HomeMy WebLinkAbout0123 ENSIGN ROAD - Health 123 ENSIGN ROAD, CENTERVILLE
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C+llln J��ctoc
UPC 12534
No. 2 kw,wsil
HASTINGS. MN
No. �o6
— 7 Fee /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: '
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppIication for Zigool *pgtem Cougtruction permit
Application for a Permit to Construct( . )Repair(✓)Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. 1 f15►qq(1 C AD Owner's Name,Address and Tel.No.
Ce.r,)re.rvtu`l:, Mh Tctme5 IvyMAtA
Assessor's Map/Parcel M AP 147 'PARCEL 7 1 Ct_ntP Qv►LL�_ M A
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
RobEe.T - 611 Lf=Dy-- fat- B C:i,LAk4&T1 0J) DA\11 0 lAlhsaN
1 `t TEA8F_Q.P.y W , FoeF-5TI)ALI A_iA vIQOJJmeNTAL �� EONS
Type of Building:
Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 3 o gallons per day. Calculated daily flow gallons.
Plan Date `1 125 10 to Number of sheets Revision Date
Title S 1 TE
Size of Septic Tank 1000 Type of S.A.S.
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 Certifi-
cate of Compliance has been is ed by this Boar f Health.
Sig ed Date _
Application Approved by Date 5111&llb
Application Disapproved for the following reasons
01
Permit No. . � ��0'�'7 Date Issued
No. •J�;YJ ---a�7 —.a > Fee /�
'a
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppfication for Migooaf *pztem Construction Permit
- Application for a Permit to Construct( )Repair('�)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. f 2 n S �.(1 e o A D Owner's Name,Address and Tel.No.
CerjerlllhL
Assessor's MapTarcel M^P 147
y ►PA C rl i C'_.2v 1 LL I`, A).R
LE L ? I
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
I?ob(fZr 671 LF0y — 31 (3 CX( AUATIe) 1,:� Mrsor4
14 TEnC3[t2Ry LAU , T_oPESTDALE, AIA L.iyJ1(2U)JMLNiAL _0L1LTN5
C/�5 � IQ �1. A
Type of Building:
Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design.Flow 3 3 o gallons per day. Calculated daily flow -gallons.
Plan Date L) 15 �a to Number of sheets I Revision Date
Title 5 1 TE
Size of Septic Tank f U 0 U Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: i
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 Certifi-
cate of Compliance has been iss. ed by this Board.of Health.
Sig ed '� lJ( Date 5 1 15 0 co
Application Approved by Date 511&116
Application Disapproved for the following reasons
Permit No. �� —0 0? Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO gRTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( )
Abandoned( )by �()b P2 i (, I LFU Q f i 1 i� E X( c V�`, T t u tj
�w at (�3 F 1\�51(a N1 I n A C-) C E t\ -1� E V I LLB'- has been constructed •n ac ordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. G(o—a dated Jr 6��
Installer_Q!)b'Iz I GI Lj:7U `,j Designer 7AV t Ea
The issuance of this permit shall not a construed as a guarantee that the syst 1, u ct n s esigned
Date / Inspectors
No. 'D 00�� �a _ - Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
&spool *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at ROAQ Tf-n L i
and 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.
Provided:Construction y�t be copleted within three years of the da`t�his permit.
Date: /,, 6/'LO Approved\by�-L
Town Of Barnstable
���Q �aaE row�o Regulatory Services
_ Thomas F.Geiler,Director
-� �irrsrhB�E,
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer &Designer Certification Form
Date: 0lo
Designer: � �� � Installer: b
Address: . �� i 1 Address: T
On. ,5'- IG -OG S,� R Excexuct.4 i o g was issued a permit to install a
(date) (installer)
septic system at TO& 614mlubased on a design drawn by
(address)
dated
(designer)
/1-certify that the septic system referenced above was installed substantially according to
the deign, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
5 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.
OF/ygs
ca DAVID
(Installers Si �
e) Cn
MASON M
No:1066
fit'�8T 6Q`�t.
(I) si 's Signature} (Affix e rgner's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF CQMIP ,IANCE YU[I NOT BE ISSITED UNTIL BOTH -THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE.DARNSTAIME PUBLIC DEA3,TH`DI�ISIOI�1.
THANK YOU.
Q:Health/SepticMesigner Certification Form
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
hereby certify that the engineered plan signed by me
dated X/ Z6 0� ,concerning the property located at
/Z c3 H1n (a �ED�-.D c/-Ekf T4:ev/L(, meets all of the
following criteria:
• Two soil evaluations excavated for detailed examination(no hand augering) and two
percolation tests shall be conducted.
