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HomeMy WebLinkAbout0025 THISTLE DRIVE - Health � 15 THISTLE DR, CENTERVILLE A= - + No. 42101/3 ORA ESSELTE 1o�ro O O O O No. v -1 � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pphtatlon for Bisposal *pstem ConstrUttion Vermit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ZWndividual Components Location Address or Lot No. 2 0 7W J 377hE v P_,l1/F Owner's Name,Address.and Tel.No. AMY Assessor's ap arce -7 S 'L 6^ I I I Now, Installer's Name,Address,and Tel.No.$��` � ���j Designer's Name,Address,and Tel.No.3. 22 --,hF$-361 7 'cJ40 2I 6-j- 1"i&teg' 4!"1 45:D l A112 D P Ta�v 6 13-c a Z &✓ -- iu v,/K r✓iA, .SAmPlrlin4 � Type of Building: (,ea -(sD I - :?- F O Dwelling No.of Bedrooms Lot Size _sq.ft. Garbage Grinder(Ajt) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �� 70 gpd Design flow provided 3 9 gpd Plan Date r a /, ./ko 9 Number of sheets Z Revision Date Title A5;P1+/fL p/,d>✓ 4 Size of Septic Tank 1060 6A4 Type of S.A.S. >eVyJ611Y 5U121'vX//�/��ril� Description of Soil 61'-J Y .o n�i C6 2f'� S'iQ�x•t� Nature of Repairs or Alterations(Answer when applicable) JT C� rW i j�-Q f 64ri-F P, S S kwr"-1-4 2--g)r) C-PA f,� S-n Date last inspected: NA 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. igne Date AaA t Application Approved by Date Application Disapproved by Date for the following reasons Permit No. � 0?to Date Issued (� TOWN OF BARNSTABLE LOCATION 2 T14 i-37/6 lD►2 SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /0V0 Co+f LEACHING FACILITY:(type) iQs'( L (size)/3 X NO. OF BEDROOMS 3 OWNER G4-Q- F� 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 77 A c-Q04 13 ,3 ) D d � v� No. a Fee `' �� ; Entered in corn ute r�THE'COMMONWEALTH OF MASSACHU9SE7 P yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppfiration for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. 2 7 rHl 37 -- p,2►v&- Owner's Name,Address and Tel.No. Ass�o ev p �.5774157'/g-c n Q GEN TIG 1/16 h,✓1. Installer's Name,Address,and Tel.No. .3"0 iI,?7 j Designer's Name,Address,and Tel.No.54-1-J} 0-34,1 7/ 644c2lA-T M6122114r1 4 tip SAn,DWinM /"1.4 Type of Buflding: (LQ - DSO - 3 31 - (j Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(AID Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /� Design Flow(min.required) 3 d gpd Design flow provided y 7 gpd Plan Date—A P2, I,�rko 9 Number.of sheets Revision Date Title SE-PT-(G S' j 19,6P14/12 P/k1 n1 l h Size of Septic Tank b A Type of S.A.S. j)r0l�ti.JE/7S'S&IR /),9-0 Description of Soil 61'--3' " t'-aykmy 5',4 32 Lol4rN t 1105, "iMN 6-'n y� ��✓�21'r� Sly x t� i tw "A Z D�-� � lTj4,—!l 54 ti0, 9� 40 fI') -0, T4'�-/UU 1614+256-� Sr\ti0 Nature of Repairs or Alterations(Answer when applicable) 6/1 C 14 P 2-5M 6-A 1 D(2-1 v 1 e-t 1 f Si,✓02.0 o s7 k a 724 y G120 3>W✓7 S-V,�v F Date last inspected: A/A " 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. .x tgne i Date A&A 6/ . Application Approved by Date �J Application Disapproved by Date for the following reasons Permit No. C7?(p Date Issued y (/ v THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired((/� Upgraded( ) Abandoned( )by �,N-yk !6 S Yy1 E,Pa/;n AA at 2 7 7 t-�i.S'T I/� D 2 C t�lµ t1lc�2yl ell- it A has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No:" i X/-6C, Q 6dated [P - Installer t S N\hQr2/r1'A Designer =- n ,7J Aj t,—'- #bedrooms Approved design flow y Cf gpd The issuance of this+Permit shall not be construed as a guarantee that the system will `fun ti n as designed. Date 4 �U t Inspector r�Cf No--�QQ ,y— / �' Fee V 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 2 5- T74 1 S T 16 CAC A, /16- hn pA ' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this ermit. Date `7 I b �O Approved 'y-- - ��� Town of Barnstable WE'� Regulatory Services Thomas F. Geiler, Director YARN&MLL MAS& Public Health Division Thomas McKean, Director — 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-i 90-6304 Installer & Designer Certification Form Date: � 09 Sewage Permit# (iAssessor's Map\P are el 171 075 _ f°g � 'r' SS'v/InItaller: r