HomeMy WebLinkAbout0091 PATRIOT WAY - Health 91 Patriot Way "
Centerville
A= 199--222
No.24SUR
UPC 12534
smsad.com • Made In USA
'fir
OWN OF BARNSTABLE
LOCATION way SEWAGE#. ��dJ
VILLAGE ASSESSOR'S MAP&
/PARCEL J
INSTALLER'S NAME&PHONE
gNO.
SEPTIC TANK CAPACITY (/
LEACHING FACILITY:(type) (size) G l
NO. OF BEDR9PM
,S
OWNER / G
PERMIT DATE: COMPLIANCE DATE: {� U
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
r
Je
y/ Back
31/'s„
. o
3=3S`S'' 3
V ' ti SI o�I 0
96
s \
o-
t
nn 2 T
No. Fee `� �
THE COMMONWEALTH OF MASSACHUSETTS Entered inmp couter: '
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplication for Migoal Q�pgtem Cow5tructiou Permit
Application for a Permit to Construct( ) Repair(/Upgrade(" ) Abandon( ) ❑Complete Systemo Individual Components
/��n Address �t No.9> ��i � t/ Own N��Address,and Tel.No.
Assessor's Map/Parcel ! C'en eIrvI/le �6
Instal er's Name,9ddres , d 1.No. v ,v !!// l/ Designer's Name,Address and Tel.No.
OOWIIeWe
Type of Building: �j d
Dwelling No.of Bedrooms v Lot Size Z� sq. ft. Garbage Grinder ( �
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.re uired) gpd Design flow provided gpd
Plan Date 7Y Number of sheets Revision Date
Title
Size of Septic Tank C
P ��/S� ld� Type of S.A.S.
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 Boa f He
Signed CC Date
Application Approved by �..� '.J Date
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued —d
gocPl
f , No. .. Fee
l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ' Yes
ZIPPricatiou for bi!40gal 6p.5tem Con5truction Permit
t
Application for a Permit to Construct( ) ;Repair V Upgrade(' ) Abandon( ) ❑Complete System ®/Individual Components
Location Address or Lot No.t�f �Q �� / o, tOwne 's Name Address,and Tel.No.
I9Z - z z Z I v'� Y . ,
Assessor's Map/Parcel Gen Irlt//1 e
Installer's Name,Addres ,and el.No. Designer's Name,Address and Tel.No.
�jp!'7�D�Dl% i L�oes�" 7?/-9,�9� t�0Weca,,��' 36Z -Cfsy/
Type of Building:
Dwelling No.of Bedrooms Lot Size Q sq. ft. Garbage Grinder (4/d
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 2
Design Flow(min.re uired) /, 30 gpd Design flow provided gpd
Plan Date 1 y
j7 y Number of sheets . Revision Date
Title Z) l� 1�; 9 Q'�ll] Ga, 1l
Size of Septic Tank ,'/5 X Type of S.A.S.
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 Board of Health.
Signed Date /713/(G%�
Application Approved by 5 Date ^d1
Application Disapproved by: Date
for the following reasons
——— , ——Permit No. — ———— Date Issued _dq
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( Yr Upgraded ( )
Abandoned )byl�/ � j
at CO �` Gfji), _Iefo has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. oo9— 02 3)( dated, '� ��.
Installer Designer
#bedrooms Approved des' flo�3 3 0 gpd
The issuance of this p rmit shall not be construed as a guarantee that the system 11 functi n as designed. f (
Date �} ll Inspector
i
No �
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
3DigP0gar *p!9tem Con5truction Permit
Permission is hereby granted to Construct ( ) Repair ( V) Upgrade ( ) Abandon ( )
System located at �/ Q'y l�l�� �` (,% V
le
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.
Provided: Construction must be completed within three years of the date of this permit. 2
Date D Approved by � r/ S ..
FROM :down cape engineering inc FAX NO. :15083629880 Aug. 11 2009 09:37AM P2
Town of Barnstable
' Regulatory Services
Thomas F.Geiler,.Di rector
:Public Health Division
'Thomas McKean,Director
200 Main Street,Hysnninig,MA 02601
Office: 508-962-4644 Fax: 108-790-i301
Installer& Desianer Certification Form
/Date: /o D q Scwa_e Permit# a�o�" Assessor's Map1T'arcel
)10
Designer: W►�..-_ a r /i Installer: 40.r'�---® G/) /J7e
939
)Od fox �D�
Address: ��ul��� U G ' Address:
On �'7 ®� O / C.-Ub/-was issued a permit to install a
(date) (installer)
septic system at .91 �_ based on a design drawn by
(address)
dated. ? °� ID .....
(d gner)
1 certify that the septic system referenced above was installed substantiull.y according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank..
I certify that the septic system. referenced above watt installed Frith rn for changes (i.e.
greater than 10' lateral rcloeation of the SAS or any vertical relocation o.f any component
of th.e septic system)but in accordance with.State d"c Local Regulations. Plan revision or
certified as-built by designer to follow.
OF M48,'9C
0 NIFI-A.
OJA1 A ``
Vtr' ignature) civil.,
No.46502 �
c�
Pc,lsTFa
fro/t1 `SSroNq�-
(De i-nces Sig nattzre)� (Aflix Designer's Stamp Here)
PLEASE RET(JRN TO BA INSTABLE PUBLIC HEALTH i)TViS10N— CERTIFICATE OF
C:OMPLIANCr, WiLL NOT BE IS.S1JFD UNTIL BOTH THIS NORM AND AS-RTJJLT CARD ARC
RECEIVED BY THE BARNSTABLE Pl1BLW HEALTH DIVISION. THANK YOU
Q:HeattUSupti.c/r)gsigner Certification rorrn 3-26-04.doe
TRAITS. NO.:
CITY/TOWN:
APPLICANT:
ADDRESS:
DESIGN )FLOW: 230 gpd
REVIEWED BY: DATE:
N/A OK NO
7.,2 !, ,::'.a.iR.aa:nk'.I.,�i aK>a:sla�9�'{.f`r.4i'. 1�:'.�f1f'•:i'.L °d? Fdd PIX►b:'�M1174.'�.�: ?..fii`.I....�',R t.lv :.rre �-ri i.:
Legal boundaries denoted [310 CMR 15.220(4)(a)]
Street, Lot, tax parcel number and lot number noted on plan [310
CMR 15.220(4)(u)]
Locus Provided [310 CMR 15.2204(t)]
Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for
components) [310 CMR 15.220(4)]
Easements shown [310 CMR 15.220(4)(b)]
System located totally on lot served [310 CMR 15.405(1)(a) for
upgrades]- if not, a variance is required [310 CMR 15.412(4)]
Location of impervious surfaces (driveways, parking areas etc.)
[310 CMR 15220(4)(d)]
Location all buildings existing and proposed 310 CMR
15.220(4)(c)]
Location and dimensions of system components and reserve areas.
