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HomeMy WebLinkAbout0063 LIAM LANE - Health 63 LIAM LANE, CENTERVILLE 167 016.005 r � I - Qn l x h Na. Z ©2 J l�Ja Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Mi!6poga1 Opotem Construction Permit Application for a Permit to Construct( )Repair(\-)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f -7 �'G G GYM a Owner's Name,Address and Tel.No. / Assessor s Map/Parcel Cyr Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. I'a r 12- 'Al Z J .5-6 - < < Type of Building: Dwelling No.of Bedrooms_ Lot Size 49 U 6 sq.ft. Garbage Grinder( ) Other Type of Building 5 .2 Ain No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �1 gallons. Plan Date � Number of sheets Revision Date Title Size of Septic Tank /ac'c ri Type of S.A.S. i Description of Soil Nature of Repairs or Alterations(Answer when applicabl �� ) 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 thi oar Heals Z Signed Date Application Approved by — Date 11,11 6 2- Application Disapproved for the following reasons Permit No. �i! P 3��6� Date Issued Z� 2' r o ' Fee/ �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ w - es ! .PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,. MASSACHUSETTS. ry 2ppricat on for Moogar *pgtem Congtruction Permit i Application for a Permit to Construct( . )Repair O Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. e5stoq-, Assessor's Map/Parce Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. '761 4.71 J .ice 3 / c' 1 v Type of Building: Dwelling No.of Bedrooms � Lot Size tjsq.ft. Garbage Grinder � ( ) Other Type of Building 5, C A.�X rJ No.of Persons -73 Showers( ) Cafeteria( ) Other Fixtures Design Flow 4_^/C) gallons per day. Calculated daily flow gallons. Plan Date . Number of sheets /'A Revision Date Title _ Size of Septic Tank - .e`lJ Cf f. Type of S.A.S. FDescription of Soils N t re of Repairs or Alterations(Answer when applicable) (14;%7 Ct C. c-14..c lti/ia C_ w 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 oard_o Heal l s Signed Date Application Approved by � � Date - 0 7- Application Disapproved for the following reasons Permit No. 2-/2i)! ; 3 2-(. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal,S�stem Constructed(; )Repaired )Upgraded Abandoned( )by at �' ? !!. has been constructed in accordance with the provisions of Title 5 and the for Dispoo al Sy tern Construction Permit No.2W 2-3 2(o dated -2S Installer : . lam' w- ;�1,/r e/f�. �rJ Designer The issuance o this permit shall not be construed as a guarantee that the sysa will f nction as de I Date Inspector 44 i 4 ----------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Mioogal *pgtem Congtruction Permit } Permission is hereby granted to Construct Repair(Y)Upgrade( )Abandon( ) System located at f Afir-i 000, ► ".,-s -s!/- 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. - i Provided:Construction must be completed within three years of the date of this Date: r7- 2 9 - ®Z- Approved by TOWN OF BARNSTABLE LOCATION 42 � ie SEWAGE # Z VILLAGE v� / ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.4 �" dr/�..1�' 36 L� SEPTIC TANK CAPACITY �A!!'''® � .LEACHING FACILITY:.(ty �E ��K�r" (size) �U . -_NO OF BEDROOMS BUILDER OR OWNERel.�F"�'"sd ' PBRMITDATE: COMPLIANCE DATE: LS Z ., 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 1 Ching facie Feet Furnished by - til / . A C r _ :7, Pe- r TOWN OF BARNSTABLE LOCATION / �� SEWAGE # Z�Z'" Z VILLAGE ��f'y� 0% ASSESSOR'S MAP & LOT "16 INSTALLER'S NAME&PHONE NO. 36 Z ff SEPTIC TANK CAPACITY c, U f LEACHING FACILITY:_(ty (size) NO"OF BEDROOMS Bt"JII:DER 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) 4 Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet oUrAching faciliA��XFeet Furnished by }� IL , ._ { 13 TOWN OF BARNSTABLE LOCA-WN L i SEWAGE # VILLAGE (0-kil'C�� r ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY LEACHING FACIL TY: (type)�6� (size) �4 NO.OF BEDROOMS BUILDER OR OWNER ( ti> � �1 -P-EMP PI5ATE: L� 1 �I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to t 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 LeachingFacility(If