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HomeMy WebLinkAbout0035 ALLAN ROAD - Health 3 5 Allan Road Centerville A= 194— 001 - 003 I 5 M E A D No. H163OR UPC 10259 smead.com • Made in USA 1 0 yu .......W._,... ..: ... ...,......�_..___r:..Y..a..u...r.:.............�s�:.. ..__.-..ray.e.....,.e........u.�w`....:...u..e�..uLia�.t.�._..�...k....m....:�.�....wu�...rw � G v� M S'`' a r b t i Town of Barnstable Regulatory Services Thomas F. Geiler,Director BARNSTABM 9e�A ' � Public Health Division TE01A0�A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 29- of Designer: F �ly� Installer: /XI IC Address: Address �j_ °yam/c�.������3 r✓ �1Z��v On A 0 was issued a permit to install a (date) (installer) septic system atJ��L.�J�✓Ul0 �Y/� based on a design drawn by (address) An dated 1— 2-a (d6si#nery I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical on of any component of the septic system) but in accordance with State & Loci' Plan revision or certified as built by designer to follow. AR , I M a R : n er's Signature) GISTS ��o - SgNITAR�P�: t' (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNS ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED,UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form ., . c ? �No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprication for Oigoml *pgmem Con0truction permit Application for a Permit to Construct( ) Repair( ) Upgrade l7C' Abandon( ) ❑Complete System ❑Individual Components " Location Address or Lot No. �j ���O � I CIO.� Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel S ✓�'��f/A1 ts��, C_. �r� l�Git//S� Cc'jo/t�rj Installer's Name,Address,and Tel.No. p , 3 Designer's Name,Address and Tel.No. Type of Building: _ Dwelling No.of Bedrooms Z Lot Size L�5:O��C sq. ft. Garbage Grinder ( ) Other Type of Building /Z6s/d No.of Persons Showers(2) Cafeteria( ) Other Fixtures Design Flow(min.required) Z140 gpd Design flow provided ���- gpd Plan Date 1 1..2— b 7 Number of sheets ` Revision Date Title Size of Septic Tank _ lOo o Type of S.A.S. 14 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 Certificate of Compliance has been issued by this Board of Health. Si ed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued NN THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes Tipplication for �Ngpogar *pgtetn Congtruction Permit Application for a Permit to Construct O Repair O Upgrade .Abandon O ❑Complete System ❑Individual Components Location Address or Lot No. ! /, Dal �d� Owner's Name,Address,and Tel.No. Assessor'sMap/parcel S /Y��i9itl o/C�� 1Ci9� "f Aexl/s.� coo"V v� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size ?� -sq.ft. Garbage Gririder ( ) Other Type of Building Prri4e- No.of Persons Showers(mac ) Cafeteria( ) Other Fixtures s / Design Flow(min.required) Z/46 gpd Design flow provided ys�_ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /per a 9iaC Type of S.A.S. Description of Soil La aM y ti D C cw,ZSP s�,,,,,r> Nature of Repairs or Alterations(Answer when applicable) / f 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 Certificate of Compliance has been issued by this Board of Health. 1 S' ned Date Application Approved b Date �} Application Disapproved by: ~ Date �} for the following reasons Permit No'� 'J c� ————————Date Issued ,' ———————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance f THIS IS TO CERTIFY,that the On-s' e�Sewage Disposal System Constructed ( ) Repaired ( Upgraded ( ) A Abandoned( )by N C C\ M ) at e,'i kny Ip Vi has been constructed in accordance with the,provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer I�eC I IS-P1 Designer rn�Q)o1Q,✓ #bedrooms Approved design flow gpd The issuance of this permit s all not b/c7onstrued as a guarantee that the system wid' fly n ti a 'esigned. Date / Inspector �•., -�""�" ——————————————— ————————————————— . I No. 0 ( ' 0 O` Feet_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Digpogal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ). pair ( ,) Upgrade ( ) Abandon ( ) System located at 3-5 10-)kr � L �G✓t �Q_, //p . �J Band 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. rovided: Constructio must be completed within three years of the date(f