[310 CMR 15.220(4)(e)]
System Calculations [310 CMR 15.220(4)(f)]
daily flow
septic tank capacity(required and provided)
soil absorption system (required and provided)
whether system designed for garbage grinder
North arrow [310 CMR 15.220(4)(g)]
Existing and proposed contours [310 CMR 15.220(4)(g)]
Location and log of deep observation holes (existing grade el. on
each test) [310 CMR 1.5.220(4)(h)]
Names of soil evaluator and BOH representative [310 CNM
15.220(4)(h) and (i)]
Location and date of percolation tests (performed at proper
elevation?) [310 CMR 15.220(4)(1)]
Percolation test results match loading rate? [310 CMR 15.242]
Certification statement by Soil Evaluator [310 CMR 15.220(4)0)]
Observed and Adjusted groundwater (method for adjustment
given or indicated) [310 CMR 15.103(3) and 310 CMR
15.220(4)(n)]
Address Sheet 1 of 7
I
N/A OI NO
Location of every water supply, public and private, [310 CMR
15.220(4)(k)]
within 400 feet of the proposed system location in the case
of surface water supplies and gravel packed public water supply
within 250 feet of the proposed system location in the case
within 150 feet of the proposed system location iu the case /
of private water supply wells
Location of all surface waters and wetlands located up to 100 ft.
beyond setbacks listed in 310 CMR 15.211 and any catch basins
located within 50 ft. [310 CMR 15.220(4)(1)]
Water lines and other subsurface utilities located [310 CMR
15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1])
Profile of system showing invert elevations of all system
components and the bottom of the SAS [310 CMR15.220(4)(o)]
Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)]
Stamp of Registered Land Surveyor (required if construction
activities within 5 ft. of lot line) [310 CMR 15.220(3)]
Test Holes adequate (two in each of the primary and reserve
unless trenches as permitted in 310 CMR 15.102(2) or as V
approved for an upgrade under LUA at 310 CMR 15.405(1)(k)]
Test hole adequate to demonstrate four feet of suitable material?
[310 CMR 15.103(4)]
Test Holes adequate to confirm adequate groundwater separation?
1310 CMR 15.103(3)]
Benchmark within 50-75' of system [310 CMR 15.220(4)(q)]
Materials specifications noted? [various sections of 310 CMR VF
15.000]
System components not> 36" deep (unless Local Upgrade
Approval or LUA requested) [310 CMR 15.405(1(b)]
Address Sheet 2 of 7
N/A OK NO
:S.
x.., x.. 9•.�' e,.d. 7S• .�$ ,„ '4frIM° lt +1 ', '` t Cr ��.}`
Size OK? [310 CMR 15.223(1)]
Inlet tee located ten inches below flow line [310 CMR 15.227(6)]
Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR
15.227(6)]
Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)]
Note regarding installation on stable compacted base [310 CMR
15.228(1)]
Separation between uzlet and outlet tees (no less than liquid /
depth) [310 CNIR 15.227(2)] V
Inlet/Outlet elevations at least 12" above high groundwater /
(except as described 310 CMR 15.227(5)) or permitted for
upgrades under LUA [310 CMR 15.405(1)(k)]
Minimum cover 9" (Tanks buried more than 9" must have risers
on all openings and on the d-box) [310 CMR 15.2228(1) and 310
CMR 15.232(3)(f)]
Three access covers (inlet and outlet must be 20" or greater) -
middle access at least 8" (by 7/07) [310 CMR 15.228(2)]
Access to within 6 " of grade - one port for systems<1000gpd,
two for systems>1000 gpd [310 CMR 15.228(2)]
All at-grade covers secured to unauthorized access? [310 CMR
15.228(2)]
> 10 ft fiom building foundation [310 CMR 15.211(1)]
Buoyancy calculation Required/Done [310 CMR 15.221(8)]
H-20 Where appropriate? [310 CMR 15.226(3)]
Setbacks from resources [310 CMR 15.211]
'i
Required when other than single-family dwelling or flow>1000
gpd [310 CMR 15.223(1)(b)]
First compartment 200% daily flow; Second compartment 100%
daily flow [310 CMR 15.224(2) and(3)]
"U" pipe through or over baffle, outlet of each compartment with
gas baffle or approved filter [310 CNR 15.224(4)]
Address Sheet 3 of 7
N/A OK NO
Located at least ten feet from any water line? [310 CMR
15.222(2)]
Disposal piping at least 18" below water line (when water and
sewer cross, see 310 CMR 15.211(1)[1])
Cleanouts required/provided? [310 CMR ffl5.22�2(8)1Thrust blocks specified in force mains? 31221(6)(c)]
Slope of sewer line not less than 0.01 (1/8"/fi) 0.02 preferable
[310 CNM 15.222(6)]
Proper pitch on all runs? (.005 within gravity-distributed trenches
and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)]
Siphon problem/ (leachfield below pump chamber)
Endcaps or vent manifold specified?
Size and orientation of discharge holes specified? (not smaller
than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310
CMR 15.252(2)(h)]
Materials specified (310 CMR 15.251(5) specifies various pipe
types allowed)
A IN
]AT 31-11
Stable compacted base [310 CMR 15.221(2) and 310 CMR
15.232(2)(a)]
Splash plate or baffle tee required on inlet/provided? (when
pressure sewer to d-box or steep pitch of gravity sewer) [310
CMR 15.323(3)(a)]
Riser if deeper than 9" [310 CMR 15.232(3)(f)]
Inside minimum dimension 12" [310 CMR 15.232(2)(b)]
Minimum sump 6" [310 CMR15.232(3)(e)]
Watertight cover if<2000gpd); waterproof manhole if>2000gpd
[310 CMR 15.232(3)(d)]
.�r krJC^l':'jL' JRt9Y�i T MI +l MIX"ts•
y M.
Capacity(emergency storage above working--design flow)? [310
CMR 231(2)]
Proper setbacks [310 CMR.15.211 (same as septic tanks)]
Watertight 20-in minium access manhole at least 20" MUST BE
TO GRADE [310 CMR 15.231(5)]
Service components accessible (not too deep with piping,
discomzects accessible)
Alarm floats - alarm on circuit separate from pumps specified?
Exceeds two units must have two pumps operating ill lead-lag
mode. [310 CMR 15.231(6) and (8)]
Stable Compacted Base [310 CMR 15.221(2)]
Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)]
Address Sheet 4 of 7
N/A OKI NO
Calculations correct?
4 feet of naturally occurring material demonstrated? [310 CMR
15.240(1)]
Required separation to groundwater? [310 CMR 15.212)]
Aggregate specified as double washed [310 CMR 15.247(2)]
System Venting required/provided? (system under driveway or
>36" deep) [310 CMR 15.241] .
Inspection ports specified and within 3"final grade? [310 CMR
15.240(13)]
Breakout requirements met? (No violation of breakout elevation
within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and
Guidance Document]
VIES'tPI�S'� 53
Chambers and Gal. in trench configuration supplied with inlet
every 20 ft. [310 CMR 15.253(6)]
Each structure with one inspection manhole(if>2000 gpd must
be to grade) [310 CMR 15.253(2)]
Aggregate I'minimum- 4'maximum. [310 CMR 15.253(1)(b)]
2' sidewall credit maximum [310 CMR 15.253(1)(a)]
In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)]
Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)]
100 feet-maximum length [310 CMR 15.251(1)(a)]
Minimum separation 2x effective depth or width whichever
greater (3x if reserve between trenches) [310 CMR 251(1)(d)]
Situated along contours [310 CMR 15.251(2)]
Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document]
minimum 2 distribution lines [310 CMR 15.252(2)(a)]
Maximum separation between lines 6' [310 CM RI5.252(2)(d)]
Maximum separation between lines and outside of bed 4' [310
CMR 15.252(2)(e)]
Aggregate depth below discharge pipes 6" minimum, 12"
maximum. [310 CMR 15.252(2)(g)]
Separation between beds 10'minimum. [310 CMR 15.252(2)(f)]
Bottom area used in calculations only [310 CMR 15.252(2)(1)]
Address Sheet 5 of 7
T1� N/A OK 1a O
BIA-4 1311f1LL
Pressure Dosed SystePn ? Provided pump and piping
15.220 4 r
calculations as required 310 CMR ]
calcul i q [ O( )
Pressure dosing required on all systems>2000gpd or alternative
systems under remedial approval [310 CNM 15.254(2) and I/A
Remedial Use Approvals]
If used in gravelless system -make sure jet is directed as not to
scour soil interface [Guidance Document]
Inspections once per year(systems<2000 gpd) or quarterly
(>2000gpd) good to note on plan [310 CMR 15.254(2)(d)]
Construction in fall -Did the plan specify that the fill shall meet �
the specification of 310 CMR 15.255(3)?
