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0005 HAYWARD ROAD - Health
Hayward Road Centerville A = 186 064003 i I a tlll � �i UPC 12543 No.53_LOR ,� woR,70004$ UN 0 TOWN OF BARNSTABLE LOCATION P�S -�yw4��/ Rom/ SEWAGE # eZ00�^5.28 VILLAGE l'c�r��d v:'l�e ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO, C. /�� /;e-17 SEPTIC TANK CAPACITY s " " w LEACHING FACILITY: (size) eZ0 BYO X NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 AP A1 15 Loo ru„K ;.Jet-et /a a f767 . T..,A oj7tl t /7141 � g VPnrt a TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE e 'tad Y;lle ASSESSOR'S MAP & LOT .INSTALLER'S NAME&PHONE.NO. T C• �� � SEPTIC TANK CAPACITY ,i.EACHING FACILITY: (type) (size) NO.OF BEDROOMS 4 BUILDER OR OWNER PERMTTDATE: I 0�-0`� 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 u - kR 3 V A /3 C Jd#- TuN k o,,Tl.t J7' �y AIX 3 7a , 7', VmT _` 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM 1, H.E L LA,141E'l�Y , ,hereby certify that the engineered plan signed by me dated 9 'Z4•V4 , concerning the property located at 5 1-1 Al W 0 0 D RD• ,C E NTLRV I'L meets all of the. following criteria: • 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. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests at the site without a health agent present. • 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). 9•6 B) G.W.Elevation +adjustment for high G.W. _ .0 -T19ti Tl.Rl S£ DIFFERENCE BETWEEN A and B 7.6 SIGNED : -v DATE: NOTICE Based upon the above information; a repair permit will be issued for 4 bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. q ASeptic\percexemp.doc Town of Barnstable •.°�I"E Regulatory Services Thomas F. Geiler,Director • snftivsrq�. • , Mom. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Forth Date: Designer: � � �+�"'0 Installer: 9 Address: Address: n_ /°0 f✓�y ; On )7 C /9�v lela was issued a permit to install a (date) (installer) septic system at #5' based on a design drawn by (address) (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major-changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system).but.in_accordance.with State & Local Regulations. Plan revision er certified as-built by designer` to follow. W OF 011&2C�i/ g HARRY �G �� o EARL ,,y (Installer's Sign a e) LANTERY, 1R. o p No.26575 p 4 ` ss/OIVA� A (Designer's Signa (Affix Designer's Stamp Here) PLEASE RETURN TO STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE :ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form *41 � No. Vu Fee 4 � 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Z(ppliCAtion for 33iopooal bpztem Conotrurtion Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �C' �7 i Own is Name,Address and Tel.No. Assessor's Map/Parcel �. �h� a•✓a XG' -G y-'3 Installer's Name,Address,and Tel.No. 9 S Designer's Name,Address and Tel.No. ,f4 I0'�—) s �1VO7 �0. �3vx `,x ,q 0,2 5 ,3 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow `�y� gallons per day. Calculated daily flow ��9 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil; SP P 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 iss b this Board of He,41th. Signed Date Application Approved by 1lt r, Date f- —G Application Disapproved for the(ollowing reasons I Permit No. dL t)e) Lt'" Date Issued 6 7 ' L No. y -. Fee ®� Entered in com ute THE COMMONWEALTH OF MASSACHUSE--� p t vl-- ' Yes ` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, M'ASSACHUSETTS-- ZIppiicatio, o`Migpooar Opztem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 5 Owner's Name,Address and Tel.No. Assessor's Map/Parcel (��� Q; //G L �• Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7c. /)a //9 e-., sf �S, yd�'ss5s f/. E4r/ Lu.,7ri} �✓. /%'' /04, /70% 33 f .i !