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HomeMy WebLinkAbout0958 OLD STAGE ROAD - Health 958 Old Stage Road J Centerville A= 172 — 156 S M E A D No.2-153LOR UPC 12534 emead.com • Made in USA �ocyct4Q t TOWN OF BARNSTABLE LOCATION �� .1'�'����•� SEWAGE# VILLAGE G'��'r ASSESSOR'S MAP&PARCEL/�4 INSTALLER'S NAME&PHONE NO. l�-r Z SEPTIC TANK CAPACITY -eXiX7---'-'-6: oOaa 67 f LEACHING FACILITY:(type) (size) cz ®'.A dY 3 �Y NO.OF BEDROOMS Z? OWNER PERMIT DATE: COMPLIANCE DATE: O� — 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 (�/ ���"�✓ C3 � a No. � Fee THE CONIMONVVEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprication for IN( ") ,, aC *potent Comaructiou Vermjt Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) El Complete System Individual Components Location Address or Lot No./ t-64 ® ✓�Ti17�pG� Owner's Name,/Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 6- r /� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2'3© gpd Design flow provided -3, gpd Plan Date / -- ,� g2— >.7 Number of sheets 1 Revision Date Title Size of Septic Tank ��'��TIy� ��OO Type of S.A.S. �/c� G c3 ®�� 3 X 6 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore.described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this BoaW of Health. Signed Date Application Approved by Date d a Application Disapproved by: Date -for the following reasons✓✓���� Permit No. 05'. Date Issued No. v Fee THE CO _ N_ .EALTH OF MASSACHUSETTS Enteredin computer: R ���� PUBLIC HEALTH DIVISION - TOWN QF,,,-RARNSTABLE, MASSACHUSETTS Yes .i Application for Ti5po5ar *pgtetn Construction Permit Application for a Permit to Construct Repair pp ( ) p (/) Upgrade( ) -Abandon(.-j ❑ Complete System LJ Individual Components Location Address or Lot No. p rCT__P[� © J Q Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. LTA/?7 �r l//r �7 o 0r7 �0. !//.eS S OI✓ 36� Type of Building: Dwelling No.of Bedrooms -_3* Lot Size sq. ft. Garbage Grinder ( ) O,Yher, Type of Building 4;�Fdf_r No.of Persons Showers( ) Cafeteria( ) -,"Other FixY res Design Flow(min.r q fired) ��� gpd Design flow provided .. '�!? gpd Plan Date /G =., per. /a' Number of sheets J Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil I 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 Certificate of Compliance has been issued by this Boagl of Health. Signed Date ,/"2 Application Approved byI Date 19 V Application Disapproved by: Date for the following reasons Permit No. Date Issued 'I THE COMMONWEALTH OF MASSACHUSETTS j BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired Upgraded ( ) Abandoned( )by at '7 5�_60 Q d----T. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,40/a " 33 67 dated Installer Designer #bedrooms Approved design flow -3yQ gpd The issuance of this permit shaj3 not be c nstrr-uuedas a guarantee that the system, 11 ftm tion es ed. ti^ i Date ,/C � C/ Inspector, Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS I Mwi5po5al �§pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at CH G.b /�Jf�"� lor 06 e e-oW-,--1. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions.Qperntmnit. Provided: Construction must be completed wit in three years of the date o L_'. ) Date .�0 /��! � Approved by ^�� o LOCATION SEWAGE PERMIT NO. k6T 2 OLD D STAGE 7 1' - 2 1 V1 L"L AG E c L V 1 F-tcv►cl L I N S T A LLER'S NAME i ADDRESS Ksy H ickc LY 7 i e}4 �� Liv �it2nr BUILDER OR OWNER Do✓rO L L,67 L DA T E PERMIT ISSUED DATE COMPLIANCE ISSUED �5 7f- ��� ��G, � � ,� ,�®' � � -. �d' � _ — ��'`'' — �l ` i' / �r oC .,/� CD,• a } e ,, .