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HomeMy WebLinkAbout0019 COVE ISLAND ROAD - Health _19 .COVE ISLAND RD. , CENTERVILLE �Aa- 1 q7L 058-1 C i 4 a2 i I i i (ell 17534 No2C-1 53COR � HASTINGS,UN __L No. ®` Fee l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z[pplicatiou for Migonl �§pgtem Cou.5tructiou Permit Application for a Permit to Construct( ) Repair(d Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. kc1 C��C' \ Owner's Name,�ddrg�s,aPnd T*<,S_<_ Assessor's Map/Parcel ` Installer's Name,Address,and Tel. d NoU. ((� Designer's Name,Address and Tel.No. V\3 �c r ` 5tr_w — A YIN Type of uilding: Dwelling No.of Bedrooms L-L Lot Size sq. ft. Garbage Grinder (A q Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 11(1 n gpd Design flow provided t-4 ( gpd T� Plan Date (, I)% t)� Number of sheets Revision Date Title Size of.Septic Tank C V Type of S.A.S. Description of Soil r1 rj cdodc.t Nature of Repairs or Alterations(Answer when applicable) ,-3 k e. �,M 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. rr Signed Date /�s to Application Approved by Date G —(roY o Application Disapproved by: Date for the following reasons Permit No. �� �� Date Issued (0— fr' 'csr.T- . .,ri-,Z.--'W ,�,, .".. - 1 ., J .. �`.�'.w.�}4« ' rt' y� .P . �,..• ,,.3..-.....,,:s!'' .r.-�=`7 1 No. . 0 00� p Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION,, TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[ppgication for-.JDi.5po,5a1 �&pgtem (on0truction Permit Application for a Permifto Construct( ) Repair(, Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.'s ����S ( 1S1 Owner's Name, dd sd�s,and T1.,No._� Assessor's Map/Parcel ", Installer's Name,Address,and Tel.No. ZV Designer's Name,Address and Tel.No. ��. j �c/�"�cx.�`r S�C�2— Gr^S F rl v 2-� 6a yp�c Type of! wilding: Dwelling No.of Bedrooms !-A Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) f Other Fixtures ' Design Flow(min.required) �t c it ram.v gpd Design flow provided � (� gpd �� Plan Date ( � ����( Number of sheets Revision Date Title C / Size of.Septic Tank 14--,%V Type of S.A.S. Description of Soil T"1 c� [6&(C-t S 0�,f j m tiJ U k.Q-%t _ Nature of Repairs or Alterations(Answer when applicable) 0 P'.3 5 V��C`a.�n \ C-0A -,&-J 6' 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.Signed Date (o 1 /6 fO Y Application Approved by hti _ Date Application Disapproved by: Date fortthe following reasons Permit No. `� �'S Date Issued % THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired��) Upgraded ( ) ti Abandoned( )by CCc� 7—c-c"\ at CA CC?-rC_ ,G(w.c� fZ C•y �`-e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. `� Ug �S� dated 6 Installer �CCA �•-t.r��_ Designer #bedrooms '. l Approved design flow L(�o / /I/I gpd a The issuance of this permit/sm l not be construed as a guarantee that the system will U G.Norm/as/designed. Date p �r/ / � g Inspector No. �LoOgr ��� Fee P"�•' � �--- T THE COMMONWEALTH OF MASSACHUSETTS r�' PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Iigpont *p.5tem o otruction permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at �Q ( ��(�L_ [�G... J R d C. t N\-p and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date (6-09 Approved by ��/J ✓ 10 Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Health Division ram" Thomas McKean,Director 200,Main Street,Hyannis,MA 02601 i Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form 1 Date: 110 08 Sewage Permit# LM-K--olsissessor's MuplFarcel l.07- 6 Designer: 9Plt1E-0-3 Installer: 5C_p-r7' � Address: W3 Aowlu- c-A _ _ Address: 113 _aL-'h • On l� (�� Se_i� r—A—r+-0AL- was issued a permit to install a (date) (installer) .' septic system at /9 eeVC_ 15 t—e°`'`•'Z�, 94:>*4-:b_ _ based on a design drawn by , (address) 6iZrPH6J4_J E-F.A.-,AS P6 dated Co 8 (designer) �I certify that the septic system referenced above was installed substantially according to i 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 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. WA (Installer's Si§naue< � IVL off, (Designer's lgnature) (Affi Des' ner's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND-AS- BUILT CARD ARE RECEIVED BY THE BARIVSTABLE PUBLIC H�+ALTiff DIVISION. THANK YOU. QMepticDosigr:cr Ccr6fimoon Form Ruised.doc i t ; I ! i TOWN `OF BARN T BLE ` LOCATION l,� QV ._\Y`0\� kN SEWAGE#9(YJY-19 r, 'VILLAGE �,� �� ASSESSOR'S MAP&PARCEL �� INSTALLERS NAME&PHONE NO. 0 0 6 SEPTIC TANK.CAPACITY S1W Q py .