� ®o7G PD /fax cifM Type of Building: Dwelling No.of Bedrooms_ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow yr7 gallons per day. Calculated daily flow , 1 oZ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil �P P l✓�w� `� 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 iss ed by this Board of Health. Signed } Date Application Approved by 1 / lMf. S Date-/1) /-V Application Disapproved for th fo lowing reasons 1"�� Permit No. 9,1;0 ` �� Date Issued U— 7 -O V THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On site Sewage Disposal System Constructed ( j Repaired(j/ )Upgraded Abandoned( )by n �� . °t at lb has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2 tl() `_Q dated jU '7 -0 Installer Designer The issuance of this permit shall not be construed as a guarantee that the s steyiltfunction a desi. need r Date I o I _o 1.1 Inspector V !6.z No. C)C)L'! —S o) Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Dizpozal *pMem Con.5truction Permit Permission is hereby granted to Construct )R pair` )Upgrade( )Abandon( ) System located atr�r 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 must be completed within three years of the date of this permit. Date: u f%,!d Approved by f i / !M_VjQ d r 3 1,Q.�i e i T 17 P U I f y,^7 _ � 1TOWN OF BARNSTA13LE aye ; LOC%P,nT ON im 3 s- A�wp.��, Cam" SEWAGE # gib-. -100 � r. E VILLAGE ' - ASSESSORS SAP & LOT INSTA'LLER'S NAME 6� PHONE NO. SEPTIC TANK CAPACITY ��po© LEACHING FACILITYArype) (size) NO. OF BEDROOMS PRIVATE WELL R PUBLIC BUILDER O DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t " i` —T THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Disposal Works Tonstrnr#inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: ......................................... --....-------------...--------------------- -----------------•-------..............--- Location-Address /] or Lot No. ...........i .... - .................................................. .._.....`E•v l_L"'■"`=------^----------^----------•----_--...........-- Owner ddress %_ram 4... �'`t_..._ S� C -F d ......oZ3 jrt�� I Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----•-------------------------------------------------------------•--------------------------------------------------•-•-•-------•-----••-----•------ W Design Flow............................................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 ( ) Percolation Test Results Performed by---_-----------------_................................................. Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit......._............ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------------------------------------- Description of Soil-----0-=-1-------SV- °-3.------------------� 1 5�v`�- ....-.................................... x ---•------------------------------------------------------------------------------------------------------�----------------------••----------••---------------------------------------•--•---••-------1 U Nature of Repairs or Alterations—Answer when plicable____`W !r_'lW�________5^F k�_i_±wt. _.___�-��_� ......... ...... ewe �----- ... _ nt _..... 5 ?C e ._.._ Q .i Fc` o ...... ......... .....`z.'s �✓ 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 - ued by t e board of health. Signedo-w :. ---------------------------- _----- -----_-_---- ------_----------.. Date ApplicationApproved By ................Qk 3....--�Z 4e, - .......... ------------------------........................... Date Application Disapproved for the following reasons- ---------------------------............................................... ----------------------- ----------------------......................................................... ----------------------------------------------- ------------- -- ----------------------------.....................................-------- .---------...-------------------------------------- ........................................ Date Permit No. .... .... .._.I -... •� D----------------------- Issued ........................................................ Date r1 `� t - �. V THE-COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratilan for Disposal Works Tons rur#inn JIrratit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Systerii,at: ......................................... --....•--•---------•----•.....-••----•----........................---•----•------...........