an wetlands exist tY Y within 300 fee of leaching facility) Feet Furnished by 0-e-cAcxv 6 31 M- 40' 04- q3' COMMONWEALTH OF MASSACHUSETTS RECEIVEO EXECUTIVE OFFICE OF ENVIRONMENTAL AFF - DEPARTMENT OF ENVIRONMENTAL PROTECTION NOV 2 5 1998 ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 AlTDWNOFBAR TABLE HEALTH DEPT. WILLIAM F.WELD ta. TRUDY COXE Governor _TPA ' Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Lt. Governor CommissionerYt'�� t�°� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A L6r 01 � ®��` CERTIFICATION � Property Address: � 4ft,-, i Lt—) i "���� Address of Owner: V Date of Inspection: it 3l`I� (If different) CA —` Name of Inspector: � t Ln as—\ �o � I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) �«��e>� �La Company Name: 1 '� L N 1 pn tna tin 1 �N1- Mailing Address: . Tt Telephone Number: •—y 11 l y,yL <3 v CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and, complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By tk Local Approving Authority Fails LInspector's Signature: Date: �..s VN t" The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUNSIARY: Check A, A C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection: or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04125/97) Page 1 of 10 Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address: Owner: Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observe in the distribution box is due to broken or obstructed pipe(s) or due to a broken. settled or uneven distribution box. The Sys m will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replace- The system required pumping more than four times a y ar due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ FURTHER EVALUATION IS REQUIRED BY THE BO OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health. safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HE TH DETERINMNES THAT THE SYSTEM IS NOT FLNCTIOND G IN A . MAINNER WIDCH WILL PROTECT THE PUB IC HEALTH kND SAFETY A.ND THE EN"VIRON1lENT: _ Cesspool or privy is within 50 feet of a rface water _ Cesspool or privy is within 50 feet of a ordering vegetated wetland or a salt marsh. 2) SYSTEM NVILL FAIL LI LESS i O OF HEALTH (AIND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETER�IINES THAT THE SYSS FU)LlCTIONLtiG IN A MANTNER THAT PROTECTS THE PUBLIC HEALTH AN SAFETY AND THE ENVIRONINUSNT: The system has a septic tank and s it absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply _ The system has a septic tank and oil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank an soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a wet water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that f cility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine disc nce (approximation not valid). 3) OTHER t (revised 04/25/97)' Page 2 of 10 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D] SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as/efined0 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to dete/rmine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloade or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surfa a waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or availa a volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT ue to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zo I of a public well. Any portion of a cesspool or prt y is within 50 eet of a private water supply well. Any portion of a cesspool or privy is less tha 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the wel has been analyzed to be acceptable, attach copy of well water analysis for --coliform bacteria, volatile organic compoun s, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the f lowing: The following criteria apply to large systems in dition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of surface drinking water supply the system is within 200 feet ofla tributary to a surface drinking water supply _ — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall'Ibring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. f (revised 064/25/97) Page 3 or to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ��n Property Address: Lqv) Owner: Date of Inspectidn: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or 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 f 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. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components. excluding the Soil Absorption System. have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, rztaterial of construction, dimensions, depth of liquid, depth of sludge. depth of scum.. The size and location of the Soil Absorption System on the site has been determined based on: j� The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. _ Existing information. Ex. Ptan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) { (revised 04/2S/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 0 U WN Owner: 1''0(4� Date of Inspection FLOW CONDITIONS RESIDENTIAL: Design flow: `T'>0 p.d./bedroom for S.A.S. Number of bedrooms:0 Number of current residents: O Garbage grinder (yes or no): V—J Laundry connected to system (yes or no): :. Seasonal use (yes or no): OJ Water meter readings, if available (last two (2) year usage (gpd): t� Sump Pump (yes or no):_p..) Last date of occupancy: vIT— COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORUN ATION PUMPING RECORDS and source of information: HI P, System pumped as part of inspection: (yes or no) �jG If yes, volume pumped: Gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) 1/I� (revised 04/25197) P2ge S of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �l Pry 4- Date of Inspectiorle 11' t cl c�j BUILDING SEWER: (Locate on site plan) f Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: S (locate on site plan Depth below grade: 12 Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal. list ape_ii Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: C )� 4►A I Sludge depth: tt �1 Distant from top of sludge to bottom of outlet tee or baffle:_ Scum thickness: %`% Distance from top of scum to top of outlet tee or baffle: 1 1 Distance from bottom of scum to bottom of outlet tee or baffle: t A„ How dimensions were determined: Comments: (recommendation for pumping, condition of i I and outlet tees or baffles, depth of liquid level in relation t outlet invert, structury inte city. evidence ofsleakage, etc.) -t� jQVA Dk y^ li t O u�7,t T- 1114 �;sA C.7 'q" —02 U L I L-CW-1 5'r tv xj �.� GREASE TRAP:_) (locate on site plan) Depth below grade: Material of construction: _concrete _metal_Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity. evidence of leakage, etc.) (revised 04125/9'n Page 6 of 10 I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property-Address: .i`INS Owner: `4� Date of Inspection: 'i] 3[�e TIGHT OR HOLDING TANK: ✓Lei (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_ Yes: _ No Date of previous pumping: Comments: (condition of inlet tee. condition of alarm and float switches, etc.) )ISTRIBUTION BOX:' S' (locate on site plan) Depth of liquid level above outlet invert: 7 �,�/( ;, r I J7jUv-t`LT-- Comments: ( to if level and distribute n i equal, evidence of solids carryover, evidence of leaks a into or out of box, etc.) tcv_i�0 Ut t , /U Li PUMP CHAhIBER: AR (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/2S/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: b WV-) Owner:�o Date of Inspection: I SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible: excavationVVno_t required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: k..& leaching chambers, number:_ leaching galleries, number: leaching trenches, number.length: leaching fields. number, dimensions: overflow cesspool. number: Alternative system: Name of Technology: Comments: (note condition of soil. signs of hydraulic failure, level of ponding, co itio of vegetation, etcof .) t oti n CESSPOOLS:._�� (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: ' Depth of scufn 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, 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, etc.) (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 341 Owner: ' b�.rvA Date of Inspection:` SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) LA - tha�d- J .y 1 �� - 4U, .RL� �ylJ (revised 04125/07) Pagc 9 or to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property dress: Owner: kb\4 Date of Inspection'. t 3 �14 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators. installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) l-�y�`aolu� cT�'vzsTc�t�0ows (4- (revised 04/25/97) P2ge 10 of 10 .g,2 - i� No ---•---•-•............. FIc$...