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HomeMy WebLinkAbout0241 CEDRIC ROAD - Health 241 CEDRIC ROAD, CENTERVILLE A = 148 093 I! 0 II/I ��tECYCIEp�, UPC 12543 Now �`bsrcoc '� HAS11NQS,MN alA No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for MispoSal *pstem construtti0rl permit Application for a Permit to Construct( ) Repair(grade(Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.oZf�/ G'�.e7.��C �'d Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 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 Grinder( ) Other Type of Building Z F;F No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �' ® gpd Design flow provided �� gpd Plan Date ram—��L�-�� Number of sheets Revision Date Title Size of Septic Tank ���pT�6:7 1"P6 O 0 6--Y'l)e otS.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ✓� ��1�lJ�' 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,ATisBoard of He e Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued +. d No. 1 rA Fee < •. � THE COMMONWEALTH Entered in computer:OF MASSACHUSETTS p Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 241ication for Misposal 6pstrin Construction Permit Application for a Permit to Construct( ) Repair(Ar-lupgrade(Abandon( ) [:]Complete System ndividual Components Location Address or Lot No.�f// G"� � OeZ7 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address and Tel.No. Designer's Name,Address,and Tel.No. s— OJ o f �6f��"J/�•/�G'/Y 4��/' ��7/6'�� Type of Building: i Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �' gpd Design flow provided y9 gpd Plan Date ��—/� 1—�C� Number of sheets / Revision Date Title Size of Septic Tank ��l fry� �O Type of S.A.S. Description of Soil X',G*-<:-- Nature of Repairs or Alterations(Answer when applicable) i 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 oard of He �i �_ 46 g/ne ,, Date 7 5 Application Approved by /' Date Application Disapproved by v Date for the following reasons Permit No. Date Issued / -------------------------------------------------------------------------- ---------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(/0< Upgraded(A0) Abandoned( )by��lj7 .1���j f at ' ?.e,> has been consxu t d' ac yelp - with the provisions of Title 5 and the for Disposal System Construction Permit N . e Installer ��J ��1'©t�`y/� Designer �d��l14kra/" 4�1?,�- #bedrooms 3 Approved design flow �y gpd The issuance o this permit shall not be construed as a guarantee that the system wi fim tlon as designed. Date (� Inspector If d lr'I� �) Qj ----------------- - -' ,------ ------- No. G 4� "'/,- "� Fee�12-0 THE COMMONWEALTH OF MASSACHUSETTS 7 PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS �I��1o8aY �pstem �onstrUttion -ermlt ; Permission is hereby granted to Construct( ) Repair( � Upgrade Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction 277 e cow/Ic d w'hin three years of the date of this permit. Date / Approved by r�/ Town of Barnstable .�" Regulatory Services Richard V.Scab,Interim Director 9 s Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-86246U Fax: 509-790-6304 Installer&Designer Certification Form Date: �`S"�� Sewage Permit# oZ Assessor's MapiParcel Designer: 12 f2, LO Installer: �� L Address: _tIC 'tPAA-1f?Lk2l(zH Address: On was issued a permit to install a (date) (installer) septic system at Z� I��ty, based on a design drawn by (addres -Pt� F, � dated �� ZD (designer) 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. Strip out (if required) was inspected and the soils were found satisfactory_ I certify that the septic system referenced above was installed with major changes (Le. greater than la' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in S fiance with the terms ofthe AA approval letters (if applicable) �%�R \y. ;�•� :5 MASON ml (Installer's Signature) 2 v No.1066 a s r£T� a S�tNltAft�r`' (Desi 's Signature) (Affix Desi may,,,- p Here) PLEASE RETMN TO SARNSTABLE 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. QASeptic\Designer Certification Foam Rev 8-14-13.doc TOWN OF BARNSTABLE ' LO('ATION �� IC SEWAGE# VILLAGE <'e-o4-,/-2tV/%?Z- -ASSESSOR'S MAP&PARCEL- ��M'9---� INSTALLER'S NAME&PHONE NO.Or� SEPTIC TANK CAPACITY �X�f'�!✓ /� lid LEACHING FACILITY: (type) C� � y�t/S (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: ` Separation Distance Between the: /?/® ZoZe Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 0� 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 \oraj IV-?se?'� 0017 Ile CR Jin �� PC . �•llta 'own of Barnstable Departitnent of Regulatory Services Public Health Division � Date s�7➢ 200 Main Street,Hyannis ft?NlA Y MA 02601 V1 Date Scheduled Time Ve Pd.