�► LEACHING FACILITY.(type) co,,AV r (size) NO. OF BEDROOMS 'S H1 OWNER C �b 5�-- PERMIT DATE: so I b COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5<&- �ONKAAFeet 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) I:Sb Feet FURNISHED BY_ <sg'c,Q`C"'� ���.� � sit � AA% :31 13k� � � 63 'ice �+AO16tag c� Town of H3arnstaDle P# /19 9- Department of Regulatory Services �11,7,1e,46F- 200IME h Public Health Division Date Main Street,Hyannis MA 02601 BAMSTABLA e y� 03 <„ f>1 v ABED MAt� Date Scheduled Time Fee Pd. 11(57 Soil Suitability Assessment for 4 age Disposal Performed By: 974?7_P -6-� I+Ay t`� P 6- Witnessed By: :..�.u. ... r Location Address �- ( n Owner's Name - Address )'�e`(V�d O J Assessor's Map/Parcel: t�� O Y Engineer's Name � / -c�,t,.l'e, L� NEW CONSTRUCTION REPAIR ✓ TeleP hone# - l� Land Use )1�_&S ,b 64_i7 A-L Slopes(%) -5- Surface Stones /V a Distances from: Open Water Body /K�_ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ZO-+ ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ' 0 R0.,10 v 'k._%' '`yam, "ar:• o .v".: f Parent material(geologic)ar,7'4-/A5 K Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater iiAN Al � ....,.... .:._. ...I.._.._. ,,.. Method Used: ��E _.Depth Observed}standing iii obs.hole' - - ., in. .Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ RM 4 Afll T :. ... .._ .. .,d__.._ - .. .. Observation Hole# 2 Time at 9" 7-5 3u 1, Depth of Perc �7 Time at 6" Start Pre-soak Time Q v �"' Time(9"-6") �' ' 33 End Pre-soak Rate Min./Inch L3 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- Q:HEALTH/WP/PERCFORM ...........................:....:::.:::..�:::::::.:.�::::::.:::.>::.>::::�+:.:;:::.:.;;:;:::.:::.::.::.:.::.:<.::<::::<eta;t�;;#::..::::..::.::.;.;:.:<:.:;::.::.::.;:<:;.:::.:•.::::::::.::.:::: Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % /32- YAT)rQ1 :.H. ::.:::::........................ . ......... o :: ::: Depth from Soil•Horizon�� �• Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (Munsell Mottlin g (Structure,Stones,Boulderes. 0 .0 LS /vYa% r� O� Dept from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. o il Horizon Sol ...::.::. .::.:.:.::: ;>:;.;;:::.;.:::::.;.::.:;.:;::.::.;::.:.;Ile;#.::::::::::::::::.:.::::::.::.: »;:.::.:.;:.:.;.:.;:•.:•::. Depth from Sol Texture Soil Color ,Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. 0 Flood Insurance Rate Man- Above 500 year flood boundary No_ Yes_ Within 500 year boundary No Yes Within 100 year flood boundary No x Yes Depth of N turalI *OCCurflng 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? Y&­5 If not,what is the depth of naturally occurring pervious material? Certification I certify that or, // !V (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 tramm , pertise and experience described in 310 CMR 15.017. Signature Date Z too 7 COMM FIRE DEPARTMENT 7 0 Make application to local Fite Department Fire Department retains original application and issues duplicate as PermIt. 7 L I Fee� APPLICATION andr""ERMIT for.storage tank removal and transpoitaIon to approver!tank.d?s;osal vard in accordance with the pr4lions Of M.G.L. Chapter 148,Ssr,41on 38A, 527 CMR :-.00, acpIlCation is hereby made by: Tank Tank Owner Name.,(please pmn!) X 'a petv'ro,—o-Wri— Addres8 NJ t Company Narn,A6�ak*,<s Go.t)0ndividuall 41 Addres an A14/7P Addrem Signature(it applyinnIcr permit) Signature(if applying for permit) C: IPD'Certifled Other Tank Location Tank Oapacjt},(,6-211ons) 42 B 12,41 Sibstance Lest Stared ! Tank Nrmsionr(disimeter length). I Rerfiark�: Firm traisr-)rung,wart 'ala Lit. 00 Hazardous waste manilesto E P A-* R, A-0lovovad tart:disposal TanK yard f ft 7)16 Tvzeof inert gas. Ta,4 yard Rdcreu 1 '01yo"Town ostafvilla FEAD# 01920 perrng# 0012163 Late expiration /21/08—_�� _—.__s_=�_.