HomeMy WebLinkAbout0035 MENEMSHA LANE - Health ---s5 MENEMSHA LANE, CENTERV L E
A= 191098
�aE�Y«Fo�
n�LG p =J o2m
UPC 12543 '
Mo. o�Posr.�c �
HASTMOS,ON
1
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St.; Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: f IS_ Fill in please:
APPLICANT'S YOUR NAME/S: N A 7 NO M k95
BUSINESS YOUR HOME ADDRESS: 35 MP 0e. M 5 Nn t4u
5(G/-77[0 E/14er u) 4 C F i M/� OZ(P, Z
` TELEPHONE # Home Telephone Number Sas 7 O - -7Fs - 0-7245
n
x ,
NAME OF CORPORATION:
NAME OF NEW BUSINESS 5"� .5 i hE Pt�In I TYPE OF BUSINESS f)Xl� t\ci - t4 -i f -�req4S
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS 3' 6 ' Z k5 AP/PARCEL NUMBER `,' tr d [Assessing]
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
" MaC4�, cz+ �rn� e�� i�ots''i� theme
1. BUILDING CO MISSIO ER'S OF ICE _ - Ib o� „� .� U1 IaCa I p,lnler'� Mq�kef;
This indivi al a en of p m't re uir ments the pertain to this type of business. Graf Vai r3 �2�v
Au h ze i a 'e**` MUST COMPLY WITH HOME OCCUPATION
EN S:
LES AND REGULATIONS. FAILURE_TO
C M
v i
11n
2. BOA D HEALTH �.(��S'd,Q�S���
This individual ha info m the r r uirements that pertain to.th AR�lTH ALL
p p HAZARDO TQULATIONS.
Authorized ' nature**--
COMMENTS: \
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS.
y
COMMONVIALTH OF M-�SSACHt'SETTS
y_ l
EXECUTIVE OFFICE OF EsxiRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONNIE�TAL PROTECTI
ONE WINTER STREET. BOSTON. NIA 02106 61?-.S_•':0G �
4 9 A�,J �.
-.4
o Tr L'D Cc=,_
N ILLIAN,F.WELD ,. . _ �t y�o.� }
Go - .
ARGcO PAl,1 CELLI'CCI '- �F°rr��D•4`.`ID.B S-j R!L
Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Go�riis is
PART A
CERTIFICATION
t0\ * 0n • ' •• - ._. �ti my w�
r Address of Owner:
Property Address, 35 ,'V'�ti1e.tMSh�• �-� � ���Q,,iJi� ���„•,�sc'ns'YbvssN� c�
Date of Inspection: 3Lz�k5� f different) Cho"e
Name of Inspector: P I�E� 'sT"
am a DEP ap roved system inspector pursuant to Section 13.340 of Title 5 010 CMR a. 00) o2\o`t�
Company Name: �7.a ,4- -a rr,r'r'M �`'� P M-�
Mailing Address: e-) /;oA 7%9 HftS6f A 17 /'� 2E4-q :
Telephone Numixr: _4_ �—� 4 Lo
CERTIFICATION STATEMF\T
I ceni� that I have pe'senall} ir.speced the sewa¢e d s*osa, system at this address and that the information re.cret. be ow is true. accurate
and comolete as o-the time of inspe,,o-•. The mspecxn was pe-cvrner base- on my training and experience in the proper iur.c.c- a-d
maintenance o!on-sae sewage disposa• systems. The systerr.:
Passes
_ Co-c!t.o^ai:,. Fasses
_ ♦escs Furthe- Evat, t e7 . the Local proving Author^
F •s •.
Inspector's Signatu • Date:
; s'1a" Subrni: a co;.-. Of this inspe�.en re.c' tc the Apercving Authcr::v within thin: 1301 days cf ccrnpieting this
insceGicr.. It the system is a share: -$\•stem o• has a design flew of 10.000 gx or greater, the inspezor and the s,,•ste•r. cwner s`a'I subr-,t
the re:o-i is the a:,.recreate reg,or al o ,ce of the De,a-ment of Env,renmenja' Frotmior.. The trig-na! should be seat to the Svvem ow-•e
and copes :-'tt to the bu\•e', if applicable. and the ap-.roving authorim
INSPEC i tON SUMMARY: Check A, E, !Cr or D
Al SYSTEM PASSES:
I have not fcund any information which indicates that the system vitiates any of the failure criteria as defir, ir. 310 C. R.13_=�=
Any failure crteria not evaluated are indicate: below.