t�F�yLQ Designer: Address: Pj L*- 6Tl 16qe..17Z-J Address: Qom- 6A W 16t4 A* 025_ 3 C TA AJ.L%1LJ LCU-- b Or. yA-10 d�lAas issued a permit to install a (date) T (installer) T septic system at ZS ` l based on a design drawn by � ./ (address) y �/,/? M t � � dated t1 0 9 (d signer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box ands'or septic tank. ` I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or anv vertical relocation of anv component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by desi(2ner to follow. OF Mgs� y cJ DA�kM. RT (Installer's Sign• ture) \Nn: 1140 _STE � SANI TAR�P� Der' Signature) (Affix Designer's Stamp Here) U✓Ve PLEASE RETURN TO BA L TABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COiNIPLIANCE 1VILL NOT B ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-264doc A B 1 14.4 27.3 2 20.6 27.6 3 26.0 30.9 \ 4 29.6 36.2 I , z I 5 24.4 40.0 Iz � I I RISERSO�Gq • I � I 10 l ® os w 5 ^' I Of I 3 RISER TP#2 N 62 I I oil z� ` � TP#1 / I RISER RISER Ilk O�Q / I I (EXIST.) 1 I 1000GAL 40 MIL• LIN o 6/ TANK (TO REMAIN) (6 I , © A I , L,w #25 LOT 75 � 3-BEDROOM AREA=15,000 S.F. DWELLING PARCEL ID: 171/075 SEPTIC SYSTEM (AS-.BUILT) CERTIFICATION EDWA EDWARU LOCATED AT: z A. STONE #25 THISTLE DRIVE, CENTERVILLE, MA. No-2 9 -j PREPARED FOR JOHN M . JR. & AMY E. GRIFFIN A APRIL 15, 2009 1 CERTIFY THAT THE SEPTIC SYSTEM SHOWN WAS , SH OF iyq INSTALLED ACCORDING TO REFERENCED PLAN DATED ' , EAS 04/01/09, STATE AND LOCAL REGULATIONS WITH THE SURVEY,INC. 141 OUTE EXCEPTION OF THE LATERAL RELOCATION OF THE S.A. SALT MEYER SALT POND BA BUILDING BE ARIA IN 6' OM THE FOUNDATION INSTEAD OF 20', o. 1140 P.D.SOX1729 O 4 RAN TH 40 MIL. LINER INSTALLED SANOWICH,MA02563 �FGI TERM S EDWARD A.STONE `S'%1TAR\ CERT.TITLE V INSP.6 SOIL EVAL RPL5428980 DESIGN SIGNATURE DATE J 1176S BW:(So8)g W639 FA&-srM)8862+96 RES:(508)3986813 oar Town of Barnstable Department of Regulatory Services Public Health Division Date 3- i 6 - o � 1e3q �� 200 Main Street,Hyannis MA 02601 �fD tiAA't� � p v Date Scheduled Time Fee Pd. d Soil Suitability Assessment for Sewage Disposal Performed By: G4. Ul�l/ we .' Witnessed By: GZS LOCATION& GENERAL INFORMATION Location Address Owner's Nhme / �,P✓!/• /�� Address Assessor's Map/Parcel: �,,��7/Af�C� 17�— Engineer's�Vame C.W 9_5 c-,,1 c%_� NEW CONSTRUCT�ION REREPAIRTelephone# �Jfj s'i' 3 G Gp Land Use �G f� Slopes(%) ' /—! / 3 /' Surface Stones Distances from: en W r Body zed ft Possible Wet Area !� `/,� ft Drinking Water Well r`r ft Drainage Way U t- ft Property Line Z ft Other 3o ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 3V�` ell� oo ra i 7 ' • I CIS �p!el Ca.� UU Gvt l j ' Parent material(geologic) vdw � / Depth to Bedrock aL Depth to Groundwater. Standing Water in Hole: A~ Weeping from Pit Raoe N/4 Estimated Seasonal High Groundwater 7 Y'U —as T// CS7►2 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: �� -in. Depth to soil mottles: Depthw/t9 Nweeping from side of o'b;.'hole: /y in. Groundwatee d)ustmenk ft. n Index Well# Reading Date:� Index Well level 4— Adj.factor Adj.Groundwater Level PERCOLATION TEST Bete Time Observation Hole Q L Hole# Time at h" Depth of Perc �4il Time at 6" -d' Start Pre-soak Time @ L�: d ___ Time(9"-6") End Pre-soak w Rate MinJlnch 2 6 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) 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 first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. " consistency. ravel c�-- O� o 'e 2/o e• " d f Z DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsistenc % ravel 3 BO /� as IVI !� 419 -a Ge d i'Y7`ey� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%G 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones Boulders. Consi en 1 Flood Insurance Rate Map: Above 500 year flood boundary'No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material' Does at least four feet of naturally,occurring pervi us aterial exist in all areas observed throughout the area proposed for the soil absorption system? e� If not,what is the depth of naturally occurring ervious maCerial? Certification ,,� �I certify that on ' �S (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 train ,ex p rtise and ex er' ce cribed in 310 CMR 15.017. Signature Date Q-\SBPTI0PERCFORM.DOC No... .