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0033 PARK AVENUE - Health
33 Park Avenue Centerville P A = 208 024 llll ® z UPC 12543 �a No.. �`�i•co `'� HASTINGS,UN 4 No. too 3 P 214 ` ' '( Fee :V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYicatiou for �Digogal *pgtem Cow5tructiou Permit Application for a Permit to Construct( )Repair( )Upgrade(x)Abandon( ) XComplete System ❑Individual Components Location Address or Lot No. 7M,3 QAiZ V AV E Owner's Name,Address and Tel.No. CC/vts 2V I L.L E' /�'1�0 s s M 1 c h W i=_L. tln oV N l H g w Assessor's Map/Parcel y l0 L A FfZA Al C_Lz AV E , 2O8 H-1An/Ivlt /,V4SS' Install is Name,A dress and Tel.No. Designer's Name,Address and Tel.No.6-0&"4_L 9 ��� � ����_ $'ULtivq/V rNGINEe21/V� ILL 7 `7��- `j �� OSIIS_&VIL L G 4S5 Type of Building: 3 Pro Pcsv-D Dwelling No.of Bedrooms 3 1 st. Lot Size 0.14 S A� sq-€t- Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow G gallons per day. Calculated daily flow G 3 gallons. g g P Y Y Plan Date FC 13 . 1 9, 2 as 3 Number of sheets I Revision Date Title PP_cP0SSD AD 2IIl04- 6-SePTIC- S\19'r0M LiPC-Y/9D(a Size of Septic Tank /cSiG> C PLLd/Y3 Type of S.A.S. 12'X 5'3 LC�c�1«�C�l1AM13�2 Description of Soil O toS ItO—0- Sg lDy La, M a-Anal r 1 O YR Z/a ; 5 /L" A DgR k- GrgyjsN 8izW CaAr5F Sf3ND I0Y2y/7- G ,, z&" 13 Dark YaL/13eU �i, iYFs T/ DI/R S�L4, 2- 1 2a CP,4j,5,F S'V/ya yR s/f" Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued thi Bo Signed Date // l Application Approved by S Date 727 b Application Disapproved for the following reasons Permit No. 7-oO3 2 7 f Date Issued Z 8 TOWN OF BARNSTABLE u` .00ATION 3 3 SEWAGE # V LAGE e Lt/`'%�J�� ASS/ESSO 'S MAP & LOT 2-08-0 z INSTALLER'S NAME&PHONE NO. ()l��� I C� it n t�l .0 SEPTIC TANK CAPACITY (_o LEACHING FACILITY: (type) C ��(/!/1.��r —(size) y� NO.OF BEDROOMS BUILDER OR OWNER Ph' Ie,11_7 PERMITDATE: (PJ-z2 b 3 COMPLIANCE DATE: b 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 4 2 13 = 2/ 1 C z C G� 2 /6 No. 200 � �l t j Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 4 F PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ,r 2pprication for Migogal bp�tem �ongtructton erm�it Application for a Permit to Construct( )Repair( )Upgrade(A)Abandon( ) Complete System El Individual Components " I Location Address or Lot No. �j 7j PARK /��/E,y I f Owner's N e;Ad�ss,�dand Tel.No. , C�i✓{E2VILl.E� n�w`s's_. �flIE '►q�sl_UIVY�VNIHIaN Assessor'sMap/Parcel N L, LA F12prvG6 AVE . NyAIV/VIs AnAL5 Instal is Name,Address,and Tel.No. Designer's Name,Address and Tel.No.50&—47L S' ` 1 4 ��rsT. $ Pwri<eA/ !?IV6IA/Et2JNf I NG Type of Building: 3 Pnq ho56D .-''"tl Dwelling No.of Bedrooms 3 X Is I Lot Size O,y 5 A sq-k- Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtu es Design Flow G G gallons per day. Calculated daily flow G G 3 gallons. Plan Date t 173 . 1 9, 2 as 3 Number of sheets I Revision Date Title PRaPaSED 4DR) I-1eA-- d-SEPTI c. Sys7CMYI UPC rid P6 Size of Septic Tank 6-/4 Ll.4P1'YS Type of S.A.S. 12'X S 3'1-4-104-11 ray`&AAW 662 Description of Soil D� 5�a�—d- S.4/YAY Lv/aWr dy�koel C 10 Y2 2-�� 11,�r A DAR V- Gr A Y isN B R W CaW r5F 5 /✓D 10Ya t 4z /6, 25-" 1B t)'9rK Ye a A FIiYEs t, ealf%E 1 a YR -V6, 221r'= 1 2-a" C Ye . 01141 U-AAUZ SA/ya Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: - The undersigned agrees to ensure the construction and maintenance of the afore described on-site.sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue thi BoKd3f H Signed (C.� Date Application Approved by Date 2 G Application Disapproved for the following reasons 'J Permit No. 2 cx)s - 2 7 Date Issued ? C- t 1 THE COMMONWEALTH OF MASSACHUSETTS ,,.-- BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CEIRIFY,that t,e O ite Sewage Disposal System Constructed( )Repaired( )Upgraded(X) Abandoned( )by D/'Ta 2O' at 7-e>3 PSI je Al/t C'Cit/��2 1/!LL!✓ /j9i� SS has been constructecyin a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 200 3` Zq dated 2 7 Cl 3 Installer Designer SU L 1 V,4,de G:/Y //.PEER t/y/G t/Ve- • �- The issuance of this permit shall not be construed as a guarantee that the system �iic s de i n Date ` 2 t`C— 3 Inspector ---------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwizpozal 6pgtem Construction permit Permission is hereby granted to Construct( )Repair( )Upgrade(,K)Abandon( ) System located at 3 3 P/4 P_14 A,L/C, e! E/IL TER VI L L,6_ S S . K� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constru tion mus/be completed within three years of the date of this pe Date:_ CO 12 ` 621 Approved by S TOWN OF BARNSTABLE LOCATION ��%�� SEWAGE# 312�� 3 VILLAGE / ASSESSO 'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I �� LEACHING FACILITY: (type) S (size) 1 f - NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: (G Z J COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by 2/ ' G/ C z = evv ,6,, s I 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:3 —�� � 17 Fill in please: :•,,,,,,;,;,:} ;.:.g��,���i�b'F.