-35.................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH __.6_W_A- --...........OF..................... ................ Appliratiun for Disposal Works Toutitrurtiun Prrutit Application is hereby made for a Permit to Construct (,�or Repair ( ) an Individ al Sewage Disposal S stem at: i- ..... q:��Aig.............. ...... Location-Ad ss i C�� _ �� or Lot N� --- _--- Owner ,Address a ��'_,e.....�.�... _f 1.�.Ca ------- .........................................--- e'-!..t...4L.................................. Installer Address Type of Building Size Lot----fn-....... ...Sq. feet U Dwelling—No. of Bedrooms.................7.......................Expansion Attic (Wp Garbage Grinder e"t� aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures -------------------------------- - W Design Flow......................:!��.�..•.•.•..gallons per person per day. Total daily flow.....................3., .4)...__._.•..gallons. W Septic Tank—Liquid capacityl.Q P--gallons Length................ ength................ 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 b �// ��.-C_.._ �- a y-------------------------�L,�l-_.� .�. Date------------•----f---------------.� Test Pit No. 1.... «minutes per inch Depth of Test Pit------ Deptto ground water_____ . �� f=, Test Pit No. 2..- minutes per inch Depth of Test Pit. ........... Depth to ground water.._.Y!!`..... ( �O Description of Soil....................... - ....L. C��e- ,�a "v ..............•--•-... ...................--- ----------------------------------- ---------------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 iITL is 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 o health. / Sign .............. • . ---------- •... ... l _ / to Z- Application Approe.. �. `..:................•-------- �••. ----------•----------- Date Application Dis ping reasons------------------------•----•------------------------------------------------------------------------------.-- ..-•--•----••-•-•-•-•---•-.....- ••••-•--•••-•••••-••.......--•-•--•-•.............•-•----••••••-•-•--•---••--•••-•--••••-----••-••---•-•------•......••--•--•••-•..--- Date PermitNo......................................................... Issued_....................................................... Date ION �3 SEWAGE PERMIT NO v1'LAG�'E TSTC(A LE nos NAME & ADDRESS d UILDE R OR OWNER �Q DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED a4r d, ��}� �.�� / 'r • ,, i �,� S: �� � �� ,r sN6.....--...../........ Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............0F.....................::: �r`T __--•............................ Appliration for Disposal Work, Tonst.rurtion rumit Application is hereby made for a Permit to Construct ( .)"'or Repair ( ) an Individual Sewage Disposal System at: -_-� ................-..... .............................iJ.----..'. PV.e...................................................-�..�Ct,; •- = ' Location-Address or Lot No. )� [/ P" .. ...... ......' ..............__... ............................1......... ..._.. ...... ......... Owner ,f Address 1 ...:....... .................•... ......................... ................................. Installer Address r U Type of Building Size Lot._ _... . ..- Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (Wt) Garbage Grinder &�y aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..w.;------------------------------------------------------------------------------•---------------••---------------......_-•--••-•---•----••......- allons W Design Flow_-.....-.q__,_..._..P:�.y-•;-•_"-_-"gallons per Legthn per day�idthTotal daily flow Diameter._._.__..,,� Depth.--dons. Disposal Trench tic Tank—Li No c. ac.. _i.. 