Impervious barrier and/or retaining wall ? [Guidance Document]
Impervious barrier installation must be supervised by
designer [310 CMR 15.255(2)(b)]
Retaining wall must be designed by Registered Professional
Engineer [310 Ma 15.255(2)(a)]
Side slope not exceed 3:1 ? [310 CMR 15.255(2)]
Breakout requirements met? [310 CMR 15.252(2) and
Guidance Document]
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
recommended) (310 CMR 15.255 (2)(e)]
Check DEP Approval letters for credits and design conditions
If used with pressure dosing do not allow pressure discharge
to scour soil interface
�e�lIOU
Was DEP Approval Letter provided and/or have you
reviewed the letter for conditions?
Is the technology being properly applied and does it meet all
DEP Approval Conditions?
Is there a note on the plan regarding the requirement for
perpetual maintenance agreement?
Any alarms involved on separate circuits
Did the applicant submit an operation and maintenance
manual?
Has applicant submitted a copy of a maintenance
y�y 11 I
Are the variances listed on the plan? [310 CMR 15.220
(4)(q)]
RLS Stamp necessary on plan if a component is within five ,
feet of property line [310 CMR 15.412(4)]
New construction or increased flow proposed- [Refer to 310
CMR 15.414]
Address Sheet 6 of 7
r
ICl/A OIL NO
Is the system in a Designated Nitrogen Sensitive Area(Zone II for
a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and
310 CMR 15.216 - also refer to Policy regarding upgrades of such
existing systems]
Is the system proposed on the same lot as served by private well ?
[310 CMR 15.214(2)]
Are the nitrogen loads proposed in compliance? [310 CNIR
15.216(1)]
Pumping to septic tank ? [ 310 CMR 15.229]
Shared System [310 CMR 15.290]
Address Sheet 7 of 7
'I
9f
to C Air ION Ce p oVvI S E W " E PERMIT NO.
�- Cz 0 � ,.
VILLAGE
Vi6—lW A e LL�r
INSTA LLER'S NAME i ADDRESS
C/ d?� aid?tt�c7-ihr�
BUILDER OR OWNER
- __��7G�CAL-.. ��S"i�U c_/✓rL'.t..� CfJ //L'��e
DATE PERMIT ISSUED �Z Zg
=,1 7
DATE COMPLIANCE ISSUED o2 -/,J- 79
•12
s a
6 7F. �2 9-Z!:�—'
............................
No.--.....................
r. THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.7. - Bj Vim.....
..............70.40.-,OQ......OF....... S.--x-A . ...........
Appliration for Dhipogal Works Tomitrurtion ramit -
Application is hereby made for a Permit to Construct, �>< or Repair an Individual Sewage Disposal
System at:
.............................................K...................................
aocation-Aoress or I.,,,t No.
-rT .. .............N ...U..............................
-AJ�j..�.F_ _Q.at'
0 Address
At
PARX--------M" _Y=-j-Ztj.-P-7_1K-------------- .........MA..................
----------( F e Installer Address
Type of Building Size Lot... ......Sq. feet
U Garbage Grinder e>.........................Expansion Attic 0<
Dwelling—No. of Bedrooms.............
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
P-4 Other fixtures ................................................................................................................ ........................
.............
Design Flow............................................gallons per person per day. Total daily flow____---. .1C..................gallons.
1:4 Septic Tank—Liquid*capacit/l ..gallons Length_............. Width._.............. Diameter................ Depth................
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 ( )
4 Percolation Test Results Performed by....eni_NZRA�_E......�DY4r./.^j...... Date........
Test Pit No. 1......_��L..minutes per inch Depth of Test Pit....12.!:& Depth to ground water......A.10N.E
fi Test Pit No. 2................minutes per inch Dept of Test Pit.................... Depth to ground water...................._...
f
.....15-0B.S.0.1L..............................................................................
0
Description of Soil...........Z=_5�........C�__-tx. I......Cor_R'.".2W.F_"L............................................................................
............... Y,.Z5L.fP........SAW-b................................................................................
----------------
........................................................................................................................................................................................................
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 TLIME 5 of the State Sanitary Code—The'i ndersigned further agrees not to place the system in
operation until a Certificate of Compliance has beep LssuSod by the
board
d of l th.
... . t.o.
Sign :.. .. .. . . ............... ... .. .IY —...e...
7..
Date
Application Approved By........
Date
Application Disapproved for the following ................................................................................................................
........................................................................................................................................................................................................
Date
Permit No....................................................... Issued---.....-T..........7
......4...........................
Date t
�J
V L
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i.. ......OF.......
...............
Appliratiou for Bisvoiial Works C omitrurtiott Prrutit
Application is hereby made for a Permit to Construct (, or Repair ( ) an Individual Sewage Disposal
System at
..... ?:?i:...ar ....C° 1 '�14le............ ................. ... ...................................
w . ocation-A ress
' y or I.ot NoA des
..
Own
W ------------- . . --t. -.- r ------ .................... :J! fi1r�5` k.-.
a Installer
. Address R ....
U Type of Building Size Lot_'J'5 _ .....Sq feet
�-, Dwelling—No. of Bedrooms............. ...... ............Expansion Attic ( j Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures ...................
W Design Flow................. .._._. ._gallons per person per day. Total daily flow......... ................gallons.
WSeptic Tank—Liquid capacit3p_1t 40_gallons; Length.......... ..`Width................ Diameter..__._ .... Depth................
x Disposal Trench—No ..... Width _ .. Total Length............ ... Total leaching area ......sq. ft.
Seepage Pit No............ .. . Diameter . Q_� O D'e th below inlet._...:
p ..: Total leaching area._.sq. ft.
Z Other Distribution box ( ) "Dosing tank( )
aPercolation Test Results Performed by.... 1�2 /, 4 : �"`'"/ ./. .___. Date..... � 1- '
,.a Test Pit No. I...... ---minutes per inch Depth of Test Pit.....t2*• . Depth to ground water.......A,,� /
44 Test Pit No. 2..... .....minutes per inch Deptb of Test:Pit .............. Depth to ground water...........................
Descriptionof Soil........... ..3 1 -------••--•..----.. ....................•-••••-•--....._..
4.
W
-•-------•----------------------------------------- ----------------.....................=---=------•-----•--
UNature of Repairs or Alterations—Answer when applicable:;:...........................°....._____.....__._......................_......._.._.._......_.
----------------------------•--------------•------------------------•-•-------...........----•----•-----• ..........................................
Agreement: s
The undersigned agrees to install the aforedescribed Individual' Sewage Disposal System in accordance with' ,''
the provisions of LITIE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance-has bee isstipA by the board.of,l th.