--••-- Location-Address (1 or Lot No. ---•••••-•-•-•---•--------------------- .....................................�A��il/ L_ ..L...........---.---•----------------............---- - Owner p dress a .....................C_,.. -�Q_44L� c .....-&``)C-------....-•---•-- y-..•......... ..........................................................E itJ! • Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ...................................................... W Design Flow............................................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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �r, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................_------- O Description of Soil......O m/------•-.Su3------------------ -•---�' ��------------...... '`{` .............................................. x W UNature of Repairs or Alterations—Answer when applicable.-__----1Z f`'lOy`�______..'5.y!�_�%W4_......L�"hlt ---------- -------Q e` e ..........I.-'- ..........y . /-/X-®------�co��•i•Fr.cx�SorCS ..... `s�►�C -------------- . -- Agreement: f 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 •e ' .issued by the board of health. .r Signed_ •w �--- ------- -- —�` Date Application Approved By ................a-ev Ls�- = - --... - - = / T� Dam Application Disapproved for the following reasons: --------r---------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- -------------------------------- ------ --------...-...... Date PermitNo. ..... lJ---------3.-�I.Q------------------------ Issued ........................D.ate..................---------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD.OF HEALTH TOWN OF BARNSTABLE r 01er#ifirate of C�araptia nre THIS IS TO CERTIFY, That the Individual Sewage Disposal System c nstructed ( . ) or Repaired (�) by -------- ...............................................' � -------------------------------------------........................------------------- `� Installer at ............................. W C? t1A................. C� e'L1 -I-V 1 i s - - - - - has been installed in accordance with the provisions of TITLE 5 of Xbe State Environmental Code as described in the application for Disposal Works Construction Permit No. ............�.. -.: l-- dated ---------/-------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE t SYSTEM WILL F NCTION SATISFACTORY. DATE---........ .---/,1 f Q -------------- Inspector ......., THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f No.. �? / TOWN OF BARNSTABLE .: •• FEE.. 0...•.— Disposal sal larks Tnnir ilan rrntit Permission is hereby granted.......K�cIC.E`'� 06' ,Sq --------------------------•--•--••--•-••---••-••••••••••-•••---•--•••-••••-•............................................... to Construct ( ) or Repair (,,IV) an Individual Sewage Disposal System 'S h`,•w at No.. P r�LqZ --------•-------------•.-------------------------------------------•-------------------•.............................. Street as shown on the application for Disposal Works Construction Permit Dated.......................................... - --------------------------------•---••-•-----•--••- {' ; J oB and of Health DATE...................Y........................................................... FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS No.. .... ......� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applira tiou for Disposal Works Tonotrnr#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at: /� peOEV_ ...Li e..... ....__....._ ................ --•--•---•------------•••--•--••--••••........-•-----•....................•-•-•--.........--.----- Location-Address or Lot No. ..... :a_.....�mts lq_mts�................................................. -•-- ! w ya t ...................................................._ Owner Address ....... ' :ao 2<3C ..%mow��4 Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................-----------------_ .Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures .....----•--•-------••----•----- . W Design Flow............................................