thiss'•�f a,te Approved by ._.,, TOWN OF BARNSTABLE ;)-Oo q LOCATION 3'S� 41111 jtJ lej�> SEWAGE# VILLAGE Cbc;0 Vi//&�: ASSESSOR'S MAP&PARCEL /9y INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY A 0,V q�L LEACHING FACILITY: (type) (size) 3— S-00 g,4L NO.OF BEDROOMS OWNER: It iSl' PERMIT DATE:. eZ �— D 2 COMPLIANCE DATE: JJ Separation Distance Between the: " I 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) ,(I/ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /✓ Feet FURNISHED BY Al,I�G ; �11`CGi%Rl,z 0 4 -z 13ITT �-1 90 �` Z3 a NQV � 4. II �'S12i 19 Ovt Town of Barnstable ` _l P# Department of Regulatory Service • Public Health Division //�/21 NAM Date 200 Main Street,Hyannis MA 02601 _ a e Scheduled �A�1 l 1 Time Fee Pd. /dlJ va /il Suitability Assessment for Sewage Dis osal Performed By: �� �Td/✓�' Witnessed.B�:�J'�' LOCATION& GENERAL INFORMAX40N �1 ECMON » � df��U4k dT �,S�G�,¢�/Q�j-�� Owner's Name ,1 /S-�' �� l//<—L� Address cY 1/�[e-4AI/� Ate[/./�Parcel: jdl�Engineer's Name ��� �'J c�/Z G REPAIR ���—B��'' " �GJ /� Telephone# ��_g-Z _ 3:e. Land Use !�I QS'r 4 L Slopes(�Yo) •- 3 Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well wort-cft Drainage Way ft Property Line ;1t t• : _ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands�n proximity to holes) W- IOp L �SSE�SD�S 7 H if r� �3S Pv76� i3 V cis IParent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit RpCe Estimated Seasonal High Groundwater V Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE �-, Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: �in, Groundwater Adjustment 79 --q v Index Well# Reading Date: Index Well level AdJ,factor AdJ.(]round vater L.evea - 9 PERC ATION TES - alpl'itne. ObseLa _ - HoleTime Dept �/ �77mat 6" StartTme@ '15m�'60,)� '� � G9J End Pre-soak iN �jyJi M. i Rate Min./Inch �- 2 G VV Site Suitability Assessment: Site Pass Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data TO Be Completed on Back----------- ***If percolation test is to be conducted within 1009 of wetland,you must first notify the. Barnstable Conseirvation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# / Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(im) (USDA) , (Munsell) Mottling (Structure,Stones;Boulders. n isten ravel C /0 jVg 4A 16 oo lot -2- 42% 76 41 le) y2 Gl v DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi en %Gravel) 6 L6 /.3 b j DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cmsistency.%Gravel) /o/vA �L Ile ?ate'% DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders, Consi ten Flood Insurance Rate Ma Above 500 year flood boundary No_ Yes Within 500 year boundary No= Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _— If not,what is the depth of naturally occurring pervious material? - Certi_ ficatton '�w I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required ,e ertise.and exper" nce tbed in 310 CMR 15.017. Signa Date Q:\.SBPTIt1PERCFORM.DOC 4 S`... g� ..... ..C�..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Jt. ..................OF...... - , ppliration for 11ispaii al Warkii Tonstrnrtiun Prrmit Application is hereby made for a Permit to Construct (V-.) or Repair ( ) an Individual Sewage Disposal System at ............ 3--•.- --------••-_.-��- v. .��;.. ............... C-ter-.-- -------•-----•--......--•--•-.---......_ catio -Address a t No 1 I O ner AddCo 4.0 ess Installer Address d Type of Building Size Lot...TS__0s.`.......Sq. feet U Dwelling—No. of Bedrooms______ ____________________________________Expansion Attic (✓S Garbage Grinder ( ) p, Other—Type of Building _ ________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _. ---.--.--- d -- -----------------•----- Design Flow.... per person per day. Total dfily flow.__.._.__�3a____._______-_______._.___ lons. WSeptic Tank—Liquid capac' y f� __gallons Length.,O_'4Y.___ Width:`�.''��°___ Diameters`____ Depth 140 x Disposal Trench—No.__ ._.____. Width _..___.___!___-_ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--/............... Diameter___.. _6. Deptl below inlet....... Total leaching area-3�9:_�..sq. ft. Z Other Distribution box (✓) Dosing tank (� Percolation Test Results Performed by___________________________ � _______.