___ Dig safe approval numb NUrnbef-8XI-322-4a4A Sig-iature ITitle tY(Acer grarifi%rarmit 11 C.) Alter removal(e)("Consumptive Use fue!311 TaN,,s e4etjipi9d)send Form FP 29UR IGrtc@ by Local Fire Dept.to 0$'T Fiogulat,,,jry Compliance Unit,Department cf Eire Servim,P.0,Rox 02.5,StaU Road,Stori,MA 0 177 *InterratioraO:ire Cods Institute FP-292(revisiad 4197) OF BAD BARNSTABLE COUNTY DEPARTMENT OF HEALTH AND THE ENVIRONMENT ' SUPERIOR COURT HOUSE POST OFFICE BOX 427 BARNSTABLE,MASSACHUSETTS 02630 Phone:(508)362-2511 9ssACHUb Public Health Administration Ext333 Environmental Health 383 Water Quality Analysis 337 FAX(508)362-4136 UNDERGROUND TANK T .ST RF.S 1f.T.S TDD(508)362-5885 NAME: CHARLOTTE BESSE TEST DATE: 2/2/98 TANK LOCATION: 19 COVE ISLAND RD, CENTERVILLE MAP/PARCEL: 187 058 TAG#: 544 YEAR INSTALLED: 1980 CAPACITY: 2000 The recent check of the vapor monitoring well(s) near your underground storage tank (UST) did not detect any significant contamination. Because the use of soil vapor monitoring for UST leak detection is a recent and limited technology we cannot,however,guarantee that your tank has not leaked. You should also realize that a*"good" result from our test is no indication of how long the tank will remain sound. Due to fiscal constraints, the Barnstable County Health and Environmental Department has instituted a nominal test fee of$30 for one well and$10 for each additional well at a site. Accordingly, would you please send a check for $-Q_, made payable to BARNSTABLE COUNTY to: Chadotte Stiefel Barnstable County Health&Environmental Department Superior Court House, Route 6A Barnstable, MA 02630 The following items, if checked, also apply to your UST: _We encourage the removal of older tanks before the expected leak(s) develop. _ We encourage removal of tanks under 300 gallons as they were not designed to be underground. _Your UST doesn't appear to be registered and tagged as required,by your Board of Health. _It would be advisable to mark your monitoring well to prevent accidental usage. The soil conditions surrounding your tank are not ideal and may accelerate tank leakage. A copy of this letter has been sent to your Board of Health and the records reflect the results of this tank test. If you have any questions please contact Charlotte Stiefel at(508)-362-2511 extension 334. cc: Board of Health: BARNSTABLE Whereas,the escape of fuel from an underground storage tank may result in civil and/or criminal liability of the owner,lessee,licensee, licensor, and/or other persons in control of the premises; Whereas,the use of vapor monitoring procedures is only one of several procedures that may be used to detect leaking or escaping fuel; Whereas, the reliability and experience of the testing procedure is limited; and Whereas, from location to location and soil to soil test results may vary due to a number of factors; The County of Barnstable and the Barnstable County Department of Health&the Environment represent that while the test results give a fairly accurate reading of the vapor content in the well sites at the place and time of the testing,the soil conditions and condition of the tank and connections may be such that leaks could occur at the time of testing or shortly thereafter without detection. Similarly,the equipment is sufficiently sensitive as to detect fumes when, in fact,no actual tank or piping leaks have occurred at all. Therefore,no party shall rely exclusively on the results of the vapor monitoring test. Neither the County of Barnstable nor the Barnstable County Department of Health& the Environment shall be liable to any person either for the failure of the test to detect a leak when such a leak has,in fact,occurred or for the detection of readings which may indicate that vapors are present in the soil when,in fact,no leak has occurred. Neither the County nor any department thereof shall be liable for any faulty or overly sensitive readings resulting from the taking of such test. LO AT ION SEWAGE PERMIT NO. VILLAGE INSTA LE 'S NA E i ADDRESS eat- OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 7e f:• 1 cy- Rn � � oU No...... FEs......... ..s...X. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ........ .. .. ..............OF.... ........................................................... Appliration for Uh4paii al Works Tun :rurtion ramit Application is hereby made for a Permit to Construct ( ) 'br Repair ( ) an Individual Sewage Disposal System at: Z071, MIS ..... .•. - ..........................•---....------..-•--• - Location-Address or Lot No. ...awa21 3A--SSe............................................... h+.K....s G, ? r . v7. c........�'J. Owner Address 144- t 2S 5. 1k .--•---.....1�-`-Asy..