-h a fit t,�.§ ' +� j„:,.P, No �f ~ . Fzcs ' 41�",: Ilr.4 THE COMMONWEALTH OF MASSACH•USETTS BOAR® Fa hiEA TI-I n r a ... r��p -- • -.,���� r�� �n ��� �t��n��If•�?l��r�� (�����r�r�Uan •e�uti# Application is hereby made for a Permit to Construct (v'or Repair ( ) an Individual Sewage Disposal System at: - JON i Locati n,-Address or Lot No `�'� T� ..fit .... e n - ••---•. --- . _ .. ... •... . ...:.... . = - •--- W Owner ��5 n Address s—�rc r� r--mod 1 •Installer Address Type of Building w Size Lot____________________________Sq. feet Dwelling—No. of ......._____________________________Expansion Attic (/ Garbage Grinder ( ) Other—Type of Building ny No. of persons........A-4................ Showers Cafeteria A4 Other fixtures -------------------------------------------------- --- W Design Flow._....__.___ ... ,,`"......gallons per person per day. Total daily flow......... .....................gallons. WSeptic Tank—Liquid capacity/- ePP.gallons Length---G____.___. Width_. __.�_...... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area-------------:-------sq. ft. > Seepage Pit No_____________________ Diameter_:__________________ Depth below inlet _._;.. _ _.___. Total 1 c Ing area.. '..........sq. ft. Other':Distribution box ( ) Dosing tank:( '.) '. �-' 0 ° Percolation Test Results Performed by--------------------------------------=...... /----------------------- Date----......-.......... .............. Test Pit No. L. ......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........................ O Description of Soil �Z ..:e-.... ... __-2 --`✓ �' r" x fit •� .. ......�. .. --- .......... !:- 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 L L 5 of the State Sanitary Code—The under gned further agrees not to place the system in operation until a Certificate of Compliance has bee is uedI y,the ar o iealth. �• Sl ___________________ ............................................ _..._�_/_____• _ ��� at Application Approved By....... ------------------ F.s Date Application Disapproved for the following reasons------------------------------------------------------------------------------ ................................. •Ate,_ '' - .........':�v--­.......................................••---------------•------.._....._...------------- .--------------------------------------------------------------------------------- Date _.. _ Permit No......................................................... Issued -�'-_o - ------- No FEi& THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH ......................:oF.....!� ?r .-1 ... •----. Appliration for Uigpuittl Works Tomitrnrtiun ramit Application is hereby made for a Permit to Construct (t/5""or Repair ( ) an Individual Sewage Disposal System at Location-Address or Lot No. ___..._._-•.J7, �f :_;... f..... :P.. ..................................... ..........--...................................................................................... A Owner _ �+P1UR � Address W .............:.........:...... ..... ........ !__. ....... �... FM�1 Installer /// r Address U �.. Type of Building � Size Lot____________________________Sq. feet Dwelling—No. of Bedrooms..........9.............................Expansion Attic J Garbage Grinder ( ) p-, Other—Type of Building ....... ....... No. of persons........=................ Showers ( ) — Cafeteria ( ) alOther fixtures ____________________................................................................................................................................... w Design Flow.........•. ...J� ......... per person per day. Total daily flow--------g-f247-Q......................gallons. WSeptic Tank—Liquid capacity,! _-•-gallons Length....:........... Width-i::.......... Diameter................ Depth................ x Disposal Trench—N Width.................... Total Length.................... Total leaching area--------F-----------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlPv Total 1 c g area_.__.".._.___...._sq. ft. z Other Distribution box ( ) Dosing tank ( ) G�: ;�_1 f%"�'' * 9s. Percolation Test Results Perfor ed by __._....__ [_ ...__ __..._.....__ te._ a .a Test PA"YNg0le._ u sf 1- � n u s p irxc 1 D�epth of Test it_ _ ....___ Ile th< o ater.. ........ .......... ' a T -t �. .............. DDescription of Soil ......-----•......-- --...------ ------------------------------------------------ x c, . x ................... ............. -• ---- •---------------------- U Nature of Repairs or Alterations=Answer when applicable...__`_ `...:..... ......... .....•......_....._...__.__................... J ._...... ................. .............................. ---- ---- - Agreement:,_ The undersigned agrees to install•the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E, 5 of the State Sanitary Code—The under igned further agrees not to place the system in operation until a Certificate of Compliance has bee i sue x the a health. Si :....r" Da e Application Approved BY ...G a Date Application Disapproved for the following reasons---------------•- ....................................... ---•----------•-----•----------------------------------------------------------------------•------.....--••••-•••--•--•--•--•••--••--•-----•-------•-••••---••••--------••----•------•------•-•-•-•---•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 OF................ • " .............. . . t Of . Trrtfrtt nm�nrr Tyl IS O CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) 1 ., Installer "a - ' ----• r air. R �� (R� __._•' ',. has bee izxned in a r with t1'le pr isions of T j o� Thnitary Code as described in the application for Disposal Works Construction Permit N f�_______ ____J_ __ ___......... dated-_.. -,. __._ ------------- THE ,ISSUANCE OF THIS CERTIFICATE SHA T C STRUE® AS A GUAR NTEE THAT THE SYSTEM;'WILL FFUUNCTI 2 SATISFACTORY. :.. DATE .................. .._...- Inspector-•- --- THE COMMONWEALTH OF M,ASSAOHUSETTS._ BOARD OF EALTH F. FEE..... - --•-•- ` i Permission is h y ranted........... . ...... .. _-- .......m•...•i.t....-•------------------•- .��..,� oto Constrit air an I ual Se po -- -- •aN S f"� 000 v as shown on'�'the application for Disposal Works;Construction Permit No ....... Dated•__-. __-_ ..f�&..... 71 _:__;___P' ------- ------------- - n ^7�' .................../--- O.a Health DATE ---- ----- ----------------------- IX, ,..- s '.� .�. . , FORM 1255 HOBBS & WARREN: INC.-"P`UBLISHERS. 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C 1.0 V R s 0 -:ep ^ .,k, '4 - k r ,�t r r<.` A r _ a e •¢, w ''; i i .+� .3,,,.w r .-1, ti r.�r ++ ,�'s< .•�: t e 4a St t °'ti Ai-i, ,t*p _ tw L --;( c r. we-� { f 'C t , �z `#*,4,`ED,:i. ARID OFt HEALTH `� , �x �z4� ,, . , ; a. r !k .y,e F C a' �` , n r dr4taw .as ^tC r , nK a1 y n a A�AJJ *9 t-A�r1 v v „� tit M n /?4'th ti y i t K -,ty'' t 'S'tt 1 nt ! N r �.,a.. 9�a N t - • rnp1 " k .