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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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........................ a ....................................................... ....... ........ � . Description of Soil z' - v _.:.. 1."'--... p......................................................` 0�tz�$ I....�--.i U .................••-----•-•---------------•---•••----••--•-----•---------------------------------•--•-----•--•-•-••-••---•----•------•-•---------•-•--------•------•-•-•._......................--.._... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••-•••-••._..._....------ U Nature of Repairs or Alterations—Answer when applicable...___ ........ ...........J¢o c....... ...... .......... L1o+ Q` `' -�,----•-.S`(niv 0-----------71----------ZF�s%/w�i------ 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 Co lance has begnjisssuued (b�the board of health. Signed --Ow.o-k-... ...E......_............................................ ------ - j cto' Application Approved By ---------- �-- =•�./.- p6..... Date Application Disapproved for the following reasons: -- -------------------- .............--------------------------------------- ............... --------- --------------------------------------------------------------- ------------------------ ------------------------------------------------- ---------------- ------------------------- ---------------------------- --------- PermitNo. ...... ....6._......3Y-3..................... Issued ------------------------- ........................... e Dace '' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirtation for Disposal Works Tonstrnrtinn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( X an Individual Sewage Disposal System at: .....!s pE� .E t,w Location-Address 3 or.Lot No. Owner Address a ....._.!.Vic_ ..._..._`NA-+'--=------�!Q=.................................... -- -ae�N7:�=cu&ue...................... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------•--•--------------•-•-----•---•••---•-•-•-•••••-••----••--•-••••-•-•-•-••••-•----••••••--•---------....--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length________________ Width.........._..... Diameter---------------- Depth................ W 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 ( ) a Percolation Test Results Performed by...........................................................................Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------•••-•--•--•-•••••-••••---•---•-----•--•••••-----............................................................................................... 0 Description of Soil...... f 2. ......... `t-3--=------------------I 1Y70 D T6 ---eO Wit . x W V Nature of Repairs or Alterations—Answer when applicable..._____ kAb__________C_��✓_ ..________ y_o40____._.'C1._A r:j 90 ................... •---1`:L.hCtl-••-• Q`T '` ---•--.-7-�---••••s e?------------I-`---------- Tiw 4 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 Comb 'ante has been issued by the board of health. Signed\ =- ------------------------------------- --------)-�_111,a'o-------Application Date Approved By �. -.\' - ��,� --------^-f--------- / Application Disapproved for the ollowing reasons: .---------------__. --------------------- - - , --------- ---------------------------------------- ------------- ----------------------------------- --- ------------------------------------------------- ---------------------------------------- Date PermitNo. .------��---------- ................... Issued ................. ................................. ------ e Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tel`ttftca#e of C11omlatia u THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by --------N!ZC .......<'OP� ;7.......:CP,TW--C-""--------------------------------------------------- _ Installer at .......-......Q P.ef �(t— t— 1'1�r iJ�J - has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. _--- --------- dated -------------------------------------........