- ..3 Fss.......�.w..o®_ THE COMMONWEALTH OF MASSACHUSETTS BOARD�OF HEALTH . w..°N.........OF..... .�.�?�..-,.'P� _V .........................Y......... Appli atiou for Uhipaiial Worku Tomitrurtion trutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -•..:....0 ..�.......:T. �s 1�.�r ------------ ------------•--C...................... 1 .e....---.......................-----.. •Location-'Address or Lot No. ..........Zro.�-fir �l .s - e s^.1.................... . ...................... .............. .. ......�`. I .......... ........ ......... Owner Address o_-s0r�.- .f ....... -. �? c r�.. .!�.v e. ..a�.14.............. Installer Address Type of Building 2 Size Lot...................`.......Sq. feet U Dwelling—No. of Bedrooms.__..,?.............:....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------•---•------•------•-••---- q W Design Flow.......�5.-6.......................gallons per person per day.,Total daily flow...... C-:;...................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ~" Percolation Test Results Performed by........................................................... -•-•----------. Date........----•----•-•-----------••---.... aTest 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........................ a Description of Soil =----•••--...----- x U Nature of Repairs or Alterations—Answer when applicable_____---n_`Q4Z>...._..�Q0.... .d4r -•--•--••----- 6-•••• �fis_ °� ----- ..E..Z� �---•-------------••-•-----•-------•-----........-----•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T ITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliancahai-been-i6F4 . by t boaSi - -- -.�1---------•---- ------------ Date Application Approved By.....-•---• . --••--•-----••••---•--•----•---••---•-•......------ .............. Date Application Disapproved for the lowing reasons--------------•---••---...._..-•-----•-------------------------------------------•--.._................--•....._ --------------•-----.......----•------....--_._....--•----•----•----•-••-••---•-•--.....--•-----------•••--.._......---••----------••--•-•-••--------•-••••-•-•--•-•---•---•-----••--••----........_.._. Date PermitNo. ---.....-••--••••-_.. Issued....................................................... Date No........................_-S Fza........ � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration>for Disposal Works Tonstrurtinn jrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .........1 s�2----•- . �".....�� k M: ::......... .................C..............................! k......................__.......... Location-Address or Lot No. ................... . ......... `A ' •- ►"" ........................................._.............. ..........X.�.f.V--- Address ! �4 .......... u ..... .!�'1W...... r... dr . '� ............. Installer ess U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._... ...................Expansion Attic ( ) Garbage Grinder ( ) 'k Other—Type of Building No. of persons............................ Showers Pk YP g ---------------------------- P ( ) — Cafeteria ( ) 04 Other fixtures ............ Design Flow......._ .........................gallons per person per day. Total daily flow.._..... gallons. W g P P P Y Y .._... WSeptic Tank—Liquid capacity.._.........gallons Length................ Width......`-......... Diameter...-......___... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ tz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ri ------------------------•----------•-...........----......-----..............•••-----......_._........_._................-••--•---...... --------- ..... Descriptionof Soil....---•-•-------------------------------••---------.......---•--•-----------........--------.........-----.............--•---------•---...........•--•......-•-------•- x w ----------•-----------•------------------------------•----------•-•----•----------------------------------•------ ---------•------------• *---- ................