CO,'MMEN'T5: — -
Bl SYSTEM CONDITIONALLY PASSES: -
----------One or more system components as described in the 'Conditional Pats.'5e= ion need to be_replace-dj-or repaire;'_The system, ucv
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, nc, or net determined (Y, N. or NDi. Describe basis of determination in all instances. If'not determine_'-, explain why net.
_ The septic tank is metal, unless the owner or operator has provided the system tnspecor with a COPY_af a Certificate of
Cempieance (anachedi indicating that the tank was installed within twenty (20) years prior to the date of the inspection;
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltrztien or exfiltratien, or tar
failure is imminent. The system will pass inspe^.ion if the existing septic tank is replaced with a conforming srrtic tank
w approved by the Board of Health.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Addevs:
Owner:
Date of Inspection:
Bj SYSTEM CONDITIONALLY PA55ES tconan,,�d
r water level observed in the distribution box is due to broken or obstructed
or breakout o. high static a .
_ Sewage backup 8
pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(w+th approval of the
Board of Health). Describe observations:
broken pipe(s) are.replaced
_ obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more than four times a year due to broken or obstructed pipe(sl..The system will pass
inspection if tw•ith approval of the Board of Health):
broken pipets; are replace:
obstruction is removed
Cj FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require furthe•evaluation by the Board of Health in order to determine if the s-stem is failing to prote--: tf,e
public health, safea`and the environment.
1) SYSTEM WILL PASS l'tiLE55 BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or pnv1 Is within 50 feet of a surface water
Cesspool or pri -, is within 50 feet o:a bordering vegetated wetland or a salt marsh.
2) SYSTEMM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THA-
THE SYSTE.M IS FUNCTIONIIG IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The sys;ern has a septic tans: and soil absorption system (1451) and the SAS is within 100 fe_t to a surface water supply cr
tributary to a surface water supoly.
_ The system has a septic tank and salt absorption system and the SA—S is within a Zone I of a public water supn'y we!i.
_ The syste-n has a septic tank and soil absorption systern and the SAS is within 50 feet of a private water supply wel:.
The syste•n has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply we!1, unless a we!I water analysis for co)iform bacteria and volatile organic compounds indiates tl^z
the we!I is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to c-
less than 5 ppm. Method used to determine dismnce (approximation not valid).
3) _ OTHER
(revised -
� a a..zs.s ) P.4e 2 of 10
IJ�
4
SUBSURFACE SE"AGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
DJ SYSTEM FAILS:
You must indicate either "1'e5'• or "No' as to each of the following
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 13.303 The oasis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessar• to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Sta:ic baud level in the distrnbitron box above outlet invert due to an overloaded or clogged 54,5 or cesspoo!
Liauld depth in cesspool is less than 6" below invert or available volume is less than 1/2 day ilov.
_ Reauired pumping more than 4 times in the last year NOT due to clogged or obstructea pipes .
Number o`times pumped _.
Any portion o`the Soa Adsorption System, cesspool or privy is below the high groundwater elevation
Am. por::on o-a cesspool or privy is w)thir. 100 feet of a surface water supply or tributa-v to a surface water supply.
An) por ion of a cesspoo' or prnv is withrr a Zone I of a.publrc well.
Am pciio-• o' a cesspool or priv is within 30 feet of a private water supph well
Any port.or. o:a cesspool or prwy is less than 100 feet but greater than SO feet from a private water suppl.• well with no
acceotable Ovate, quart` analvsis. If the well has been analyzed to be acceptable. attach cope of well water analysis for
coliiorrr. bacteria volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
Nou must indicate either 'Yes' or "No- as to each of the following.
The ioliow;rg criteria apa;% to large systems in addition to the criteria above:
The system serves a facilrn with a design flow of 10,000 gpd or greater (Large System; and the system is a significant threat to
public hea!th and safety and the environment because one or more of the following conditions exist.