Sign ::, �. ..... ...-- ��-�-
Date
Application Approved By..:�.... `
Date
Application Disapproved for the following reasons:------•------------=-------•--------------------=--•-------------------------------......----•----•-----•----
.......-•------------------•-----------•-------•--•-•-------------.----------......................................................-------------•--...................................
Date
PermitNo.........................................................
Issued...........................Date
THE COMMONWEALTH OF, MASSACHUSETTS
BOARD OF HEALTH a ,
�.C. a,l :. OF.....
Tntifirate of faompliFaurr _
THIS I ,�,TO CER�TIIFY, That the avid 1 ewage Disposal System constructed �or Repaired ( )
by............C �,."r--•�-`�-�•-- ..�—I-°l------ . .................... -- .............................................................
er
at.................. . PAS t r,1 / 1l 1 Lit
-
has been installed in accordance with the provisions of TI of The State Samtabry Code as described in the
application for Disposal Works Construction Permit No. ' ..... ................ dated_....../"._��''^.7?..............
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..........................................................-...... ----- Inspector........ - r,
THE COMMONWEALTH OF. MASSACHUSETTS
BOARD '..OF, HEALTH
Of 1
............. ....:. � :►'`, J.��"" a.? .............
No................�---•-- FEE...2 ''"`"...
R11111rsttl ks Tottfitr wall rg K
Permission is h eby granted..�-=="�.�.�,a_ !�✓ �- �� ........................................ ....
to Construct or pair ( ) au Individual w ge Disposal System
�e ,
at No.....................•....... '`sue" .......f"" Yet 1�. .. C",
Street r q
as shown on the application for Disposal Works Construction P P2niit No Dated.... !7,/ ,t..`.............
=} .: .. ----------------------_
�y Board of Health��
DATE-- y t'---•--•-•-------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
,. p
Yitt'�"d
y �g
FPr
l r 1
f + 1 niF�s �J✓'�' b ♦ , .. 7 ''+-' f 'A' r a �;�
} g W t� .r. .. j' c �� t t /4 -• x a 6 sr`'t��a d �`' � �l� F.
ri
It
P r l
Ina°� �l l x n r. { } �+ t t s •r i !,7 i" t.. r: x b , > S k krl f 3 i '
-,n fi' ;€`'4'if„�J d7 ♦ �.'�. .t yk .� 4; ` s• ' F(. ,Y r�fv .,,r r .l i x'`
k '•ff. - Y r . W 1,'
^ { �a. r,1t ..t<
" ,y4b t,f. ,.i't ✓ i. tee' 4. a q,•< _ r <t .t d� Zt. r1 f
]
tir !t' dll. t ' t 1 s r a
t Tr�'!,
l� ik ZK`r i��aJ` ytti _ � ( 4 • y �,� � ! t 1 /}•"��r 1
ty,,yks '� '� I.{d t & d; { .Y .. 1. _• f �• J *,, z t i
� y '.t� t .. t '.N. F] y f y E,•.�f ff T Rl k
,,lid"v£f i A(eS � '' V �1 Y• > � ,i f � 1 t y f .
::q ] `f f. •r ( �, ,a aa. ,: s Fi t
/ F C j.
i b -F y,{ •T/ .D' Y r + 4 -_1 y'�6 .�
OCp
V �� - •:"' �r ff i
p�b r} �y, Yi L NYY •',� .? t -� I C' 1 '_.� D-Q �'.y' /� A + l to�'�i�., �y 1,• "'�
{^!t lar
I" '��y, �,«�y �#,•� } }' ,! ° h •e i:,r i ./ /- 't �.,.. � 1 "4.. 9 �] Sa� .. r y'.�� a + .���+� � �l
��� �iv �at,.;ti ,xX. C, yy. t �a` + ��.4GHIn/y p/7" 1` - /D xaA•4,vs/� r °� 1* �y , � '�
?S'g �Sy�fi',}� }i�i� ,� °art t , u � :. , � N p /000�.AL; � � � } � � 'r:y u.�,.nti ,�• r
TANK0. ^ e l,r. ire. +
-t Jr / v�y P t Y• d• t .O ryf� � j- '� tad � ���� ," �r
I � ICA�. } -fy(,��• , 1 ^�l t 1<- °V � N a Z }A � a ql 1 ra
.50
Pt
.i'rt• T+.h /t�;`s t 'r ,,: r t`t a Z � � 4 '�, a er .+ '
h ,
tom. .•� Fy �,kTt"�`ry �r { '� y � �• � 2-� �`�;�: / / /r .. f — . a¢t .�, 4A sy .•.t�
ff'�..,,
��. qs+ a v
s ✓.V�,./ r. �lti .n S9 `p ,,r Y' '�
"` r ��� ROBERT
f : - P.', rn t t
BUNIKIS h ti
No.22162
i' r �0 FGISTSQ�
�O
F
t�+,.t'3 �•>titi-wl�' ` `� - } ,ts IFS NAI..ra�1 ,t LEGEND l a�
td] -:„ - — — - _ _ ,. CERTIFIED F;LdT"a7, ._.PlL_A4
EXISTING SPOT ELEVATION 010
�r;r `-tXfS,,TING, CONTOUR — — — 0
rihiSHED- SPOT -ELEVATION - „
14
i 'FfNI:SHED CONTOUR --- 0 --- CE/✓TE2V/LL,LE _ !
r IN
.APPROVED BOARD OF HEALTH y x h
eft:
h� , TE AGENT SCALE : Jt0 DATE h
DREDGE,ENGINEERING, CO. INC ID✓ n/�i
CLIENT .__ , I CERTIFY THAT THE PROPOSED
' "° EGISTERE REGISTERED JOB NO 7�' D BUILDING SHOWN ON THIS - PL.AN
4 �•�CIVIL �:'� � LAND CONFORMS TO THE ZONING LAWS, _ tr
�f + `ENGINEERS SURVEYOR DR. BY _ OF BARNSTA E MAS
a,33hCMAIN ST + 712 MAIN' ST ' CH. BY:
�'. SO e,1�ARMOI TH, MASS.r HYANNIS, MASS.
SHEET 1 OF 2' DATE R G. LAND SURVEYOR
OR
7*A Ac�
>V*
Fb FT._ /M..
Af
AD V-A& All aP##
0 tN
A214'r A(&, -'rAi-AN /Z
Z-4 VAM jF;�
CO
<0
/V AMX
_k AWAI.,AITC
e. 'N - /RON Ct�i!E/P SHALL BE USED
CO)v --,4 V YCA CAST
ZE4 io 0-0 lPr/Ao' OA F/VA=WA Y'
coFR 4
CO;01/
Coe
C-2% MIA'.
CC) V
C1_,FAV .SANG _
&A C-le,=1
- s
LAYER
)%"0 CJVA S 7 417 0 OF 11B'-
Otq 0
WASHED 57VIVe
OAL
M iN.Jpjrcw
SEPTIC TANK
314
0 WASHED STONE
41 4D P .0 PRECAST S--AffRA
4 ip P170R EQ411V
41.
IAWMr 4w,4BVA7'1,0#Vs
IMMERT' AT ff4V14 I*VCv 97.0 P/Am-
D
F7. PIA M
-r-4,v,< - 9 6 C SEE TABULATION,
OU'r1_a=_ T`SEPTIC -rAVH Pr
SH-c-rION 0,0= GRODvo wA rE,,r TABLE
F7
SEWAS&E 01SAOSA 4 SX-571,6M
IM4.,,=r i-rAnw1ova oc>.,7- 9s:5 Fr • i-rA5ZILATIOM
LEACH11V6
D i m ilvs/o A/ A FT.