� Soil Suitability Ass ssment fog- Se W�e Dispo al Performed•By:. Witnessed By: U+ LOCATION& GENERAL INFORMATION Location Address �-9:A9e?Z 1--4e � Owner's Name Address Assessor's Map/Parcel: Engineer's Name NEW CONSTRUCTION REPAIR Telephone ii Land Use Slopes(%) Surface Stones .. Distancea from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Dralhago Way ft Property Line ft Oth • er ft SIC'TCH:(Street name,dimensions of lot,exact locations of eat holes&pere tests,locate wetlands in proximity, to holes) r / Parent material(geologic) Depth I4 Bed+'ock Depth to Oroundwater. Standing Water in Hole: Weeping fi'oln Pit Fnt e Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONAL*ffiGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depot to egll mottles:Dc{lth to weeping from aide of oba.hole: Ill. Groundwater Adjustment g1, Index Well Ir Reading Date: Index Well levol _ Adj.facitir Adj.Groundwtter Level Observation PERCOLATION TEST bate„_,,,_,, rt'lwo }�ji Hole R Time at q" Depth of Pere Time at G" Start Pro-soak Time @ A Time(9"-6") wT�' End Pro-soak Rate Mih./Iuch Site Suitability Assessment: Site Passed •Site Falled: 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 100' of wetland,you must first notify the Barnstable Consefvation Division at least one(1)weep;prior to beginning. Q:\SEPTIC\PERCFORM.DOC Iv 6�� DEEP-OBSERVATION HOLE LOG Hole#V Depth from Soil Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. ^"^ mlatency %'t3rayen If r/ t/ t .. - f o k119 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldcrs. o is cn Ayell ]DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseli) Mottling (Structure,Stones,Boulders. Consistency,%Omyoll DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color 5011 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders. ` C-onsistencY. Flood Insurance Rate Maps Above 500 year Pond 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 pery o eriai exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the dep 01 naturally occurring per ous material? , Certification L I certify that on o (date)I have passed the soil evaluator examination approved by the Department of Envirkrime6jal Protection and that the above analysis wasp rfo med by me consistent with . the required train!n , x rti a nd experience described in�10 CMR 15. 7. Signatur Date �IK/ QASEPTICkPHRCPORM.DO C 03 /3 ,3s- BORTOLOTTI CONSTRUCTION,INC. O f 765 WAKEBY ROAD,MARSTONS MILLS,MA 92648 °� 508-771-9399 509428-8926 FAX: 508-428-9399 APR .S Q 19 9g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FOR[ilNoVSr PART A CERTIFICATION / Property Address, Date of Inspection: / lnspec oes Nam : -Ownees Name d ddress: / CERTIFICATION STATEMENT: I certify.that I have personally inspected the sewage disposal system at this adress and that the informa- ltion reported below is true,accurate and complete as of the time of inspe-ticn.The inspection was per- formed based on my training and experience in the proper function and mai.uenance of on-site sewage o dis stems. The System: ✓ Passes Conditionally Passes Needs Further Eva 'on By th ocai Apruving Authority Fails y/,Y/�— Inspectoes Signature: Dale: � . c3. . The System Inspector shall submit a copy,of-this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared system )r has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Pro(ection. The original slit uld be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY, A)SYST VV46PASSES: I have not found any information which indicates that the sydjm violates any-of.the failure e. 4_ s_e- _.� ' n�+�.Rn r,e �n2. �.••.fails:`:Cr.t_c�•. np oynt� fey�.ri serf.i a#e.�att . Cauaa,,a as u.;alIICd 41 310 C,%,U. 1..✓:t . rv:y below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or rel a.r xi. The system,upon comple- tion of the replacement or repair,passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND).Describe basis of de'.e urination in all instances. If "not determined",explain why not. The septic tank is metal,cracked,structurally unsound,shov+s suboutial infiltration or ex5ltration,or tank failure is imminent. The system will pa-iE inspection if the existing sep- tic tank,is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level obser/ed in the distributionbox is--due to broken or obstructed pipe(s)or due too broken,settled c r uneven distribution box. The system will pass inspection if(with approval of The Board of health): - I - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipes)replaced ". Obstruction is removed Distribution Box is levelled or replaced The System required pumping more titan four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:, Conditions exist which require further evaluation by The Board of Health in order to determine if the-system is failingto protect the public health,,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH`AND SAFETY AND THE ENVIRONMENT: —- . , ' The systm_has a septic tank and soil absorption system and is within 100 Feet.to a