Yes No .
the system is within 400 feet of a surface drinking water supply -
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater-treatment program: .: .
___requirements of.314 CMR-3 00.and-6_00. Please consult the local regional office of the Department for funheriniocatatiact --- _ —
(revised 04/35/97) pegs 3 of 10
S
' � 1
r,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Addmss:'3,, �Z- ��►
Owner:
Date of Inspection: �`ZNViet
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No�;O
} 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
ater have not been introduced into the system recently
flow rates during that period. Large volumes of w or
as pan of this inspection.
XAs bull: plans have been oo:amed and examined. Note if they are not available with N,A.
l� The iacae. or d••elhng was inspected for signs o-*sewage back-up.
The s%stern does not receive non-sanitary or industrial waste flow.
x _ The site %%as inspected for signs of breakout.
All s•sterr co nponents. excluding the Soil Aosorption System, have been located on the site.
X _ The septic tank manholes Nere uncovered. opened. and the interior of the septic tank was inspected for condition of
baf ies or tees. materta;. o: construction. dimensions, depth of liquid, depth of sludge. depth of scum. _
The size and locat-or, of the Soil Absorption Svstern on the site has been determined based on. Pei maintenance of
The iac,111, o•.ne• ,ano occupants. Ii dtheren: trom owners were provided with information on the pro
Sub-Suriace Disposal System.
---IR Existing rniormation. Ex Plan at B.O H.
_ De;ermined in the meld !r am of the failure criteria related to Part C is at issue, approximation of distance is
unacce:)tabie 113-3023t:bi!
fraviaad 01/:S/S' Page 4 of 10
{
s
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORNt
PART C
SYSTEM INFORMATION
PropertN Address: "; is
Owner:
Date of Ihspection:
FLOW CONDITIONS
RESIDENTIAL:
Design f!o—y�g.p.d.,bedroom for S.q.S
►vumber of bearooms (23
Number o current residents
Garbage g': der (yes or no::_L�
Laundry co-•^ected to system (,yes or no!
Seasonal use ryes or no:: �J
Water meter readings. if available (last two i2 year usage (gpdt:
Sump Pump Ives or note
Lai: da:e o'occupancy V*�jt-
COMMERC i4L'INDL'STRIAL:
Type of establishment
Design fio%% ¢a!ionsida%
Grease trap present Ives or no_
Indusma! Taste Holding Tani: present. -ves or no_
'kon-sancta,\ Haste discnargec to the T!tie 5 system ;ves or no_
X%ater meter readings if availabie
Las:Pa:e o: o cL p2nc.
OTHER: .De:cribe
Last pate of occuoa-ic.
GENERAL INFORMATION
PUMPING RECORDS and source of iniormatior C
0
�Q�w��Olu�G►
.System pumped as Oar, of inspection: Ives or no.
If yes, volume pumped ¢allons
Reason for pumping
TYPE OF SYSTEM
_ Septic tank/ ,orLberefsoil absorption system
Singe cesspool
Overflow cesspool
Prig). —
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technologv etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: =OV994 -
Sewage odors detected when arriving at the site. iyes or no)
(revised 04/25/91) Page 5 of 10
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORNt
PART C
SYSTEM INFORMATIO% (continued)
Property Address:
Owner:
Date of Inspection:?1, 1\
BUILDING SEWER. I
(locate on site plant
Depth below grade.
Material of construction. _cast iron _40 PVC _other (explain)
Distance from private water supply well or suction li-e
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:4s
(locate c site p Pan
Depth below grade
Material of constructio `!C.,rconcre:e _me-,a _Fioerglass _Polyethvlene _other(explain
If can's is metal, lis: age _ Is age con'.irmec o% Ce-i,fica;e of Compuance _("res.-No
�ADimensions 10W
Sludge depth _
Disiance from top o:``:udee to bonorn o' ou:;e: tee o• ba;-:;e
Scum thickness-
Distance from top o; scum to top o' outle: tee or bare
Distance from+ bottorn o scurn to bo- -1 o'outlet tee • bac•e .