---•............... Installer Address Type of Building Size Lot 3 ........Sq. feet a, Dwelling-•�No. of Bedrooms...........3..............................Expansion Attic ( ) Garbage Grinder (se Hc> 44 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------------------------••--- . W Design Flow...............//0......_............__gallons per person per day. Total daily flow.......°-r��...................--......gallons. WSeptic Tank—Liquid capacity .gallons Length----�.e.... Width-_��...... Diameter---------------- Depth................ x Disposal Trench—No--------------------- Width.................... Total Length................... Total leaching area....................sq. ft. Seepage Pit No... ? -------- Diameter...� ........... Depth below inlet-_!.............. Total leaching area... 7.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 114 ....> es per inch Depth of Test Pit.... ...... Depth to ground water........................ Test Pit No. 2.................minutes per inch Depth of Test Pit....�1 ..... Depth to ground water........................ a -----•-•-----•-••----------------------------------------------------------------------------.......................................................-- (xj _.. 9 Z � A. =gjij-.__..O Description of Soil--- a_ .. . . - /IKP b............................. . ----•--------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------•--•-•-....._..._..... U Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------te.............._.__...._......._.. i Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Gpde—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has -' issued b the board of health. ............................... l Date Application Approved By..... .:.�� -........................................ Date Application Disapproved for a following reasons------------------------•-----------------------------------------------------=--------------------.......--•--- .....................................••---••----•-------------------------------------•-••...-----------------•-•........•----••-----•-•-----•---------•----------------------•-----•-•--••------------ ' (J Date Permit No....3..�....3.......................................... Issued......0` 1 ..-- ....... .......•------------ Date No....... - ...... Fic$.......... '" u THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f, ............ ..--.-'Cw ---------------OF...-. t ,t/1 t ..:.......... Applira#iun for Bispaa al Works Tonstrnrtiun rrati# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage 'Disposal System at: .........f &p.. fes, ..,E eU/i-c L ..... ...........................................................1. f .............................. ,,y("/J�q y-pP�p� -• Location-Address , or Lot No. ! F. r. ._.._....--•--. � ......._�. M. A-& Owner Address .................................................. ......?9�.! ............4.1. Installer Address Type of Building Size Lot.3 .XS. . ........Sq. feet U Dwelling—No. of Bedrooms............a...............................Expansion Attic ( ) Garbage Grinder (x ) /`J 4c) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .----•--------------------------------------------•-----••-•-•-••••••••....•••--•---•------•--•••-••••-•-•.........•-----.........-•-•••......--•-•-- W Design Flow................/ZQ....................gallons per person per day. Total daily flow........ •'-..........................gallons. WSeptic Tank—Liquid capacity_fAa .gallons Length.___ _l._. Width._._____._. Diameter________________ Depth................ x Disposal Trench—No..................... Width_..`............... Total Length.................... Total leaching area___..-••-•-.__------sq. ft. Seepage Pit No....t f- ,A __-__-- Diameter.._. ........... Depth below inlet_-•............. Total leaching area...A 67_.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a.. -----------------------------' =Scai ...... "- 2" d7 +rvM •SA J........r�=f........-�/W � U0."-:14"..I �uNt_.... r!'fiS�. .-•----------•--••-•--------------------•-•------------------------•-----------...-----•----...............----------•-----•----------- w 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 TIT`_ 5 of the State Sanitary L e—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has besued by the board of health. Signed--.......... ..................... .._.....'"