___. Date_____.S"!•7'g' -___._ Test Pit No. I....___a___.minutes er inch Depth of Test it_-11_____________ Depth to ground water_. r P P P fs, Test Pit No. 2__Lca`_�___._._minutes per inch Depth of Test Pit____________________ Depth to ground water..............._........ a r ------------------------------------------------------- _------------------- •---------------_- r O Description of Soil....®_'-_1X�•••---......!'..."0-• v O{4--....................................... ---------------------------------------------------------------------------------------••-------------------------------------------------------------------------------------------------.......__...-- U Nature of Repairs or Alterations—Answer when applicable----------------------_----------_.............................................................. ...........................•••--•-------------------•------------------------------............----------------------------------------------------------------------------------------....... --------- Agreement: he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with e ovisio is o i i'!.L of the State Sanitary Code—The undersigned further agrees not to place the system in op ion a ti e of Compliance has been iss d by the board of health. Signed........... - - --------------1-•--- -� ate' te pcat on Approved By-•••••-•- - •- ••• -•-------------------•---••--------------------•--••------- .......... Date plication Disapproved for the llowing reasons---------------------------------------.....................................................---------_. ------- ---......-•.....................-..............--....---............••••...........................-•.......------•--•--•--•----•----•-••--•---••--•-----•-••---•••-•-•------•--------------•---...------ Date PermitNo......................................................... Issued-...................................................... Date No................-....... FEs..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c?v.� ..................OF....... ,tJ Appliration for Disposal Works Tonstrnr#inn rnmit Application is hereby made for a Permit to Construct (DL) or Repair ( ) an Individual Sewage Disposal System at: { ........... f4(��c •-�`- --------------cf ta.1I �.11..�. -1.. ...-----•---...---•--... ... C -....... ca ion-,A ddress ` ( A� �r Lo£'1V� M.t _ _.... ._.:�3.. ------ ---��-`-..� � ' .....�'--� ......?--------ate... O ner Address ••-- Installer Address VType of Building Size Lot.-'-VI' 0--a t.......Sq. feet Dwelling—No. of Bedrooms.......:...................................Expansion Attic (✓S Garbage Grinder ( ) aOther—Type of Building ..l�/'''`'.............. No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures A. gallons per person per, ay. ..._..........-...--....._gal A............................................................................................................................................. W Design Flow....,5'?..................................galld Total daily flow____----_ � Ions. WSeptic Tank—Liquid capacity�jaee...gallons Length,-k...... Width`-"W..... Diameter...._. Depth:'.4F.r, x Disposal Trench—No. ..A/.W......... Width.................. Total Length.................... Total leaching Seepage Pit No._._ ..�. area.__._._..._.........sq. ft. pag /_______________ Diameter.._.. ..: Dept below inlet.....''......._. Total leaching area.'_-.;4.A5...sq. ft. Z Other Distribution box Dosing tank (!+% i aPercolation Test Result Performed by.......................... .............. Date......9_Uf.191 ............. Test Pit No. I...... .....minutes per inch Depth of Test it..11............. Depth to ground water_./-A- ...... rZ, Test Pit No. 22�_.___..minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .....f..... ....................•....... -----................................................................................................... O Description of Soil..:©: � _...._ ...... ._.3v�' o�-- ----------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .............••----....----•-•-•----------•---•-•••-----......-•---------------..........---•........---••------------------------------•------•---•-------............................................ Agreement: he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with e ovisi s . T TLC. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in op io /n ' a er to of ComplkI]I ,has been iss ed by the board of health. Signed---....... ---- --- r------------- ......... M VDatF PPlication Disapproved for th I Bowing reasons-----------------------------•-••-------•----•-----------------•------------------ --_---.---------.------- ---------------------------••-----•-•----............-•--------•----------------•-•-•--.._......---------------......----------------•---•-----...------......----•---•----•------------•---•.....-•--- Date PermitNo.................................................... --. Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ........ ............OF......... 4!..................................... wrtifirate of Tomplianre THIS IS TO CERT�Y Th t the�ndy��}}'dual ewage Disposal System constructed ( ) or Repaired ( ) by- -------------------- Y -.--� -- /rr��_.61tic. - _f uer at_. �:1.....'_��_.•--------------•---.......--•---......-Z --- •--. ------------ has been installed in accordance with the provisions of TIT F 5 of he State Sanitary Code as described in the application for Disposal Works Construction Permit No...... ... dated............. __. ........... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI L FUNCTION SATISFACTORY. ;{ I ... -� DATE............. •- - -----.----ru1- 5•-•-------.:. _...._. Inspector.......... _....._ ._.... .-----•---.._...... r THE COMMONWEALTH OF MASSACHUSETTS 9 BOARD OF HEALTH . ....................OF ............................... No. ................. Disposal orrko Tonstrortion rr it 5J Permission is hereby granted...................... 47----------os...........�(1. 0---------•-•-••..............•---......---------- to Construct k ) r RPai=r 1{ an Individual Se gage Disposal S stem atNo........................... -----.. •--- • �--- ...........................ae y Street as shown on the application for Disposal Works Construction Permit No.-_... Dated.._........................................ DATE �.721 Board of Health ((i7� ^r/ ------------------------------•---------•-----•---. FORM 1255 A. M. SULKIN, INC., BOSTON ` f jDtFA CsMT. 3 a ' 4 � St 5 , T r S F.� 'T1yn i d/ ALERT r, A. .` I u MC) lkl 0 No.10951 O x. Zb N . - - - - ` 1t M � i t tN OF ROD€RT.s�G^ LEGEND. .� B. ELDREDGE E EXISTING SPOT ELEVATION •0x0 . ` . �o. 9���,� CERTIFIED PLOT PLAN I EXISTING .. CONTOUR —­_ O :FINISHED SPOT ELEVATION "FINISHED' CONTOUR . 0 . - LD T 3 i4 GLi4 rtr'. ITV/L,L NOTE; The location of any existing an er roun ewe'rage, •. wells,..or other- utilities shown on. this: plan is approx IN imate -on ly as determined from records and/or verbal ; nformati.on.. The contractor is responsible for the. "RA J U I S IA.0 L Z,#A ASS* t.. verification of. the existing locations" in` the: field.. SCALES l = �''v DATE g /VJ c Inc-0 N. 1.D-�RED GE, ENGINEERING CO. IN I a—'N' '' .. . CLIENT: I CERTIFY THAT THE PROPOSED EGISTERE RE013TER,ED JOS. NO. f4o 6 BUILDING SHOWN ON THIS PLAN - ---`—+Z CIVIL L'A°ND CONFORMS TO THE ZONING LAWS, . ° E 0 NER RV DR.BY� OF BARNSTABLE , : MASS 71.2 MAI N. STREET CH. BY�:/z-� �• S' /L _ -- MYANNLS, :MARS:` �. - 9HEET,.LOF . T;E RE(3. LAND SURVEYOR Ia(OTE' /F E/TiYE�4 TKE SEPTIC:I I -. OR G . Q1�IZ" GE�lG //Y P/T.'4IlE; •MQRL�:,TiY.�{JV L.D�i/ N l0 FT M N "' 3rFA DES /9 24 to /�1�?:E'74cle G'ONCR.F 7`E. CO /E.P :1 4.F BRDuGNT !TG'�oRAv SNALL - .6A/V X, RA Q'PYC p/PE ? ' COJVCRETE �. . }/EAYy'.C^S•T IRON`GO{/ER 5/l:44.1- DE USED • W. P/TCN JF%N J>R/✓EFWA Y t L J3.2o COYE/4S �'PS,q FT � 2 CONCR�.ac-TE... BADE Cd VER CLEAN SAND IJ9411D LEVEL A"D1A zL _ _ _ - ' AYER 4 sai ULfa 40 - /p i MJN.PlTGN IO 00 GAA4 n of i . . . .i D,,'� WASHED S7�NE %4 I.PER/T. % .`.SEPTIC TAN/�.0 DisT, �.. , q. ,.� BOX v #Ar i . � •. • • • -�. ,..a • a ECTr✓ • o HA5AFD'9TOh�f so 0 • : psi .. ,� I7S;q •x;•Z.S= ,¢,35,43 f ll4jY� .ILEY�IT/oNs�5P3�,Ty K � n jJ , • , � � • :.:.••„• •�.., s,oe oo;o 593 c7,f i- PfY • cr ° Ci7 f , s 4E�L t Z• ♦ /V INVERT AT 01114DI V6 FT. 3 7>5LUi-A7 JON� �4 _ FT. :Ol�4/►'!. C tSFE i :' INLET TANK tz C fT OV7LET SEPTIC 7ANK l z-k4 fT. //VALET DISTRIANT/ON BOX i z$•�-FT, GROUNO 14�t.TFR TidC E 04Vr4WTD/5TR/BUT/ON dQX I y � FT a z�:g . SE}•4/AGE. O/S/aASA t SY.ST.