- ­ , , , - , - , ol_;.�,�,, , �,,,, I 1, ,� - 4"', , �, �:�, ,� � :�,,,� '��,� _1�11!11,�_ ,, -,",K�,_� - ,,, �', 1_�";, toy ,46 � �1'i`�';��`__,_,�"_ �,,Ilrl: ,�,. ,�� ,,,­., ,, , ,,,,,, I 11� �-,,,,I,,,i,�lx;�:�"',"','. -��,!,��,:� "I� ",",� , A j', ", ,�:_', " 50 1 ;AI Q"I - . - - � - "Z� _,;, - J TOWN Or BARNSTABLEs LOCATION Z, t /`12 /-Prc kP (.(1 SEWAGE # 90 �q VILLAGE W, ASSESSOR'S MAP LOT �INSTAI.LER'S NAME PHONE NO. 1-y4n P, SEPTIC TANK CAPACITY /00 M LEACHING FACILITY:(type) /ooc, ,L (size) x . �NO. OFF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER_ 6r��r� DATE PERMIT ISSUED: —:2?- 9/ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No S,fraa t y 1 r r \ 77 1 ` 01 1 NAO.-V ........................ THE .COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 5"%OceJV ...........OF.... .................................................... f . Appliratiun for UhipmFal Workii Tatuitrnrtiun ramit Application is hereby made for a Permit to Construct (,K) or Repair ( ) an Individual Sewage Disposal System at: e 1 .......... -�d ... .. CA.'.0 1 1 Yt'..0j r ��_ ........are a,....&)v........................ `_Location-Address _ �'. or Lot No. . ...................•----=----........... __. its!` f-1��L�- - .......... ner `�-_ _ Address _.. . V f..r lrrrt� c ...................................................... .................. Installer Address Type of Building Size Lot.... ....Sq. feet V Dwelling—No. of Bedrooms----771.e e.in%......................Expansion Attic jam) Garbage Grinder (4 0) '04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ---------------------------- W Design Flow................................... ..gallons per person per day. Total daily flow----------------------------- WSeptic Tank—Liquid capacity.iLSW.gallons Length.--lair.... Width.'.`-_lb". Diameter________—--- Depths`_.Je_ x Disposal Trench—No.--_-------_--.---. Width..i................ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......0nti ..... Diameter..... Depth below inlet..... ........... Total leaching area._;-?.7....sq. ft. Z Other Distribution box (X) Dosing tank ( ) 14 Percolation Test Results Performed by..Ae-s l-...eldt. 4X_.'..._M®py ................... Date...!®AA_7............... a Test Pit No. 1......Zv......minutes per inch Depth of Test Pit..../5.......... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wat ------OF off _.__ a ----------.-••--••-------•----------••--....•••-•-•••---••••-•---••--------------------------------------------------------- y 0 Description of Soil------a- -�--z--�---.Tray..�... --------------------------------------------------------------------- v t'CY1c ./.. ..- ...s��. r a.:v . .t.l t-. ... 2 ------ALLM*----- W ------------------------- ----------Y3-j_A.o-----cxc l---1 ---------------------------------------------------------- muLSQN------ A U Nature of Repairs or Alterations—Answer when applicable. No.30.1. O -----. ------•---------------•---•----------------------•-----------•--...........------.................--•---------•--------------------------------...--•--•-•-••-•-----. ej Agreement: s The undersigned agrees to install the aforedescribed Individual Sewage Disposal System ' acc a with�"�`yo the provisions of iIT,IE 5 of the State Sanitary C de—` The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee s by theboard of he th. Signed --------------------- Date--•- 7�y _.. ApplicationApproved By.... . --- -- --------- - --------- --....... .-- ----- --------------•-------------•----------- Date Application Disapproved for the following re s:.-------••-•--••--•••---------•-------------••••-••-------•---•-•------•-•--•-•--•--•-•-•-•--------------....._ ... — —....... A Date Permit No. ._.. - -•-.. Issued.... No. ..� � �' Fss... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...----..