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE +--... '_-`�---./ --------------- Inspector. --------. . .. .t �,, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE / No..., �. FEE ...................... Disposal Works %Tnnfrnrtion rrntit Permission is hereby granted------..t}.cc K `......-- `.. X___-�...... to Construct ( ) or Repair ( an Individual Sewage Disposal System at No........tr.....P PP 2..........4_ y'°}/`t^I Street zz as shown on the application for Disposal Works Construction Permit NQ\:\ _3!.. Dated.......................................... `�___r �7- V Soard of Health ` .,...�,.,. ,DATE-----------------------------�./1--=---���..--------------------•---- \ FORM 36508 HOBBS✓&WARREN,INC..PUBLISHERS TOWN OF BARNSTA`BLE" LOCATION 9�p� �1a: �� SEWAGE # O� VILLAGE L '\C'1�u� ASSESSOR'S MAP & LOT 'INSTALLER'S NAME & PHONE NO. ���� i SF,PTIC TANK CAPACITY i ffc`-0 LEACHING FACILITY:(typee))�h %�.1-il-0 (size) NO. OF BEDROO11S _PRIVATE WELL PUBLIC WATER BUILDER C5NEB� DATE PERMIT ISSUED: 1Lt> DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ". �u r y� �L �� �� � � �_ �� � �� 9 ,�� �� �� � �, ,� �s,�� (��"��� LOCATION SEWAGE PERMIT t• NO. 'VILLAGE Cr£Ni� �VIL-i— INSTA LLER'S NAME & ADDRESS d U I L D E R OR"' OWNER MDATE PERMIT ISSUED WA E COMPLIANCE. ISSUED 5- a:� � ( ��. < /\ 6 � ��. No...... ........5S.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , ...........................................OF..................I—............... ----------------------..................... Appliration for Disposal Works Tonstrurtion .ermit Application is hereby made for a Permit to 'Vonstruct or Repair an Individual Sewage Disposal System at: S_. W") X ...................................................................................... Address or It........ N.. pe ........ .................. ................r- (a ---------------------------------------- .... .. ....... Owner Address Addre . ..........Alc. ......CeA �Q ......... Installer Address Type of Building Size Lot_.Z?}0CW-----Sq. feet U Dwelling—No. of Bedrooms.............Z........................Expansion Attic Garbage drinder Other—Type of Building ............................ No. of persons_______.___.____.__.__._____ Showers Cafeteria 04 Other fixtures ----------- Design Flow............. ........gallons per person per day. Total daily flow.............. ...............gallons. J9 Septic Tank—Liquid capacity j (PO-gallons Length_._____.____. Width._.___...._ Diameter__-____________ Depth.....V---I... No..................... Width.................... Total Length.................... Total leaching area----- ....sq. ft. Disposal Trench Seepage Pit No_____________________ Diameter____.__:____-_______ Depth below inlet______.._._....__._. Total leaching area......... .......sq. ft. Z Other Distribution box Dosing tank ... .......... ........... -formed by............................ .............. D ...Percolation Test Results Per ate..,- ,.-I , & Vol Test Pit No. 1.:!��.Z_minutes per inch Depth of Test Pit_____ Z.. Depth toground water------7!4�!...... -inch Depth of Test Pit------T7........ Depth to ground water-------7.. .......... r.14 Test Pit No. %.minutes per --------------*------------------------------------.................................................................... 0 3. . ..... 0 Description of Soil..... ......... ----------- ................................................. lek ........................................................................................................................................................................................................ U. Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------....................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dis oral ystem in accordance with II A. 5 of the State Sanitary Cod — The 9�igned f a s not to place the system in the provisions of 'LL operation until a Certificate of Compliance has be iss ed by oa d o Signed................ .... .... .. .... ........... ......................... ..... Date Application Approved By.