` ! 'P _ y t Fs.t I' :% 'y. `! 1 ;� " k A6EN1` � `� i, ".,r 1r,I-: SCAL rtdl� �{0 !w 'D`4TE _ ' ` ,. <k N it✓ t INEERING CO l-NAG �°� k ERT ,� 6 , ;. . ,4 _ CLIENT — _ M A:1?, �G�' ENG rr n t •" � 0'p' I C IFY, THA 1' r �;E If i'oE REGISTERED `' J08 N0. _& BO,L'Dlh $HO'WN w ON.�,�'H1. rr a 'v�i a ",C1,VAU , ! _ LAND *v<, CONFORMS ,;,.TO 'TIiE 0 1( -,;, ,x 4, D R B Y fi_,R ' Fsr IV01�JC6S: LSUAVLYOR ,' ��' OF OARNSTABLE "MASS; � er w, r {. v �y r , MA`I ,tT t n. , 712P MAIN St CH;'9Y . , '" ': C` ,r r `� �C3 'H:°'AAASS �HYANNIS MA,.SS ��G��u t ,� F �, SryHEET_�''OF 'A_ DAT[r`r RE0 LAB 4`§11 , J, � r . E . 'FRt },�'1�' v,rri y.. z lT rt, .i - �i,�,re M f - f �' � j}. , _ q 1� xu''�F , urn .. .Wr .°mA. ..Y r yk.+ � Rg }_°!n, kt m<•Nv",,,, ,.,•t to a 'f a."t�.k +yd " p rt! h x " wx'-9-4•+t. :... y... . . ,. r y. �r .s�-.:as.. _ _,E; T-�.rf:•"' t r aD'..-�sS;. - - " a _ - ±: 3•-y�{ i .. �"�s, '' :'},:�`,..�-,'' t yy# �-':,. '-:"G»,^ -.s. .•7, y.. Ec, tt '�`, '-,r. 2� '4£>> -a� t""' t •>; 7 :9u.:. 45 y. - _'� - ��•f�'"-1@Gnf .. t: - E:. „-..y �._ y.,'.� .-„ is_ -T-."i;-. :t' ..l:e _ ta. •; .,.,;, -_ ,...�, -'�*��. +'!.' .:� a _� TOP iew a .i.�•bgy .t. yy,-•r -:��- s.• ./' �S'.^atin;ya_p� ;_�,.�i-'' -v' ��- rr� - `S.�ye aw �i ' Eye ;•' / p .�. a i E - _ '�,''x's.-� r a... �,;• .e•� -3..� :-'." :s'' yADE Ci4/+/ :SAS .r ., a � .. P LfIYERw� lr:4" CAST y + r' o �a�o Qom`'/fp�r 'y�B P1PE t w` P s v G. a. c '4 � rh .¢3 /O�� GAG. . I • / . . ,p ' A a 5/tr0>`STY�NE t' R t"T. rPT/C TA/YKo�`a 4 .s � 3 :'SL. > xs! BQX p f 1. • T O I: a 0'.p , ice' j . ;. •' ` o b c,.• � �a _ of e. n t •o DFPTH • I c • e. � ',o WASH Obl STD/YE f .Q �: .� Z. '.tY.1++ • a,• =s ,y 4_t •:- 't I I, O µ-•ap - O • •'I t �.,0 p "`z _ - i L `a�riY -� «. r - - y. > - V-' I •' p ''� •>,•• p'I. :-� o v "� , s r c + v PKE S r SEEPAGE'. sso, PT RYl E4U/ - S- __, ... d S - /NYERT.:AT.=Bu/�D/NG ,^ SS,_D �T. Ic t+c�U z r;v".t v Ja•1 _ O - _ F CS �r� ri %NLET, SEPTIC_ TA:/VK �.t.I c C, 'r p C� p�/TLE.T SEPT/CTANK: FT. �t ;KG�ea0e� CTJ`'b 'ye ! /NGETDI TR/BUT/ON:.BOX may'G FT GROu�Vo .WftTER TALE _ r 3 SEC/ /0N0F'. OC/TLETDfSTR/BLl7tiONBOX`��, FT ff T EOA E F��T t :: s3 ,+ T T TABULAT.l4N ' SE ., �' F.-•_.�n "� �;- EN/AGE O/S'POSA�t. .SY r . _ - L E�4CH 'PETaN«A DESIGN CR/TER/Ar `� w k, °p1MEN5/ON . ` ,• x r: z `' - n A r _ k 01IwJE/VS10N N[%MBER OF®EflROOMS _ G4,4Bi4GEt7/5P03AL.UN,T'`-_ "X oaf' = ` . ; SO�L ,.�OC? s . � �, 'x o L. T .S �' •; _ q ,. ,r nh TOTAL ESTfi►�t.4T4=_D F OW�,2 G.4L,�pAY t SO/L:TEST _ - - iSIU/WeER QF SEER4GE.�/zS _ t z} „�* y F[Ei! • O _ EL�Y "?, 0 ' .OA7 P S0 1 L...TES7' 4 _ ACH N R PIT- S FT ;, `� -, T W/TNESSEP ,BY �. pERCOLAT/ON R,4TE ' BOTTOM LEa9CH- PER fs/T SQ.. FT ;- # ;- * : s$ AFR oZ Ariwv:RA7,E A.2' �►7r.�v. /roc TOTAL YEACK/1►rG..:AREAFT �y,.:Stf�'' h` +►" Sit �. aJ f q�/'� *v. r•--'�'` u p i$ 'i!"' , - h { - ..e -n. - ESL�ie1/E}'E/iCf�lNG ARE1°► •S4:' FT: y {{ .-.. � � .• ...'t- :i f ..,:. ...Tie... Mt'a'� •��_ FR.4, �dvz.� �.� 'Y� �S` ! .��. - -r.n_,ry �s ,-h ''..-w rr �. ��Gr• �u:: t Q __y - '•..�$ >S- 4 n ''4 Hf %s- ti`7 ,•3�` _ "".,",�s._ L, ",> _H-� fr' .4. . .:..<' ,.a :-c? a. {..s. Y ��, V" M t.;p'. � .;a,' t} ,,,, r. : _*-. �` _ -�` �,�`-.`�: •'"�, ;,�;' yr�',` - r.r g, !:^ )s�- ..'_..- '-T' :r r` t'.tt.' Q .� '.; .