_... x ...•------------------------ -------------------•--....-------•----._... --------------------------- U Nature of Repairs or Alterations—Answer when a plicable......... .'D d> P ✓ � �• ! �° ................. !R cd ....._7`sX.I.V- .....T...Is..!�-��1�Y!'� .......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has-been-issu@d.by the boa d 'health Si ed...... --- - --- ---- Application Approved B D to Date Application Disapproved for the lowing reasons:..................... = ...___ ..._.. ......... -••------•.....................................•-- ■•--- Date PermitNo..........- ..................._ Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF ..................................................................... (9rdif iratle_44 Toutphanu THIS IS TO CERTIFY, That the Individual S wage Disposal System constructed ) or Repaired bY----•.......................•-------•-----.....................P < ..... QeYL.. ............................... (.....�. Installer at........................................................ .s` .`!hlS a_ £ - 4.) �' = - .). ' ............................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ ........ dated------- .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............1 .....f -� ....................................... Inspector..... . ...- .. ---.--- ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c ...........................................OF..................................................................................... Fa�.....0," ..: Disposal Works Tunstrurtiurt f rrutit Permission is hereby granted....... .O Q.(zf.t ........_P-C2 'I�..t: T's................ to Construct ( ) or Repair) an Individual Sewage Disposal System `;- at No..--------Qa--5' ....'tt•1lSlj=--------------t?....+� ... .L..-..V� � Stree as shown on the application for Disposal Works Construction Permit No.Q!.1?S . Dated........ ................ ................. .. . . ............................................. Board of Health r: DATE........4!!. `.��........................................... FORM 1255 A. M. SULKIN, INC., BOSTON i LOCATION SEWAGE PERMIT NO. , ZJS TN%SL-e -.DR1vE g5-953 VILLAGE �E✓/��K?�1 l Lit INSTALLER'S NAME i ADDRESS 0 U I L D E R OR OWN ER DATE PERMIT ISSUED = _ DATE COMPLIANCE ISSUED r �7 44t ,�S�STt� ►cX�ft�..9EP[tr��yr f L Pam- .s �v PAR Real Estate System General Property inquiry Help Parcel Id! 171 074- - Account No: 99244 ParenU, Location: 35 THISTLE DR Neighborhood; 36BC Fire Dist: C() Devel Lot; 76 Lot Size; . 34 Acres Current Owng BARNICOAT, DANIEL E & State ClassE 13() SARNICOAT, WETTE M No. Bldgs: 1 Areal 1984 35 THISTLE DR Year Added. CENTERVILUH* MA 263:2 Deed Date: 020192 ReferenceR 7870/078 january ist: BARNICOAT, DANIEL E & Deed MMDDP 0292 Deed Re' 7870/0W--,, Comments9 Values: LandN 26800 Buildings! 84800 Extra Featurem Road System: 35 Index: 1711 (THISTLE DRIVE ) Frntg: 10C) Indew ) Frntgl Control info2 Last Auto Updo 050695 Statusg C Last TACS Updatw 12139:3 Land Reviewed ByP Date: 0000 Bldgs Reviewed By: ME DateN 039::..*, Tax TitleN Account', Takew Account Status: Hold Statum CanceJ.. Press XMT for more data Next screen PAR Action Owners Name Road index Road Name Parcel Number 171 075 ,P, A- A ---------------- - ------ TOWN OF BARNSTABLE DEPARTMENT/DIVISION VIOLATION REPORT EA L-rkf NAME (LAST, FIRS , MIDDLE) RACE SEX BIRTHPLACE ADDRESS (permanent) {� Cit /To Sta MA �� �0� ©� OPERATOR LIC. # OR S.S# STATE TELEPHONE # EMPLOYER ADDRESS LOCATION OF VIOLATION TIME .� DATE dl�Des oco I DATE & TIME OF INVESTIGATION PHOT GRAPHS TAKEN OFFICER NAME s VEHICLE/BOAT INVOLVED (YEAR, MAKE, MODEL, V.I.N. , REG. #, STATE) EQUIPMENT, I.D. #S (FISH & GAME ETC. ) HELD EVIDENCE TAG # MAKE, MODEL SERIAL # OFFENSES CH/SEC. ORDINANCE/REGULATION DETAILS & OBSERVATIONS: VOIAT122AI Ta �ALLL DlEi24kC—�6 Or L , 120)��L I A 41MN, Or- kAkAL"AR YL 0 A gE - Lk2:L o A ti-OW80 TO S / d,) aAV / 10 '7b � - 2�2c� 0 1 L i SUPPLEMENTARY REPORT DONE? CITATION #S, TYPE WITNESS: TELEPHONE # DATE: SUBMITTED BY: ® TOWN OF BARNSTABLE DEPARTMENT/DIVISION VIOLATION REPORT , y NAME (LAST, FIRST, MIDDLE) RACE SEX BIRTHPLACE ADDRESS (permanent) City/Town.