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 ( ) �J a Percolation Test Results Performed by......................• .. ....__. _... :.. Date.............._...,......::_..__.:__. . ,.� Test Pit No. I.....,. !J minutes per inch Depth of Test Pit........'e?..._.. Depth to ground water..... ~'?..p fro Test Pit No. 2........�....minutes per inch Depth of Test Pit......I.......... Depth to ground water..._Y....:'...041 .. rod" O ......... ` 1 ---------•-----•-----•-----------------------------•-• -•---------.......•--............------ p -•--••. Description of Soil-----•--••--------....�-�....---�---•-=°-.---•-•............... �' ��^ '4 --�--0 Iz -S g t. U ......................................................-.�/`rT""...I_.S_.......................__--!-Z:--^✓......... ............. 14-F.+Y-.0......................................... ...............................................................................................____..___.._......____________....___........_.__._......__.............__............__._._._.__..___.... 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 TITF!— 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. /J Si n• 1 . , f 1 Date Application Approve B'�. -•-- -----------------.........------...:"`..------.............._..............._......- Date Application Disap rov or t e following reasons----------------•-------------------•-------------------•----------------------------------------------........_ ...................................... -----•---------••-•-•--•----------•-......-•-••----•-••-----. Date PermitNo....................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD = HEALTH a. .............. ..r.''../�;✓Q OF............ .........................�... ........................... C�rrtifiratr of T'lontpliatta THIS IS TO CERTIFY, That the Individt aq Sewage Disposal System constructed (, '") or Repaired ( ) by 'y: ±-�-. � ✓ ------•-----•-•----------------------------••--------•---- P Installer ,r '1.., ..... `• has been installed in accordance with the provisions of TITJ j bt`t& State Sanitary Cody ib d in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................................../.1..e 1A.... Ins ector-- THE COMMONWEALTH OF MASSACHUSETTS ,_�.. BOARD OF HEALTH __, No......................... FEE........................ Disposal Works �onotr ion frr ti Permissio <s�llereby granted.. ........:........ r to Construct or Repair an Individual Sewage Disposal System atNo. •---•---•--e- ;✓----------- p ---- .........o Street :............ as shown on the application for Disposal Works Construction Permit- _.. Dated.......................................... Z Board of Health DATE................................................................................ FORM, 1255 HOSES & WARREN, INC., PUBLISHERS ....wd.aeYud•an..ta..�Yetz.. �' ...�:a.:.d^s. v,-w,wuwucr^ - ..::a.;r:....,..a.w;...; ._ _ _ .._..._.........._ ._.... ..w.._... _ _ .._ .__h.. ..... _ .„ _. ,. _ ---- -.._.......v.._._,... IV07E /F E/T!'/eR THESEPTIC TANk OR 20 FT. MIM. ,GEi4CH/,eVG P/T ARE 11ORF 7-,qA.4/ /2-5E40.4v /O fT MAN �RAOE� 24'OIAM ETER CONCRETE COVER SWALL BF BROUGI✓T To GRAZ> �.-a!✓ EXTRA CONCRETE gwPYC P/Pd t�ERVy CAST /RO/Y COVER SIyALL QE USEO M/N. P/TCN w !FIN DR/VEJ+VAY '. Fc C✓, 480 CovERs /B PER Fr. 2 J M iN. Cry/V CRE TE G APE <�OVER A CLEAN S'ANO rr— BACJIF/LL LIQ(I/D LEVEL 1. :,• �_ z ?'LAYER IRO P'/PL / 0 O [� 0 • o w o 0 0 G1f ��8 -3�8 d MJN..P/T4V ' G.4L. o• o • • . . . . • a e WA SHFO 57-ONE q %a'PAR rT. SEPTIC TANK D I sT• , 4 • • . . • , , BOX o • • $ • • � • • I .o• � iir•.; .• + � � • •ERECT/VC , ' . , •3�4 w- � �2 ;� a i • • • DL`PTt/ • • • • • v WA5NAFZ> STDNE • :�.i . • .. • • • • • • • • • vp . ` _ • a. • • • • • • • • • • p ••v PRECAST,SEEPAGE lNIYL'RT ELEVATIONS s •. • • • • • . • • • a o P/T OR EQL//V. INYERT:AT QuILD/IV6 FT. INLET SEPTIC TANK 4•S FT1 OAAIM. �C(SEETABULAT)ON� OUTLET SEPTIC TANK. ` - •3 FT1 INLET D/STR/8�/TIO/V,BOX 44'•d FT. O F GROUND meA7,FX TABLE SECT/ON O!