Now dimensions were determined
Comments
trecommendation for pumping. cond't n o, inlet and o• tlet tees or baffles. depth of liquid level 1n r lauon to outlet nv rt, stru¢u I
integrity, evidence of leakage, e;c.1Ion s-1,
r
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 i,,let and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
Integrity, evidence of leakage, etc.;
(ro,ia-d 04/25:9') Pago 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: C lit—S
O%ner:
Date of Inspection:
TIGHT OR HOLDING TANK: '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 floN gal(ons'da.
Alarm level Alarm in ,%orking order _ Yes. _ No
Date of previous pumping
Comments
(condition of inlet tee. condition o- a!a•m and float switches. etc.)
DISTRIBUTION BOX:_
ilocate on site pia"
De;th o' Mould level a00%e oune: trne,.
Comments
mote ^ leve! and dis;nbutior is eoua- evidence of solids carrvover, evidence of leakage into or out of boa, etc.)
PUMP CHAMBER:
(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.)
(rw:aed 04/25!97) Page 7 0! 10
a
R
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Addr-ss: 5
Owner.
Date of Inspection: 1 7-
SOIL ABSORPTION SYSTEM (SAS): S(locate on site.plan, if possible. exca. ion not required. but may be approximated by non-intrusive methodst
If not determined to be present, explain:
Type:
leaching pus. number. )6 .
leaching chambers, number:_
leaching galleries, number.
leaching trenches. number.length:
leaching fields. number, d.rne-)sio.n.s
overflow cesspool, number
Alternative system
Name of Tecnnoiog,,
Comments
in conditi , of so.i. s gns of hvdrauGc failure, lee of po ding, fq,ndjtion o'veg lion, etc.t
CESSPOOLS: _
(locate on site plan a
Number and coafigjra:,on
Depth-top of liquid to inlet Inver.
Depth of solids lave-
Depth of scum layer
Dimensions of cesspool
Materials of construaior
Indication of groundwate-
inflow tcesspool must be pumpeC as pan of inspection
Comments:
(note condition of soil, signs of hydraulic failure• level of ponding, condition of vegetation, etc.)
PRIVY: I"l�
(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.) -
(rev:..e 04;25i97) P.§0 8 of 10
TOWN OE BARNSTABLE
LOCATION 3 S SEWAGE #
VII.i;; ;E C�tl�� -�+��\��— _ ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY �C7C1iC�4 rf��
LEACHING FACILITY: (type) i LJA 6-, IQ t T (size) l C)U O
NO.OF BEDROOMS
-BUILDER OR OWNER At
TTAOAff DATE:��XN C g'1 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility h'` I Feet
Private Water Supply Well and Leaching Facility (If any wells exist f
on site or within 200 feet of leaching facility) l`�0 Feet
' Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by2C
y �
T �� ' �
� �a�
vv 1
="-) `L JJ�
1
� �
�4 �-a�► �
�3� 32� �,3� 36'
8 2- yy No............... Fes$.... ... .:oo. .....
.........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
......................Town Barn stable
... .. .... = ......
Appliratiou for liuvuuFal Works Toustrurtion amit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
35 Menemsha. Ln., Centerville, MA 02632
................__ ----•......-•-----•---••----•--......-•----•-•-••--......._........... .............---••...-•-----•-•----•--...--•--•---•--......---•-•-----•---•-••••--..............•.
Robert F. Sullivarin Address n
3.. Menemsha Ln. , �eI...�erNo.ville, MA 02632
Addr
W A & B Cesspool S47:'Me 128 Bishops Terrace, lffyannis, MA 02601
Installer Address
PQ
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.................3
........................... Attic ( ) Garbage Grinder ( . )
aOther—Type of Building ............................ No. of persons..............4-.--.-_-. Showers ( ) — Cafeteria ( )
a 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.---..............-----.
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
••-•--•----•--------•--------------•----••--'..-----•-----•-----.------•---•----....._..._.............-----•---••--•-••-•••-•-.........................----
ODescription of S oil............ aXld-----------•-•-----•-----•------•-•----•-•--------••------•-•-•---------•--------•-----------••-••---------••-••--••..............•--.._._....•---. .
x
V ---••---•------•--......--••---•...........................•••--••••-•--•--••-•-•.............----•-•-•--•--------••-•-•----------•---••---•-----------•--•-------•---..............--•---•............