- State ZIP r , OPERATOR LIC. # OR S.S# STATE TELEPHONE # EMPLOYER ADDRESS LOCATION OF VIOLATION TIME DATE ti DATE & TIME OF INVESTIGATION PHOTOGRAPHS TAKEN OFFICER NAME VEHICLE/BOAT INVOLVED (YEAR, MAKE, MODEL, V.I.N. , REG. #, STATE) EQUIPMENT, I.D. #S (FISH & GAME ETC. ) HELD EVIDENCE TAG # 1 MAKE, MODEL SERIAL # OFFENSES CH/SEC. ORDINANCE/REGULATION DETAILS & OBSERVATIONS: r , SUPPLEMENTARY REPORT DONE? CITATION #S, TYPE WITNESS: TELEPHONE # S UBMITTED BY: DATE: TOWN OF BARNSTABLE BAR-W 421 Ordinance or Regulation j (� �/ WARNING NOTICE A `" � o Name of Offender/Manager �d _ Address of Offender (, Reg.# Village/State/Zip p f 19 Business Name ,,y-°� )� am Irp_m)x on J Business Address ,2 grgfiature of�Entording Officer Village/State/Zip -'Location of Offense '- &5 / � L L 3/0 CMA 300 ORO Enfor(::'ing Dept/Division Offense VTa44c6 OF alp 00n/ nA/Gftdj) AO SPIUk--i�M4A0 Facts c,-)PIU .0 Or 09 . Gol p � r4' ) �I N6 ` _A5 f� l i� 12A ,�1„6- �. AIM Orf3b r This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary, compliance. Subsequent violations will result in appropriate legal action by the Town. TOWN"OF BARNSTA13LE BAR-W 421 f Ordinance or Regu llation , WARNING NOTICE w Name of Offender/Manager r y Address of Offender ! 1 M 7/FMB Reg.# Village/State/Zip s `tli � i� l� �( ..� Business Name ,-- am/(m; . on 194 Business Addressed oo y Signature ofndforcing Officer C� _ Village/State/Zip Location of Offense 13/0Cftl 0 9 Enfor ing Dept/Division Offense 'oei,,�c-,r OFC),&, 00niI)c AJG&j1pry) AdD- i govaD Facts �1� i! t' �!_... �/IUI �l�t 1 f do `r` 1�35 ellA / 1, U W n)::� d' This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. TOWN OF BARNSTABLE BAR-W 421 f Ordinance or Regulation .: ,, — � ,"f WARNING NOTICE ' Name ofOffender/Manager _.1 '.'c i%{ � � t ' `tC �. ' ,, Address of Offender .. ,fir , /;f % '� r MV/MB Reg.# Village/State/Zip �' ,_-f ,�'� AI � Business Name am/;pm,,m� on 19 €` �,� X • . Business Address f Fµ ttf Signature of Enfordi°ng Officer Village/State/Zip Location of Offense �� A ►�f..__ f f 1._ � /�.�t �.� l`—fPoV "i� � " � { off 1o00 Enforcing Dept/Division Offense .Y./A i . A41 Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. No... ............. F$s... ........... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ...Town...................OF..Barnstable .je I\- D�j .. ............................................ ........... . Application for Bitipusal Works Tonstrartivit trrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Thistle ...Dr.Z...Centerville............................... Lot 7.. ..�jo5e,..r2.r�........................................................ ..... ....ry ... Normest Homes Inc Address Ashley Dr. Centb�bl°lle ................_..........---...............-----•----•--•----------............._.............. ..........------.................................................................................. W James Dollovay Owner Five Corners RdAdditnterville Installer Address 15 000 Type of Building Size Lot..............9............Sq. feet Dwelling—No. of Bedrooms.........3................................Expansion Agtic ( ) Garbage Grinder ( ) Other—Type of Building WOOd Frame No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................................... Design Flow-------------------- 300----•-------------------------------•--- W g gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.DQOgallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... W34S.I(Me..... Total Length.................... Total leaching area---- @-.......sq. ft. Seepage Pit No..................... Diaineterb_Ri..P....C-K- Depth below inlet.................... Total leaching area.. .._....._.....sq. ft. Z Other Distribution box ( ) Dosing tank (. ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.................. �Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W --•-------------• ....-------•------------••-----....................