/TLETD/STR/BVTIdN BOX `f 3.9 - SEI�NAGE /SPOSA t SYSTEM /n/LFT ctAcNlwG PIT` fT, TABIlLAT/D/V PIT L EACH//VG O/ME/V.S/ON A. 3 FT. SCALE �4 � / - O DES/6/V CRITERIA 101MRN510" B—�-FT• NUMBER OF BEDROOMS � D/MENS/ON Gi�-FT. �/^� GARaAGEOISPOSAL UNIT 14 ONE SOIL LOG TOTAL e3T/NLSYEG FLOH/ 3-3 0 GA L.1DAY SOIL TEST At/ SOIL TEST402 SD/L TEST ,VUMBER QF 40ACRIM4 P/TS-7. / f`Z-Z& -4-5-O �` ELEY, PATE OX SOIL TEST "-7/3 S/DE L1'ACHJNG PER P/T 6YT7 SQ FT. p _ -'A RESULTS *V/TNE5SE0 EYJP-C-' ('-'-- OoT-'rOM 4Z4CN/NG PER P/T 7� S4. FT. Lo, M PERCOLA7/0lv MATE At/ L 4--5S MINy/1)VCH TOTAL LEACN/NG AREA -2-L" SQ. F TOP 5 o r L I9EhCOLAT'lON RATE RESER{/EGEACNlN6 AREA �6 SQ. FT. /vGDf � �11 OF 9c `N OF R'fl �1 nt..L7 L 0 TT 2 3 AL R O H o No..10s51,0 ELOREDGEENVG/IV,ESRIACr CO,/NC. Q t� Q` 9 �GIST6?`vN�� 33 b 71Z MAIN ST. yYQ"AIlS• IN,c,�Ss, ` '� NO SS'TL,��yO • � o�FSS/ONAL Eat\ Ll C�L�V, GR�[`NgPle 2 ® ND GRO[/Nt7 LY,4TER ENCOUNTERED CL/ENT,- DRTE: .9 Q GRO LINO Lv<1 TER AT EL Et/ - JOB NO: q Z t2 SHEET�• OF • SNOFM�S JOHN s F" C 2w4 ISTS 4Nv sua`+ LoT IV Lq 3 m D CL It N m N PIT �lJ AV OPR: EAs.M,T -L- 5cY 7 °4 6 ' / v w 4 LoT 22 i /.V✓/ l: 7Z:)f OV- , LEGEND x T1FlrO PLOT PLAN EXISTING SPOT ELEVATION` . OxO �"ER !i EXISTING CONTOUR ---- 0 — ' — 02� `A R 40 T z3 L A IV E FINISHED SPOT ELEVATION °( c rzFA/7 V1/--L C- FINISHED CONTOUR 0 C MORSE y ,o ,p No.10951�O 4 IN APPROVED , BOARD OF HEALTH 9 ��I$TEP • I' oONAI E 9 A M S fA S Ja A J ASS• DATE AGENT SCALE / `= 10 ' DATE $ 9 z7f�z LDREDGE ENGlNEEfeJNG CO, !N CLIENT i CERTIFY THAT THE PROPOSED EGISTERE REGIST-ERED JOB NO. cp___..°�� BUILDING SHOWN ON THIS PLAN CIVIL LAND ,A-^7 CONFORMS TO THE ZONING LAWS ENGINEER U0lVE' R •®Y'=�---'--- OF BARNSTAB E , ASS. 712 MAIN 'STREET ' CH. BY H YA N N I S, KA S S. � Z q 21 a2 _ LAND OF A E G__. - LAND SURVEYOR WPO-1ZZ-80S 6310N NVId "dOOIA 6NODIS 31VDS 3DNMIS3?1 R ?13 N [ VMS Z016LIZO N VI d 2l OOI J iS`d lJ KL I Z('d yD 31da M s Z O O 'Q MASTER BATH W coLl.. fV MASTER BEDROOM N „s - - - - - - .- - - - - - - - - - - - - - - - - - - - - - - - o- W - - - - - -, ; - - - - - - - - - C. I I _ I I it I I I I oy I I o a I I LL- N VI ' I FAM1L I ROOM t i O KITCHEN 0 UVING ROOM - GARAGE IV O N O N N N DINING ROOM b o 7 L 0L,£L .8/9 L-..Z — — — — 9 i+> ft j. I LLi O t.f') 4 N ! w Q _ - oo V� z Z- O V I ..� TTTTT- ® ® ® FFF z 9QYj'7LrYjY1Y1 I I I III I-LILI-1-11 I I I I lIJ ,, ® O I TM LLJ S. z FRONT ELEVATION /( n �? C - w ti C \ 11'-9 1/2" 24'-1 3/4" FTi I -�� ON VVVI O I W> o< > X 0 l 10 z ui N O `n MASTER BATH bo Ld 13o CV ClN F-- O J MASTER BEDROOM Q 0 0V, z 6-9" - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -DN -y z _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 - - CL o . z � o 0 1 1 CO r w i i 51_0�� 5'_0 M �� 4'-0"' w 16'-0" Z w Q Lw V e-1 SECOND FLOOR PLANC a�2 L6170-LLL-80S 6310N 31dDs 11VDS IDNIdISTd ?1I N l `dMS zo16LILo = „V/L 'N�1d ?IOOI� 15211� �( ��(�dD 3lViJ Z Q � v � ' it z o 0 --1 FAMILY ROOM LL l .. KITCHEN r� GARAGE 7,� V - - - - - - - - - - - I DINING ROOM t 1 jI I. co ya . t-- G� L � O w �- Z 0 uj N � LLJ o J ui ~ or �Q Z E-=- w ..__, . . . . . . . . . . . . . I ® 111 1 1 ifJ � Q IIIIIIIIIIIIIIIIIIIJIIIIII L'' REAR ELEVATION w FIAII-51-1 FLOUR EL . 57, 5Z T---_ --- -._ _ SD/L S 7 5�S7- /PEs'Ci� Ts . 5�t�1i;GE s ys TE/y PRO F/L E a — /�v/SH MAk. 6RA�E Nl/N- -5LvPC- 2 7 4OAM MAX . /15r 06x W1GSUM36 --7--- 7, sy,P 3/z ,Q LoAMy /OY.� %6 /2'' n l//V• /NNEZ M�45a er--- SA�vD 5�N• 4b PVC y '' N?Inl. L L 1 U l a LL=VL:L �; - 4„� SC H -`to — N V. Z�J - "Nv N�• IlJ1/• vC � ' NCH_ 46 Pvc s2.2o 36 MAX. '/ • j. / l N V, - Ch > "e 53.75 53 4s COV 3. o _ S Z 5 3.0 2��Z• S S --�J� -f/ c ER J F / ; z" STONE 3/4 s10 N c- ---= �2UsHED EG9. 95 �2" ST6 N DOD 6 � U TON C ME,I�/L/M /OYJP /3 sc' E-k'/ST/NG 1, A'ECAST CONC. 4� --�`- 34 -�— 4' C 8 EPric TANk WITH l/.lL ET/ �TLFT TEES s�1N� CON5TRucTEv PCR 310 CMR 15,227 S.`?S - l0' 10' �L 4, 56 So/L s Au50RP7/61,/ sYsTE Al Bl�TTOM OF �57- P/T S��`.dGG- � ySTEM v ES/GN C'��cuL.gT.'U/VS G?oU,t/D W-47 NOT �iVc'o Ui✓TE.2ED 4 3EDRCOM6 X /lo GPD1-3.bRM. _ �•�O GPG' SO/Ls TEST ,p�7-E,- 7 /8- oZ 2- �f'E�U/l�ED /NG/LTR.4T/ON Ake-oq : SO/G5 EV9L�/,gTO�% �/D,�/N 1�DyLE 440 6P,p -= 0. 7 G�SF/.DAY = 5� s; F. 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