�,,, APPLICANT'S YDUR NAME/S: do BUSINESS YOUR HOME ADDRESS: 3.3 e �.:c?s,�^u.�_,7:jr• ats"a ;!i:r�ef�g- '�zf�-��3�- Ce�r�e�-�,'/1� /'�t�z. �d2�.3� , a, ays' " 'r TELEPHONE # Home Telephone Number t'• r:J F;LIt�: ;f"iitLkT t'>(� � _ - - NAME OF CORPORATION: NAME OF-NEW BUSINESS 0v ,' TYPE OF BUSINESS C4•'e IS THIS A HOME OCCUPATION? YES NO O�� Q� ADDRESS OF BUSINESS. . ilv� w+ /y4.O263MAP/PARCEL NUMBER (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�02�O0 Main St. — (corner of Yarmouth ' Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your liu !s Hess in this town. 1. BUILDING COMMISSIONER' OFFICE UST COMPLY WITH HOME OCCUPATION This individual has bee f d of any mi e e ents that ertain to this type of busi RULES AND REGULATIONS. FAILURE T�) COMPLY MAY RESULT IN FINES. Authorized Signa ure** COMMENTS: � . 2. BOARD OF HEALTH This individual h s een infor e f t er it requirements that pertain to this type of business. MUST COMPLY WITH ALL HAZARDOUS MATERIAL'S-REPL111` CO!IS�•. Authorized Signature* 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: Date:3 /�� / 2-6 !� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: A-Q li--r BUSINESS LOCATION: ,4e4e e, Ceiln-i- INVENTORY MAILING ADDRESS: --f-c ►P TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: /y` 4e tl EMERGENCY CONTACT TELEPHONE N BER: _ � 775- 0/p2 MSDS ON SITE? TYPE OF BUSINESS: Ca.e AlAe-- INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers /v (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant' a Staff's Initials I off . Town of Barnstable A Board of Health P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,KS. FAX: 508-700-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. Mr. Peter Sullivan, P.E. March 25, 2003 Box 659 7 Parker Road Osterville, MA 02655 RE: 33 Park Avenue, Centerville A=208-024 Dear Mr. Sullivan, You are granted conditional approval to construct a soil absorption system designed to be connected to a home with a proposed addition proposed with a total of six bedrooms at..33 Park Avenue, Centerville. The approval is granted with the following conditions: 1) The designing engineer shall submit revised plans showing a 100%reserve area prior to obtaining a disposal works construction permit. 2) The septic system shall be constructed in accordance with the revised plans. 3) The designing engineer shall supervise the construction of the septic system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans. Since ly yours Wayne iller, M.D. Chairm BOARD OF HEALTH TOWN OF BARNSTABLE Q:HEALTH/WP/SullSixBedsMoynihan dG TFtE DATE: FEE tiAMSTA M y HAM �,�� ►��g REC. BY Town of Barnstable SCHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: _ 3 IAA R t< AV C G511/1'E21/1 L LE W,q S Assessor's Map and Parcel Number: 2 d5 - O 2!/ Size of Lot: 0, SI 5 A C Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: M I G k A[.C.� iM&Y lV/h 4 A-' Phone 9--- Z y 3 - "2.7 3'2 Did the owner of the property authorize you to represent him or her? Yes �_ No PROPERTY OWNER'S NAME CONTACT PERSON Name: '1/1 I C k 14 L-t. M c 11lV 114p I✓ Name: Address: `{ (, L.I4 rrV/UGc r41/E /-/yA/!'/L/SAddress: Phone: 5D Z q 3 — Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) ilr NATURE OF WORK: House Addition House Renovation ❑ Repair of Failed Septic System El Checklist(to be completed by ogee staff-person receiving variance request application) _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman V . NOT APPROVED Sumner Kaufman,M.S.P.H. 01j REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ . r� 1 — N t e � 1Q Z%z. .Lw-�mSz/z:� .,L N .. C - - ?' - - I�.� AwTKJv __.. - _....._-._.. ------- :...._.. Z._t I� 1 I CI ^� i�� �. � � Gt I.T 11 • f� �I_'?11E.. .o:z.� -"`!.�IJ 4��— � I� f i 1 r c „q J 1 1 " h- 1 JL - 1 .r f fr� lil - �f�' -nn4 P�Z7o?7 fnr) .j.9 n � _� �r�✓�'/ �`-��- fl�-=---=` �--__' -�-, .— �n= .._--tom=-- --...--- -- — -^_ - - _ _ill----�--•- f r I , aw 41 I r I I i wl l REA I ' -1 - +%r 9/`— — I i _ 1 + I A L + Ell I I i It' I I`TI I + EN a .I ! III I ! II .iI II � a . I. I 110, I ' ijil � II I ' � I �- i+ I' I. — oaa Eoa. o< 9s I I ,- j�ccss , � U A:CI 5:z,- 1YA :... ttI I I I I r _ — LI 7� 1 ......a.. t m - �.I IS YB -78 J!. I 2k31 V.6.w- it ! I n - i l/N iT if {� I OnOVI . II // by .. � ., � � � •_ Ley I, fk � Exr•` 33 ,,. �P.. Vni7 Ljr B� i { i f/0. Hoare 23 i COMMONWEALTH OF MASSACHUSETTS. ( EXECUTIVE OFFICE OF ENVIRONMENTAL, DEPARTMENT OF ENVIRONMENTAL PR TEC r *4R9 V Fo 7 SJ♦ "�0�� /oo� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:. A Owner's Name: Jw 0 0 Owner's Address: Date of Inspection: Name of Inspector: please print) l gar) - S40IO� Company Nam. d-;d Mailing Address: z®V g . �- Telephone Number:—'908-• c/DR--5� � 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 the inspection.The inspection was performed based,on my training and experience in the proper