-_,42 If. ...... ... .. . ..... ................................... .........9:7:tl ...... Date Sanitary "0' — The un Sewage Dis osal�l,f s I Sewage as j__be ed by oa 0 ............0... . .......... ................ . ..... .. . . .... ............ s Application Disapproved for the following reason ................................................................................................................ ....................................................I.................................................................................................................................................. Date PermitNo.................................................... Issued........................................................ Date ------------------------------------ --------- ----------—------ No._x.. -.-- /C) Fps..... .�............ THE COMMONWEALTH OF MASSACHUSETTS BOARD "OF HEALTH •' ............... .........................OF...................................... - - .......... , 1tr�i iott`fux'`his n gal Works Toustrtirtiou rrmit s< Application is hereby, made fora Permit to Construct or Repair ( ) an Individual Sewage Disposal System at• ��..".^-L..... r'-�-T_........ . ........................................... -c -Address SZ ; or No. �> CAJ Owner Address !................................. .................. ...--•-•-•---------...----...--------•-•-........••---•--•-------...............----•-............ Installer Address of Building . feet U TypeDwelling—No. of,\Bedrooms............ ........................Expansion Attic ( ) Size Lot-Garbage rinderq � aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures ---------- --•-----------------------.._..-----------•----------------- ............................................................. Design Flow............. g P P P Y Y dons- W ....�.i`...._ gallons per person per day. Total daily flow............. WSeptic,Tank—Liquid capacityl.____....gallons Length.....t?...._. Width....6....___ Diameter________________ De th...... DispoS4'Trench—No..................... Width.................... Total Length.................... Total leaching area---- .........Sq. ft. , x See e'pag -Pit No_______________--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) r a, Percolation Test Results Performed'by........................... a ��'4r .................. Date. ............................ a Test Pit No. 1."�»__�'�'....minutes per inch Depth of Test Pit. ..lam._. Depth to ground water..___-- ': ; __..... (s, Test Pit No. 2...._..._.��.._..minutes per inch Depth of Test Pit.....Z........... Depth to ground water......7.............. Pi .......-•---- O Description of Soil T�� '`�. � 4 J -`S0 ✓'cJ V ---•--------•-------------------------------------• ------•----------- W U Nature of Repairs or Alterations—Answer when applicalile .... .................................................................. .... t; ,.., Agreement: The undersigned agrees to install the';aforedescribed 6Individual Sewage DisposaVystem in accordance with the provisions of TITLE 5 of the State Sanitary Co The ugj signed f 1 a es not to place the system in .ope'ration until a Certificate of Compliance has b'e " is ed by,t,Yi�'board il`"e f:. F Signed '' .' �.:_ ' Le.......... D te/ P �___________________ ------- . --....APPlicationA Proved BY _ ate Application Disapproved for the f oRowing reasons •-----------•------------•••---••-------------------------•-----------------------------------••............. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date Permit No..:..................:._-=--------------------------: Issued-------------------•-------• . �.r.. e: - Date l THE COMMONWEALTH OF MASSACHUSETTS -` BOARD OF HEALTH 4.1 Trrtifiratr of Toutpliaita THIS IS TO CER.T JFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by •-•••-..... ---•-----------.•• -•-•.....----•-----•-------....•••••.....-- ----- - ---.. „ Installer has been installed in accordance with the provisions TIT FFi c5 of The State Sanitary Code as described in the application,for.Disposal Works Construction Permit No...................'. 1 ........ dated--------------------------•------............