�/►f : //VZ:CT L.fACNJM6 P!T FT T/4�ULATIO� LNG peo a/MF/vs/oav I1 3 f T -. LEACH SCALE DIES/6N` Cfi/TERlA _Ditl�rsJOJV ..��_f`T� � ��, NllMdER OF d'ED,ROOMS 3DJMAJVS/ON C FT G,•Ra.o,Fo/sPos�s�t!H/T n�o � SO/L LOG. TOTi�1L;EJTJ/ TED FLOIN:3 3 0 GAI..IPAY SO/L TEST IIE/ SD/L TEST�2 SD/L TE37" ISlUMQfR QF �,C`AClVlNT.. P/TS J FtE✓. �3 P E[�Y, pA're OF' SO/L TEST 717-7, S/OE A0ACHI.MCr PE/2 P/T 9 SQ p Z RES1lLTS h/ITNESSED dY ao7—ro+?L,4Cs l ver PE1t PJT 15 3 SQ. 1rT 'PEIt COLAT/Old lG4Tlf / S S MJ /NCK l��t? =� TOTi!IL LEACH/NG �tREA 3Zq�SQ.. fT. S�cSr-% AEAtCOLA�/ONR.4TElb2 RESERVE LEACH/N6 ARE^ 3 8 S.P. F.T. i O r o ROEERT aj F,LE=RT.CD c ELDPPED -E tc n SE G jtTr�f� •��7 �,��\ Yo.10951 r �_ r F-714A 6E E,1�GIN6 Rl CQiJVG rGcT�r`� .c � N...9T® W10GOVNPW,47:4 FNCOUNTCGROUAIO N%.r�TER RT ALE✓ No. .... Ft�s..... ®. .... -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /... OF ..... .�/ .. . .. ............ ...... Appliratinn -fur Uinp]anttl filar n Tomitrnrtinn Vrrntit Application is hereby made for a Permit to Construct X') or Repair ( ) an Individual Sewage Disposal System at:,740 � 4 . -------• ••---•---------- _ y�-� -Address � or I.ot "o. Owner Address --------------------------------- Installer Address / ^ Type of Building Size Lot.... U Dwelling—No. of Bedrooms................... -.._.. _.._.___ ..._Expansion Attic Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons....--__--________-- _--.-- Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------------- - -- - W Design Flow............................................gallons per'person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv�W..gallons Length................ Width_.............. Diameter__-.-....-.-___- Depth_--._----_--._.. x Disposal Trench—No. .................... Width-------------.------ Total Length.................... Total leaching area...............-----sq. ft. Seepage Pit No......Z........ Diameter......t :.--------- Depth below inlet____________________ Total leaching area-------.----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) .Percolation Test Results Performed by----------------------------------------------------------- --- Date----------------__-----------.-------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water..-.-_--.--__-.--.:._._. G1, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--..-._..--_---_-__-.__. 9 ------------------------------------------------•----•------....--•-----------------••---••-..•••---..................................................... 0 Description of Soil___-_-_-_-._-_--_._----_-___ � -----------------------s���--------.�v--------jam---�`e-------------------_---------------__------------...--__----_----------- -----�__--------------------------- ---- ----=-- - - -- ------- ----- - - ---------------------------- ---------------------------------------------- --------------------------- --------------.-------------------------------------------------------------- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t boar�health.. Signed._ -Ylyz-• ,l/1 ' Date ApplicationApproved By............ � e ------------------------------•-------------------------------• ----•- ---•---------- - ---------------- Date Application Disapproved for th following reasons-------------------------•------------•---------------------•------••--------------.----------------------------- ----------------- --------------•----•------.........------------------------•------•-----------•............................------ -------------- -- ............................................... yam` Date Permit No.......9•--- -•--_-_------_--------•--• Issued....-. y 7 ,.-----..-_--_------• +>r Date t No... _.... F1as.-.... �?.. �.._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f........... OF........... .� Aplifiratiou -for Ii,4puottl Wor Cnotuitrurtion Vaunt Application is hereby made for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System at: ! Lei, ddress W Owner Address Installer Address // ^ U Type of Building Size Lot..... Dwelling—No. of Bedrooms-----------------�............