function and maintenance of on site sewage`disposai systems. I am a DEP approvedI.system inspector pursuant to Section 15.340.of Title 5(310 CMR 15.000). The system: /Passes Conditionally Passes rther Evaluation by the Local Approving Authority ,,,K;1?'ed Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report.to.the,Approving Authority(Board of Health or DEP)within 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 ubmit ahe report to the appropriate regional office of the DEP..The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at:.the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different. conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 $•C.,,NI i :f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM >f, PART A CERTIFICATION (continued) Property Address: ., Owner. ' Date of Ins pection: ' Inspection Summary: Check.A;B C;D or E 7 ALWAYS complete.all of Section D A. System Passes: ii I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal.and`over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltratiori oraank failure is imminent:System will pass inspection if the existing tank-is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken;settled or uneven distribution`box. System will pass inspection if(with approval of Board of Health)_: broken pipe(s)are replaced . r obstruction is removed distribution box is leveled or replaced . ND explain: The system required pumping more than'4 times a year 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 ND explain: 2 Page 3.of 11. OFFICIAL INSPECTION FORM;'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION:(continued) Property Address: P Owner: Date.of Inspection: -3.//a fO f C. Further Evaluation is Required by the Board.of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with.310 CMR 15.303(1),(b)that the system is not functioning.in a:manner which will protect public health,safety anal.the environment: _ Cesspool or privy is.within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety.and environment: _ The system has a septic tank and soil.absorption system(SAS),,and the:SAS is within 100 feet of a surface.water supply or tributary to a surface water supply: The system has a septic tank and SAS and the SAS is within atone, l of a public water supply. The system has a septic.tank and SAS.and.the SAS is.within 50 feet of a private water supply welL _ The system has aseptic tank and.SAS and the.SAS.is less.than 100 feet but 50 feet or more from a. private water supply well**..Method used to determine distance. **This system passes if the well water analysis,performed at a DEP certified.laboratory,for coliform bacteria and volatile organic compounds indicates that the well.is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form,. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-,NOT FOR.VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: � R P",�, Owner: Date of Inspection: s h-->/Of D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes Ncy _ ✓ Backup of sewage into facility or.system component due to overloaded or clogged SAS or cesspool _ 7 Discharge or ponding of effluent to the surface of the ground or surface waters due-to an overloaded or /clogged SAS or cesspool l/ Static liquid level in the distribution box above outlet inverrdue to an:overloade& clogged SAS or / cesspool -/Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number _ Iof times pumped V,Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of 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 Zone 1 of a:public well. Any portion of a cesspool or privy is within 50 feet of a.private water supply well. Any portion of a cesspool or privy is less than 100 feet but.greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system-passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence-of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria ^/ are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined thatone or more.of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system:owner should contact the Board of Health to determine what will be necessary to correctthe failure. E. Large Systems: To be considered a large system the:system mustserve a facilitywith'a%design flow of10 000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 If you have answered"yes"to any questibn in Section E the system is considered a significant threat,or answered "yes"'inSection D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. I .4. • Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT-FOR VOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Fi OwnerZLO Date of Inspection: /v / Check if the following have been done You must indicate"yes"or"no"as to each of the following:. Yes No Pumping.information was.provided by the owner,occupant,or Board of Health . Were.any of the system components pumped out in the previous two weeks? _ Has the system received normal flows.in the previous two week period? Have large.volumes of water been introduced to the system recently or as part of this inspection? 