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCT ON SATISFACTORY. DATE............... ..... cif Inspector....._....... -•••--•--•---•-•--------...•. ---------------------------------------------•-••--•...._. .THE COMMONWEALTH OF MASSACHUSETTS t41 BOARD OF HEALTH C , • No �t��ro��t1 ork� oito�rii�ion* rrntt� - Permission is hereby granted---------------- --•-------------------- . ............ to Construct ( ) or epair ( ndividual Sewage Dispo al System - .......... • -•-- Street y as shown on the application for Disposal Works Construction Pe�rmitt o _................. Dated.,_=_. e !/................................................. m_s,, � ' Board of.Health v ' .DATE----------------------- ; t�12M 1255 q. M. SULKIN, INC., BOSTON 1• T J • aids�r�F't.v� _ �( •�� A SESSORS . REF. : 0 1 6 0 � `• o: • �yt+e• '�. �� ,�� Hi . �, —•� OWNERS:1�1 W I'p 186 - . " Parcels 64-1 64-3 ¢' '` �� o• ; 5�a vc �° Nay ' & 64-4 Parcel A (pending, •' •° o� AeF �o� :� �a8re >ydth _ P Hayward Realty Trust Fuca oleo �� � waYJ Christopher J Pappas Tr. 21 Pendulum Pass ,a. ..., CO - '� '0 Ea 40 i o 5s 32' Hopkington MA 01748 ' z 10 �- Parcel l3 (pending) o •. :• go- R=25.00 - ,a0' Jed a wail � 5 ' - �, � Qo �..� -s- '•� 3�82' _ TEST PIT � PLRC. TES Larie P Snowden-Lebel T _ �' .. .. •. • W L=46.40 SINGLE FAMILY DWELLING W/ BEDROOMS c/o Heritage Custom Building boa,.° •'' ' o •— �..`• 8 A26t Tan=33.38 NO GARBAGE DISPOSAL — d •t° "�• . ary'..• a l A :106`20'27"• O DAILY FLOW= 4 9 40 72 Pine Street ^ r4 EXISTIRS I IORE D G.P.D. H a 'Q .• e.•,s'r - i ite' oc / =° /• N ` Latin SEPTIC TANK(VOL Q' ) Hyannis MA 02b01 d '':Ft�btia .:• Utility l Q o) 0) GRADE .,•• . .• ~,is Pole V D rl• °J,6 - G.P.D. X _ ' s • �,, _{.;� SLanditt�.. _•c ��.J� ;• `Y [) q O `� =580 GALS ••. :� �i w r , tt�, L io LOAM 2,00C) GAL.TANK-O.K. s. "5r.•AF •s At `. ,?•. :io: ; : Lawn• 9. •• a �i• ••. M1%:Y 'Jt ; .� ro• • ."i/ t u L DJa M Y LEACHING AREA(S:A.S.) �' t } r r e .3 '• +iii / e�'i- °�°. f SAND USED 6 -4'X8'X I' PC.L.C.+4'STOIJC A25 � - REFERENCES: ,. 1 N87 3g30►� 1 �� EFFECTIVE DEPTH 1 ,o Locus Map 40:00 _ a OT 10 M 8 N L�1^/ LCC 10433-D V CTF 96937 Scale: 1"-Z 000±' I 5'' �'�` 1v1 E ►�1 U M 4&x Z 0'z 0.7 4 =59 Z CTF 110655 CLEAN SA 1,J➢ CTF 137000 / TOTAL CAPACITY--fir' 9ZGALS. / A24 C 0��..� � Iro '<�r DE51GN ZONE. RD--1 �� �c5� •�,; - 2.0 TOT/�,L R I S E @ fi ► T•t p� 1 / �` •,�� o: Area (min.) 87,120 SF (RPOD) 1*0 WATER Frontage (min) 20 1 FLOOD ZONE; Width (min) 125' f I Setbacks: 1 Zone 8, A10 (el 11), & A 13(el 11) Fron t 30 Community Panel No. #250001 0016D Side 10 I . i . Rear 10' i A23 ° to 1 TED . y-1 3 f 0 i h Tj r_: ;. July 2, 199?_ . TE5 1 / 0 VERLA Y DISTRICT A22 a ` I own r AP - Aquifer Protection• otection District Existing Drain Damaged) '•7 T I Reset Rim & ate to Grade. ` r AS Shown on Plan Fnfitled `- ,rf ► 1 a "Revised Groundwatar Protection 01 Overlay Districts" - April, 1993. -oco#ion t a I I: { l0.5' 1 v • ;.A2! Lawn. r•� SP r FIRST FLOOR tie \ � t: EL. 12.0 a I; 51TE PLAN TOP OF WALL ., EL. r y A2 ���' , ` :.S / •"' p• IN.GR. EL. 1 0`5 EXISTING GR. EL. l 0,0 2%SLOPE l — #106�` '� ! O - / ACCESS \� .\/). \\ .\� .\/\ 9"MIN,COVER 2"PEASTONE ACCE 1 i8` j [FOOP, TE57 °o°e-110gJAt9 LEVEL. 2 LEVEL t Lawn o ' 2,000 GAL 4J.I D-BOX 8.0 Q. �I-I-�O] ��°A�° s l :I EMq 2 CFi 11� P.C. CONC. ��a a ,gwb4�b�` ` , 54.8' / A13ga�je 1, SEPTIC TANK to-1Q� GASBAFFLE 6"MIN. g?, ogo 8 EL.- 7'Q �$:8Y • /' 31 o soda oo B,5 .8A o °�8, ?Y 3/4"TO I I/2"DO UBLE -_Corog a y ° WASHED STONE -.,be refoc 't ✓ `—G"CRUSHED STONE OR COMPACTED I 0 MIN eA) . ? 'MIN- A78 / / . SE3-12J0 9 C 20 MIN. 1 � t • 1 I / t 1 2 DEPTH OF LIQUID-4' 0 BELOW INLET TEE DEPTH- 10" 1 i OUTLET TEE DEPTH 14 EL. _O , i t ► p r-,Ftt t= Of D15pn5gL 5Y5TEM DRAWING NOT TO SCALE) Lawn — A16 o ' Ile off o v. men't os co00 �,, -`� I Proposed hay bales CIO 1 & Siltation Fence o ,� if� •i 1�` �� I •��•� '--•--- F�"'q Lawn f ti Zone 9 ` rN Parcel Proposed hay bales 1 .� l �`': 1 ` 0.3 •O y J 1 & Si7tcr#ion Fence i i0 l C 7 / Sed f ti i Pu M� O �4�`� * C v. V G ! .y c i // Pr°fie privy MILL 1• �.. a`.........