}, : . ' .., s` z / n � !:s'� t -,, � `a� G `�' �lI/ Dui ..;.'' "�. a*,t ."i�' ,s _ ., I/RAs !" +, " : -< .rp. ., � {r•+ { .ir:r ? •a G :f ..h_. ...,',ey.-s ..Y. t. b :�'—s +•7` „ - S *�. •f'R" �' � 'k _L az a ;.3 ,� -, � � •>r` � h �`�:yE"'�n`�r +`F..r �='.�„ _ - �- »� �i.,�� a., .. .., - -.,._m':.L ,' �':•. _ _ !. .� 'rr $�y_•3� sl•I�.e e.;.-•.,x. Est - _ �pc5, ;. 2.. .. , ....'..•�� :. '� - .« ��. _ ._.. .§ yz.4� �... ::'� to t- •.,{+ _ L'+�y7. �`6,3 �+/�y!� r D ep'�/p .�'x .+.e'_ x.. y'A�yy •p-�e _r - �A, ..++r. :C L ILL/'iT f�j�.�/ /�'�yA�947 ��- - +p : i' �:¢},'-.vow ;:.'Q �j��1..,.t•!' s•:. �/!�.. .`:r. :z`�'i.. � - ,' t� },� ..p - ig"- - _ pa `3'.-a. -,T"',.'>."., �,:n �- .G -:..-. Vim`•-!!0� nS.'..Y': .S..a_ `}'Fc. .z,',� o,,t:`�':J�� .?.- .;t - � "+'.r.; �:-< �: .,L:Y�� '.�A- .mot. .;i%. "[`,4�s+.- ,,^+L.:«�.. 'n.�` _:y�'1 `�/ 'd.:f£.�y a��; -E,• � 15 .�'� '�"�` .ar_j,_ o. ) -„y. �.- .r ..�'�#"•`�.. xs� ��,_�F ,.��P'.�- '! ' ,u�^ .�. - w�8�.',�'��`. T. ->.. �- '='�.. ,i_ y... :!^...4 �•, „ ��..:'' ,N-::.� 1_..Yti= ;'(�•,�iS ::'y�c;.!F�' cr,^ems ..2.+.' r _ •.�.�}�• �.: e�O �Y; _ .,a.. _ 4 H fir. py ' -_. Town of Barnstable Regulatory Services Thomas F.Geiler,Director ,ARN9UBM ; Public Health Division A` Thomas McKean,Director 200 Main Street, Ryannfs,MA 02601 Office: 508-862-4644 Fax: 5 8-790-6504 Date: �y 4 Sewage permit# Assessor's Map/Parcel Installer &Designer Certification Form Designer: // V� . MA/NA Installer: I �-k Address: F -JtM)9Wt0t} Address: I+TAWWI-'5 On ��as issued a permit to install a (da (installer) d septic system at -I% pL'� based on a design drawn by ,,..,,�, (address) l l� 'MSC dated --"o —or (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_ Stripout (if required) was inspected and the soils were found.satisfactory. I certify that the se tics stem referenced above was installed with p Y 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 P- '-tioas, plan revision or certified as-built by designer to follow. Stripout(if ro- ­cted and the soils were Found satisfactory. OF Njgss o p S Ip �0? (Installer's Signature) a MASON Na.1066 o c3 Jg7 � y Q (Designer's Signature) PLEASE RETURN TO BARNSTABLE PUBL.- OF COMPLIANCE WILL NOT BE ISSUED UN a iL jjp 1 t1 b=LN P l)17M AND AS- BUILT CARD ARE RECEIVED BY THE 13ARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formMesionercertiCCation form.doc IVOTESo ' 1.) The structures shown were located on the ground ASSESSORS REF: by conventional survey methods on 01/APR/19. ,�'� Map 172, Parcel 156 2.) The property line information shown hereon was compiled from available record information. i ;%\'��.'`'' \ °"may ZONE: RC 3.) This plan is not for recording and is not to be 4�fP�o Area (min.) 87,120 SF used for construction layout or deed description / ' / s2�, ' °she Y P / !/ ,oe� . >I.• 2rg' Frontage (min) 150 purposes. . •°i c�a�,�,� a/ .' c •'`•�. `••1.a7' Width (min) — Setbacks: 6�, O'• `\\R� a1 ce/°H Front 20' °g0 IE ,e end Side 10' / C" A �' \ > 38.4' ; Rear 10 / R rox Septic /oc Deck '. System !a / Lott ;y � 17,700tSF! 39.1' 3 / � p• Q o / Shed Nb 25.1y_1 PLAN SHOWING NEW GARAGE N 2.9 i/ �° At 958 Old Stage Road o Proposed044 �? BARNSTABLE CB/D , eon, / / 00, Fnd /�i //,� Garage �' / CENTERVILLE �`!1 MASS. V�t y n4 DATE:21/MAY/19 SCALE:1°=40'� � 0 10 20 30 40 60 80 FEET ®- � FtBCHA PREPARED FOR: �6°' `4o. 3va Andrew Little PREPARED BY: o CapeSury 23 West Bay Rd, Suite G Osterville MA 02655 DWG #: C912gl cpp2 FIELD BY. WHK/ASK (508) 420-3994 / 420-3995fox 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 signaturfz5 can this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Officer, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. gw'fa DATE: - k- 1 Fill in please: APPLICANT'S YOUR NAME/S: (Y1CASOn r BUSINESS YOUR HOME ADDRESS: C S} n 'z C77y)VIC- o� e ur 12 �t TELEPHONE # Home Telephone Number C7-iH)-0 o-oco- NAME OF CORPORATION: LO-C�j JGY-Q- ELrv' e�- S2rViC�� NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION?_ YES NO ADDRESS OF BUSINESS EE A- :3 MAP/PARCEL NUMBER 1 (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_Wa in St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your usrness in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual hasl be ed of the permit requirements that pertain to this type of business. Authorized YSignature** 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:. Town of Barnstable, P# 1,376 Department of Regulatory Services �. Public Health Division ®` rE 9.h� 200 Main Street,Hyannis MA 02601 Date Date Scheduled 1-9 Aa A'` i } -Time ram' Fee Pd. ji Soil Suitabi t,� Assessmelnt,for Sewa a Disposal i Performed By: i 1 •au.a.:., ,`� ��,Witnessed By: n i `•. > ; J, y LOCATION 8a GENERAL ` Location Address 9�-� OG INFOR;MATION ' i STiSr�� . Owner's Name ` `� Address 9s"6p Assessor's Map/Parcel:�,� _ 1 V—� Engineer's Named/� NEW CONS PRUCTION REPAIR Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possibll Wet-Area+' �•, 1�_ft ,Drinking Water We]!, Drainage Way ----__ft Prope6;Line `Other ` ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands I`n proximity to holes) r i i Parent material(geologic) Depth to Bedrock ----------------- Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face -------------- Estimated Seasonal High Groundwater D— ' , ►,.'�`�N FOR SEASONAL HIGH WA'TEIt'I',�BLE Method Used: Depth Observed standing in obs.hole: _ De th tow ing from side of obs.hole: in, Depth to soil mottles: In Index Well De Date:'' Index Well level ( ' Groundwat stment In AdJ,thctor m� Adj.Groundwater Level PERCOLATION TE$'�' Observation, � ' bate Thne Hole# �M —� Time at 9" Depth of Perc - — -- i Time at 6" Start Pre-soak Time @ � Z Time(9".6") End Pre-soak !� + r Rate Min./Inchf� �+ 4,`•� '. Site Suitability Assessment: Site Pass Site Failed: Additional Testing(deeded(Y/N) Original: Public Health Division � `J Observation Hole Data To Be Completed on Back----------- ***If percolation test is.to be'�copducted within 100'of wetland` t o must first notify'the Barnstable Conservation Division at least one(1) week-15rio'r to�'begimm�g.- , Q:\SEPTICIPERCFORM.DOC - v. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel 0 (o O ?2. 1 L L' Io1- � Z. l l � • DEEP OBSERVATION HOLE LOG Hole# Zf Depth from Soil Horizon Soil Texture Soil Color Soil Other` Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) _ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Colon 'Soil Other Surface(in.) "(USDA) �• i.