1..L — Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility.or dwelling inspected for signs of sewage.back up T Was the site inspected for signs of breakout? _ Were all system components,excluding the SAS, located on site V _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition o_f the baffles or tees,material of construction, dimensions,depth.of.liquid,depth.of sludge and depth of scum?: _ Was.the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal.systems? The size and location of the Soil Absorption System:(SAS)on the site has been determined based on: Yes no ✓ Existing information.For example,'a plan.at the Board of.Health. _ Determined in the field(if any of the failure criteria related'to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) 5 Page 6 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE."DISPOSAL SYSTEM INSPECTION:FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: 3 I FLOW CONDITIONS RESIDENTIAL ►� Number of bedrooms(design): 3 ;::.Number of bedrooms(actual)::.. DESIGN flow based on.310:CMR 15:203 (for example: 110 gpd x#of bedrooms):w-0 Number of current residents: _ Does residence have a garbage grinder(yes or no)'.��&- Is laundry on a separate sewage system(yes or no) f if yes separate inspection required] . Laundry system inspected(yes or no)/,&- Seasonal use:(yes or no):�� . Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no) Last date of occupancy' �'� �ffl _ COMMERCIAL/INDUSTRIAL A4 Type of establishment: Design flow(based on 310 CMR 15.203): _ gpd Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):V, If yes,volume pumped: gallons--How was quantity pumped determined? Reason'for pumping: TYPE OF SYSTEM tic tank, distribution box, soil absorption system Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes.,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy'of the DEP approval _Otlier`(describe): roximate age of all components,date installed(if known)and source of information': SC?2L42- _ S- - '7 Weresewage odors detected when arriving at the site(yes or no 6 Page 7 of 11 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C' SYSTEM.INFORMATION.(continued) Property Address: 33 12zd, j4 Owner:11.0 / Date of Inspection: —79 /1 O BUILDING SEWER(locate.on site plan): / Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):" SEPTIC TANK:vlocate on site plan). Depth below grade: Material of construction: concrete_metal_fiberglass Polyethylene _other(explain) If tank is metal list age:_. Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions.: ��•� X� X Sludge depth: Distance from top of sludge to bottom.of.outlet,tee.or baffle: 3 Scum thickness: Distance from top of scum to top of outlet tee or baffle: Z �� Distance,from bottom of scum to bottom of outlet tee or baffle:- _ How were dimensions determined: �ze,��Z. 0AZ1 In Comments(on pumping recommendations,fnlet and outlet tee or baffle condition,structural integrity, liquid levels s related tN ,evidence of leakage etc.): _ _ / � GREASE TR10 A� "l7ocate 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM_NOT FOR:YOLUNTARY ASSESSMENTS SUBSURFACE`SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C . SYSTEMINFORMATION.(confinued) Property Address: 3 & " 4i Owner: Date of Inspection: 3 f a C1 TIGHT or HOLDING TANKy)j(j—(tank must'be pumped 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 present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: -✓(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,.any evidence of kage into or out of box,etc : 242 PUMP CHAMBER//INlocate 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;): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY,ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM.INFORMATION(continued) Property Address: 0— Owner aL Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): a/(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ le hing chambers,number: reaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil;condition of vegetation, etc. CESSPOOLS: . cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth'—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of.groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVYt%(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.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM.—:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM , ,PART C SYSTEM INFORMATION(continued) Property Address: 22� Owner: Date of Inspection: •SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water enters the building. 