surface Water supply-or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with+a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is teas than 100 Feet but 50 Feet or.more from a private water,supply well,unless a well water analysis for coliform bacteria an"!volatile organic compounds indicates that the we1!is free from pollution from tha '7d.y zmzd:fry ps},:y-=ce cf mn nonhn ers;.rogcn and nitrate nitmgpa is equal to or less I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool Discharge orponding of eDuent to the surface of the ground•oc surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert-due.to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than 6 below invert or available:volume;is less than 1/2 day flow. Required pumping more than 4 tunes in the last year•NOT due.to.clogged or obstructed pipe(s). Number of times pumped -2- t 1r{ � Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,:cesspool or privy is below the high groundwater elevation. Any portion of a.cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool,or privy is less than 100 Feet but greater than 50 Feet from a private water supplylwell witli.no acceptable•water quality'analysis. -if the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health,and safety and the environment because one or more of the following conditions exist: The:system is within 400 Feet of a surface drinking water supply The system is within 200 Feet of a tributary to a surface drinking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)'or a mapped Zone II of a public water supply well. . The owner or operator of any such system shall bring the system and facility into hill compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: _Bumping information was requested of the owner,occupant,and Board of Health. 1/None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. ✓ As-built plans have been obtained and examined. Note if they are not available with N/A. -/The facility or dwelling was inspected for signs of sewage back-up. �ftte system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System,have been located on site. The septic tank manholes were uncovered,opened,and the interior of the septic tank was in for condition of baffles or tees, materialvf construction,dimensions,depth of liquid, depth of sludge,depth of.scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- E t r,� 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) t,""'The facility owner(and occupants,if different Goni owner)were provided with information on the proper maintenance of Subsurface Disposal System _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION FLOW CONDITIONSRESUMNEAU Design Flow: llons Number of Bedrooms:_ Nun ben of Current Residents:_ Garbage Grinder: Laundry Connccted'1'o System: Seasonal Use: V� Water Meter Readings, ' ailable: ------------------------------- Last Date of Occupancy: rnMMF>Q�iA JINDtiSTR1_A� /JJ Type.of Establishment: � ": _ allons/da Grease Trap Present (ycs'or no)- Design Flow: a Y.: Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System:.. Water Meter Readings,If Available: Last Dale of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUftZPING RECORDS a0d source of&nofo'naint on: A System Pumped ai ilakI v:inspz,;!,...::Y 'r";, !ryes,voiunee put jic�:- galloc� Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System If es,attach previous inspection r rds,if any) Other(explain _ - AP ROXEVIATE AGE of all components,date installed 'f known)and source of informati n: age odors detected when arriving at. ,e site: U . .. . -4: _ . ..._._ .. M t� . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: y S Depth below grade: r' ' at'rial of Construction: oncrele metal FRP Other (explain) / Dimisions: � �' ' Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: _�_ Distance from bottom of scum to bottom of outlet tee or baffle:— :7 __ Comments: (recommendation for pumping,condition of inlet and outlet tees of liq�d 1 in re don to u t invert,structural inte rity1 evid ce of leakage,etc:; /r GREASE TRAP: Depth Below Grade: Material of Construction:_concrete__metal_FRP_Other (explain) Dimensions: Scum Thickness: _! Distance from top of scum to top of outlet tee or baffle: _ Comments: (recommendatiogfor pumping,:condition'of inlet and outlet U;es or bafll@s,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage; TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:_concrete_metalF1tP_Other(explain) Dimensions: Capacity: -=-gallons Design Flow:_ gallons/day Alarm Level: Comments:(condition of>inlet tee,•condition of,alarm and float switches'eh ) V DISTRIBUTION BOX:�w Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP'CHAMBER: /Vd Pump is in working,order: Comuterits:(note condition of pump chamber,condition of pumps and anpvTtenances,etc.) -5- y r 3S! t ne kk • e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if 06ssible;excavation not required,but may be'approxinmated by non-intrusive methods) If not determined to be present,explain: 'type: Leaching pits,number: Leaching chambers, number: Leaching galleries,number. Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Comm nts:(note condition of RI,si ns of It lic fai0ye level,9f ponding,condition of vegetation, is i CESSPOOLS: Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: 1 .. Dimensions of Cesspool: Materials of construction: Indication'of groundwater: .. Inflow(cesspool must be pumped as part of inspection) - Comments:(note condition of soilk,signs of hydraulic failure, level of pondino;condition of vegetation, etc.) ]PRIVY:�� i', teriats of consm, On Dimensions:' —_--- Depth of Solids. Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -G- 4 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (conlinucd) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. . to J DEPTH TO GROUNDWATER: Depth to groundwater: Feet T Method of Determination or A proximation: I"d.�'f > C'�'''1 ✓� �B , / -7- ' }� €bra afSA�pL J , r TOWN OF BARNSTABLE p, LOCATION SEWAGE =L GE ASSESSOR'S & LOT T1�VSPEciDi?3 NAME&PHONE NO. 70� SEPTIC TANK CAPACITY �— LEACHING FACILITY: (type) (size) QD e� NO.OF BEDROOMS BUILDER OK OWNE PERMTTDATE: 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 at qo No../3.: _,7C1./-... Fps.. ................. PPRO tp THE COMMONWEALTH OF MASSACHUSETTS F.�'n��� BOARD OF HEALTH "TOWN OF BARNSTABLE Oata Appliratiou for Diripooal 31 urlio C�ogt tr rtion rrntit Application is hereby made for a Permit to Construct ( ) or Repair W) an Individual Sewage Disposal System at: !t C.....� c ..u.. .... Location-Address or. Lot No. ..__�� os d"W....C� �'- ---- ----- L - ............... owner dr ss CL - ••-- ----------------------------- ----- ................ Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------___________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ................ .............. . . W Design Flow...................._._......__..gallons per person per day. Total daily flow--------�3�_......_.._..........._gallons. WSeptic Tank—Liquid capacityl0-60--galIons Length............... Width................ Diameter----------------- Depth............... x Disposal Trench—No. .................... Width.................... Total Length...._.__..__/_._._. Total leaching area....................sq. ft. Seepage Pit I�'o.___ -:...... Diameter..../4 ....._. Depth below inlet___..`............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water..__........_.__._...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ---•-------------------------•------•------••--••-••••---•••---•---------------------------------.--------------..........---..............----------...... 0 Description of Soil........................................................................................................................................................................ x ••-•-••--------'••--------'--..........•--•-•-------•--•------....-•---•----•--------••-•--••••-••••----••---••••--••••-------•--•----------------- ----•-•--- ---------------•---•-------------------. U Nature of Repairs or Alterations—Answer when �applicable.---------,DJO...........�. � ... 1T�. ..................................c J ;.-u.............................. ......S. =.Z................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance be Yuedy th oard of health. Signed ........... .. _. ---- -------V�,� e Application Approved By �...... .............. ...../..a-.�.L-.. .. . Dace Application Disapproved for the following rearons: ................. ' ' ' ........... .......................... ' ..................... .................... .............' ........... ......... ' ... ................. ' ............ .... ' ... ....................... ........................... ................... ........................................ Dare PermitNo. -----'.a 77-6.1.............................. Issued ...................... .......................---.................. Dace a✓'^."`�- ..--•-".N-'1�:..sir--`:,5..-+--_....r,......ti>w--.i.��.r1.e-wit,r""t!v'�V'L"-^�---`�--1•v.aa-�-_----'w•--"..---�'✓r^�v-r-.�::"fi'�:;. .:;-,r�;a.....e„+`1::.�>:.�r�V✓�`y�"`s`-'...*,�. 9j Fxz. ��................... r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,,,i-S_jTOWN OF BARNSTABLE Apphration for Diripwial Works Tonotrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( . ) an Individual Sewage Disposal System at: .......... G1i l ' � �_. ...........!Lb.................... ,_1)a v> �c<- ..... Location-Address / �/ 'or Lot No. >...................._.._•-•---••24 ..........