--------Expansion Attic ( Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures W Design Flow-----------------------------------1----•-gallons per person per day. Total daily flow--------------------------------------------gallons. Septic Tank—Liquid capacitv&,!�O.gallons Length---------------- Width................ Diameter_----_-------_ Depth---------.......- W Disposal Trench—No- -------------------- -Width Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No------- .-..--__ Diameter.....A�........ Depth below inlet____________________ Total leaching area-------.----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date...............-----------------------.. Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-..-----------------.--. fs Test Pit No. 2----------------minutes per inch Depth of Test Pit.-_---------------- Depth to ground water------------------------ P4 --------•--•--------------------------------•--------------••------•-------------------•-•--------------•--•--•------------------------------------------ O Description of Soil--------- --•---•----------------•------- �4 4 A r,/_ T; - /:�- ,/%r------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------- 72-TIT'-------------------------------------••-•------------------------------------ �''!-•---- ---..___.._.. -------•---- --------- W l L-�S,� t�U� � ma y _ l., r . x ------------------------------------------------------------•-•-•--•------•-• -------------------------------------------------------------------------------------------------------------------------- U Nature 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 Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bb'y tth/,e-,board `f health. / 7 Signed-- . _^_�-``�� -(!!/,�/' .=:�` ................... ---•-- te Application Approved By- /` ------- ------- ------ Date Application Disapproved for the f ollowing reasons:.--------------------------------------------------------------------------------------------------------------- -_------•-••--•-••---•--------------------------------------•-•-•------------------•---•-•----••-•------------•------------------•----- -------------------------------•---------•--------------------- Date PermitNo. --------------------------------- Issued--------•-----------------------------------•---__------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF....... .........J....................................................... (Irrtif iratr of 01,11mpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY ........-•-•---------------........................................... ------------------------------------------------------------------------------•---------•---•----- Installe C at ---�r))-- �--------��-------------`----�--' j-" tit has been installed in accordance with the provisions of Article NI of The State S�itary Code as described it the application for Disposal Works Construction Permit No-------7X4, - :----- dated--------.--7--./_ 74 ------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .....`` Inspector----------- -- ----- .......................... THE COMMONWEALTH OF MASSAC 'SETTS BOARD OF HEALTH ��.<c.. ,fir .�,�:r/; ......................................._.0F.........�•7.! ' .-............. �c------------•---.-...-...-...... r No. - h FEE '' =-= Binpaiial lVarkiq CITouotrurtion Vamit Permission is hereby granted-----------L-L_--`S S'`/ 1r1' 1 to Construct ( or Repair ( ) an Individual Sewage Disposal System at No...........-'__♦_ -•••••A 4 ?r ,..Sr--•- / /A- 7e._... _...-- --6 a ��5 -------------- - ------------------------------------------------•-------------------- Street f as shown on the application for Disposal Works Construction Permit No---_��'-_-...._ Dated------->---_ .�_.._...-�___.__ - - . --------------------------------------- -------------_ ------A----------_---------------_ -•-•-------------------••-------••---••-•---•--•----- Board of Pealth DATE.