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LOCATION , Zoo ®d � / ` N SEWAGE
VILLAGE SSESSOR'S MAP & LOTA���
INSTALLER'S NAME&PHONE NO. :5®8
SEPTIC TANK CAPACITY
!N X/®
FACILITY:
�'
LEACHING (type) (size)
NO. OF BEDROOMS_'_
BUILDER OR O M7/d/
PERMITDATE: COMPLIANCE DATE:
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
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2,07THE COMMONWEALTH OF MASSACHUSETTS •j I FEE
No.2Ae I,,
BOARD OF HEALTH
OF
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Per it to Construct (,Xi) Repair ( ) Upgrade ( ) Abandon ( ) - [-]Complete System ❑Individual Components
Location Owner's Name
2'i f3 ►F 2-S
Map/Parcel# Address
f � Lot# T Telephone#
�.J l C-�� ,�F—E.1?d a)(r 1-1 c—+
In Iler's Name Designer's Name
An f-4
Address Address
Telephone# Telephone#
Type of Building: Lot Size k 05, 2-5-7 Sq.feet
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 gpd Design flow provided==F-gpd
Plan: Date -Z- C L-1 �z I Number of sheets Revision Date tj r
Title '��-G 5 ��.�c. � t� a'h ►-a'T" -7
Description of Soil(s)_ AE j7`:
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation 1� 1 to Z9 D
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 and further agrees not to place the system in operation until a Certificate of Compliance has been issued b the Board of Health.
Signed Date r
LI, 4e
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
` N�o (+'' 0THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH /
--low OF 66404.14
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct (X Repair ( )-Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components
/ r
Location Owner's Name
Z--1%S 4't -
Map/Parcel# LL fy Address
Loi# p Telephone#
f lutr ller s Name Designer's Name r
„ �'3�J' RAriM �lt�7_A/t�MT"1t v
' { Address e Address "t
i
3rz --I tr-"rl f"
Telephone# Telephone#
"r Type of Building: 42'mil+,f lit c-'e_ Lot Size .1 t 7,57`7 Sq.feet
,. `. Dwelling—No.of Bedrooms -cc Garbage Grinder
' Other—Type of Building 0 No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) l gpd Calculated design flow C°a4;2) gpd Design flow provided 1;c;io:::� gpd
- Plan: Date 'a- 1 2-1 lot Number of sheets � � Revision Date N 1 A
Title , 5 ,k Pu*cti.l off' ► a r '7 C, -10 -An
�
Description of Soil(s)_ ---hr
Soil Evaluator Form No. Name of Soil Evaluator • _C45k-" Date of Evaluation 1% !1 c,/"2 a e j
r �
DESCRIPTION OF REPAIRS OR ALTERATIONS
i
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
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.
Signed Date 19/�t/ d/
In e�cations ,('� �P' s • A r?
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 �..-- 1.
No. le)ll D THE.-COMM 1N EALTH OF MASSACHUSETTS FEE
F �� C'�1/►tY OARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑Complete System
The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( )
by: {. .l� a
at
has been installed in accordance with the provisions of J 0 CMR 15.00 (Ti'tle-5)•and the approved design plans/as-built
plans relating to application Nc��rt dated - '' Approved Design Flow (gpd)
Installer � �.47 .� �,�,/�
Designer: y Ins ecto ,I tV. iD le-
The issuance of this certificate shall not be construed as a guarantee that the s, stem will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
- _----------------------- -------------------------------=----- --- -- --
THE COMMONWEALTH OF MASSACHUSETTS FEE
r — I
Z_BOARD OF HEALTH /r
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage
�.µ disposal system at ee7,4.O 4;r�: fas described
}
in the application for Disposal System Construction Permit No. dated
Provided: Constrructi6n shall be completed within three years of the date of this permit? �oco( conditions
must be met.
Date U / "Vol Board of Health LI
/ I/ uI -
FORM 2 - DSCP DEP APPROVED FORM 5%96
TM
FORM 1255 (REV 5/96) H&W HOBBS&WARREN PUBLISHERS- BOSTON
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.`-�M� �.wr —Y
OWN OF ARN�STABLE � 1
SEWAGE hh
LOCATION
V
VILLAGE /
SSESSOR'S MAP & LOT
INSTALLER'SNAME&PHONE
N0. I �a8 CD� '
SEPTIC TANK CAPACITY �'
_ �X/O j
LEACHING FACILITY. (type) �� �YAN, � �,Q.� size)
a _
NO.OF BEDROONIS
BUILDER,QR OW1E �'
PERMTTDATE: _ cv, COMPLIANCE DATE:
Separation Distance Between the;
Maziizium Adjusted Groundwater Table and Bottom of Leaching.Facility
Feet
private Water Supply Well and Leaching Facility (If any wells exist
onrsite or,witlun 200 feet o leaching'facility) '. Feet
:..
Edge:of Wetland and.Leaching Facility.(If.any wetlands exist
wiahin 30q feet of leaching facility)
eet
Furni hed by.