� p- .. ................................ ;/7 ApplicationApproved BY--------- •=A......................................................--....................... ....................Date.............. ,e Date Application Disapproved for t'he following reasons-----------------------------•-••----•----•--•--------------•-----------....................Da.t.e.............. --------------------------------------------••----....-------•-•-•---------------•--•------•-•---••---.....--•-----------------•--•----------------------------------------------------------------•--••- Date _Permit No..... .a............................................. Issued_Issued---•------......--------•------------.....----.......•-- Date THEmCOMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ul.� r.............O F..... .', !lea,3.............................................................. Trrtif iratr of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ..._--•••• .................-.............................................................................................................. Installer at.............G.�!27........ ........ ........................ 7 ,.!r✓/' ...................•--•-......•-•-•-••-••-....••••••---•-. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works`Coi struction Permit No _"4' � ...................... dated_ _._._ ''.' _.___............... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ -- a �' sx• . . . s_ �"� •� ."� ,.�i� ...w"'y,'"w.Y Spa �,'t"�- ` '� anti `.x<t.Y 't„.`""��, Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF' HEALTH 1 4 � q!&A!..'....0 F............ 'f�'y! e�,f + ............................. Gl ........... .. No...... ....... FEE.... : .-''r i��u�ttl urk� �un��ra�tiun �eraati# ' : _ � Permission is hereby granted........---••-- � ... ----•-•-••-------.......................................................... to Construct ('�() or Repair ( ) an Individual Sewage Disposal Sy,ter at No.........._. r Z -•-• . ...... ukr �. �..__..! _� s*c cr y i.�t e �. s.. `"• ---------•-•---••---------------••-••-••••......••• ....... Streetx as showwxon.the application for D0pos410Korks Constrqc(on Pe.mkt No.__.. _.Z3..... Dated......... .•...• t ,• t' f Board of Health ' DATE. r .� , . FORM 1258 HOB119�& WARREN. INC.. PUBLISHERS Sg u �W G yi k. a.F 04 �� ESL �U vN. Q o 40e p ( titi' I 01) 10, ti C. �ti 3 q 4 i v yp IV ti L°ego' � -- - ; 'V (r $ / ti EZE e,"AFD oti 3 � a CERTIFIED PLOT ' PLAN LOCATION V1 LG ;.. /`9<►s5. _ SCALE . .�. . . DATE .,`.7. . . /o rt7, PLAN REFERENCE OF Af$ EDNNARID I CERTI FY 'THAT THE ... ..... SHOWN ON THIS. PLAN IS LO A E GROUND AS SHOWN HEREON AND I ORMS TO THE // SETBACK REQUIR E TOWN OF Cl/Aiae-o 777_ 5��L . . . . . . WHEN CONSTRUCTED. MA J N S7x?-d�;F'7 DATE . PETITIONER: O&Wr"VI46 — REGISTERED LAND SURVEYOR N59345 f L. .ZZ,ao. . ... . TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 0 4"CAST IRON 12"MAX. MAX. • , ova► PIPE (OR 12" 4"ORANGEBURG(OR EQUIV.) eI EQUIV)- MIN. PIPE- MIN. LEACH � PITCH I/4"PER. PITCH I/4"PER.FT PIT ono PRECAST INVERT L •. Q LEACHING EL./.7-Bz.. INVERT INVERT ? . o•: PIT OR SEPTIC TANK / DIST. ,�p • w �;� EQUIV. a INVERT EL..7 . . BOX EL..7..... '.: \ >x �. � o; EL..l.7•4/.. /qa9 .. .. GAL. INVERT ':• V c~ia INVERT wW :�: 3/4��T011/2 EL�ZV EL. � /,.8 u- �: WASHED W STONE ,'.• /2`--► -W DIA. o, • �-- /o• DIA.---+1 /o - PROFI LE OF GROUND, WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE PRELIMINARY SOIL LOG WITNESSED BY : DATE e4pE 4 9,1�79 TIME. . . . . . . . . . . /�A2.4 . !?�!� BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ev,F - CEZl��/� P,E,• ENGINEER ELEV. .!`/.9S . . ELEV. z3.d Loan-, 4` ' ,V. • c os+� fe '.;/ .•a-so,c. ,'; s�aso�� DESIGN DATA NUMBER OF BEDROOMS J� . . . . . . . . . S ,D PAC Sauv TOTAL ESTIMATED FLOW ..3.SQ. GALLONS/DAY 7z " 7- 5- "' BOTTOM LEACHING AREA ���-'�0, . SO.FT. /PIT GNE ' SIDE LEACHING AREA . . l8B•.•SQ. SQ.FT./ PIT SAD GARBAGE DISPOSAL NvNE. .(50% AREA INCREASE) SAD TOTAL LEACHING AREA . ZL7.�?o. SQ.FT PERCOLATION RATE . . . ./T►. .5��.. . MIN/INCH LEACHING AREA PER PERCOLATION RATE .45�4. . SQ.FT. //. .WATER ENCOUNTERED NUMBER OF LEACHING PITS .1,P�T. W��•TY✓�.��T APPROVED . . . . . . BOARD OF HEALTH QF S`roc. o.