---•---•------------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE �OCATIQN i35 Nt1G�n ���� - -- - SEWAGE# d ©Q s 5� VILLAGE We4 ^�l "a ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. a, u Cut t r,'41-r SEPTIC TANK CAPACITY ,f Ca % LEACHING FACILITY: (type)_ 7" 14 - ,�� 4+ �q . �ssize NO.OF BEDROOMSA 40 �' ° OWNER IC.r Lid rnc+u Y1 PERMIT DATE: 00ne 1. Q00(, 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 l Ink Aef 141F ction " - . a 3 `� rof`l .1 ,i _. TOWN OF BARNSTABLE LOCATION ', n ��u� SEWAGE # VILLAGE 'llt1r; e ASSESSOR'S MAP & LO INSTALLER'S NAME & PHONE NO. �;� OU6(,,4 L' JAC: SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �'..T (size)* Obi y a 1 3+S5'e= NO. OF BEDROOMS J PRIVATE WELL OR FUBLIC WATER 0 p ,(! BUILDER OR OWNER A��1/��� DATE PERMIT ISSUED: �tT DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No -�. t " ` _..` ` �, , �- a -- � � , e '`�� O '�' .�� I ��` .y ® ,� # � TOWN OF BARNSTABLE �� D LOCATION —G�C�A AI SEWAGE # � / �3 VILLAGE Ce tJ Q 5/! ASSESSOR'S MAP & LOT t INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY Q_LEACHING FACILITY:(type) (size) " NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER c-KiC c Pj DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED:; �) �1 1 i VARIANCE GRANTED: Yes NO ��( Zs oI ' 4 f STANDARD NOTES TOP OF Raise covers to within 6" vF 1) THIS PLAN IS FOR THE INSTALLATION OF A SEPTIC SYSTEM. FOUNDATION finish grade install risers as needed i EL 99. 72 2) ALL INSTALLATION PROCEDURES AND MATERIALS SHALL CONFORM TO 310 CMR 15.000, THE STATE ENVIRONMENTAL CODE, TITLE 5, AND THE TOWN OF Barnsta b1e SUBSURFACE DISPOSAL REGULATIONS. Gr 98. 6 ---- GRo UND SURFACE Elm 979 3) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE OF AVAILABLE PROPERTY INFORMATION WITH ,RECORDED DEEDS Proposed T D - Box OR ZONING REGULATIONS. ypic (T•ypical) 94. 63 t` 4) TOWN WATER DOES NOT SERVICE THIS PROPERTY v4 - �-- TOP EL , 96'- �� ��` 2"MIN 3"MAX 5) THERE ARE NO ZUSTING WELLS WITHIN 200 OF THE PROPOSED SOIL ABSORPTION SYSTEM. MIN 2' LAYER DOUBLE WASHED INVERT EL Y,. 1is'- v2' STONE 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BFO Ui rHT TO WITHIN B" OF FIND:yHED GRADE 10 7) ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBi;E FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY 24 EFFECTIVE � � INSTALL • •• < SIDEWALL UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS WHICH WOULD INTERFERE , WITH THE PERFORMANCE, ACCESS, INSPECTION GAS BAFFU LPUMPING OR REPAIR. W W W W Three 500 Gal Conc 3/4'- 1 112' DOUBLE W b b WASHED STONE 8) NO DRIVEWAY, PARKING OR TURNING AREA, OR OTF.ER IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION d. Er h Cb chambers w/4' stona all around � i n2 nj Z . :b 91.88 SYSTEM, EXCEPT WHEN VENTING HAS BEEN PRO VIR4,0. 6 STONE .BASE � � � � ti � W (4'-10" x 8 -6 x 2-9) < � o BOTTOM EL (Existing) (H-10) v, 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS :AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6 STONE BASE �J � ti � �•, �, � 4, 1,000 Gal Septic Tank '~ a I TO ENSURE STABILITY AND PREVENT SETTLING. I i (Typical) S. = 0.015 1 1 1 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL JFOR A MINIMUM OF THE FIRST TWO FEET OF'THEIR LENGTH. 10 60' 11 ® 4� 1 1 C 12' EL.__84.� _ 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF �17THSTANDING H,10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' BOTTOM OF TEST HOLE 1 ® 22' .33.5' ITo Ground Water OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-f-20 COMPONENTS SHALL BE USED. 2) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4 AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC. N/F 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESS VENTING HAS BEEN PROVIDED Ma 194 Parcel 1-4 - �" ca.Zl7erlf'I2 © 14) IN THE AREAS OF EXCAVATION EXISTING GRADES (HALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS. 15) IF SOILS ARE ENCOUNTERED DURING THE EXCA VAT ON OF THE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM i THE DEEP OBSERVE TION HOLE LOG, CONTACT THE 1',;ZNGINEER BEFORE PROCEEDING. 