17 10 i Page I 1 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: (&J� Owner• Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated.depth to ground water feet Please indicate(check)..all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: hecked with.local-excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 5 0 o Cyr 11 TOWN OF BARNSTABLE LOCATION EWAGE # VILLAG e� �l'Ui��� ASSESSOR'S MAP & LOT c; c�- L� INSTALLER'S NAME & PHONE SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �,, C (size) c /� NO. OF BEDROOMS PRIVATE WEL OCR WATE BUILDER O OWNERS / `� � DATE PERMIT ISSUED: QZS2 a/ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes Now 'AN 00 4 _ TOWN OF BARNSTABLE LOCATION L,04.4e S35AC \LL SEWAGE #,__�7-2.75 VILLAGE �,,[Vu'�1::t�V r E ASSESSOR'S MAP & LOT 6 6 - (51 3 INSTALLER'S NAME 6i PHONE NO.SEPTIC TANK TANK CAPACITY 2 — I .c)on LEACHING FACILITY:(type) 21 I (s . OF BEDROOMS PRIVATE WELL PUBLIC WATER BUILDER OWNER Cb DATE PERMIT ISSUED: gZ- DATE COMP E ISSUED: _ I la qZ, VA lA C. G RANTED: ,-es _._ L No 16 � o o � l + _ LOCATION : v-5EW0,CkE _PERMIT 1UO.v; IWST&LLER S W&ME ADDRESS BUILDERS Q / VAF— ADDRESS DINE PERNAVT ISSUED =— D ATE CONAPLI &NaCE ISSUED : .� ., .____ s i � ml �� c��- k~ �f �L ��t� �?-- No...76.-.-I,- ..q Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iration for Di-nVoottl Morko Tonotrnr#inn Famit Application is hereby made for a Permit to Construct ( ) or Repair (DL) an Individual Sewage Disposal System at: -o anon-A dress �'fCejp 41�i .�j��i s�N~7ZM ", MILLI ......................-..... ..-••---. ...--------•-••-----•--•-••--------•-•----•--.._..._...• ..................................................--••----- .----- -- Owner Address ........ .............................. T11�.-----7fa� r'�/3'/�L t -----, .. / r /- (..S Installer ddress d Type of Building Size Lot....X5,7_4A t----S feet U Dwelling—No. of Bedrooms----------------_?-----------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures/-- ---------------------------------------------------------------------------------- W Design Flow................. . .................gallons per person per day. Total daily flow--__.-----...__s.?�R ................gallons. WSeptic Tank—Liquid capacity./ d_gallons Length................ Width_______,___.___ Diameter...------------- Depth---------------- x Disposal Trench—No. ........2........ 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........................................ 1-4 Test Pit No. I----------------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........................ ._...--•--•-------------------•---••...-•-•-•-•----------------............_._...------------•--.........--------------- ------------ •---------. --.--.... 0 Description of Soil..................-...................................................................................----------------------------------------••......----..........._.. x w Z. . •--------------- ------------------------------------------------------------------------------- ........................................................----------- U Nature of Repairs Qr Alterations—Answer when applicable... -Sl y _�...../JZu > Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed . ........................................ .. . .................... -- . ........ . ......... . .............:...... Dace Application Approved By ............... `c3 ,� .......- - _........ c —6t5" Application Disapproved for the following rea.rons: ............................................................................................ . ...................................... ........... . . . . -- -- .............. . -- . . . ---- ............................... ........................................ �j •�, q Dace PermitNo. %l_`7....... 1... ./ ...................... Issued .................................................................... Dare TOWN OF BARNSTABLE LOCATION r' PGl ��?U� SEWAGE # VILLAG 1`��(Ji��f'_ ASSESSOR'S MAP LOT �� INSTA'LLER'S NAME PHONE NO.�10109 6"f7— ;-' SEPTIC..,TANK CAPACITY LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WEL OR PUBLIC WATE BUILDER O OWNERS 61,S � DATE PERMIT ISSUED: DATE' COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No�\ i j 00 y` Ile �r TT�. i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ TOWN OF BARNSTABLE CZer#tftrate of C oraphun e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ... . .................................. . . OE( cLfl-�---- - C nJ 5 U G ' at ................ .......... ------------------------------------- has been installed in accordance with the provisions of TITLE A of The/State Environmental Code as described in the application for Disposal Works Construction Permit No. ......... dated _...__..................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................. �........:..... Inspector -:'�� .`.�_... t1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Gay Y TOWN OF BARNSTABLE No..........�../ EK.."ZO ........... Ditiposal Workv Tomatrurtinn ramit Permission is hereby granted.........................�a _�_-r(--_.!L__.......