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TOP FNDN = 93.0' SYSTEM PROFILE TEST HOLE LOGS
LEGEND
NOT ALLOWED ., ACCESS COVER TO WITHIN 6" OF FIN. GRADE (nIr?T To SCALE)
SEPTIC DESIGN: ACCU:S COVER WATERTIGHT TO ENGINEER: A.H. OJALA, PE
1OQ.0 PROPOSED SPOT ELEVATION (GARBAGE DtsPos[R Is } WITHIN 6" OF FIN. GRADE }
DESIGN FLOW: 5 BEDROOMS ( 1 10 GPD) = 550 GPD 92 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM DONNA MIORANDI, RS ROUTE 6a
;. 84.0 WITNESS:
100x0 EXISTING SPOT ELEVATION USE A 550 GPD DESIGN FLOW i
y RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 1 1/16/2000 o
100 PROPOSED CONTOUR SEPTIC TANK: 550 GPD ( 2 ) = 1100 90.0' FOR FIRST 2' < 5 MIN INCH
PROPosED 1500 81.0 PERC. RATE _
USE A 1500 GALLON SEPTIC TANK
GALLON SEPTIC W
100 EXISTING CONTOUR 89.75' 89.50LEACHING: TANK (H- 10 ) GAS o oCLASSSOILS p# 9883_� 80.5 ����191 .9 ' BAFFLE 80.77' o0 80.6 2 SIDES: 2(56 + 8.83) 2 (.7? Locus
MINBOTTOM: 56 x 8.83 (.74) = 365.9 ( 2 % SLOPE) �6" CRUSHED STONE OR MECHANICAL 2' ELF/ ELEV,
COMPACTION. (15,221 (2]) �• oTOTAL: 753.8 S.F. 557.8 GPD DEPTH of FLOW = 4� 5o$gr14 $ o� 78.5' Q Q 86.9'
( SLOPE) Q' 85.0 0
USE (8) H-20 HIGH CAPACITY INFILTRATORS WITH TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE O/A O/A
,. INLET DEPTH = 1O" SL
3 STONE ALL AROUND AND 14 UNDER
OUTLET DEPTH = 14" 3„ 7.5YR 2.5/3 LS
LOCATION MAP No SCALE
E 6" 1 QYR 4/1
FOUNDATION--- 10 SEPTIC TANK 156' D' BOX 3' LEACHING 5.5' LS
.goo FACILITY
8„ 10YR 4/2 LS . ASSESSORS MAP 278 PARCEL 49-5
ZONING DISTRICT: RG
BOARD OF HEALTH - B
1QYR 5/8 YARD SETBACKS:
, MA 30" 84.4'
LS FRONT = 30'
APPROVED DATE
BOTTOM TH 1 = EL. 73.0' Cl SIDE = 15'
7.SYR 5/6 '
40" 81.6 LS
_ REAR = 15'
60" 2.5Y 6/6
Cl FLOOD ZONE: C
LS
LS
84" 10YR 7/4
2.5Y 7/4
105"
00 C2
C3
�z l LS LS
4-1 2.5Y 6/4 2.5Y 6/4
o, 144„ 73,0' 132" 75.9'
+J900 ,..
NO WATER ENCOUNTERED
so
/ 92 -,a
94
�99
297.39'
_ v 6.
` �` 787z �o° +79� LOT 7
o. 105,257 SF
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•.66 ® 0 PROP, GAR
w SLAB EL. 95.0' z.,6
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- W 4-05 93 s 98 LP TITLE 5 Sl TE PLAN
96 4 �\ �°� 0�` P\\v�
_9� i 92�0 �gy� of LOT 7 OLD JAIL LANE
V .N&68
p0, 92 $ �;' `L� IN THE TOWN OF:
I a
BARNSTABLE (VILLAGE)
PROP. DWELL.93.0'TF 86 PREPARED FOR: DON AND DENISE ENGEL
Is.w +ea.n � +ecea
30 0 30 60 90
93,$
84
93.0
e �l7.66 Sys, SCALE: 1" 30' DATE: FEBRUARY 27, 2001
Cp Idol 00
B6l�-
.00
80' Q.��
NOTES: SLEEVE SEWER LINE FOR 10' EITHER SIDE OF CROSSING �'
WITH WATERLINE
+
a.6� �tiN Of M,qJ
1. DATUM IS APPROXIMATED FROM BARN. GIS
M OF
2. MUNICIPAL WATER IS AVAILABLE
OJAL.A
3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o.28348
1 _
4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10
' f
5. PIPE JOINTS TO BE MADE WATERTIGHT. AR ALA DATE
L
6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 'WITH MASS.
ENVIRONMENTAL CODE TITLE V.
�i
7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
USED FOR LOT LINE STAKING.
8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
362-4541
9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT fox soa-W-"W
toy Soe 36z-9eao
INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
FROM BOARD OF HEALTH.
10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE
down cape engineering, inc.
LOCATION OF ALL UNDERGROUND do OVERHEAD FUTILITIES PRIOR
TO COMMENCEMENT OF WORK. CIVIL ENGINEERS
LAND SURVEYORS
939 main st. yarmouth, ma 02675
00-316 ;
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