• This failed system is connected to a residential dwelling only. There are no commercial or
business uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes
per inch.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will be located no less than five feet.above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation (using GIS information)
B) G.W.Elevation +adjustment for high G.N]V , __ ,
421
DIFFERENCE BETWEEN A and B
SIGNED : DATE: aC
NOTICE
Based upon the above information;a repair permit.Will be issued-for bedrooms
maximum. No additional bedrooms are authorized in the future without-engineered septic system
plans.
gASeptic\percexemp.doc `
TOWN OF BARNSTABL E
L(XATION J22 EA)SSG,tW Al. SEWAGE #9006
VILLAGE Ccn4cr yi 11 c ASSESSOR'S MAP & LOT/IV 7- 71
INSTALLER'S NAME&PHONE NO. .C- £ f3 E xeAyATSonJ. Sob•I/77-06S3
SEPTIC TANK CAPACITY /� O�ca.l
LEACHING FACILITY: (type) SOO!�cx 1 ck m-3 ('z (size) 13 x g?1/ x 2-
NO.OF BEDROOMS 3
BUILDER OR OWNER rn rh n.1
PERMIT DATE:„ -/G-O 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
Ai- 09' -�
A2-ay '
BZ-yr
,
A3. 19'
.03- G7 .
,Ay- 21
'By- 7,2 '
AS- a9 ,
BS " 74/ S d
Frn-4
i,�
John Grad D.E.P. Title V Septic Inspector
64-681
¢ . 5 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM -INSPECTION FORM
Address of property. 1� E'5ijn. Rp
Owner's name- -_ - -
Date of Inspection yln
PART A
CHECKLIST
Check- if the following have been done:
Pumping information was requested of. the owner, occupant, . and Board of
Health.
None -of the system components have been pumped for at least 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.
ii _ The site was inspected for signs of breakout.
All system components, excluding the SAS, have been located on the
/ site.
The septic tank manholes were uncovered, opened, and the interior of
the septic tank was inspected for condition of baffles or tees,
material of construction, dimensions, depth of liquid, depth of
/ sludge, depth of scum.
y The size and location of the SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
v The facility owner (and occupants,
p nts, if different from owner) were
provided with information on the proper maintenance of SSDS.
Cb
� , 40
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B - -
SYSTEM INFORMATION °
FLOW CONDITIONS
If residential l
3 number of bedrooms
number of current residents
garbage -grinder, yes or no .. -
(Ie elaundry connected to- system, yes or no -
(I� seasonal use, yes or no
If nonresidential, calculated flow: -
Water meter readings, if. available:
eE'f Last date of occupancy
GENERAL INFORMATION
Pumping records and source of information:
1
NO System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
Type of 'system
Septic tank soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection
records, if any)
Other (explain)
Approximate age of all components. Date installed, if known. Source of
information:
NO Sewage odors detected when arriving at the site, yes or no
. 9 r
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
f>. PART B
SYSTEM INFORMATION continued
SEPTIC TANK:_ -
(locate on site plan)
depth below grade::-
. material of construction: concrete metal FRP other(explain)
dimensions:-
sludge depth - -
�J' distance from top of sludge to bottom of. outlet tee- or baffle
0 scum thickness
5" distance from top of scum to top of outlet tee or baffle
0 distance from bottom of scum to bottom of outlet tee or baffle -
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in:selation to outlet invert, structural integrity, ,
evidence of leakage, recommendations for repairs, etc. )
5jem 61,o✓O 8e
eve
DISTRIBUTION BOX:1
(locate on site plan)
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, recommendation for repairs, etc. )
PUMP CHAMBER:
(locate on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for-maintenance or repairs,etc. )
SUBSURFACE -SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B -
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM SAS
al.ocate on. site plan, if possible; excavation not required,pproximated by non-intrusive methods) but may be
- If not determined to be present, explain:
Type'
leaching pits and number
leaching chambers and number
leaching- galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool, number
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding
con�dition of vegetation', recommendations for maintenance or repairs, etc. )
CESSPOOLS (locate on site
plan)
number and configuration
depth-top of liquid to inlet invert
depth of solids layer
depth of scum layer
dimensions of cesspool
materials of construction
indication of groundwater
inflow (cesspool must be pumped as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
PRIVY:
(locate on site plan)
materials of construction
dimensions
depth of solids
Comments:
(note condition of soil, signs of hydraulic failure; level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
r
a
. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -
- PART .B
SYSTEM INFORMATION- continued
SKETCH OF SEWAGE DISPOSAL- SYSTEM: -
include ties to at least two. permanent references landmarks or benchmarks
locate all wells within 100 '
-
i
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i
e.. Q
d d
4A y'
Cc
DEPTH TO GROUNDWATER
depth to groundwater
method of determination or approximation:
/ S c�af�S
W`
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
- x:
PART C
-__ FAILURE CRITERIA
"Indicate yes, no,- or not determined (Y, N, or-ND) . Describe basis of
determination in all ,instances. If "not determined", a:-plain why not)
Backup of. sewage " .into facility?