(Munsell) Mottling (Structure,Stones,Boulders. Con iste c Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consi ten Flood'Insurance Rate Man'"'' Above 500 year flood boundary No_ Yes✓_--_ ; i Within 500 year boundary No= Yes Within 100 year flood boundary No Yes'— Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perv'o material exist in aWare',"',observed throughout the. area proposed for the soil absorption system?If not,what is the depth of naturally occurring per ious material? certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envir nmental Protection and that the above analysis was performed by me consistent with . the required training, erti n e erience described in 3IG CMR 15.01 Signatu Date l0 i 02 Q:\SEPTIC�PERCFORM.DOC i � t/ IT i I777 :� y J33 s' i v l L � r IV) ij 11 i i i i fi , 1 y d 4 u�i }✓ _ Aj 4414 F j I :.. �'i FEe E Oy LI S � a { 9 a * f f ; r.. "a 9 ri irk � v � ff,iyy' pp 3d J.K. jj ------- fit _17 aL 49 ILI -3K 7 CIL JA A, ...... 47 ........ 1"13 SEP I ! Rl 3: L j.'S .ems�.0`.''. i 0 0 ASSESSORS MAP : _ I _---------------— - HOLE NOTES: - TEST IIc�LC LOGS PARCEL: 1 �� � SO I L EVALUATOR :-A�19 �• Wkk� c -t L FLOOD ZONE: I `Ply 1) The installation shall comply with 'Title V and 'town of W I TNESS :�0✓^� 'p M4�1 I Ie� ' , ��l;c,tird of i Ilh It�l:,iiltiU� ny, ac REFERENCE: �li� 27 � _ DATE: w 2) The installer shall verify the location of utilities, sewer inverts and septic b� /9 _ �C(,�j PERCOLATION OPJ RATE: .,G. 01�1 l components prior to installation and setting base elevations. �j •,��, — ---- 3 All gravity septic piping to be 4 inch Sch 40 PVC t " .����'� ._._� ��_�C/____----_._..._�.._..� � '�(,� �U•�Q � .�a ) g Y p p p g a 1/8 per foot. The first two feet out of the d-box to the leaching shall be level. TH- i TH-2 4) This plan is not to be utilized for property line determination nor any other i "1)Lv purpose other than the proposed system installation. 6' r �� 5) All septic components must meet Title V specifications. U 6) Parking shall not be constructed over 1I10 septic components. LOCATION b LDS � A"/ 1�" 77) The property is bounded by property corners and property lines. MAP �� ) The property owner shall review design considerations to approve of total � � �,V � �• � � P p Y g pp otal 2J� design flow and number of bedrooms to be considered for design. Receipt ��pp G� of payment for the plan and installation based on the plan shall be deemed U �'' ��'� Q,� approval of the design flow by the owner. _ 9) The existing leaching or cesspools shall be pumped and filled with material `� � i per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Ak �A J Al Title V specs. M%11 SSA f 2��2 �� 10)System components to be 10 feet from water line. Sewer lines crossing the ,I�l A -------- ► J water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if -_� applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in lace. SEPTIC SYSTEM DESIGN ( p ►'� o 11) If a garbage grinder exists it is to be removed and is the responsibility of the FLOW ESTIMATE owner to ensure such.' 12)The installer is to take caution in excavation around the gas line if such � exists. °%' BEDROOMS AT 11D GAL/DAY/BEDROOiA -v GAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer lines exiting the dwelling`prior to the installation. SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting i Title V requirements. 13Z g5 - � GAL/DAY x 2 DAYS - 960 GAL ° ly ab i USE (000 GALLON SEPTIC TANK A r SOIL ABSORPTION_SYSTEM - MASO�1 m ti SIDE AREA: I��4 1(i� wNO"1t186 _ BOTTOM AREA: 2-0 SEPTIC SYSTEM SECTION -ou ► 1 'D1M but W l b �W�p ?tow q,No GJ J� %'q /� ��n��,/� pry " Li 1 D_B0 � IbCX:? GAL , DO v SEPTIC TANK °--LP�Y�� � -b� DiVSTJ NP AND", SEWAGE PLAN - -- LOCAT I ON :4tg5� QD I�OA� %VI Y �. 20 ' PREPARED FOR : 1 SCALE W ' DAV I D B . MASON 9'5 HATE: DBC ENV I RONMEN�AL DES i G14S 11AST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833- 2 177