W --------------------------------------••----------------------------------------------------••------ -------•-•-----------•------------------------------------........................................
U Nature of Repairs or Alterations—Answer when applicable... nst ] t oil---Qf---a---l,99Q_.-
stone packed leach--pit-.�overfl-ow) ...........................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITi U 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 ealth.
Signe -•..:...... .... ..........
9,28 .82
ApplicationApproved By--•-•-••-••--........•----•••-•-•-•...........•••---•--•-•••--•--••------•-•-•----•-•--•..---• • ............9�28 2-
Date
Application Disapproved for the following reasons----------------------------•------------------------------------------------------------- ......................
Date
Permit%o...................••--••.........: Issued_ 8,82
Date
LO-C A T 10H S E W A G E PERMIT 130.
He Worm 5 h A A jv
V-1LLAGE
IgSTA LLER'S NACH b ADDRESS
QUILDE11 OR WM
t�c) F &o vgk) 1
DATE PERMIT ISSUED
DAT E C0MPLIARICE ISSUED p_a�sP�z
�u lIr d/�1n>
t
lCoo aA 1
x
No....82-_... FEs:- .5,.00'.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town. OF............Barnsta. ble .
....... ............. ........ ........
a
; VvIiraffou for Dispaii al Works Tuntrurtaun rrm'd
Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual'}Sewage Disposal
System at:
35 1�enemsha Ln., Centerville, MA 02632
-•-----•................................•---•-------•---.....-------•--•----•---•--•-....._...--•- ..........------...-----......-----------------------.---.--------------------------••••-•--------
Robert F. Sull�iva'nl-Adaress 35 Menemsha Ln., �enerville, PEA 02632
•--•---•------•------.................••-----•--......-•--•-..........---••-----------•---•------ -•----..---- -------•--•---•-----
W A & B Cesspool SeMbe 128 Bishops Terra dire yannis, MA 02601
a ..-•-----•...................•---------•--•---•----..................................---•••-----.. .....---•-•--------•------------•----•---.....••••----•---------------•--•--•--•--......._.....---
Installer Address
` U Type of Building 3 Size Lot___________________________S q. feet
�., 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.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water.......................
fr, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-_------_---------•___.
jW ......................................................................................................:.......................................•_•----------•-
0 Description of Soil----------•-Sand-------------------------------------------------------•------------------------------------•------.............--------------.......-----....._..
x
U
w
UNature of Repairs or Alterations— nswer wh n applicable.___installation_--of a---- 000 ..a 11on_,___pre..Cast,
_stone packed leach pit (averfl aw) .
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITS 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 boar of�riealth..
Signed/�� ��� ------------------------•--.�f--------- ................................28�y�82
Application Approved By................................................------...•-• 9/&p2 ....
Date
Application Disapproved for the following reasons-----------------•-----•----•------•--------------------------------------------•--------------------------------
•................••-••--...................--•----------•---•---•-----•••-------•-•......------•--------...-----------•-------•----•-----•---•---------•--------------------------•--------•--••-----....
Permit
------------------- Issued------.?/28/92
o.
Date
.........................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................T°w2?.....OF.........Barnstable.............................................---- .'tc t�,4
TntifirFatr of TonapliFaurr
TL�I Y 0 'CERTIPY That th vid al Se z e Dis os� S-st m c tru• ) or Repaired
( x)
A &� g G�esspool setvice, �2 ishops FWrac�, HA. s, "- � b01
b \
at.....35.Menemsha Ln., Centerville, 02632 Ins`�6bert F. Sullivan d" T
---•------------------------------ - ----------------- -----•----------------•--------•-----••-.--,...........
a .`� ...... . ---
has been installed in accordance with the provisions of T r2l1F, j/ Tile State Sanitary°'��d�,as iescribed ;n theo
h �?
application for Disposal Works Construction Permit No........................................ . dated......-------.____`-''-. ._.- _.'.T_`.s_..___.__.:
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE t,
SYSTEM WILL FUNCTION SATISFACTORY.