✓ G Si 'S, _ 467, TD•vs o,� DATE . . . . . . . THOMAS E.KELLEY CO. AGENT OR INSPECTOR ENGINEERS—SURVEYORS 346 LONG POND DRIVE 4 pUTH yARMOUTH,MAS . H OF MgSS OF OZ664 TH r OVIARJ No.24160 O to '/�'I t,J. .S`f� t�s"�T �,•.,� © i 9o�sslONA PETITIONER �'�t/�•;�V�GGE M�)sS, �4�y S�EN �/ J SUBJECT- TO OPROVAL OF BARNSTABLE CONSERVATION /S THE COMMONWEALTH O ETTS _ BOARD'-OF' HEALTH �.O.w.?,5 oF...... .R-.IJs .. C-........................... Appliratinn for Disposal darks nntrnrtinn rrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: -»C.OUEE_ TSLA! 17 �?��- .{.:eE1�1TE?CCU�I_1.E..............................»L 0......-»�-......------..........----------- -(� c �` �Loocation-Address or Lot No. ...................a7»._ x...S.C-!-......kA......------••.........--.................. Je `ME. 4 /�l "f .....- ►JST�-��5.� .... .... ................ Owner (F_ 1 G ZA.QQ Vim!n j � 5 cJ l Address ... ------------------------ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............. .............................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons...._._8................ Showers — Cafeteria a' Other fixtures . __. ------------------------------ ...................-...................................................................................... w Design Flow...... .....r _._._..____gallons per person per day. Total daily flow........ .......................gallons. WSeptic Tank—Liquid capacity............gallons Length___---_..._.. Width--- ........ Diameter________________ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------_---------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( � Dosing tank ( ) l ,� c y/�.� /> l J "" Percolation Test Results Performed by.._._._ _�7�,..���. �. .y4 i.!............. .. .:..... Date___ ............ Test Pit No. 1____.a-__.-_.minutes per inch Depth of Test Pit.................... Depth to ground water_._______-_._-_.---..__- f� Te�t Pit No. 2................minutes per inch 'Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------•-----••----------------•-----------•------------------ 10 Description of Soil--0.---2.j......-QDIA.-- --..'--? -A,L------.... 1' 4��.. ._f=11U �A x w 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 THE 5 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 the board of health. N Si ed . ................ ®�=- _.... / .��. �C3.o`noJ, fh�. 1 Date Application Approved By, - - /- ra�%1 / -----------------------------------•--------.......................... Date Application Disapproved for the following reasons:.................... .._.._..__..._ -•------...---•..................•--------...---....---------...---------...-----•------.......----------------------------------------------•--....---•------•--------- ................................ Date • v PermitNo.................•---•-----•------•--._._....-•----_.._» Issued_--- `� •.' ---•------------•- Date ... r r THE COMMONWk= ,LTH OF MASSACHUSETTS } BOARD .0E ---HEALTH Appliration for Disposal Works fonstrurtion Frrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: .....Ui� .+�...c'.,�� .......,C- 1.... ocatigp Address ^n or Lot No. .....................--- ..... ............................................. -•-.....-•--.........----------•-••-••-•......•----............................................... —� Owner ] Address ! C !vim t�C�� :, 1 'r1 T�J` } Installer Address QType of Building Size Lot............................Sq. feet U g— -Expansion Attic ( ) Garbage Grinder ( ) Dwelling No. of Bedrooms..............1._.__..._...._...._..__..__. Other—Type of Building ............................ No. of persons........�............... Showers ( ) — Cafeteria ( ) a'' Ot tures . » W Design Flow..................... WSeptic Tank—Liquid capacity............gallons Length......``.---.... Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..........----...--. Depth below inlet.................... Tota lea ing area..................sq. ft. Z Other Distribution box ( � Dosing ta�1 ( ,,� �e A . if-f4-77 ,�i p 04 Percolation Test Result Performed by....... �t..d1�P-._j Y ji..............l).--J.--::... Date.... :. �j_~..'7r........... aTest Pit No. 1................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........................ -----------------------------------•------------------------------------------------•----•-- -•-•---------- O Description of Soil.............z`; 1_r;�Nl I.J;L' ,01� L► ' ^ _�`,1.