Discharge or ponding of effluent to the--surface -of the -
surface waters? ground or
Static liquid level
_�N in the distribution box above. outlet invert?
VLiquid depth in cesspool <6" below invert or available volume< 1/2 day
Y
Required pumping 4 times or more in the last ear?
number of times pumped y
.N Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent?
Is any portion of the SAS, cesspool or privy:
below the high groundwater elevation?
I
within 50 feet of a surface water?
within 100 feet of a surface water supply or tributary to a surface
water supply?
within a Zone I of a public well?
within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the SAS) ?
within 50 feet of a private water supply well?
less than 100 feet but greater
supply well with no acceptable water 5quality 0 feet fanalysis?rom a vaIf the te wellhas been analyzed to be acceptable, attach copy of well water analy:
for coliform bacteria, volatile organic -compounds, ammonia nitrogen
and nitrate nitrogen.
13
" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D _.
CERTIFICATION
.Name of Inspector
_ JOHN GRACI -
Company Name - - - TitleY Inspector
- P.O. Box 2119 - -
Company Address Teaticket, MA 02536
Certification Statement
_ I certify that I have personally inspected the sewage disposal system at
this address and that""-the information reported is true, 'accurate and
complete as of the time of inspection. The inspection was . performed and
any recommendations regarding upgrade, maintenance and repair are
consistent with my training and experience in the proper function and
manitenance of on-site sewage disposal systems.
Che one:
I have not found any information which indicates that the system fails
to adequately protect public health or the environment as defined in
310 CMR -15. 303 . Any failure criteria .not evaluated are as stated in
the FAILURE CRITERIA section of this form.
I have determined that the system fails to protect public health and
the environment as defined in 310 CMR 15.303 . The basis for this
determination is- provided in the FAILURE CRITERIA section of this
form.
Inspector' s Signature
Date /-
Original to system owner
Copies to:
Buyer (if applicable)
Approving authority
-- TOWN OF C � BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION
-TYPE OR PRINT CLEARLY
PROPERTY Y INSPECTED pp //►► /y� l
STREET AD-DRESS
ASSESSORS MAP, BLOCK AND- PARCEL #
OWNER'-s NAME IV IWAA
- PART--D - CERTIFICATION -
NAME OF INSPECTOR
_ JOHN GRACI
COMPANY NAME !I ispeeter
P.O. Box 2119
COMPANY ADDRESS
Street own or City Stets LIP
COMPANY TELEPHONE ( ) - FAX
CERTIFICATION STATEMENT -
I certify that I have personally inspected the sewage disposa-1 system at
this address and that the information reported is true , accurate , and
complete as of the time of inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Chec one :
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection which I have conducted has found that the system fails to
protect the public health and the environment in accordance with Title
5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form.
Inspector Signature It Date -Ta
one copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF HEALTH.
* If the inspection FAILED, the owner or operator shall upgrade ' the system
within one year of the date of the inspection, unless allowed or required
otherwise as provided in 310 CMR 15 . 305 .
partd.doc
1 f
LOCATION S NIA PERMIT
G E NO.
VILLAGE
= c
I N S T A L R'S NA i ADDRESS
w
iU.ILDER OR OWNER
J
DATE PERMIT IS U E D
DA,TE COMPLIANCE ISSUED /�/� v
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V -7
1
D i13,
u P' ,
TOWN OF BARNSTABLE
LOCATION �3 654 an RW SEWAGE # 1
VILLAGE Cep kIM //T
11 I. f/'I style. ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACELITY: (type) PCe ol(size)
NO.OF BEDROOMS 3
BUILDER OR OWNER 'S
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the: a 1�.
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 JAc,�Gco C..� f- 7 YU �5
AA
A� �7d
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................... ..............OF.......... .......................