=::_�DRWMX- CM17EMIA '0 AfN5 0 45 FT.
F T.
NUMBER OF&EIZ>'MOOMS
GiaReAGED/SPOSAL UNIT so//- I-OC7
TO TA L Z:2rT1A1ArejD 1p='Lo AIV 3 0 GAL./DAY S014 TEST / $04L 7LES7-41*2
A(UM8,=R 0.0.40A CH/Ma P/r..S� 7.0 2-';C 7 Ar—
_I - A=-/-A-- ,DATE aor so,,,L 7'&.s
$/ADZ A�-ACHIM6 #401eR A717' IR-1—sip. �-;r i y f.f GIAII K I S
0 - AV17-1V--SSEP B.
4L9or-romi,&4cHINcrApeR PIT--2-t' so. Ar 4.OA-0" A4WCOAAWON RA7'40#1 7-.10 M11VIINCH
2-&-6 C:) Pm-1CC04A7'101V RA7-Ar 02 —
r •OTA4jL_4ZACH11YCr AREA F;1
SQ. F771
14IC-1�_'A/ER
_,:�Ii 7k, 0 T/_0
4-
Be
P.
IP!_
C3
ButylKis
)r/p/G C49111yc-
No.ggip
0 4 PRzDaz E)Vcri IVAW
PWAW
7',OeA
71Z. 3 MAl"S
Ic*L W47*0,? JCOI�Al ne
-YAM '13 MA SA
V JFR ATG/CO 1JAID4
_7
A
L0.0 T ON SEWAGE PERMIT NO•
VF&I. AGE
INS/TA LER'S N4 E & ADDRESS
B U I'L D E R OR -OW*tR-
"DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED °y
.. �
l
.1��
r�`
� �M �
7,
No.......
............. �; Fps.... .. ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.cv _................0F......... .... ......._............
Appliratinn "for R,iplagal Morks Toustrurtinn Prrulit
Application is hereby`"made for a Permit to Construct X or Repair ( } an Individual Sewage Disposal
System at:
& ................................ .......... ------ ��..............................
...............
.......
jJ� L/�c`at�n-Add /i �� 9 r Lot No.
11-r-., s�IS zer---1!Vd./O�-e!��Z. .../i c..................... ............5��eCS✓1 dCf ir!1.f.��- .... -•---••-•-----•---••--••---------.•--•----
, owner ` Addd/rfess`
............................... "L ! .�i 6!sf!,� �T��� &-`<-.---_------
Installer
� Address �
UType of Building / Size Lot....... _ - ---Sq. feet
Dwelling—No. of Bedrooms.--..r"i ........................Expansion Attic ( ) Garbage Grinder (flo)
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ......................................................
W
Design Flow............................-.:? ........gallons per person per day. Total daily flow.........`33G.-:.......................gallons.
Septic Tank—Liquid capacity_ _f7ft.gallons Length---------------- Width................ Diameter--------.------- Depth................
W Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No..f ...... Diameter----- ----------- Depth below inlet......... ________ Total leaching area_.__"zs___..s(j. ft.
Z Other Distribution box oe) Dosing tank ( ) —(Jf
,�/ `7
'-' Percolation Test Results Performed by.-R),U..�� --_---_ �'�!�� >
ay--- ----- -------------------- Date. - ` 7
Test Pit No. 1........I-------minutes per inch DeptK of "hest Pvt.___r.. Depth to ground water........................
fXA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.------_--_-_----_----
IYi ................ : ir
O �-- '--------...
Description of Sotl - -' � *)..cc. `nth 3 - •----- ---'fr..��P_----- l;�j__/ �''
/ ----- ----------•----
l'
--------•---- -------------•-----------••-•-------------•---•--•--------------- ------------------------------•--------------------••-•--------------------------------------------------------------
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 Article XI of the,State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee i sued by the board of health.
�) % Date,
Application Approved B .. �l`r. (��% . - ----_--A-_
Application.Disapproved for the
following reasons:----------------------1_._.--•--------------•-------••--•-•--•---------...... _........Date--------------
---•-•--------------------------••------••--------------•-•------•-•------•--••---••---•-••--•------•••--------•--------•-.....---...------------------------------••-•----------•-••--------•--•-•--...
Date
PermitNo......................................................... Issued........................................................
Date
JL_0= A ION SEW A-G--E-�P E R M 1 T N 0
i
IL LAG E ( v
INSTA, LLER N{A.ME & ADDRESS
B UItDE R 4R Ak**R-
DATE PERMIT ISSUED '
DATE COMPLIANCE ISSUED. w/`
< � 'V
• 3
\.,, f
�� �� ��,,
i
t✓ .
No.........19--y3.... Flc$..... ., va...
_1 THE COMMONWEALTH OF MASSACHUSETTS
_s,g
BOARD OF HEALTH
..... ..OF...........:! �,...A1. ...n......................
Appliration -for, Uiiipuiittl Works C onfitrurtion Vrrut t
Application is hereby made for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal
System at:
...................... � --------------------------------- ----------
y
Lorca/tion-Addrods f or Lot No.
._._...."`: `=•" °-'-=-"-`�"---- I!! f__...�+�P,..`_/k�Cirs..................• ............[-_!I fir../•r�r—=.iS`d�! ...................................................
Owner Address
:: S�:
� Installer Address
d Type of Building / Size Lot:::____.l j.. s_{�... feet
s;... Dwelling—No. of Bedrooms--.__ ___...r"a .......................Expansion Attic ( ) Garbage Grinder (A�A
aOther—Type...of Building ____________________________ No. of persons.-____-_-----_--...__-_-_- Showers ( ) — Cafeteria ( )
d OVA fixtures -------
� -
Desi .•n Flow................................ .. Mons er erson er da Total dail flow__-__--_---?.7/a_-__-__-_____-.-.--.-_. Mons.
W .�, ------------g� P P P Y• Y - -- g�
WSeptic'T`ink—Liquid capacity--!7fl.gallons � Length---------------- Width................ Diameter---------------- Depth.__.._..-__----
x Disposal Trench—No_____________________ Width-------------------- Total Length-------------------- Total leaching area-.--.-_-..__.___--•sq. ft.
Seepage Pit No.:.V.1 _------ Diameter__.__f.__.`...._._. Depth below i et__ _____ _______ Total leaching area_..` 2_ _' sq. ft.
z Other Distribution box (lc) Dosing nk ) .C/� 77
Percolation Tes mesuffs kPerformed by._ .AV_ --------. r- !------ •--.r_____________ Date-----_ .. `-t
Test Pit No. 1........I------minutes per inch Deptlf of Test P .......!.`".____-- Depth to ground water------------------------
(s, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__.-..---__-._-._:_--__.
O ,�'3 r'
Description of Soil +`4� 4 ........ ! '
c.� L`) tic•r�S ate.. -- ---- ,�` - ---- .-- --- '
w
� '�,c,{
U Nature of Repairs or Alterations—Answer when applicable................
.--------------------------------------------------•------------.......------------------------------------------------
Agreement: rr
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article tI of the State Sanitary Code—The undersigned-;'further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
_ ,i
Si e ' ---="-----•
-- Date
Application Approved BY 4 - � = --7
Date
Application Disapproved for the,f ollowing reasons----------------------- ----------------------------------------------------------------------•-----•--•-------
Date
f
PermitNo......................................................... Issued---------------------------------- ....................