`� �: C� I KUE_ _ 1�t) ---------------••-- ................................................... x V --------------- -------------------- --------- -.......... W -------•--•-------------------•-•-•-------•--....•-----------.......------------------..........-----------------------------:-----------•-•----------------=........................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------- .......................................................-........................................................................................................................... A eement: 'The undersigned agrees to install the aforedescribed Individual Sewage Disposal.System in accordance with '--the provisions of TITTLE 5 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 the board of health. Si e �,, L _ ca t ti_f t� ►_cot. ---•-- •-•-------••--•..... ...... ---•-•-• ..•. ................................ a� 5 �. (i Date Application Approved By..---- `------------------ ------- - ''. 1D 4 Z~ 7 Date Application Disapproved for the following reasons:----•--------------------=------------------------------------------------------------------------------------_ --------------------------•------•-------.....-................................................................................. -----------•---••••••---•-•---•-----•--•------•---------------•---•••-- Date PermitNo......................................................... Issued........................................................ Date 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........�.� . ..........OF..... .1 C .C�1 ........................... Tn#ifiratr o-f TuanpliFanrr �. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) k� �[. Installer at.................................................. r 1 ----- `� _`?1_I *5 J.. ;7,�. ----' -.......... ------------------- has been installed in accordance with the provisions of r 5 gf The State Sanitary Code as described in the application for Disposal Works Construction Permit No G---I.�----.--_--_-. da.ted.... .��-C".�7............: THE ISSUANCE OF THIS CERTIFICATE SMALL NOT,BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.. DATE.........................................,•.......................:............. Inspector.............................................-=`•..................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (77; No.....:.. FEE. ��.......... y ...................... Disposal Works fit %Uono#r i.�n rrmi# Permission is hereby granted - 2.1.1... to Construct ( L,�'or Repair ( ) an Individual Sewage Disposal System atNo. 1 7 T. t ' 1 - J ` � _� ? �=0 = _ T .......................................................... Street as shown on the application for Disposal Works Construction Per o..... ;:_ J Dated.../0."!7....`7 ............ _ DATE................................................................................ Board of Healt FORM 1255 HOBBS & WARREN. INC., PUBLISHERS LQ C AT 10N S EW A G _PERMIT NO. ' VILLAGE t t N S T l ER'S JA ME & ADDRESS B U It DER OR AN ER DATE PERMIT. ISSUED `0 f2 DATE COMPLIANCE ISSUED 6 i 9 �?> 35 `'' ' 1 _ "_ •2-- T E S T HOLE S- 71 o a aA # tiff _ 7 a s 4 f4; MENU " �� .a ; � Ety ` 1D F Z , �• '7 � 0�/max- tR 4. NO t�)X T R- ai-Alct)JiIi)rE, to f''E R 15 i � . p5 Li 4-DIAIG s Ereac :. �Qu�, ,M T,s �- t.. 1 0: ! a 3.0 F20V TD Si a� -T24,2 t� � BE,D 120cOM5 "� 5E P T 1 G S y5 TEc�! CANS T2 UC T%�N - R S 4A L.L• GOnlFO2M To .oI-S,. ?K D 5/G Ai FL 0 w. '� } GAL MA ENd!/;eONMLNTAL GOo4 .TiTL,I /A/C/-/ { LAC. R Lam. a L ray. Aoe�A-(*�o, ' 4)(t, TOP OF NFr.4,L 7`N a2�6U.Z-A T/O/1 ICJ r `' -4CN o 5O;00 2 0F ST.oNr MAA1110Lt_- V6,22 7-0 TEEAstp .Tq �MpEQ✓/IUUS GOt/E� WI r;94/A/ /• OJT IF//�I/$HEa Gl�A D� >. TO P-2E✓e,,I A--IAZ•-•5 7 r F/zO ./ /A/I,-,e,477A/6 x; I 5 M, r z tow a � � '4 CAST/.r2oN N/i o v s r� E30�C Z1. M/Nii yUii/ _ 6 M r � 4_ ,D/A T£r A . P/TC.N -F moo, �,rve �6 r _ ,� 4 II 7- d A1iN /4" /q /Food N?{iv pi rc.v. t D/A'. - rt % aflF WAS 1aEo SO SE pT/G .TA-A/� V N 3 q (WA TG Z.T'1 G i5/°T) .+ dTl"OM aF 4 hv • . VE Z� t �^ , La. CA TiO/l/ -�i?E FE 2�I1.l�� L3 A�� �� ==� •.+r�'S-�l`ILI.��2CLl't� ,: ,- r s - -A6 1 ^ TAA e- j?/S'r-e/87:-T/0AI Aav17 � E.AGas!rG sir li k?s q W t 20000 Q x 10 LOAID/A/& x. rp.: �? tY tN�i Y '/ fO,T TC7 BE L C�C. i TE D. UAI TE N: R ?