--•-••-----.................----------•-----•-•-•......_......----•--•----..........••-- O Description of Soil...........Sand...&-__gravel x W x •-----•---------•--•--------------•---------------•---•---•-.........-•----------------•---•-•----•------------------------•--•-------.._...-••---------•------•----•------•-------•-•------------... 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 13 en issu UdbeLoardof healthVa Sia -- . .--------•....... ....... :m,G,, ................... ................................ Date A Approved PProved B Y = = ��GL L _----------•--•-••------- .�-�-Z D te' - Application Disapproved for the following reasons:..... -------------------------•----•---•--------------------------------------------........------.._..........-----------•--••-•-----------------------------------------------...-•------•---•••--......._. Date PermitNo......................................................... Issued........................................................ Date No.., .. _........ Fizic._2........J. ......._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........T'o ..:...............OF... s. bh....... , rlta inn f>�r Dispsal Murky ,C onstrudiun Vami# Application is hereby made for a Permit to Construct .(. ),,or Repair ( ) an Individual Sewage Disposal System at: _'Thistle �3r� .Cel^.tQrvil�... ..... �,t......�5................................,....................................................... 1rEIlE'S i;. Homes Lrl�C Address............................ A€� 3 e D ' C Lb 1!� ........ . ..... 4 ...... .... ......... ............. ......... .... W Jame s Dolloway Owner Five core er s' k�e��aa ntervi�.1e................ = . ..........................................................• ............. ••• ....._............a.....:-_..-• ---------- Installer Address UType of Building Size Lot------- _..Sq. feet �-, Dwelling—No. of Bedrooms......... ........---------------------...Expansion A�tic ( ) Garbage Grinder ( ) P4 Other—T e of BuildingV 9X' "N, o. of persons............................ Showers ( ) — Cafeteria ( ) Other fix t Is ....................... --.-• -• ---•--••-•--••-I...................... Flow..... 00............ -------------------- Design .............gallons per person per day. TotaLdaily flow....__..:__............:.........._._....___gallons. W P MIg ► e � a Diameter................ Depth................ D s osal T ench 1 No c..acit :.......\N dt s Lemon Total Len�Width................ToDtal leaching area. sq. ft. Septic —Liquid P Y x � � C Seepage Pit No..;.................. Diameter... .....____ Depth below inlet. ............ Total leaching area. � _.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.= --------------------- Test Pit.................... Depth to ground water-.____--_--________--. 4, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 �AI3t.. O Description of Soil.....------ ..�:..gr8..t® ..........-•-------•-=--------•--..........................................................................................-------------------••-------------•----- -----------•--•--------------....•..---. x U ------•---•-•-•--•---••----••-......•••..............•-•-. -••........,•--•---•-•---•........_..•••--•-•--•------•-•-.....••••------•--••-•••-••----•-•-•-•--•-•--•------...........---••----••----•--- 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 en issu�efby the oard of health. 44-ASi e � ►.... �...._....-•---. ................................ f �+ Date Application Approved By.... to /r Z"-. Application Disapproved for the following reasons:..-----........... ...........................................................I............................. Date PermitNo......................................................... Issued....................... ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstabl ..........................................OF....................................I................................................. Tatif mate of Tourplianrr THIS IS TO CFRT11 DT©h t,©e ndividual Sewage Disposal System constructed ( ) or Repaired ( ) bY---•--•-------------------------•-�._� .