Date
t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD % HEALTH
... .. .,
T-rrtifiratr of f��am Iittnrr
THIS eR That the Individual Sewage Disposal System constructed (/-1/0r Repaired ( )
by .f' - ----------------
w
4, Installer "
.......
/ /
......A,
has been installed in accordance with the provisilxhs of &Zr�'
le I f The State Sanitary Code as desc 'be in the
application for Disposal Works Construction Permit No :_. _ ,,,, ................ dated-.-. .._. ..."'.. ....__._.._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS`A GUARAPITEE THAT THE
SYSTEM WILL FUNCTION
//SArTISFACTORY �`
DATE-----------//V-"•-a-(l---------{---........... -� ------ TiJs�pector
THE COMMONWEALTH OF'-MASSACHUSETTS
7 BOARD HEALTH _
/ .........OF...:... .. :. .. ...............................
No. FEE/
�tt � fr�trti,aat rrmit .....
Permission�ereby granted. y = --=--------------------------- --------------------------------------------- --
to Con uctf.( ) r .parir ( ) an nd• id}ial Sewa �salStem
atNo. .- �Z' 1�. .... �F�1 ---------------------------------------
et
as shown on the application for Disposal Works'Construction P t No/_.._ ___ ated.._. _. .....
. . -- - --- -- -
tJ� ' _
DATE:°.
' Board of Health - ---
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS '
►`lo C�ARTSAGE (�RI�ID1Z
L ti.f `f I '-V/ : Ito -4 S. D 6-PV.
tw tA,u
SPoSAt_ PIT -. usr✓ Idoo GAL_.
CmwAL-L AZEA = ISo 'S. .
Loge-..N pal
Sao 95-. A t •o _ SO G.RD.
GIST
T(ST'AL T7ESIGtJ = .425 C .P.D. Q r ;1 BaK
V
TbTot_ mat��f �c Uw = 3w 6,FD. N 5
R20noL&rIr- CZATE t I0 2M I Q' o2 LE'% qi /D110 a44
ntN S4'TIC >
,_?.e tK Of•��--t^� .,�.�^'+". ice. '
S q`• WILLIAM ��'� `i J'J• '
YC
15334
OIS
4 �
KIN
Tor Pw 0 L 1 v o.o
Lok14 "Pi tuv.-
4'APt- VIsr. lum � .. �L • .
R l oao `16.C tlrv.w S S ,.
S W I1J
v.
FIT
e•
WITIt •�
t.1M
i WASWED
SC+Np�( STOWS= 0
GPrD.V>�. I�"_ QTE�tD pl_bT P_L_ ./1.t�1
LVTATI oV-4
f Gt-.VT1F-{ T14AT C-. t-
TI-1oUUD*-1.T10IJ 5O/"
wx
Pt�b.� nF�1za1-�c�
t-.tI`.t_7 L :J GIPt_%,!5 11'1 Tt-1� 5tvt ,t_tI.1E: 1_G�`1., �It
AWC> SETLY-Ar-4
i�'�GIS•t'GiZi=D • LJatJG SuL'u��:.`(Ur�
Q UT CU S-•E.tZV t 1.-t_C o M A(S-5-, r
t(J r f`C"Jlt/�C=tJ�'• ��LIt_�/t=�{ � Tt•1C. Ui^�'�i=.Y'�, SI-lotslt.�7 /�5��a t_.I GI�.f-�!T'_ ��T NU� IIL.NII.:t!>t 1.�i. I
t
C-7)0�
No......1.__'�l%:_..... F>ma.... J�.... ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH-TI
',c�... .................OF...._..-. .....�% i.Y.: .b/ .....-t.......................
Appliration -for Uiiipuiitt1 WorkD C otuitrnrtimn Prrniit
Application is hereby made for a Permit to Construct (vlor Repair ( ) an Individual Sewage Disposal
System at: ,e)
catip(1n-Xddress or
Lot No. -
Owner Address
1 =l `1
----------------------------------------------
Installer Address
d Type of Building Size Lot.. �.ZP�....Sq. feet
Dwelling—No. of Bedrooms---------t �t�J 4........................Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ____________________________ No. of persons..___-'/.................. Showers ( ) — Cafeteria ( )
Otherfixtures ........ .................................... --------------------------------------------------------------------------------------------
W Design Flow------ _.--------------_---- ___________gallons per person per day. Total daily flow----------- ---------------------gallons.
-9 Septic Tank—Liquid capacity-°+—_gallons Length................ Width..._..:_....._.. Diameter................ Depth-__.__--__--.
Disposal Trench—No. .....�__.__.__.___ Width.................... Total Length_-_.___-__--------Total leaching area-.--_---_-_--�-:__sq. fi.
Other Seepage
Pit
Noon box . YS Diameter......
D�ng t-- Depth)belo inlet---4 `- 7 Total leaching area-`r°�___ 1.
az �_it
Percolation Test Results Performed by._____ -__ /� !1______________________ Date..._ 'r'_�.7____.__..._..
a Test Pit No. 1____�------minutes per inch Depth of Test ____________________ Depth to ground water.___-_-_.-.--.._-.-..._.
rZq Test Pit No. 2................minutes per inch Depth of Test Pit.--___--_______-.___ Depth to ground water........................
-- •--------
O .......
" " - - - -
x
w
UNature 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has n :h health.,
gned- _-�._......-:7
Date
Application Approved BY f G -------------•---- ................._�-..._7._7_.._.
41l/ Date
Application Disapproved for the following reasons- -------------------------------------------------------•---...__.___..-----------..._.._....__.-----------•-••--
------------------------------------------------------------------------------------------ ----------------------------------------------•---•-------------------------------------..._....------------.
Date
PermitNo........................................................ Issued...................... -------------- .................
Date
Date
its
No.---•------•....::....... >c�. ..............
t THEJ001LONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r .a., c.�L,t.�_ . _. OF.............:.. �� �1!;h5'sfr_... ........
'Appltrtttij rn #or Di,ipmttt Works Tottotrurtiott Vaniit
Application is-hereby made for`a Permit to Construct ( /) or Repair ( ) an Individual Sewage Disposal
5ystem:at.
Location-Address or Lot No. 1
W // / Owner Address
Installer Address
Q Type of Building Size Lot....�2U..? :4 ...Sq. feet
Dwelling—No. of Bedrooms...._!............................• .Expansion Attic ( ) Garbage Grinder ( )
Aa Other—Type of Building --------------_--__........ No. of persons.-.----- Showers ( ) Cafeteria ( )
QOther fixtures tee' •------------•-•--'---•----------------------------------•-------...._................-- .
WDesign Flow.................: ......... .........gallons per person per day. Total daily flow..x•:_...... -.--._- .........gallons.
WSeptic Tank—Liquid capacity.':t'>gallons Length---------------- Width................ Diameter.....__....-_ Depth................
x Disposal Trench—No- --------------------- Width-------------------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..! G 4,," r Diameter....._&......... Depth below inlet --. -_._.-. Total leaching area.-`� 4.___-.sq. ft.
Z Other Distribution box ( Dosing t k ( ) VP. ./r'7 7.
.Percolation Test Results Performed by..------- ........
. td� .................... Date-----.... .