/ CR1 #' THAW : !/E . €XlS.FfNG 1 '`Io, /5' coRk r 9S .404.c 'RM W17'N rN ■■ zs. r�sn�i�* ,.;? s:s ,� 'Fr`_= ,S,F..{ .".r.� .. ,f9 _ ul:.-3-3 -i:.a... .-..tb— - f - ~' ♦�.: 3 r .xs � t*` ACCESS COVERS MUST BE WITHIN 3- MINIMUM. XI 6 * OF FINISH GRADE INVERT ELEVATIONS : DES I GN CR l TER I A GENERAL NOTES : 3 MAXIMUM COVER INVERT AT BUILDING: 19.5 Ru �1 22 6! FIRST 2 ' TO DESIGN FLOW: fps a' a RIVER RD j V BE LEVEL M/N 2' OF PEASTONE INVERT IN SEPTIC TANK: 18. 85 4 BEDROOMS AT / /0 G. P. D. PER I . THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION Br7rINVERT OUT SEPTIC TANK: 18.5 BEDROOM EQUALS 440 G. P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. DrAM PIPE 3/4" - 1 1/2 D1A. INVERT /N DIST. BOX: 18.57 1 1 . q � 12 -. ] F__] �o DOUBLE WASHED STONE INVERT OUT D/ST. BOX: 18.4 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS B•85/ OAS 1 7 v I $ 14 INVERT IN LEACH CHAMBER: 16.3 SET. SEE SITE PLAN. I BAFFLF SEPTIC TANK REOU/RED +- --LOCUS 4-3050 INFILTRATOR CHAMBERS BOTTOM OF LEACH CHAMBER: 14, 3 SCUDDER 5 3 OUTLET 440 G. P.D. X 200% - 880 GAL . J. ALL CONSTRUCTION METHODS AND MATERIALS AND BAY �� D-BOX W/4 • STONE AROUND. 12 'r x 36 ' I x 2 'd ADJUSTED GROUND WATER: N/A 1500 GAL SEPTIC TANK PROVIDED: 1500 GAL . MIN. MAINTENANCE OF THE SEPTIC SYSTEM SHALL OBSERVED GROUND WATER: N/A you SEPT/C TANK 6' CRUSHED S SE TONE OR CONFORM TO MASS. D.E. P. TITLE 5 AND LOCAL COMPACTED BASE BOTTOM OF TEST HOLE #2: 10.0 SOIL ABSORPTION SYSTEM REOU I RED: BOARD OF HEALTH REGULATIONS. DESIGN PERC RATE ! 5 MIN/INCH PROFILE .' NOT TO SCALE SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER y EFFLUENT LOADING RATE - 0. 74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 4NF 440 GPD / 0. 74 GPD/SF - 595 S.F. REOUIRED THAN 3 ' IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. PROVIDED: 4-3050 I NF/L TRA TOR CHAMBERS LOCUS MAP W/4' STONE AROUND. A-625 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR 625 S.F. x 0. 74 - 46/ G. P.D. APPROVED EQUAL . { r 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED SOIL TEST PIT DA /7 A & PRECAST CONCRETE AND WATERTIGHT. D-BOX SHALL I ND I CA TES _y l ND I CA TES BE WATER TESTED TO CHECK FOR LEVEL WHEN THERE PERCOLATION _ OBSERVED IS MORE THAN ONE OUTLET. TES T - GROUNDWATER P►12222 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE". 4 TP r! TP •2 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. A HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR FOR LOCATION OF UNDERGROUND UTILITIES. 0' 21 . 6 O' - 21. 0 F I L L F I L L 8 SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION 36' - - 18. 6 28' - 18. 7 OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE LOAMY IOYR A LOAMY IOYR 4 SAND 3/3 SAND 3/3 CONSTRUCTION INSPECTIONS. 44" 17 9 34" 18.2 B LOAMY IOYR p LOAMY IOYR SAND 4/4 D SAND 4/4 64 ' _ 16. 3 56" ... _. 16. 3 I MED-COARSE IOYR C / MED-COARSE /0YR SAND AND 6/4 SAND AND 5/8 GRAVEL 72- GRAVEL A f0 D /25.66' �\ 132" NO WATER /0.6 132' NO WATER 10. 0 A L ` \ DATE: MAY 27, 2008 TEST BY: STEPHEN HAAS 4 I r WITNESSED BY: DONALD DESMARAIS PERC RATE: ! 3 MIN/INCH O I � LOT 10B 30. 750+ S. F. r Q r a r � r r - I h CATCH BASIN ' _g A �a O z,. \` l�IF \\ ST_ ONE M --I CATCH BASIN \ Dp/vF ^�L ® \ j YIy PAID QP BAI. C8/OH FND F L-27.20 '° u D-Box` ✓�/ / Fes,.. . o 148 2 1500 GAL L ON m 7_ SEPTIC TANK BVM ! o o n TV�I 4-3050 1NFILTRATO) 7,0 {� T A CHAMBERS r/4' S TOME °\ 5 AO-E 6N.CORNER OF B � s N 9 5,i EL-22 43 N o 0 BVr 2 EXI ING c 6.8 y T NK 1 AP0p1 ( st 3 NMS � ` p EXIS ING G iL i v / LEA c PIT No.35461 K,w < <LN' BVr• 3 4+6 s m CHAIN'LIN�� 295 A oo G/�� v +✓ �;�,, e; ,;:.L-4� �V 5 4 4 o N -•1 I m - h SEPT / C 5Y57-E/VI ES / G/V CO VE / SLA /VO PO,4O "AP / 87 . PARCEL 58 v ! ; BVW5 SAR /VS rA6L E , lCE/VTERV / LLE" > "A 6. l CB/OH FND PREPARED FOR L EGEJVD ■ CB CONCRETE BOUND C fH,4 P L 0 T TEE B E- S S E -W- WATER LINE SCA L E O HYDRANT V \ / -G GAS LINE F A G L E S U R E Y I N G I NC OHW- OVER HEAD WIRES # LIGHT POST � � _ 923 Rou t a 6A -E- UNDERGROUND ELECTRIC LINE = Y a r rno u t h p o r t NA A 02675 -T- UNDERGROUND TELEPHONE L /NE /�i�j�l 11 �� ( 5 0 6 ) 3 6 2-8 1 3 2 -CT V- UNDERGROUND CABL EV I S I ON LINE �I t/ I 5 0 8 4 3 2-5 3 3 3 + 40, 4 SPOT ELEVATION _ _40- - ,EXISTING CONTOUR EMMA PROPOSED CONTOUR 0 /0 20 40 JOB NO: 08-O26TFlELD:CFW1EEK 7CALC-- SAH/CFW CHECK: CFW DRN: SAH