�rwa..................OF....Ae,?P./K. ApplirFatiun for DinpunFai Works Tunitrnrtiun Vanfit Application�iss hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. K W ....G 1cc"i.L�r�cr... sa eFa:.._..---•--...�� .............. ... va lzr...._f..�i// .......................................................... Address 1.4 Installer Address pq UType of Building Size Lot----- d.._.Sq. feet 1-1 Dwelling—No. of Bedrooms..... ......................Expansion Attic ( o) Garbage Grinder (i(fgl Other—T e of Building No. of persons............................ Showers a Other—Type g --------•-•-•-----•--------• P ( )--- Cafeteria ( ) Otherfixtures .-------•--••-•-•----------------•-•-..........------..-•--....---------•••--•-•-•-•••------••--••-•-••------------- -_--•- Design Flow.................................... _$..gallons per person per day. Total daily flow-----.--.-.----.._-------._-;�k3._gallons. W WSeptic Tank—Liquid capacity.1.6CO.gallons Length.E_:.&..... Width.4.. Diameter--- Depth S_..__ .�`. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ Diameter.....1.0......... Depth below inlet._.._4P.......... Total leaching area...a4!.Z...sq. ft. Z Other Distribution box (X) Dosing tank ( ) aPercolation Test Results Performed by... c.vy....Ve/ez �C...9...Ale f t*teu............. Date...la�.% .............. Test Pit No. 1......Z.......minutes per inch Depth of Test Pit....IS.......... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w ......... P4 ...........r•--•-•-••------•••-••---......---•-•_..................................................••--_ ,OF M -- 0 Description of Soil....... 2.y�..�. o £ Ssl.ka�cai-............................................................ -----------•-----------•-•--- . -------•---••---•----- ti�;� � STEPHEN �G - (� z I- f�k'1teQ_�..Ftt7e� ''c�►31�._..tc� Y �Ced 5.1 ........ Att�i�F....... - ---------------------------------1. ..-.1 _l_� .-..M.cat- anc ..................................................... ...... . 14 U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------- Na0216 -------------------------------------------•---------....-----------•-••--•-••-•--•--------------------------•-------------------------------••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal e in a nce with j/Wp the provisions of TITLZ 5 of the State Sanitalbeei de The undersigned further agrees not to place the system in operation until a Certificate of Compliance has by the and of health. Signed ------ -------•-•-•---------- •y ......._.. . . © Date Application Approved By.... -- .. ---------- -- ----• ........................................ Date ....Application Disapproved for the following teas ...................................... .........-•---•---------•----•--------•-----••---- •-•----------•---.....•---•-•-•------•--------------•-•---.........----•-_------------------............. ..•--•.........Da......---•--•--- te 0 Permit NO..- , n�......................._ Issued._... - 4. o Date THE COMMONWEALTH OF MASSACHUSETTS ............��(/().. BOARZlq .��a��.��................. / � .OF...... Trrtifiratr of (SautpliFaatr�e TH�S I 0/C RJ IFY That /h�ej�Indivyi�dual ew(a e� isp sal Sgs�)tm c structe/ or Repaired .......!!'!L�! t ..... � k•�•: OC--� --° !L/- _\ __... A.: f.11._...................................... q. 7._...... l�?staller--------------------------------------------- --------- -- has been installed in accordance with the provisions of TIT 5 of Thf State Sanitary Co a�sd i ed in the application for Disposal Works Construction Permit No..__. .Q' off. Y . ._.. dated-...� _ ___._................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CON Rll AS A GUAR EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .._._..�.-" "4:: 4 ........................... Inspector..-- ----•--•---------- . .......-- THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH9L 1OF. ... ./.. ............ //�� 0 " /", FEEL../ No.qV-. . ............ DiupunFa1 Works %unutrnrtivat r rrntit Permission is hereby granted-----f. �....e— .�- Co........................................................ to Constr ct or Repair/j� an Individ al S vva e Disru S sj �j at No......- ( -••� _ �. -�./F0 ... yJ�►/D !`! ................. eet as shown on the application for Disposal Works Construction Permit No..- _ Dated.... ..0 ......... ..................................... t ......................................... Cy o rd of Health DATE................... )rf... 7• 2--•---......_......_... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS a ClS TVD ON PUW NOTES: 1. ALL WORKMANSHIP AND MATERIALS OTtFORM TO D:EQ.E 10'mmum TITLE 5 : THE TOWN OF �a� �'� RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE: T.O. Tw AND THE REQUIREMENTS OF THIS PLAN.VOL r { �--�" 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO M WITHIN 12- OF FINISHED GRADE. 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE ro Tpt ' �.sm. 40 PMC SHALL BE MORTARED IN ,PLACE t 4' PER R. M41,PITCH A? OW 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE y e� oil now uN¢ Y LATER OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDO.OR , tw ��lone WITHIN 10 FT. OF DRIVES OR PARKING AREAS- H-20 LOADING w 3 SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR r M+f .• +� r E.33 S PARKING. 5. CAST IN PLACE CONCRETE TEES ARE SPECIFICALLY DISAPPROVED. uWio ! 3.1 4' - 1 SANITARY TYS WHERE INDICATED ARE REQUIRED. nrorESrVaL DISTRIBUTION 6. EFFLUENT PIPING FROM• DISTRIBUTION 80X SHALL ENTER LEACH PIT .- �+ ,.$. BOX I'1 r_c* THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH MASONRY LOCATION MAP ' + EXTENSION WALL NOT BE ALLOWED. f 0(;OGALLON S TIP TANK L�� G l 7. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED RESMC71ONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL _l a OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. AGE DISPO �IL SYSTEM PROFIT E BOTTOM OF .TEST HOLE if 8• HORIZONTAL AND VERTICAL CON SEE LEVY, ELDREDGE Not To $WE ---�� do WAGNER FIELD NOTEBOOK If CURRENT ZONING INTERPRETATION: DESIGN CALCULATIONS: Y V 1A ! MIN. FRONT SETBACK 3> FEET 3 fc�-~ NUMBER OF BEDROOMS 7 0 \/t� C) MIN. SIDE SETBACK FEET GARBAGE DISPOSAL UNIT MIN. REAR SETBACK 1 FEET TOTAL ESTIMATED FLOW ( A GAL/BR_/DAY X _ B.R.) a GAL/DAY k} 4 REQUIRED SEPTIC TANK CAPACITY GGALr- \ ACTUAL SIZE OF SEPTIC'TANK /' GAL �� c ,`; LEACHING AREA REQUIREMENTS t - �9 , PERCOLATION SOIL TEST LSIDEWALL AREA 2.5 GAL./S.F. �I DATE OF SOIL TEST 1w BOTTOM AREA GAL/S.F. EACHIN(7 CAPACITY (BOTTOM + SIDEWALL) JOIGAL WITNESSED BY L) ! z a PERCOLATION RATE —MIN./INCH RESE VE 2LLE ACHINGSCAPACITY�/?) () O) `jGAL SME OBSERVATION H LE 1 OBSERVATION MOLE 2 ELEV.— ELEV.— BREAKOUT CALCULATION: �y "F �r r Y 00 TOP"s �U$:,()IL -0.00 INE LEGEND: i / t aA40 W/T 0 EXISTING SPOT ELEVATION OOXO LOT I Li� r � �: � t s lf.C' EXISTING CONTOUR --00 --- \ \ [,. t0� GL 1r�gp - FINAL SPOT ELEVATION 00.0 .�r"� FINAL-CONTOUR SOIL TEST PIT LOCATION AT ELEV. 11 WATER AT.ELEV. TOM WATER. W - W�-- 1 SEPTIC TANK L� DISTRIBUTION 'BOX O PRIMARY LEACHING PIT 0 �. N \ y `� WATER LEVEL ADJUSTMENT: RESERVE LEACHING PIT I � I �— r'r _ WATER LEVEL 1 Z2 O R T .� TEST DATE 1 f ti i3Y INITIAL ISSUE � \ "�' o T r \ INDEX WELL BATE INITIAL,ISSUTION B —) n'F 5, >~ WATER lEv£l RANGE ZONE ' DEPTH TO WATER LEVEL FOR INDEX WELL SITE PLAN & SEPTIC DESIGN -.. � FOR THIS MONTH :uAl��` t�L. ;I-La, !�!a - WATER LEVEL ADJUSTMENT ^ Al C14'riol I.,MASSACHUSETTS I to f00f 1 61 14, DEPTH TO HIGH WATER J013 NO:. !�1Y `SPLAN C� STEPHE�J � '. OPEN �..+f PAC � ALIYN APPROVED: BOARD OF HEALTH WILSON N0.30216 40 A�t7 �cIS��`�� 4 /p LEVY, WIM & aAGNE AS5i1CIATO INC. . SITE PLAN DATE AGENT U== >