Appliration for Uhipoiial Works Toustrurtion runfit
Application is hereby made for a Permit to Construct -(I-eor Repair an Individual Sewage .Disposal
system-at:
............................ ... . ...............
...........4(v!���.............................. ... .................. ---------- ---7
or Lot K7�,
L t' Addgess
........................... ........ ...............1-3-,
OwnerAddress---------------------------------------------------
......................... ... .............................. ............................$.. ............................................
Installer Address
U Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.._.___.___.. Garbage Grinder A�L4&—
'�?---------------------------Expansion Attic V�_V
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfix es ......................................................................................................................................................
Design Flow............ ..............................-gallons per person per day. Total daily flow............. ........_.....gallons.
W Septic Tank—Liquid capacitj-'.00.Qallons Length................ Width._.............. Diameter--------_----_ Depth................
Disposal Trench—No..................... Width.................... Total Length_.___.............._ Total leaching area....................sq. f t.
Seepage Pit No..................... Diameter.._...__.___.__...__ Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box (,_� Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1.�.s:5.minutes per inch Depth of Test Pit..../_'(...... Depth to ground water_/4�-Ji
nch Depth of Test Pit____________________ Depth to ground water..-
Test Pit No. 2-1-c"k-minutes per i'
...........................4.. .C.........
fqs
Description of Soil................................. .... .
0 ...................... ...............✓
...........
-----------.............$----------------------
-0...... ' ................
---------------- .................14e. -ie. _t.t..... --------
------------------------ ---------
.......................................................................................................................................................................................................
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 TI I TY-Zn 5 of the State Sanitary Code—The undersigned further agrees t to place the system in
operation until a Certificate of Compliance has been issued by the board of hriftlffi.
ne ./� / -
Si 1
d.............0.. .............................................................. ......
1 e
Application Approved By.... .
.. .. ... .. .. .................................... .....
ZOP.............
Date
Application Disapproved for the following reasons:...............................................................................................................
...............................................................................................................0.........................................................................................
Date
PermitNo--------------------------------------------------------- Issued.................. ................................
Date
i •
f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...............OF.........
Appliration for Uiopoii ai Works Tontrurtion jiumit
Application is hereby made for a Permit to,Construct _(.--)�.or Repair ( ) an Individual Sewage Disposal
Systemat.._............... ... .............................. .........................................'
j� ( C✓ ,9t/S;
+ Loc atio Address t � t Nh
Lo
.............•__.... .:� .....................................f �)-.......................... -.............
t
Owner P j/ Address
a .. .r 9 ...f f� .. '�............... ...........................a�r'` r...•.?..:'l w�..............................................
• •-•..
Installer Address
Q Type of Building ,, Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.............`/......................._---Expansion Attie Garbage Grinder kA-JCs----
p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures -----•......-•••••............•• •
W Design Flow............. ................:..........gallons per person per day. Total daily flow............. z__ "..............gallons.
WSeptic Tank—Liquid capacityiC.k��llons 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 (114--" Dosing tank ( )
Percolation Test Results Performed by..-....................................................................... Date........................................
Test Pit No. 1. ,tminutes per inch Depth of Test Pit..._f!_.�... Depth to ground water..f=:_to -'`
. ��.5
_-
�i, Test Pit No. 2._,*:Z-A*--:minutes per inch Depth of Test Pit.................... Depth to ground water.._-
Description of Soil
W --••-•-----•----------------•----•........_..........-•••-••---••---••--•--••---.....••-•••-•--•-...---•-------•......----•-•••.........----•-----••-•-----•••-•.......................................
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�'T' I:�
p 5 of the State Sanitary Code— The undersigned further agrees,,npt to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed............... . 'tom a ._ ......... t r' g
• •.................... ............... ........... ... .....
Application Approved By•••. '' '" "•. . ..:..: ....../ , ----------
Date
Application Disapproved for the following reasons---------------------------•--------•------------------•---------•---------..•..--------------------------•••••-
----------------------•-••-•-•----•-•----------------------••-•----•---------------..........--------....••••--••-•--••••-•••••-•-•---•••••-•.....---------•-•-••-•-•••••-----•-•••••••---••••-•-------
Date
PermitNo..................................................... Issued.-•••-•......•----••-•••-•.---- -....-•--------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD �Oj Fop HEALTH
........�1....fd.. .......OF.........d�JZ'f,_ .........
(Intif iratr of ToanpfiFanre
THIS IS TO .UERTIFY, That the individual Sewa e Disposal System constructed-( ") or epaired ( )
In alley
has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.___ .t-)_Y ............. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATIS.ACTORY.