--.-- ---.1 .---------------- -------- ------------------------------------.-------------•-------•---•---•---•---..------------------ Lot 75,14s tle Dr., CehUr ville at........................................................................... has been installed in accordance with the provisions of Article XI of The State Sanitary Code as desc 'ibed in the application for Disposal Works Construction Permit No.__..:...................... -__1__., dated.---- 7. -.._....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector-...... -..._�......--`-•---��..�_L.�_. .-- • --.. �.�.n,...:.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable d ...............................O F.........................................-•----...._................................. No.....1 13---•-- FEE ................. uisp4saal 1U rkp C n r�trfiun truth amen o oway Permissionis hereby granted.........................-.................................................................................................................... to Construct ( ) or Repair ( an d' dal, wa a Dispo S stem Lit ?5 W s U,e fir. en erville atNo.. ....................................................1..- ----.....-----........................................ ....h........... .. .. .....Streetas shown on the application for Disposal Works Construction Perm N ._ . ..�-' Dated.__j%�/.. ............. •----- .....:cam- ----- -- ..r*.'%� ................................_ �,'�� ..,1 / i✓y� Board of Ficait DATE .................. ........ / FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS CENTERVILLE FRONT 60.2 aI o a 4 LIVINGROOM BEDROOM P0�X BATH \ �• � GARAGE HALL 1000 GAL.LEACHP \ � KITCHEN BEDROOM BATH BEDROOM (TO BE(PUMPED / \ �� RS r�cY� O q�'F AND REMOVED) 00 � / BOO, X0.1 N J` 4 HOUSE #25 FLOOR PLAN p ��P� \ .^, O \ O BENCHMARK: 00 TOP OF NAIL Z t @ARo '\ / DATUM: G.LS.t •'" .� PINE \ `\ LOCUS INFORMATION 600 GAL. PLAN REF: 247/84 O\ \ LEACHPIT TITLE REF: 19614/258 LOT 76 __ / $ 00, 60.0 (TO BE ABANDONED PARCEL ID: MAP 171 PAR. 75 IN STATE ZONE II S ( \ PER TITLE 5) ZONE: "RC" "GROUNDWATER PROTECTION ZONE" (GP) / ::�jp, \ FLOOD ZONE: "C" BARNICOAT , Dc0 _= — 24-B / COMMUNITY PANEL: 250001-0015—C DATED:08/18/85 PARCEL ID: 5� - PG INE ::. PINE (TOWN WATER ��� __ GPI / \ G <: : , 02", . ... �9. `1�>, \\� SEPTIC SYSTEM ( ) � � \ \ REPAIR PLAN ® P� PINE \ 59.8 LOCATED AT: #25 'gyp #25 THISTLE DRIVE N/F 3 BEDROOM PIN / \ so CENTERVILLE MA. ` - — r' � _ CHAFETZ ___ DWELLING �, GPSj \ PREPARED FOR PARCEL ID: _ 171/096 — = r. JOHN M . JR. & AMY E. (TOWN WAT TCF=63.60' / / GRIFFIN LOT 75 __ APRIL 1, 2009 s� AREA=15,000 S.F. ��p�0 �HOF.'►�s � ����1HOFn�yss �o PARCEL ID: pp, ��o EDWARD 171/075 M. o " ��,, �LOT 74 MEVER U STONE F N/F No. 1140 NO.2898 WELNINSKI PARCEL ID: SANITAa\ NITAV �o 171/076 P N/F . �tx0� (TOWN WATER) v -o1 0� PROAL �0 5��h .` E & S PARCEL ID: �- ' 171/097 GRAPHIC SCALE �.'' ROUTE 6A (TOWN WATER) SALT POND BUILDING 20 0 10 20 40 80 P.O.BOX 2729 SANDWICH,MA 02563 EDWARD A.STONE I IN FEET ) CERT.TITLE V INSP.&S01L EVAL. RPLS•28980 1 inch = 20 ft. BUS:(508)8883619 FAX:(508)8$8.2496 RFS:(508)398b813 NOTE: EVERY PROPERTY WITHIN 150' OF PROPOSED S.A.S. IS ON TOWN WATER SUPPLY. SHEET 1 OF 2 J 1176 TOP OF FOUNDATION ELEV.= 63.6' 2" LAYER OF MIN. PITCH U/8" PER FOOT PROFILE O F 1/8" - 1/2" SEWAGE DISPOSAL SYSTEM DOUBLE WASHED STONE 10' MINIMUM--� (NOT TO SCALE) OR FILTER FABRIC f EL= 61.7' EL= 61.6' , 6" MAX:" ............::� g EL= 61.5 EL= 61.0 6" MAX. ....,.,..,. ADD ADD ; ;.;,. ...,..,,..............:it:;.,,. ......, RISER IS ER & CONC. INVERT CLEAN SAND FILL COVER COVER RISER & EL= 57.8 '� �' 9 MIN./ EL= 60.08 FIRL2j' ���,� PER 310 CMR 15.255 36" MAX. COVER EXISTING PIPE 3' S= .02 EXIST. EXIST. FLOW LINE =09 EL= 58.5 INVERT INVERT 110" 14" INVERT I"RT INVERT ° ° ° ° 0 0 0 0 0 (_� 0 M77 EL=59.25' INVERT0' MIN. EL= 58.83 E6" SUMP INVERT8. " ° ®° o° 4' ADGAS 24 0 � o � C� OC� O 0 0 0�06` BASE OF MECHANICALLY p o BAFFLE COMPACTED SAND o ° EL= 55.8 PROP. DB3 ' DISTRIBUTION 4'0 8.5' 4.0' EXISTING BOX 3/4" TO 1= TYP 1/2" ( . 