9/28/2
DATE. . --..•----- . Inspector ......................•--•-•--•-•-------
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
82— Se/� ..........................................OF..................................................................................... $ 5.00
�\
No......................... FEE ....
Disposal Workii LTonotr ion amit
Permission is hereby granted..__._
.. & B Cesspool Service
11 ( - --- -- ---S-------------- -------- ----y `\
to Construr teriemshae ri., en Irnvr jl eual 6%jj Disc � ste11 Sullivan
at No 3
Street _
as shown on the application for Disposal Works Construction Permit No,,_.__.__---- Dated_9�28�82
qp ............................... Board •--.. ealth......... •-•------
#: 9/2(J/82 -..--•-- Board of Health
DATE...................................•----------------•••-----------•--
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS '
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM NFORMATION (continued;
Propert. Address: 3 S V1�s1� S�c ,
Owner:
Date of In,pection:
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)
(revised 04'25!4') Fogs 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTlO1 FORM
PART C
SYSTEM INFORMATION (continued)
Property Addres■• Jjs 0'-kr4�W Ste`
Owner:
Date of Inspection: -3 SI(N
Depth to Grounclwater��J Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained irom Design Plans on record
Observation of Site (Abunmg property. observation hole, basement sump etc.)
Determine it from local conditions
Cnea. %%ith local Scwd o- nea::^
Chec� FE�tA Mans
Chect. pump,ng records
Check local e-xca%ato-s irs:alle-s
Lse Da:a
Des c-ibe in %cu- o— %••o,c= ro- %o_ es:aoi+shec me 6-:g CroundNate, Elevation (Must be cornpie:ed
Irw_u3 :�.'2S'9- Paq• 10 0! 10
WEQUAQUET
S'�8 LANE LAKE
N87;2615 W W
39.22'
tf19� �: g
� EN MSNA
ti -
#d PR POS D ac o
1
A DITI N
`ter l
I a.
36. 5'
LOT 28 /,,,,/„jf35 ,,,,,,,,,,, LOCUS MAP
A.M. 191-97 DECK
PLAN REF- LC- 32898E SK2
CERT REF 148447
• , ZONING.- "wc""
le
SETBACKS: 20"-10"-10"
FLOOD ZONE: "C»
PANEL NUMBER: 250001 0005 C
DATED: 08-19-85
- � o THE SEPTIC SYSTEM A.M. 191—30
-WAS DRAWN FROM THE PLOT PLAN OF LAND
b. TOWN OF BARNSTABLE LOCATED AT-
SEPTIC INSTALLERS CARD
35 MENEMSHA LANE
CENTER VILLE, MA.
LOT 29
A.M. 191-98
o -
SHE AREA=16462fS.F. D�®*4AA°,4q ; PREPARED FOR.'
BRIAN THOMAS
`s�8 28�0 o S c JH_N JANUARY 31, 2007
REV
�1 �'��q ' s F`�®��® REV
ca o.i. �• REV.
(FND)
LOT 27 YANKEE SURVEY CONSULTANTS
A.M. 191-96 GRAPHIC SCALE UNIT 1, 40B INDUSTRY ROAD
20 0 ,0 20 40 P. O. BOX 265
MARSTONS MILLS, MASS. 02648
TEL• 428-0055 FAX 420-5553
1 inch = 20 ft. SHEET 1 OF 1 JOB ! 54178 JF
i
41'-7'
26'-0'
10'_2■ 9'-3° 10'-2' 5'-9' I3'-O' �_
13 0.
TRANSOM
2446 244G FWG 100611-4
0
Y�«
Qv 2446
c:
24310 p p
�` ILLW
II IlI HALF WALL I I Icr
v ® 10' FG COLUMN I I 4 p
BAT'' �J( I LIVINGIROOM I
I \ I I 's 2A
sED ROOM KITCHEN
a
LINEN
ICL
I E MUD ROOM
�y
RFJ 10VE WALL --
_ 2
nH
CL CL j�](? ` (�✓� _ --;a = — I HALF WALL I I I LVS308 + - IT
n II b•�c96■10' FG COLUMN I 4
.. ....