DATE....................................
/ ......................... Inspector---...........1.t- yw`Ac�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF I;tEAL.TH
1.......................OF...........................�.`...."..............r:........... ................ '?
No...Ro---".lY FEE---•--...17-.........
Disposal Works Tonotr ion rr9t/
Permission is hereby granted....................... - � n....----•t-�•-�r��........................ ��°
to Construct ( ):orFRepair ( ) an Individual Sewage Disposal System - 47
at
Street _
as shown on the application for Disposal Works Construction Permit No..................... D ted.._..._.___...........
-.......
......._....
DATE..........
_ Board ealth
-•--•-- ��
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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�SSIONAtE���
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LEGEND it OF
—�
EXISTING SPOT ELEVATION. Ox0 ��� L: CERTIFIED PLOT PLAN 4
EXISTING CONTOUR --- 0 --- �o N Z
L� r `
FINISHED SPOT ELEVATION o ROSE") ti
FINISHED CONTOUR 0 /l�us Z `/y7 1�.. L
APPROVED : BOARD` OF HEAL 4p�o y° �N
DAT E AGENT SCALE= / " 3 v " DATE$ 1112,5— g/
LD.REDGE ENGINEERING CQ IN �l�eEWl3h'J�2
CLIENT I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB N0. gad�3 BUILDING SHOWN ON THIS PLAN
CIVIL LAND DR. '4- CONFORMS TO THE ZONING LAWS
ENGI-NEER SURVEYOR OF BARNSTAB E, ##ASS.
I
-12 MAIN ST. CH. BY • R , I I'�s 4 -„�1_... .., �.�
HYANNIS, MASS. SHEET / OF 2 DATE LREG. LAND SURVEYOR
S
20 FT. M/N. /VOTE /F E/TNER TN,E SEPT/G TANK OR E
Zz-ACHIM0 c7/T ARE /YORE T/•/A/V 12"JELOW
/O /rT. MIN GRAOEj A 24'wO/AMETEK CoNcoeET.E COP&M
SHALL BE BROUGHT TO GRAOE.��9N EXTRA
CONCRCTE 4'PV4r P/Pf 010E.4VY CAST/RON C0//ER SAIAL-L- a-- USED
C • /D P M/N. R/TCN
L COVERS /F/N DR/VELVA Y�B"PFR ,
FT.
2% M/N. CO/VCRE TE
`:e. _ - i- G .4oE CO✓ER CLEAN .SANG
-r •_ . . BACK/=ILL ,
M.
2 LAYER
o
MIN.P/TGN -� - gOAL. e • . . • • •• • A 40„ WA S7VNE
S'EPT/C F A/vfC O/ 7. 1 4 • • • • • • 16 Q m t
J�'s: BMX O • 1 61 • • • • r °•b °
(CfIONA�) : e o r • •• DEPTi//� • .v i
� l•V.45XEof
D 9TDiYE !
M l��•5 x 2.5 = 4-7 I v.P. D. :a. . • • . • • • • • • p •�o PRECAS T SEEPAGE 1
aL
/NiieR'T ELE✓ATIONS 7�•'� x 0 78 6•P.D. a r~. • • • •. • • • • • e o P/T OR EQU/✓. I'
/NYERT AT OU/LD/NG • FT. �r c1 r' 549 v.P. G O A
SEE TBU L rJON
T SEPTIC N .. -
/NLE .
OUTLET SEPTIC TANK 9 •G FT.
INLET DISTR/B!/T/ON BOX 99,4' FT. SECT/O OF GROuNo P44-rE TADLE
N
98.2 '.
OIITLETD/STR/Bll7YON BQX
Er LEA HIIV PiT 94.o T. SE'yVAGE O/SPCkS'A L SYSTEM
/NL c G F - U N
' LEACH//VG P/T
AT!T S L O
DIMENSION . A
FT.
;,.