25' 1 ,000 GALLON TANK DOUBLE WASHED STONE 2-500 GAL. (H-20) DRY WELLS (4'-10" X 8'-6" X 3'-0") (TO REMAIN) SOIL ABSORBTION (TRENCHFORMATION) cD SYSTEM (S.A.S.) 12.83 X 25 I CERTIFY THAT I AM CURRENTLY APPROVED BY THE;DEPARTMENT OF BOTTOM OF TEST HOLE #2 ELEV.= 49.2' GENERAL NOTES ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT NO GROUND WATER SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS DESCRIBED IN 310 CMR 15.017. 1 FURTHER CERTIFY THAT THE RESULTS OF MY DESIGN DATA: FOR SUBSURFACE DISPOSAL OF SEWERAGE. SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, 2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ARE ACCURATE AND IN ;�ODANCE WITH 310 CMR 15.100 THROUGH 15.107. ACCESSIBLE WITHIN 6' OF FINISH GRADE, WITH ANY REMAINING r ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. q NUMBER OF BEDROOMS.........---3- 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE / CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE GARBAGE DISPOSAL.................__ NO _- ':UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY EDWARD A. STONE, CER IFIED SOIL EVALUATOR TOTAL ESTIMATED FLOW MUST WITHSTAND H-20 LOADING. (110 GAL./BR./DAY X 3 BR.) __330 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION TEST PIT RESULTS: 330GPD X 200% = 660 GAL OF ALL UTILITIES PRIOR TO ANY EXCAVATION. USE EXIST. 1000 GAL. SEPTIC TANK 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. SOIL TEST DATE: MARCH 25, 2009 INSTALL: 2-500 GAL. DRY WELLS (W/4' CRUSHED STONE 6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE OVER THE S.A.S. AND DISTRIBUTION BOX. B.O.H. AGENT: THOMAS MCKEON ON THE SIDES, 4' ON THE ENDS) AND BACKFILL 7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF SOIL EVALUATOR: EDWARD A. STONE WITH CLEAN SAND FILL PER 310 CMR 15.255 SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6' ABOVE THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND BACKHOE: JOHN CONDOM SOIL CLASSIFICATION................ LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN DESIGN PERCOLATION RATE..... 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT EFFLUENT LOADING RATE......... ELEVATION OF THE OUTLET PIPE. TH#1 EL.= 60.5 (PERC © 54 <2 MPI) REQUIRED LEACHING CAPACITY.....330 GA�DAY 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES. 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS ELEV. DEPTH IN. HORIZON TEXTURE COLOR I MOTTLING OTHER LEACHING CAPACITY PROVIDED.....349 -GA-DAY BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. ""59.84 0 -8 OEA LOAMY SAND 10YR3 2 10YR5 1 N/A LOOSE SIDEWALL: 12.83 + 25 X2X 2 SIDES . = 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND / � ' '( ) ( )( 74 112 GAL/DAY) FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL 57.83 8"-32" B LOAMY SAND 7.5YR6/6 N/A FRIABLE BOTTOM: (12.83' X 25')(.74)= 237 GAL/DAY BE LEVEL. -- 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION 49.5 32"-132" C COARSE ! 2.5Y7/6 N/A PERC TOTAL= 349 GAL/DAY TO EAS SURVEY AND APPROVAL. INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW NO GROUNDWATER ENCOUNTERED w/coeBL 349 GPD PROVIDED - 330 GPD REQUIRED = 19 GPD RESERVE 13. PROPOSED SEPTIC SYSTEM IS WITHIN STATE APPROVED ZONE II �H OF A(q CONSTRUCTION NOTES: D.61=.2 TH# EL2 SEPTIC SYSTEM DETAIL PAGE 1 ti 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND ELEV. DEPTH IN. HORIZON TEXTURE I COLOR IMOTTLING OTHER EDWARD cyG #25 THISTLE ROAD ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING co ' » � MEYER g WORK ON THE SITE. 60.54 0'-8 OEA LOAMY SAND 10YR3/2 10YR5/1 1 N/A LOOSE o A CENTERVILLE, MA. 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE 58.37 8"-34" B LOAMY SAND 7.5YR6/6 N/A FRIABLE q NO. 1140 STON c No.2898 WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 49.2 34"-144" C COARSE SAND 2.5Y7/6 N/A PERC ��G1$TE �% 90� APRIL 1, 2009 IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. SgNfTAR�P� R / TE 3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING NO GROUNDWATER ENCOUNTERED w/COBBL 'N o SHEET 2 OF 2 J# 1176 TAPE OR A COMPARABLE MEANS. Off' r