�'. � TVIJ� ..................... to Construct ( ) or Repair (5<) an Individual Sewage Dis osal System atNo------------------------------------------- ....................................... .... --- ....:..c ...t.. .L£---------..........-----........ Stret as shown on the application for Disposal Works Construction Permit Dated___---- .--. -------------------------------r.�/,:.: _......................................................... V Board of Health DATE............... .-. _ ....I---------------------------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No. _ y Fes$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ap.phration for Uivjipuittl Wurks Tonstriir#iun Fermi# Application is hereby made for a Permit to Construct ( ) or Repair (V-,,) an Individual Sewage Disposal System at: On G t� �JP GfL Loation• lddve N / i"//� us�, % /,j ;;k /M I t.Lf -------------•-•-••-. ................................................. --•----•-•---•••--•-------------------•-------•-.........-------••---.. .........------------ SI ' Gig-c Address 74m � Installer Address U Type of Building Size Lot.... feet ., Dwelling— No. of.Bedrooms..............--2-----------------------Expansion Attic ( ) Garbage Grinder ( ) ri, Other—Type of Building ............................ No. of persons------------------------.... Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... .. --------•----------------------- W Design Flow..................:a....._........__..gallons per person per day. Total daily flow............... ................gallons. W Septic Tank—Liquid capacity./..�'�.4d.gallons Length---------------- Width.........._... Diameter-...------------ Depth................ x Disposal Trench—No. --------Z......... Width-------P......... Total Length-----11.......r. Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter_----------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. l----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..--:_--------.-..-._... W ............................. ..•-•••-------•-------•------•••--•--------------•----•---------._.............------------......-------•-••••----....---------- 0 Description of Soil........................................................................................................................................................................ W W x •----•---------------------------- --------------------------------•---•---•---.......-•-•---------------------------•------•-•-------------------••------•-------------...---•---••-••-----•------.... U Nature of Repairs/oar Alterations—Answer when applicable.---l!v S%fit----- ....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed -------------------------------------------------------------------------------------------------------- .................................=----- Date Application Approved BY �^' - .......................................................................... ------ ApplicationDisapproved for the following reasons- ------------------ ----------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- ........................................ .� Date PermitNo. ....... .--. ---- �------.�......... ........ Issued ------------------------------------------------------- Date 9! El-r `5 flkSPNtPd ILI EU-41 _ I I gFF t /fir.. S f1 r i i n � U1V rT '� 4-1 rE f rrrt- � � J �hY I� ---- -- ��Es Jjr .3,3 r Ir L I X , n ,� ; �t inn 77 07 o ac3 z9Y� r , � I r it ---------t- .-• :"-----; i w� . � j I . r� 1 I� 'y 3 1: ; , i : 44 . 6 Yi T;Prra v °r L4f� feS �,LD; I + 6'X ylVie• '; ^ _ ` — . 9�� '�`�1j til��• ill; . . �_<� �—= ;;� ysl°;,�, � �y � - %O— �' 0�,. � If� 6mp�Tr 1' v �.1a6 I t 1h, ta L J- 16. cr C C vs ` VV--- ( -77 LL— ' <; lomN nINN I i i 1•' ' Cl / t� AlluS P4� Ir RftSPAfPA .i I _ t U/V rT - _ Ll C rat E - - Hare 33 r Ie #t �. f r r.. , - - _ ... --. Xis� b -17 17 x 1 tt i 4J" I ' �fly - - -- 1 r , E i I U r -, . r I , i. 1 � 77 rz � 7y�� fit, /l Hsu � 1 , I . j i � e. € _ W - .0 y I 6�dc �6 R"JsP Y Fx 1 S :. j i i I I R , + J i 36 j i I 3 f dh^ v j Cam` oy f' �' ¢ -- l i -r I ., P --fit P 10,436 LOCH TION MAP: Pero Test!Test Hole Date:Feb25,2002 SElnc. P.Sullivan J.O'Dea Scale: 1" = 2,0001 f Board of Health D.Miorandi Test Ho 1 LEGEND. f ,• le ev / p �� ���• ' CIT O Sandy Loam with Roots 10YR22 •;,•• / A•�• D • p •• •b 5"-16' A Dark Grayish Brown Coarse SAND 10YR42 so �+ '• d• © �",-ie 16-28" B Drk Yellw/Brwn Fines w/Coarse 10YR416 Deciduous Tree sh 0•• ��•: •,••2 ��� ,, e. -, 28"A20" C Yell Bm Coarse SAND 10YR518 •� BM 60 ,"•� - No Water Encountered ® Catch Basin _ �.• o„ � Perc Test Hole eechwood ° h Pero Test Q 38" 25 Gallons in 11 minutes exactly 0 Sewer M a n h o I e t 04" O Sandy Loam with Roots 10YR2rz Wetland Flog ;;• •,. .� 4"-16" A Dark Grayish Brown Coarse SAND 1oYR42 O Water Manhole - 7 T - ,; •, •• ° '•, 16"-26" B Drk Yeltw/Brwn Fines w/Coarse 10YR as © Gas Gate (round) -a k j: n em •: , 26'-60" C Yell Bm Coarse SAND 10YR5/8 .••• 1„ w. - ,O- Utility Pole a �' o e 5t,.