DESIGN CR/TER/fit D/�f�E/vs/oN 8
NUMBER OF eEDROOMS 3 D/MENS/ON C FT.Al/^/
GARBAGE DISPOSAL UNIT b SOIL LOG
TOTAL FLOK/ 3 3 d G.at./0;4v SOIL TEST / So/LST2 - SOIL TEST J
NUMBER OF zz-ACNI/vG P/TS_ L— �^ELEK /c7 0•�6 "EL1FY, PATE•OF SO/L TEST
S/OE LL�ACHJNG PER P/T SCE .FT. .. _ j ! 1 RESULTS iV/TNESSED BY
BOTTOM LE4CN/NG PER P/T 7g S4, FT. ( Z PER COLAT/ON MATE,�IE
(o 6 L° '''1 AEhCOLAT/ON RA7F At-Z •v M/�v. //vc y
TOTAL LEACH/NG AREA SQ, /:'T. S v S o < <-
RESER{�ELEAG'H/NGA,?EA
1 �
y -�Z G'2c-C--n/► A'-IC=
� iA OF Mq�s '� P��N Or MASS CD V L D T Z z_- Cn/Si 7 N
cr HN tf o LB r, �cti - . s A-n/i� Chit/ la of
MOR'E -
" F o p No.10951 0 EL DREDGE ENG/VEE)?/JVG CO,/NC.
7/2 MAIN ST.
4NG SURD FFSS10NA1-��c NO GROVNO YYi4740M ENCOUNTI�RE'O HYANN/3, MASS.
(� GM UNO kVA-r--R AT 6L.E(/. - JOB NO. 0 2-3
ASSESSORS MAP:
TEST HOLE LOGS
PARCEL.
NOTES.
� . I
8 FLOOD ZONE:,-,-- D �`f�r�JG
SO1 L EVALUATOR.� � r,
` WITNESS
�-�
REFERENCE) e�o��, 81 ,
a! 7 I� DATE:
_
1�� � ) . The installation shall comply with Title V and Town of Barnstable B
oazd of
PERCOLAT ON RATE: I
f G �"j7 �d� [ Health Regulations.
2 The installer
- � ) e shall verify the location of utilities sewer inverts an
�'��� �•� �1.L� �. � iW � , � � � � d septic
_ components nor to installation and- - --- - P P setting base elevations.
TH- i TH-2
f7�i�`� / I z Z 3 . .
) All gravity septic piping to be 4 inch
----------__---- -._ ._ ._ gT' X P P P g Sch 40 PVC at 1/8 per foot. The fir
_ � 3 t!D P first
Rchs � Z
S I two feet out of the dbox:to the leaching.
to i2 Z , g•
4 This
plan is not to be utilized for roe line determination nor an
; igltwt property rt3' y other
Lj purpose other than the proposed system installation.
P P Y
5) All septic components must meet Title V specifications
6 Parkin
O CA T 1 O N MAP '.,s ) g shall not be constructed over H 10 septic components.L �� P p ents.
7 The property
) p perty is bounded by property corners and roe lines..
property�Y
8 The ro e p p rty owner shall review design considerations to approve of total
G_2 design flow and number of bedrooms to be considered for� . o design. Receipt of
t for the plan an payment p d installation based on the plan shall be deemed -
t y, approval
r
`e J pp oval of the design flow b the owner.
t � Y
The existing leach its shall b) g p e pumped and filled with material
P Pper Title V
LJ abandonment procedures.P u es. Those within the proposed
SAS shall be removed
,�• , � ' w P P
o W44Pi - r along—._ g with contaminated soil and replaced with clean washed sand •- P a d per Title V
secs.
10
w YV ) If a garbage gander exists it is to be removed and is the responsibility of the
-. SEPTIC SYSTEM DESIGN owner
P Y
a
to ensure such.
FLOW ESTIMATE
3 OO ID
BEDROOMS AT GAL/DAY/BEDROOM• .GAL/DAY
SEPTIC TANK
GAL/DAY x 2 DAYS UoD GAL
- USE aO GALLON SEPT 1 C TANK
Z
t6 i
l C4 1W
2
47 SOIL ABSORPTION SYSTEM
t-t' s
4 1 ,
S I iE AREA. Z ?C �
BOTTOM AREA:
/ v
- � a
SEPTIC SYSTEM SECTION
r r- .
1 •.t_ }�
k
Y
_ 5D1�g
« O
1 GAL
4jo J_ Imo- I� �
a SEPTIC TANK •
�C - 1
. L y
F
N OF
qss Z.
o? DAVID 9�y
B. Cn
MASON m
SITE AND SEWAGE PLAN
9 No.low �= E E L A
8tE
s LOCAT 1
pp�P . I Z ovl c
• PREPARED
A ED FOR :
M
LE7 Al
g
SCALE. /
W - Z
DAV I D B . MASON 4245 DATE.
DBC ENV I RONMEN�AL :DESIGNS
W EAST SANDWICH MA
DATE HEALTH AGENT I----------
z (508) 833 2177
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