16) CONTRACTOR TO 4RIFY LOCATION OF ALL UNDERGi'?OUND UTILITIES. &, 17) EXISTING PLUMBING TO BE MODIFIED TO MEET PROPOSED OUTLET ELEVATION & LOCATION -6' 18) EXISTING CESSPOOL TO BE PUMPED AND REMO VED PER TITLE 5 a� DEEP OBSERVATION DEEP OBSERVATION � Parcel el 11 N Map Lo t 3A HOLE LOG HOLE LOG 1� 4 a c 5heppa- 'L 45, Cl 7 ± Sq. a Ft. _. Test Hole #9 Test Hole #3 i (EL = 98.4 ±) (EL = 96.2 ±) Dgp h lev Soil Soil Soil D p h lev Soil Solt Soil (eft) Horizon Texture Color �mft) Horizon Texture Color (USDA) (Munsell) (USDA) (MunseIl) DESIGN -a DATA. 0 - 6 97.5 A Loam Sand 1 0 - 4 95.8 A Loam Sand - s" - �8" 96.9 B Loam Sand 4" - 14" 95.0 B Loam Sand -' S) y 7.5YR5/6 7.5YR5/6 • $ 18" - 36" 95.4 C1 Coarse Sand 14" - 78" 89.7 C1 Coarse: Sand Number of Bedrooms- 4 10 YR6/6 10% Gravel 10% Gravel NO e Garbage Grinder: 36" - 42" 94.9 G,d2 Silt Loam IOYR6/3 78" - 84' 89.2 Cd2 Sandy Loam 10YR4/3 Design Flow: t 42" - 78 91.9 C1 Coarse Sand IOYR6/6 84" - 144 84.2 C1 Coarse'` Sand 10YR6 6 5 440 r P e 10% Gravel 10� Gravel / o (l1O`Gal/BR/Day x Number,=of BR) w _ . .._._ p.2) 78" - 132"t 87.4 C3 Medium San 2.5Y7/4 _ Sep ` tic' Tank: r e -- i. Dee Obs e 1 7 _ ,, ._ .i. P Hol Date 2/2 ,/0G , _ µ Deep Obs .Hole Date. i2 2,: 06 � , , _ ,` • , .� ��'9 0� - - __ - _ Soil Evaluator. ED St"�1� ,. _ .C Sou ..,valuator:. its ,-.. .w„.r. , ,.: ,., b Witnessed By. D. Desmaras Witnessed By-. D. A s narars �3 0 Pere Rate: z bi1N 1rr ®ss" 3 Leachln F Area: ooJ / q5) / Pere Rate. MINIIN ® 66 g /' ` a / Soil Survey Description: CARVER Soil Survey Description: CARVER , e - '' _ � s Geologic Material GLACIAL ourwasH MORRAIIJE � Geologic Material: cl.Aclti.i ovTKASH MORRarx�' = + $ - Depth to Standing Water: NA Depth to Standing Water. NA Sidewall 33.5 12.83) x 2 x 2 185 .3 SF Depth to Weeping Water: NA " . Depth to Weeping Water. NA< 33 5 12.83'. f 429.8 SF / Depth to Motthng(Color): NA Depth to Mottling(Color): NA BOttOITl. xt X x - Est Seasonal High GW: N4 Est seasonal High GrP: NA; Leaching Area Design Capacity: 6151 SF ! i USGS Observation Well: NA USGS Observation Well: ,NA Sidewall Area i- x 0. 74 ( Bottom Area) g LTAR Date of Last Measurement: NA Date of Last Measurement: NA C> - -- Comments: Comments: GPD Provided 455 GPD 455_ GPD Provided _440 GPD Required _15 Reserve f 2) DEEP OBSERVATION HOLE LOG a° v f� o) ret e-�'_ g o) Opp / Test Hole #2 Sl t e Ck Se LI�.' 01C- i D Re pa I1"' U ha de Tev Soil Soil Soil ft) Horizon Texture Color (USDA) (Munsell) r 'ig 0 - 6,. 97.4 A Loamy Sand 10YR3/2 �35 AIM Road 6" 16" 96.6 B Loamy Sand 7.5YR616 in / � i� � 16" - 84" 90.9 C1 Coarse Sand IOYR6/6 Cen tE'r`V�lle 1V1A I�' \ v �C� 95 3 -� ii °� _ 10% Gravel g 9 Afa_p 194 Parcel l -1 g ` a ot 59.8 (96 0) 84 144 85.9 C2 Medium Sand 2.5Y7/4 Sca-le: 1 = 20 DATE' 1�12107 j .z isa za Pump, Sand Fill 0� �°4 7.4' (9 REV. & Crush Existing SAS per Title 5 (9 '2Tx i . Deed Reference -' #3, 5$) Deep Ohs Hole Date: 12127106 9$ . Proposed ! Bk. 15953,, Pa 213 Prepared Fora DI-Box Soil Evaluator: ED STONE Craig 7 �Q�. Denise 7-� 7�-v p Witnessed By: D. Desmaras t✓1 1 (.Y L/l�111 ti7 1 Coombs � 9$. (DE--6) 17 9` Pere Rate: Soil Survey Description: CARVER - r-_ �_-_�__ , � / $a) it ,: ) i Plan Reference e Allan �y7 l9 J $r3 �eS r�� Geologic Material: GLACIAL OUTAASH MORRAME 35 Allan Roa l.i L7edroora Depth to Standing Water: NA J� �j / J� Existing �� Depth to Weeping Water: NA Pl ; B•« "7 00 1 9 30 1 #3 ti 2) p g Cen terTW]q, AM 02632 1,000 Gal 4 9� / 5 Around Strl Out Depth to Mottling(Color): NA f ! Bedroom Outlet Invert s- � � Strip out Seasonal High.GW: NA Bedroom _� - S=Tank EL = 95.17 1Q $•1) 4 to Teinain 2 ) ( / l i to Minim um 7 depth USGS Observation Well: NA # 7i $) fig$• 9) ,�$) Date of Last Measurement: Arsq Fema Map Ref Prepared By. - -r 13.5 �s. Cg%" Comments: ' �50001 --; Bath __ 1 s 9 Cd2 Horizonsto e A; B, and �' DAS Survey, Inc. # (See Test Holes 1 & 3 Zone C y-2-92 141 Rte 6A P. O. Box 1729 -- Bedroom 11. 25.6 PROPOSED L.�'ACHING FACIL.tJ` Y Sand Rich, MA 02563 Three 500 Gal Conc Cham,Hers 9$9) / .21�A (508) 888-3619 d F11or T&h 4 Stone all around ( ASSESS'ORS MAP 19`� LOT 1-3 Fax 888-2496 I IVTS (4'_10., x 8,-6„ x 2,-9 ) g9 �) Total Dim s = 12 -10 x 33 6 Dwg No. 3304 N/F 1 Ma ' 194 Parcel 1-2 i i Hines e,e � \AON_j °7in -Room Ktchez Cape z` �' �'� 4•(N OF M,bspsd,, F Family / M. �y'c� -• ,:;,3 Room GRAPHIC SCALE T Service Rd No. 1140 ` A• Bath - 20 0 10 20 ao ao �P� for GTO a, Lry aTl-n _ � .. .. - ANITAIav Rm 0 Ys V.V - ( IN FEET ) 7st Floor 1 inch = 20 ft. L 0 C Uhl ATTs ---- ------ _ __ _ -- _ _ _ __ _ ________ _- _. , . .•,.,,-_ a _, __._ -------_____._ . ___ _-___._____.___.__- y