.. `.. .------------
Test Pit No. 1.... .4*_.:..minutes per inch Depth of Test Prt-------------------- Depth to ground water......._.-..-..-....._.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.,_ `�--:...___---k Depth to ground water------------------------
-------- ....................................... ---------------------
O Description of Soil �r - `?` ''r, ---------------------
yy��,, ,�y/I .•----- ,ram/J/'J�'3
M ------------------------------------------------------t'..............-------...'_-------------------- -.-�-------_-......_...-........-_._-.----.-..----.._.....-----------..-..-------.--_-....
U Nature of Repairs or Alteradbns—Answer when applicable.............. ....--------------............:..,...............................................
Agreemefll
K 4'
The undersigned agrees`to' install tlfe aforedescribed^ Individual Sewage Disposal'^System in accordance with
the provisions of Article XI-of'the 4'State Sanitary Code—The urider5igned further agrees not to place-the system in
operation until a Certificate of Compliance has ben f J the_b 9/heaalth'. �r�
?gne ---------------7__
/d. ..
te
Application Approved BY .- - ------ ----------------------- -�----
Date
Application Disapproved for the following reasons:----•......................:....--••--......... .........-•-•----...---------------........--------..._......--
.-.-.•-------------------------------------------------------•-•-•------------------•----•---•-----------...-._....-•---••--------------------------------------•-------------•-.-------------------•--•-
L„ Date
Permit No........................................................ Issued...................................
``
Date
THE COMMONWEALTH OF MASSACHUSETTS
—BOARD OF HEALTH
..............�. ..... "..`......OF.... .'............................................
Trrtifirttte of Toutphattre
THIS 0 C IF 'at the Individual Sewage Disposal System constructed ( ) or Repaired
b •-. . ---------•--- ----...'--•-_..................
_...._- �..j/7fI_- .-.-,.--.. -------
atF �! _.St_-.r =.1.-. -. ±..... ...........
has been installed in accordance with the pb visions of Artl 1 •tate Sanitary C a cli. the
application for>Disposal Works Constructio'nk Permit No..._. dated........-.-.
ti
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM"WILL FUNCTION,SATISFACTORY.
DATE..... ------- Inspector..................... ..... -•-••- ...............
,...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L?iti'L�
''•� 7 ..........................................O F5�.
No........ .......... FEE........................
�i��o�ttt ork n �rurtioit hermit .
Permtss>tin is h
ebY gr'n d---------- .. -%
.......
to Construct r a ) an` Indd 1 ewa I 1 to
i f�, �
at No.....
Ll ------------
Street --- ~Z.%.... pry.-----
as shown on the application for Disposal .Works Construction Perm' .. d .................
.....
---•- -- ----------------- t --•-••-••------
i Board of Health
DATE--- ----•= . ;-
FORM 1255 Hoe es' 8i WARREN. INC.. PUBLISHERS.,,
r
.S/AID
uGLE f.4.yiLy - 3zrp.s.� ,
V1SAtZ,4 o_/T
375GPD 0 C ,
go rroA,i 50 .5,c-
�ZD �%'
7'07'44 V414, c�O(c r G _ a
G'SE /offaG PiT
�.�,.• \ to `'\f� ';
f4 GO
ZOA.41 70�= 98
d
S�rasoiC 4l9 L7 Ape
�,c 9s �� �lrl z� /N'1 /sic IN 73 IN P
LA V� ��2naic/caQ �� yb.so T.dAie, 97
G r SAC Al
ptr
AA1b dui ram,
r41E*� per n&�'Zy" C�EtZTtw=AEU pro
SAu D
�i5!'1')
G.Gt:TIP;—j TtdA-r T14G FovQo4-TtoQ 5"Cvvj►Q �LAF.� '�EF'cPa►.lc_a
GC.1,V%PL VG W i Tt.a T t-AG 51 rrS in NC--
"Cnw►,t ot= Sr42NST t3:. �i-A►� ootL l�7 �Co� I2"
REGtStz��D L..e.t.tto 5UevaYovS
1"t-1t 17L-AW 'IS LJOT T':5bI-,t*TD 04,4 AW 05TEV-V%L-LG. a /bCASS,
lt�,t�.?U.ihL.W;• �,c�c�vr--.•� ..+ -T�.tf:=, c:i=�'S�:fty i�-IGwL.�
�' AF�ct._t CAST
lb
. 2
` 7Town of Barnstable
Department of Itegulatdry Services D
nArwareete Public Health D1'YYSimi A➢ate
)Hess 200 Main Street,Hyannis MA 02601
Date Scheduled Time.. Fee I°d• /Dd
SoilSuitability Assessment for Se age lsposal
Pcrfonned By: Witnessed By: �' '✓
LOCATION& GENERAL EWORMAT ON
Location Address Owner's Name
cle. yVJ !e / Address
Assessor's Map/Parcel: Engineer's Namc &,), CA-e e
NEW CONSTRUCTION REPAIR Telephone It U ()�
Land Use&k��e���e.t�.. slopes m U—�O Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well It
Drainage Way R Property Line Z� ft Other ft
SYXI'TCH: (Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands)1"proxiituty to holes)
10 �t0 t f '��t �f, po
rvl
PEC
t
Parent material(geologic) T `^- Depth to Bedrock, 7 G C7
Depth to Groundwater: Standing Water in Hole: Al c)fV f Weepilig I'rgm Pit Nee
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL, HIGH WATER IABLE
Method Used: ,�
Depth Observed standing in obs.hole: vV In. Depth to Spll ItuU[tlt 3t ht.
Depth to weeping from side of obs.hole: -___ —In. Groundwnter Adjustment—
Index Well# Reading Date: Index Well level Y Ac1I.factor�,� Adj.flruuntlwuter Level
PERCOLATION TEST Data 'A'ittte
Observation
Hole# 1 Time at h"
Depth of Pcrc �7 Time at 6"
Start Pre-soak Time @ Timeff'-6")1 � -
End Pre-soak
Rate Min./Intl[
Site Suitability Assessment: Site Passed_ SiL.q.Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must Cast notify tile.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DE ROBSERVA.TION HOLE LOG Depth from Soil Horizon Soil #._..�
Soil Texture Soil Color Soil:
Surface(in.) Soil
Other
(Munsell) Mottling (Structure,Stones;Boulders.
Con istenc %a' ravel
be DEEP OVSERVATION MOLE LOG
p[h from Soil Horizon Soil Texture hole#--1�
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
0-12-- Consistency,%Gravel)
SL i�Y/L
/Z -
3Y
-------------
DEEP OBSERVATION HOLE LOG _
Depth from Soil Horizon Soil Texture Hole#
Surface(in.) Soil Color Soil Other
r
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Co siste c Q vel
DE,LP OBSERVATION HOLE LOG hole#
Depth from Soil Horizon Soil Texture —
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) M9ttlln
l; (Structure,Stones;Boulders.
Consi ten a
Flood Insurance Date Mal).