•� -0Hw- Over Head Wires s '• o Concrete Bound - • i': a� , i USGS High Ground Water Calculation Qo M o g.N a I I _ - n o� •��. Cape Cod Commission Technical Bulletin 92-001 A7 0 "• D Index Well MIW-29 Zone C Date Feb.25,2003 \ Bay Monthly Reading Index Well(Feb.2003) 7.4 Elevation \ Water Level Adjustment 2.3 Q Observed Water(Ponded water within wetland) 19.1 Elevation0. D/ ! Corrected Ground Water, 21.4 Elevation O \� Y A5 l FLOOD ZONE: ZONE: I Il 1 Zone B RD-1 I / / Community Panel No. Area (min.) 43,560 SF #250001 00160 Jul 2 1992 Frontage (min) 20' I jl j i s� y , Width (min) 125' `oa,. Setbacks:Fron t 30' ASSESSORS REFee side 10' Ede of BVw Map 208, Parcel 24 Rear 10' 1 Flagged by ENSR l / A4 Water El. 19.1 At 2/28/03 21 22 23 4)v /had / ,\Q�, i\ /ao ;,, j �o' oar—� NOTE: J / / o 1•) The property line information shown was //� / ^� /P / a�s compiled from available record information, oi 2.) The topographic information was obtained a, / % / �� , `rca from an on the ground survey performed on co 0 / 3.) The datum used is NGVD '29, a fixed mean �o sea level datum. .FAO / \ r' a c r r Area Within 100 Ft.Zone 1694 sf i 0A_ _J /I l >°E Re Grade & Plant with Fescue 1524 sf fie Re Grade & Pave 170 sf �,, P rS <°�\ v' 4- \ o o` F L 00 o S�� Fi I QQ IL NOTES R� \ 33 Cr!. I. Water Supply For This Lot is Municipal Water. DESIGN DATA T tt ` 34 �, I ape,. / / 2.Location of Utilities Shown on This Plan Are Approx. Existing Dwelling:3 Bedrooms �A\ \ — 3 �/ 0 / 1 I( l < o \ h�, 1' / b / O At Least 72 Hours Prior to Any Excavation For This Proposed Addition: 3 Bedrooms 1` 3 / S p / 0 Project The Contractor Shall Make The Required No Garbage Grinder c r� I �G� /5 Notification to DIG SAFE-1-888-344-7233. Daily Flow; 110 x 6=660 gpd rr_ 3.The Contractor is Required to Secure Appropriate Septic Tank: 660 d x 200%=132b d 6 _ t1 m ---- _--- / 0 - Defined From Town Agencies For Construction Use a 1500 Galion LEACHING AREA Septic Tank. j/ 0� �J� `� �o ! \ 0 / /, •\0� e Defined byThis Plan. 6 / / / / 4.Install Risers as Required to Within 12 of Finished 660 gpd/0.74=892 s.f.Required �• O ) Grade Sidewall:2(12'+53')2= 260s.f. r, 5.AI I Structures Buried Four Feet(4�)or More or Bottom Area:12'x 53 = 636 s.f. ' O_ � 4o I / e�f/ / \ �o �� °�� 0� 0� Subject to Vehicular to be H-20 Loading. 896 s.f.Total Previded. of / / 1 / / � ��e _ — �F • / �\ OQ 6.Septic System to be Installed in Accordance With LEACHING CHAMBER DESIGN <'S�L 3 / O:r., ly S�. 310 CMR 15.00 Latest Revision And The Town of All Pipes to be Schedule 40 PVC.Use 6 0, • Barnstable Board of Health Regulations. -500 Gallon Leaching Chambers in o 7. All Piping to be Sch,40 PVC. 12'x 53 Washed Stone Field as Shown. 116 / V F G.41.5 Vent 4 J 0 V� 39.0 4, �o \ /4t, 0 1500 Gallon , Top El.35.0 38.8 E Q All Components Bedding as Septic Tank - 35 Bot.E1.32.0 1*L \ \ Q Jp� 5.25 35.0 \ 5.51 �i � �e ° a e onents tobe g d P Bot.Test Hole El.26.5 0H-20Loading. PerTitle5 Adj.GroundwaterEl. 21.4 3 °�� `�� Scale: III 20' DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM / Not to Scale � R=46.5, Grade v ' f Filler --Cam acted `m-n Fabric G aL 0, d - Pea Stone t �4.y _n �y aQ Chamber 3/4"—II/2"DoubleR, 1�tl ,l6il a VIA Washed m. U110. 4"` CROSS SECTION OF CHAMBER ��eeggpq° NOT TO SCALE V / Title: PREPARED FOR: PREPAR Y, in Su n ineer Cap eSUf VPROPOSED ADDITION & g g1 Inc. SEPTIC SYSTEM UPGRADE Michael J. Moynihan o Box 659 Po Box 718 `�- sterville, MA 02655 Hyannis MA 02601-0718 33 PARK AVENUE 4E LaFrarC@ Ave.j CENTERVILLE , MASS. Hyannis h�✓1A o260� (so8)42s-3344 (508)428-3115 fax (508)790-7902 (508)790-7905 fax yPSullPE@ool.com copesurv@ccpecod.net O 20 0 10 20 40 60 Comp./Draft: M.J.D. Field: w.H.K /M.D.H. Date: Scale: 6111111 Review P.S. Comp./Draft: w.H.K February 18, 2003 As Shown __- - Proj. # 23004 Drawing # C-216.3 LOCATION MAP: Scale: 1" = 2,000' f f.O,FRAME i GRATE C.B. FRAMG b G13 Arl _ RIM r-t_•3`4.5' RIM 11L. al.0 1 GINIS FJED GRAOb Tom-- �• � �A.• '•.� •• IF REQUIRED O ,'��•• / c;l/� �� • ♦� i�`: ' P 10,436 D 2'1 g FI LTGR FAORIC p • • • �•••� r Z-1/Z,L64J oLa5 1' __ ,I • �• 7 O�' • c1. (7'© �° � ••O• Perc Test/Test Hole Date:Feb25,2002 0 �tvv.31.9 -. - -- �� ,••: .. o. �, x SElnc. P.Sutlivan J.O'Dea P h 2 BM 60 �"�;d ` • , 1 \, Board of Health D.Miorandi 0� IF Test Hole i ¢iasTo,+E �•• p,• ,,` D D - A 11.1V•2S- 7 • eechwood f Q'rtio 01 O Sandy Loam with Roots 10YR212 n - 5'-16" A Dark Grayish Brown Coarse SAND 10YR42 PI E4aOPE /vim- 1'/-z:'DouL9l_.•wAstteq 1E-26" B Drk Yellw/Bnvn Fines w/Coarse 10YR 4/6 J45-1 D . S��H.=_ \ AFL kxtn „D28'-120' C Yell Bm Coarse SAND 10YR518 - • - o `• No Water Encountered A , D ► +•.1_• LPLu 1Nc.