..:L:,.i:AiR"..�.:XxS.b'C' ES.r.3?¢':eo:.::::v;X... .. N _Q,
.... >::- ,. ..xK FIRE ram" .
j — 6/8 FIF E RATED GYP BD ,<
BETWE N GARAGE AND LIVING SPACE 1L1W ((�
rPULL DOWN I� U°
I STAIRS I 2d0's• 16'O.C. ` n n n
ABOVE 1 CJ'e ABOVE m WLI
BED ROOM BED ROOM DINING ROOM / L————� 00
/ W IEEEEEEEE 2442
CL
m
W
, .
�.I GARAGE �
W W
I Z Z
W
o I 2442 Q V
W
IZ4Lu Q
74x9' OH DOOR ' 7SA' Old DOOR '� J Z
WITH TRANSOM WITH TRANSQ7
Q Q
W
Z
6 W
'-2' 2'-9' 9'-0' 9'-0' 2'-9' L
�'-9• 18'-10' 26'-0■
0
NOTE..
WINDOW DESIGNATIONS ARE SWEET 3 OF 5
ANDERSEN WINDOWS,
CONTRACTOR SWALL VERIFY
LOCATIONS t DIMENSIONS PRIOR
m fro TO WINDOW ORDER t INSTALLATION
L
- ( NEW WALL
�T-
FIRST FLOOR PLAN REMOVED weIi r-------
� - 0
STRUCTURAL RIDGE Q p
2dd• i IL' O.C. 1UL
R30 F.G. INSUL./ Q�
rwa' PLYWOOD SHEATHING/ < �(
12 ASPHALT SHINGLES "L
av
a• IX3 STRAPPING /6•
1/2' GYP. BOARD �C
TYP_ EAVES
o IX8 FASCIA / IX4 SECOND MEMBER
'HURRICANE CLIP' M u, CONTINUOUS VENTING SOFFIT
FASTENERS AT ALL O z IX5 FRIEZE BD. W/ BED MOULDING w
RAFTER IO/ TTYP. LIVING ROOM Z
TYP_ EXTERIOR e i
3/4' TMG OSS SU13FL.00R Q 2R1 EFT. STUDS• 16' O.G./
NAILED • GLUED TO JOISy 1/23PLYWOOD SHEATHING/ llJ 11_IL
TYVEK WRAP/W,C, SHINGLES
W
Il 7/8' 1-JOISTS _
L
-
FFOUNDATION Wei I Lu LU
P.T. SILL ANCHORED 41-0' O.G. (�
6'XV-10' CONCRETE Z
DAMP PROOF BELOW GRADE L? LU
10'xib' CONTINUOUS FOOTINGLu Q V
Lu
26'-0' Q O
SECTION "A" Q Q w
SCALE: 1/4" - 1'-0" N
}— LU
Z
Lu
LQ
m
544EET 5 OF 5
JOB: 0728
DRAWN BY: KW
DATE: 12/28/2007
26:-0'
4-6' z
ul
—— — ———— — — ——
Ia I r------ ---- ----------- —
I I Q
e'xr-9' CONCRETE wAL.t. I
16'x10' CONTINUOUS FOOTING . I n n n
I I �
m I
FULL BASEMENT I o
4' CONCRETE DUST OAP
r VAPOR.BARRIER
�Fss I
<
- I o
EXISTING RESIDENCE I
�FORSET TOW. TO ALL OW — — — — — J
------- -----EPTH t-
DIFFERENT JOIST D —————
MATCH EXISTING FLOOR HEIGHT ——————————————-I
Wx46• CONCRETE WALL I
16"x10' CONTINUOUS FOOTING I .
, I
GARAGE I ` I W
4' CONCRETE SLAB I _j
PITCH TOWARD DOORS I o J
I I Ir. I 0.r
U W�--
..` I Z Z
I I I W tU
a o I ' ` I I N
; I I W W
s I I I � Q
` I L—=------------------------- Q
-- ---------- ---------- I Q
— 0 fL
l w
1 21_6. 9I_6.. 21_0. 9.6. 2.0 W
26:_0.
lI�
J SHEET 4 OF 5
FOUNDATION PLAN
SCALE: 114" 11-0"
p 1:.
I
V_l
iJOB: 0718
DRAWN BY: KW
DATE: 12/25/9007