Above 500 year flood boundary No_ Yes
Within 500 year boundary No_ Yes
Within I00 year flood boundary No _ Yes
Depth®— f N�Iturally ®,ce'urring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? $
If not, what is the depth of naturally occurring pervious material?
e- tification
I certify that on �(date)I have passed the Soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training, expertise and experience described in�10 CMR 15.017.
oe
Signature
Datb
Q:ISEPTICftRCFORM.DOC
ALL
EM
S SHALL
SYSTEM PROFILE MARKED�WITHCMAGNETICTTAPE OR BE NOTES
PROVIDE MIN. 20" DIAM. WATERTIGHT
(NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD (GIS SPOT) - Service Rd
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2, MUNICIPAL WATER IS EXISTING
TOP FOUND- El 76.4' FILTER FABRIC OVER STONE
MINIMUM .75' OF COVER OVER PRECAST 2� SLOPE REQUIRED OVER SYSTEM 75.3' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. �o yak Street
BLOCKS OR 4. DESIGN LOADING FOR SAS UNITS TO BE AASHO 4
PRECAST H-10 H-2_Q (D'BOX = H-10)
RISERS (TYP.) PRECAST RISERS
2'0 73 3' 4"PES LE PVC MORTACOMPONENTS H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. Three Ponds
PIPES LEVEL 1ST 2' equaquet
4 (np,) INV'S EL. 71. 4 01, a
ENDS �SlDES EL. 72.0' 1 Lake
" ,ep�oa oo ao o 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 5ro
73.15' 1D" EXISTING 14 6o°o°O°°
Ct 000� �•�M0 �MMEl o 0 o ao V
,V. TEE 1000GALH-10 TEE 71.9f*' " o � oo 000a o � oo 0000 00000
WITH �o
SEPTIC TANK 0 °'° ° 0`0 6 MIN. SUMP >00000°oo ooaa000aooa oao��000aoo >o�o�o�o� 310 CMR 15.000 (TITLE V.) Locus
0 0 0 0 0 o O > o 0 0 0
( �" GAS BAFFLE;• 000°0°00000° 12" MIN. INT. DIM. °°°°°°°° �0��0������ aaoaaa00000 ;00000000
RE-US o 0 0,o o_ nj 00000000
°°°°0000 a�000�oo�oo aoMoo�ooao� ,00000000
7. THIS PLAN IS FOR PROPOSED WORK ONLY AND
° ° ° ° °° ° °°° EL. 69.0' NOT TO BE USED FOR LOT LINE STAKING OR ANY
71.57 � ° ° ° °
71.40 OTHER PURPOSE. c o o '�o°d
Loke pc
r H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. g, PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED
ALL AROUND PRECAST STRUCTURES 9. COMPONENTS NOT TO BE BACKFILLED OR
*THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.0' X 12.83_ o CONCEALED WITHOUT INSPECTION BY BOARD OF �c ,
. 221 [2])(15.
UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS COMPACTION. HEALTH AND PERMISSION OBTAINED FROM BOARD
PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM OF HEALTH.
**INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP
1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE CALLING DIGSAFE (1-888-344-7233) AND
WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. ( 2.27. SLOPE) ( 1 ! SLOPE) NO GROUNDWATER FOUND VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE
OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
WORK.
15' D' BOX 12' LEACHING ASSESSORS MAP 192 PARCEL 222
FOUNDATION EXIST. SEPTIC TANK FACILITY
11. ANY UNSUITABLE MATERIAL ENCOUNTERED
SHALL BE REMOVED 5' BENEATH AND AROUND THE SEPTIC UPGRADE ONLY - NO CONSTRUCTION PROP.
PROPOSED LEACHING FACILITY.
AP DISTRICT, ESTUARINE PROTECTION DISTRICT
12. EXISTING LEACHING FACILITY SHALL BE PUMPED
AND REMOVED OR PUMPED AND FILLED WITH CLEAN
LEGEND- SAND.
99- EXISTING CONTOUR .75
X 99•1 EXIST. SPOT ELEV. PROP. VENT WITH CHARCOAL FILTER 75.16 SYSTEM DESIGN"
\�Ci
99 PROPOSED CONTOUR AND BUGSCREEN (FINAL PLACEMENT BY +74.72
CONTRACTOR WITH HOMEOWNER
GARBAGE DISPOSER IS NOT ALLOWED
198.4] PROPOSED SPOT EL. CONSULTATION)
O
TH1 10 HORSES + DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD
�g 5.75 PIT USE A 330 GPD DESIGN FLOW
/'� �TEST HOLE
YY 7 5 HORSESHOE
2> SLOPE OF GROUND +75.68 PIT �� SEPTIC TANK: 330 GPD (2) 660
° °
Q� UTILITY POLE 5.94
�o � �-72.8 4 **RE-USE EXISTING 1000 GAL. SEPTIC TANK
+
FIRE HYDRANT �" I
7 +75.02 BENCHMARK �"'/1 2 49 LEACHING:
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING COR CONC, BULKHEAD
. . �TH 2 � ELEV. = 76.4' SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD
.59
�TH 1 G 4.34 +
BOTTOM 25 x 12.83 (.74) = 237 GPD
TEST HOLE LOGS GAS - °73.58 /
4_9 M TER �> s �7 oNw�REs / TOTAL: 472 S.F. 349 GPD
+7 9
7 60 + 5.55k
ENGINEER: ARNE H. OJALA, PE, SE ?�• 76 8 5.61 75.68 72.70 USE (2) 500 GAL. H-20 LEACHING CHAMBERS (ACME OR EQUAL)
WITNESS: DAVID W. STANTON, RS 4' ,, �3.3 / WITH 4' STONE ALL AROUND
/
DATE: 7/28/09 75.. 75.32 iX 5.69 67 �
/
PERC. RATE _ < 2 MIN/INCHO�F \� \\\\� EXISTING DWELLING
(f � 75.18 TOP FNDN. /
12641 {`�,1 f_ ELEV. = 76.4'
CLASS SOILS P# '` { +75.18 DECK MA
o' /��� O APPROVED DATE BOARD .OF HEALTH
ELEV. ELEV. r , 75.25
4 Q 75.18 75.44 /�
0'f _ 75.0' 0" 75.0 �� 75.1 SLAB w /�
4.50
� i / LPIT
A A / �_� 74.83 74.39 �So
SL Ls 75.03 75!�8,, 57/\\ 7 .00 ,/ TITLE 5 SITE PLAN
10YR 2/1 10YR 4/2 508
GARAGE
1201 1291 75.1 SHED 75.0 SLAB / V 72123 OF
VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE
B B 4.60 / AVED -4 72.15 IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR 91 PATRIOT WAY
/ RIVEWf,Y 72 65/ BY HEALTH INSPECTOR CENTERVILLE
10YR 5/4 O' 10YR 5/6 Z4.71 / PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED
48" 71 39" 71 .75' LOT 11
15,008 SFf / BY THE BOARD OF HEALTH REVISED DURING A PUBLIC
74.49 / HEARING HELD ON MARCH 10, 2009 PREPARED FOR
72.70' / 3) FAILED SYSTEMS ONLY: SOIL ABSORPTION SYSTEM BORTOLOTTI CONSTRUCTION/
C C
_-[�2.12 INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW
PERC GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) DUCHESNEY
/ AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS
MS MS BE LOCATED MORE THAN SIX FEET BELOW GRADE.
/ JULY 29, 2009
A r--'-
2.5Y 7/4 1 OYR 7/4 - 71.72 �o� sq .
1.1 A x s
' KH �Ia off 508-362-4541
fax 508-362-9880
downcope.com
tOILA' No. 0
4��, �� down cQ�e engineering, inc"
144" 63.0' 132" 64.0' 4� �-, r o civil engineers
Scale: 1 20
a� 57 _. eQ� E _iU d land surveyors
"= � � ��
NO GROUNDWATER ENCOUNTERED -`��� �0 �'DSUR'JS . 939 Main Street ( Rte 6A)
DATE DANIEL A. OJALA, PE., P.L.S. YARMOUTHPORT MA 02675
09- > 64
0 10 20 30 40 50 FEET 09-164.DWG(SBO).