�... Legend:..................... ..... ... J 1 L54 bblestd��aVed) i ; �'' p C' . 3.a7�.. Ught Post ,� S �� - - 0- i ► �' � � LD Wetland Flag � !as © Gas Gate _ �. ! C Water Gate E uJ '^ eve I t/ o t r 1 �✓ I, e Parcel A, sty w/F 'ems, O Misc Manhole rl /` Wetland Limit as Flagged by f i / icy, �Q W �N ?Dwelling ® Drain ENSR September 12, 2003 'sn!ls , 1 m .�� ��. SE3-0866 -& Hydrant l Lawn SE3-2029 ' �• � '= � � ( O Iron Pipe 0 CB/DH - Concrete Bound w/Drill Hole 4 O SB f DH Stone Bound t.0 I l i Existing Septic System a J / U MN magn it r . . ilk, Lawn � p Z WoodOea • ,�....•..... ............. V ..QO ................ / J Gu l .1s h�11' ..� ,�• ,•,. • -0- Utility Pole � �'� - t^ 11 E \ / ✓•2awn 1., Deciduous Tree 1ri i 1 G' S . Ali PA ,r 61�� SE3-1064 N �i !/ I N 0 T•1`5 e\ \ \ 2 Sty W/ / , ` iI. SINGLE FAI\AIL/\ DWE\_LINC6wmi E1\DULTAAuz4 TEENAGE GIRLS, Dwelling SYSTEM DCSiO&I is OVERSIT-ED 13ECAUSIZ WATER USAGL- Di5TF66IED • I i � / 1 EXISTi N G S,A,-q, 1N LE IO iR yEAS.� / r i Z, DIS GSAL SYSTE M ,-o ae COI\tSTi UCTEbiuSTrRICi ACC_QR1)RNC'E w taw C0I\AN\6NWEALTN•ar- MASS. D, E.P. T ITLF--\E. l ' ! Pat I 3, A5SESSVR5 PARCTL Ni)MBZi� , 186 - 64-3. to•..••�••• / �._i ' i ° ,•� / � > l � '� .�' -' ` � - 1 4. CflNTKACTGR c—. CALL D16 .0_3AFE 72 HOVRS PRIOR ro BE%6IMIM t C0N S7RUC7I0N A),IbJo? EXCAVA718t1. I - T. PUMP .Aiib FILL EX197'11`lG SE.Kit ►}NNk' wi-rN �A�ND. t snt: 1 t I '� �� ,.•'' l B. PLUMPi N 6 j.4 H 00SE '► o ?,F- IR AISEn. -7, CX1STM6 F1-ELD raist REMOVEDw1m ALL 1MPEIZV10U_5 MA1E71IKLS t 1 1 Lown ,,._ -. . - _ A��sa �hE�LAC .DvJ3TF� CLEAN IUI .bIUM SJ�N1� i snaa / �i mac+ ti i1 r 8. USE 2)OlYj GAL SE1PTiCTANK wr )aT'S ANL GAS BAFFLE F PER< I 1 , edge of Salt Mars1i Smlo _.. as Raggedly ENSR Snl5 /3' ..x ✓ 9. USE 6- 4 x x I P i'E• C{1.S T'. C O N C E TIE L L- I C I"I C M J�1VlBE R S w N 4' o s: \ . �� Septern er 12, 2003�-� , � ,,,, y - �r ,.. --=' �,, 3 J4 _ T •�s 10.1-S.OUN D EA Ct CF1 Afvt3E1. "ro I Va" D OV IS LE W I S 14 T-13 S .0,NA . A t I 7 ,. �' , �,• t r Solt nr..•sq, h ' Salt Afwsh V. l'S'rti \N! AS'' .•c TES I C11.1 �,�► o P. ��.-' �?ic. I -/ — ' t,,i(t , r 1 r:�e 3'; �1 13�.F?S'rL7 ML ! `! SM9III, / �� \�'�' �' r' lam' !� ICI♦ VEIV 1 LCA'tH C_ iAIAIR 1�5 WIT-A A " PVC SCI140 ANDFILTER, AL AIL •""mow` / t• ; �'��• � Salt Rlorsh � m _ s .J i o SE3-1106 .fl 1 mean High water w I > =l.La rlcvn SE3-1046 SEWAGE 5Y5TEM DESIGN o a SP'3-1713 POR I LARIVE- P. SNOWDEN- LEBEL - S' H AVW 8GD R15A D Root C ENTE i-2- V I LL 1=,MA 0'2 b 3 Z HEALTH AGENT APPROVA ON sE3-3so2 -� 5 F-1/ail W a0 D R OIaD 9/a PN ,la G-64-3 hoFl �c OF CENTER V I L E , � , • oADVANCED TECHNICAL 5OLUTION5 FLN w piver `` HARRY CONSULTING ENGINEERS LHEUREUX r 1IDaL o. EARL I� ,4 ;13A312 �„ 3 !� c3 UINEARY, ;R. e P.O. BOX 99 9a o o fl°ot e r� r �.: ��No.26575�� I ens flood �` E. SANDWICH, MA 02537 ebb H. EARL Y, Jr., PE IV AL DATE: S 2 04 SCALE: 1 20 rtle: PREPARED BY: PREPARED FOR: Notes/Revision: Plan ShC)W1ng �, ! t �l 1.) The property line information shown was I t.rE e! Hayward Realty Trust compiled from available record information. rn Proposed site Modifications 7 Parker Rood r4. I //V7_A=_ .4T/ON.4L 0sterville MA 02655 Christopher J Pappas Tr. 2) The topographic information was obtained at r� Q&X L/ road 95 State Road 21 Pendulum Pass from an on the ground survey performed on i.7 HaywardSagamore Beach MA 02562 (508}420-3994 (508}420-3998 fax copesurvC�cape-;oc�ne` or between 28/MAY\03 and 19/DEC/03. � Hopkington MA 01748 (508)888-3900 (50s)s88-6689fax Centerville} Massx 3.) The datum used is NGVD '29, a fixed mean Bamstable , -+, Draft: Field: WHK/MDH 20 p 10 20 40 80 sea level datum. � P/ raft: RRL D Date: March �8 2004 �n—�Q► Comp/Review: Coin ., ., Proi i lDrawing # C247-1 1 • i . - -" _. .. : . _ _ - ;� 111�7. .< 1. .:. >, , ,,: r'e„r..a-w,.- —.�----______.____.__; .._. ...,_. ,--,,._.___.17_._.-,+,w..w,., — -...._....r___......_,_-^.,.-.._-„_.n„_...w,,.-...,._-..._ ...,...�.+,::_r,. w � .. ,.-_ _ p- , 1 " -d , _ ,. r, +,; , - , I .. � t , 3 ' : '' - y . ' 9 4 ', - , _ .e I I - .1 ,: . I - ..«L - a ` .. 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