----_.............._. Owner Address Installer Address Type of Building _ Size Lot............................Sq. feet Dwelling— No. of Bedrooms........._..'.____.__.+"_r_______________Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures ................ .............. . . w Design Flow...................5151".................gallons per person per day. Total daily flow........ .......................gallons. WSeptic Tank—Liquid capacity-Z!cX0-gallons Length________________ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. ................. .. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...—=4......... Diameter-:.ZQ./-------- Depth below inlet..... ........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................--- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ s� �,' 0 Description of Soil..................................................................................... ................................................................................. x U -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----......._..---- w U Nature of Repairs or Alterations—Answer when applicable............ __---__--__�,4+c�d _...__... .f � ...._2!T. 1�—?/_. ... ... S.............................. .............. -------• ,yl-----------••-•....................... Agreement: - The undersigned agrees to install the aforedescribed Individual`Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code_` %The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued y the board of health. Signed - l� r' " .... Dare Application Approved By ..........c .� Application Disapproved for the following reafon.f: ................................... .. . .. ..................................................................................... ................. ..................... . . . ................................................ ...................... . -- ................................................ ........................................ Dare PermitNo. .....��.. -- - .. i..�.............................. Issued ....................---- . . . ....................... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (ILlPrtifirate of (ILlIImylianre THIS IS TO CERTIFY, That-the Individual Sewage Disposal System constructed ( ) or Repaired Q/ ) Insr,Jlcr at ............. �/. - - ,.-f%.� .1.�- ............4/l O . ............... ..... {v.a-L-`t....... has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......._. ..-_7c) / --..-..... dated ...._......_.....__.................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,,.� DATE......., ^..�i. .... ._7 ............_._._...................._ Inspector ..C.-- .. a2a��i./- THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH �S 3 TOWN OF BARNSTABLE FEE...........Q... Bispoiial Worho Tum itrurtion "rrmit - � . Permission is hereby granted-------------------------=-' f l=>/ -------C-1'- -5 . ...........................................JGt� to Construct ( ) or Repair (- ,) an Individual Sewage Disposal System ,, at No.. �--z �/ C :0 bra Cam•---------_-/` r�i ---- - == Street as shown on the application for Disposal Works Construction Permit No7,3:7(2_1.... Dated___-_� .............•---••••------;�J . ..................... Board of Health DATE........ = �-. ------•---•----------------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS r �U TOWN OF BARNSTABLE LOCATION,-99j �a�/`o(� ,�� SEWAGE # 5�3- 7O1 VIL LAG OP40 Pl1� ASSESSOR'S MAP & LOTIVe-093 INSTALLER'S NAME & PHONE NO-,"IQy � yt�p� SEPTIC TANK CAPACITY LEACHING FACILITY:(type (size) NO. OF BEDROOMS _PRIVATE WELL O UBLIC WATER— , BUILDER DATE PERMIT ISSUED: ZQZ2l /9 R DATE COMPLIANCE ISSUED: f VARIANCE GRANTED: Yes No y/ �a 3�� LOC&TIO-Nye �d 5E\N&C4E PERMIT UO. VILLAGE IN57QLLER5 W&M ADDRESS r k :i"77li BUILDER 5 IU &"F— ADDRESS DIJ,TE PERMIT ISSUED = �_—Z — — to ATE COMPLI &I,4CE ISSUED : �.., 1 l^l ova � °� No...........(../� F�s.�G.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H T H 1... .... OF............................ .-------.......................--- Appliration -for liapoottl Works Tonstrurtion Vrrnlit Application is hereby made for a Permit to Construct C--ror Repair ( ) an Individual Sewage Disposal System at: J.....(J .... (--"v" _ ••-•--•••. Location• ddress B ..... Lot No ARCS Owner Address a ---------------------•----------••- -•--.g� -P nstaller Address d Type of Building Size Lot.... ---Sq. feet U Dwelling—No. of Bedrooms..___-__-.__--?______•__________________-__-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.------..-----______-___--_- Showers ( ) — Cafeteria ( ) Pk Other fixtures ............................... .. d �7� W Design Flow......_.....t3-u________________________gallons per person per day. Total daily flow.........J&--- � ............gallons. WSeptic Tank—Liquid capack< gallons Length .............. Width................ Diameter___....._.._--_ Depth--- -•- f-- x Disposal Trench—No. _____.. i.... of L h... Total leaching area..... q. d � ���,w Seepage Pit No.. er----------- ------- Dept el w in et- Total leaching area------- ----------sq. ft. z Other Distribution box ( ) Dosing.tank ( ) 0. 76 aPercolation Test Results Performed by--------------------- .................................................... Date----•------------------------------- ,� Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.__._.--___--_.--.--. f4 Test Pit No. 2________________minutes per inch Depth of Test Pit. ------------------ Depth to ground water------------------------ 1 0 1----------,;r ' � � x••------• ------•------------------------•--- --- O Descr tion of Soil-----`--�--- --'-�-` c!G�-r--i.S � ....... . /.U'-�..1...V_:� - f �•_,-.%�-��«�.✓/ �� x - _ - �. ... ------- ----------------- W ------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ V 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 be ssued by the boar f health Sighed. ..........•• - • -- ----------------- ----------------------------- _ Date Application Approved By....... _.......... = --tea-i7:.-.-/l, Date Application Disapproved for the following reasons:................................................................................................................ ----------------------------------------------- --------........----- ---------••----.------•---------•----•--------------------------------------------•-----------------•----•--------------•. Date A Permit No..... ------- Issued........3--------- /---776 q-•........... Date -------------1------------------------------------------------------------------------------'--------- - -- - - (97 No...........Z40....... Fiziz.A?..................... THE COMMONWEALTH OF MASSACHUSETTS B 0 A R D/)b F H T H //1" pItA .... OF... = .... 1. �... ..... ...................................................................................... Appliration -for 4iipwial Works Tomitrurtiou Prrutit Application is hereby made for a P it to Construct (-I-ror Repair an Individual Sewage Disposal System at: 19 Z_? __J-1 ........................ .................................. ......... . .. ..............................It---------------- -------------------I------­11------- Location- ddre ; or Lot No. ... ................... ........ ................. ................................ address Owner.. ......... ................................................................................. ................ ..... /;..................................... e—,----- ;( nstalle ---- Address US Size Type of Building ize Lot_._._ �__ ---Sq. feet Dwelling—No. of Bedrooms..-----------3-------------------------------Expansion Attic Garbage Grinder ( ) �4 PA Other—Type of Building ---------------------------- No. of persons............................ Showers Cafeteria ( ) Otherfixtures ----- ------------------------------------------------ .............................................................................................. Design Flow________.___ .......................gallons per person per day. Total daily a flow..........4 ;;�0.0----------------------------gallons. 1:4 Septic Tank—Liquid capacity­ __Vlo s Length .......... Width._____...__. Diameter._...__..._.... Depth___...____.__... 0 s Disposal Trench—No ----------- L e /.. Total leaching area.....�;_C`---—---sq. f t. Seepage Pit No........2�Tt�Mel ...... Depth be40;� j inlet.,, ....... Total leaching area------------------sq. f t. Other Distribution box ( ) Dosing tank ( ) �P — J—/,;x 76 Percolation Test Results Performed by-------------_ --------------------------------------------------------- Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit--.____-________---- Depth to ground water...._-..--------.--. - rz, Test Pit No. 2----------------minutes per inch Depth of Test Pit..-................. Depth to ground water-------------------- ..... --------- ............... .'r....... z ------- P4 I -------------- 0 Descr* tion of Soil-----7:0... V . _ . . CA ------- -------/........a ........ ...... ---------- ----------------------------------- -------------- -------------- U --- ------- ---------- ...... ..... .......... ..... ... . . .........t .....t--------------------------------------------------------------------- W �'W_ �ri ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has jbDejssuued bDy the boar of health V C SiR6 .......... e -- --- -------................................. .......... -------------- --------- Date Application Approved BY------ . ....... Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- .......................................................................................................................................................... ---------------------------------------------- Date PermitNo........................................................ Issued----_----------------------.......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE=, ............. X..................................................................... .........C ........ aT V.Prrtif iratr of Q-10utpliatirr THIS IS TO CERTIFY-.,That the IndLivi :,al �Wagispol.."jstemjWpstrucd (V-) Cr Repaired by------------------------------------------------- -----------------r...*----------------------V�. ---------------------------------- taller 14 at...................................................... ...... ............................. ....................... ..... ....... .. ---------------------------------- has been installed in accordance with the provisions of Art' e X of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._"________________------:_---_--__.-___ dated...7,774.d....-........7Z-.- .. ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS)rJUED AS A GUARANTEE THAT THE SYSTEM WILLfUNCTION SATISFACTORY. /,-/C�X�?Z_ DATE............... ............................ Inspector................................................. .................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD /PF HM�ETTH ................lek�...0 F....... ................... ................................................ NOA.............. FEE---.................... Markg 0141 rti t rroti Permission is he b ted------------------_ ............................................. ....... ...................... 9 ----- to Construct an I 4ivid4l Sewa D* oral Sy Fyn at No................ gk�'? .................................... 5------------------------------------------------- ------------------------------------------------- Street -7t10 - as shown on the application for Disposal Works Construction r it Dated--- --------------------------- ------- ...............................------� � �------- .... ........ Board of Health DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS MUIa r d ��4 "44 ;N /yt t 4i r� � f v"�•. �y7r IN #-is3g 94 36 a i I 31 � F Y. • �Eiv s' C o-T ,-.3 F�' S ,_,/-,/o w�/ —� � �C,OE.O?is/� io � �'�d� ryy7 c. •.� .v TH,C?T 7 , C- . lip QLA:ia/ /S LoCg7 Oa/ ' AVC o. ; FJ.S --t"O WN FVB,eBOti/ A*X1 D 7-1--1,7 T i T .t ,. co.v�oc-r.�-� ro a F T<-/E Tt7 tNN OF O 0 F t1f<-I st./ CO"ST.E'C./CTEZ7. ARNE �E� 634w ; s - L.4.v0 t1111W�llllll IYp�IIgWWI�N111�WNWIiINI�INW1� ASSESSORS MAP � C TEST HOLE LOGS PARCEL: 1) The installation shall corr),A with Title V ui�J `fown of l*vodrd o1 SOIL EVALUATOR: d I FLOOD ZONE: lfealth Regulations. • . �. WITNESS : " - h 2) The installer shall verify the location of utilities, sewer inverts and septic REFERENCE: �r0 „ ,/ I DATE: 1 components prior to installation and settingbase elevations. PER ION RA`f E: -�'--. °'U.o(c 1 r 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8 per foot. The first D two feet out of the d-box to the icaching shall be level. - — 1 4) This plan is not to be utilized for property line determination nor any other ' TH- I TH-2 purpose other than the proposed system installation. V% W r 1 5) All septic components must meet Title V specifications. 6) Parkin shall not be constructed over H10 septic components. g p P 7) The property is bounded by property corners and property lines. _ l �i �' 8) The property owner shall review design considerations to approve of total LOCATION MAP design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed a approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per 90 Title V specs '�-- ' `� '�` "' -�^-� ��,•�x�.�_- ����,�; , ,, �;m„ � `� 0 System components to e LO feet from. water line. Sewer !Ines crossing the rf(v.�61��.o�' tiPhw � Y` sr water line shall be sleeved with 4 inch SCf 140 PVC with ends grouted if �----? applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforemeniioned and maintained in place. SEPT C SYSTEM D E S I G N 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. I ` FLOW 12 The installer is to take caution in excavation around the as line if such L W ESTIMATE ) g s exists. �) �✓-� � ,. lg BEDROOMS AT 110 GAL/DAY/BEDROOM -� GAL/DAY 13)Tae installer shalt verify the location, quantity and elevation of the sewer _ 4 I V lines exiting the dwelling"rior to the installation. SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting g, Title V requirements. fn GAL/DAY x 2 DAYS - GAL USE. 10 GALLON SEPTIC TANK 1 .r S I A O 01 =� V26 3 b SIDE AREA: U"v 'f' 2i�� � Z� r7 I I ( i 17aviD vy 2 _ — , '; BOTTOM AREA: �t :: ZJ , I MASON 1 14 AN SEPT I C SYSTEM SECT I ON 01 ld0 � � J �b GAL 5 3 , SEPTIC TANK � r ,. SITE AND SEWAGE PLAN LOCATION : 2 I PREPARED FOR : I M I o I r SCALE: I r 21) z DAV I D B . MASON ?6 DATE: ► I DBC ENVIRONMENTAL DESIGNS W EAST SANDWICH . MA z DATE HEALTH AGENT ( 508 ) 833— 2 177