-IDOq GE Perc Test Hale - PIT _ « n rry I a• D C ATGFI t3AS1N � • �• �- � `/ Perc Test Q 36" 25 Gallons in 11 minutes exactly T R A P / f O � de • O 6 y 04 O Sandy Loam with Roots 10YR212 �,� • ♦• a= 4-1E A Dark Grayish Brown Coarse SAND 10YR42 16-26' B Drk Yelhv/Brwn Fines w/Coarse ICYR 4165 C.H'S FRAMEb GRATE To 6E ;Z // DRAINAGE PROFILE LE$ARON MODEL. LF2•i6-2 Q ,u 2��(T C Yell Bm Coarse SAND 10YRS8 '`-- ,�, _ OQ APPROVsO EC4UAL. _ - Not to Scale A7 b I J�1 H`, _ y Y, Note: The catch basin and leach pit will Smdder USGS High Ground Water Calculation Cape cod Commission Technical Bulletin 92-00, \ be covered with filter fabric during the v Index Well MIW-29 \ e Zone c \ construction process and/or until all areas Date Feb.25,2003 \ I\ have been re vegatated. -- Monthly Reading Index Well(Feb.2003) 7.4 Elevation Water Level Adjustment 2.3 \\ Observed Water(Ponded water within wetland) 19.1 Elevation \ 4� Corrected Ground Water 21.4 Elevation \ A5 FLOOD ZONE: ZONE: cQ I 1l Zone B RD-1 I I i Community Panel No. Area (min.) 43,560 SF #250001 0016D Frontage (min) 20' I I sc-5 July 2, 1992 Width (min) 125' / C6, Setbacks: gib' l s ASSESSORS REF. : sidet10' Edge of BVw I / / \./ R9, Map 208, Parcel 24 Rear 10' 1 Flagged by ENSR I / A4 1110103 Water El. 19.1 At 2128103 ` \ A3 / / / \/ - - - 2t _� � / / / \ / \ A2 22 LEGEND: " 23 Deciduous Tree ® Catch Basin °�' `' 'oo / // o;C � NOTE: (3) Sewer Manhole / 1.) The property line information shown was I> Wetland Flog / rah / / / / / / / a compiled from available record information. p Water Manhole / / ' ^s / / / / o Qv�"' 2.) The topographic information was obtained © Gas Gate (round) / / o tx / ,r �•A / / a,6 pQP from an on the ground survey performed on Utility Pole / / I\� / �" / /- h v 1OIJAN103 -0Hw- Over Head Wires �6 �� / // / a��`/ \� 36 j LrQ Aug"�Fi/ ,c �- h p 41 If Concrete Bound / `� Q // / / / / 1 `9��, /1/Qr,P ,r:�� 3.) The datum used is NGVD '29, a fixed mean O Mag.Noil / �\ r /��a� sea level datum. 43 ? z, i '7 � •i , ;0 � vo's .00 Area Within 100 Ft.Zone 1694 sf i °m I J / o� o / /2 Re-Grade & Plant with Fescue 1524 sf I I � I / �oPQ< E Ce � \l ceRe Re-Grade & Pave 170 sf \ �/ 1 , I QP rS ti o\\ / 0�1 \ OD`�0 45- r 'A \ +�� LA s\oo."I S ��. �10� l v4P� \` ► I rd��� n\`oL 5l\(Q�� O �. O-��,• 1�" 1 '� j I�'r x I �' �o � ooR� +o00 ��0o �`sI '5 2 u m I a Z ti NOTES �,yS��b \ 33 oQ¢ / a/® U F I. Water Supply For This Lot is Municipal Water. DESIGN DATA C9�rlL r 34 2.Location of Utilities Shown on This Plan Are A roe. ExistingDwelling:3 Bedrooms < � ` h At Least 72 Hours Prior to Any Excavation For Proposed Addition: 3 Bedrooms Project The Contractor Shall Make The Required No Garbage Grinder O Slz 61 Notification to DIG SAFE-1-888-344-7233. Daily Flow: I10x 6=6 6 0 gpd `F, �� �' J 3.The Contractor is Required to Secure Appropriate Septic Tank: 660 gpd x 200%=1320gpd Permits From Town Agencies For Construction Use a 1500 Gallon Septic Tank. C L / C� / GIL v JO Defined by This Plan. LEACHING AREA 2 �'(4� )vim m10 4.Install Risers as Required to Within 12"of Finished 660 gpd/0.74=892 s f.Required Grade. Sidewall;2(12'153 )2= 260s.f. 5.All Structures Buried Four Feet(4�)or More or Bottom Area 12 x 53 = 636 s.f. l j ��� l Subject to Vehicular lobe H-20 Loading. 896 sf.Total Provided. 00.+ 40 gG �o` �( o�� pO, / 0�\ 0 6.Septic System to be Installed in Accordance With LEACHING CHAMBER DESIGN o� 2 i3 / tiQTS / SOP i 310 CMR 15.00 Latest Revision And The Town of All Pipes to be S ch 40 PVC.Use 6 �G edule 0- .e /� Barnstable Board of Health Regulations. -500 Gallon Leaching Chambers in 2 �, NO 0 I h, / 7 All Piping to be Sch.40 PVC. 12'x 53 Washed Stone Field as Shown. 0\\ QP,LO ' ry ,F��•� 'ORp4\ R \ 1 QOJed Q PLb y/ V F.G.41.5 Vent100 �� � F.G.38.0 ��4 �l, i �/ a 4/J �C' n ril n 39.0 4. r�� 1500 Gallon r Top El.35.0 �AV RiL �e t- 36.8 Septic Tank 38.55 �` * 0� �C QO \\G1 T Bot.El.32.0 p��- Z \ 0� Q�0 w.;. :- <:,_:• 35.25 35.0 \ 5.5' \ I ��e de 'rAll Components tobe Bedding as Bot.Test Hole El.26.5 0 PLAN VIEW F H-20 Loading. Per Title 5 Adj.Groundwoter El. 21.4 0�� II ' Scale: I = 20 DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale / R=46.5' ride Directions to Site: From Barnstable Town Hall G ad• take Route 28 towards Centerville; Take a left onto r111.r Phinney's Lane; At the stop sign go straight across CompadadIq Pn1 _ onto Park Ave. and house is on the right#33. Irw"BA I/ems-Ile A ''s.�•.°i`. P'.St.r. PMR SULLIVAN _ Ls hlnQ _ chamber _ 3/4 1 1/2"Dwbl• p N .2733 p1 R. W.,h•d (� 4=10 CIVIL CROSS SECTION OF CHAMBER NOT TO SCALE / a/31 /03 AOOE� '3/Z7/03 S,RR COM\�nL_NTS O�/2l 03 A.00EO SL=PTICSySTEP� RESE.RVL R�vISIoN 03�12�03 Apbl_o PARK\NG SPAGGS Title: PREPARED FOR:: PREPARED BY: CIO Engineering, Inc. CapeSury Sullivan PROPOSED ADDITION & Michael J. IV�'oynihan Po Box 659 Po Box 718 SEPTIC SYSTEM UPGRADE 46 LaFrancE Ave. Osterville, MA 02655 Hyannis MA 02601-0718 33 PARK AVENUE (508)428-3344 (508)428-3115 fax (508)790-7902 (508)790-7905 fax CENTERVILLE , MASS. Hyannis MA 02601 PSWIPEOool.com copesurvOcopecod.ne t 0 20 0 10 20 40 60 Comp./Draft: M.J.D. Field: WH.K /M.D.H. Date: Scale: Review: P.S. Comp./Draft: W.H.K February 18, 2003 As Shown ' I Prof # 23004 Drawing # C-216.3