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HomeMy WebLinkAbout0138 BETH LANE - Health fH LANE y Il • s { P e 01 L ED 0 0 lip- 'Ll\nNGAREA 15"sge -g- �3 Lin Town of Barnstable Health Inspector oFtHE Office Hours do Regulatory Services 8:30—9:30 ; Thomas F.Geiler,Director 1:00—2:00 &UWSTABM s6gq. Public.Health Division qje A10 _ t Fo�� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508=790=6304 AMNESTY PROGRAM APPLICANT - SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: °3S Address: 13t g�L Apq= MapR�L Parcel Name: �y Qi✓���ir. 0 Phone #: 7 37— O S� l 2a. How many bedrooms exist at your property now?-,3 2b'. Are you planning to add any bedrooms? If yes, how many? 2c. How many bedrooms total are proposed at this,property(including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms.in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If the wellin g is connected to public sewer,�skip.questions#4 through#9 below. - t it Locati n of dwelling is �SID 'or OUTSIDE a Zone of Contribution to public supply wells? Is the d, elling connected to an ONSITE WELL or to PU LIC WATER? .1,,jIs a dis 1 works construction permit on file? YES or NO If yes, ow many bedrooms were approved according to this permit? Bedrooms. :70Vere an building permits obtained for construction of additional bedrooms? YES or NO �. c-,, 8. Is there an engineered septic.system plan on file at the Health Division? YES or .NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or ; NO ' FOR OFFICE USE ONLY Pheublic Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: (Y7 Q;/health/wpfiles/amnestyapp ^�j �l�d 7 + JAY, ,3 2007 10: 28AM N0, 643 P. 2 G r CN i a I i 30. 2007 10 : 28AM N0, 643 P. 3 �45 V1� I i i ' )0 ,' 1 : 05AM N0: 691 P. 1 Town of Barnstable HealthIisp,-,ctor Office I°l:rurs Regulatory Services 8:30 9:30 1:00 Thomas F.Geiler,Director ll.iR'1:rd.SIE. x ;; Public Health Division Thomas McKean Director 200 Main Street,Hyannis,MA 02601 3 (A62-4644 Fax: 508; 7::'0-6304 `k NESTY PROGRAM APPLICANT -- SEPTIC QUESTIONNAIRE C Information: Size of Property_ [� s ;. �/ �. Map l Parcel /� � LA 31 4Phone 0: 7 3 —D C' 1 3:o a`zaany bedrooms exist at your properly now? .�,.r; ,y ou planning to add any bedrooms? If yes,how many? a 1knvinany bedrooms total are proposed at this property (including the amnesty unit)? Ir id. Flea se include a copy of the floor plans for the fire property-.showing the existin o oyrn) in the home.plus the proposed amnesty apartment and/or addition. Please label ;,': ;room clearly on the plans. c 13 :ne dv, lag connected to public sewer? YES or NO m v tilling is connected to public sewer,skip questions#4 through#9 below. �t ocatiaf dwelling is INSIDE or OUTSIDE a Zone of Co bution to public supply wells? VQ ling connected to an ONSITE WELL or to PU C TER? am 1..3 cl-Joosal works construction permit on file? YES or X(i' If yes. how many bedrooms were approved according to this permit? BedroonL;. Were an),building permits obtained for construction of additional bedrooms? YES or Nt1 Is tae,C sa engineered septic system plan on file at the Health Division? YES or N�:7 Ha:tide:septic system been inspected by a DEP certified inspector within the last two years? YES or 119 FOR OFFICE USE ONLY 'le'.Niblic Health Division has no objection to bedrooms at this property. :�e;cial Conditions: Date: 'hea dth.4- rileslamnestyapp % i:007 11 : 05AM NO. 691 P• 2 CN 1 f . .).)0' i 1 : 06AM NO. 691 P. 3 3!96i: v 1 .4 117� . — e!NRf ! UN. 26. 2007 4: 23PM N0, 756 P. 1 Town of Barnstable Health Inspector Office Hours �L o Regulatory Services 8:30-9:30 Thomas F.Geiler,Director 1:00 0 2:00 MRNSTAR9 �g Public Health Division Eb39' �0 _ 'Fo Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-63N. AMNESTY PROGRAM APPLICANT-SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: &j 0�11 Ma a-7 Parcel Name: Phone#: 23� _o s 7 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? W If yes, how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? Zd. Please include a copy of the door plans for the kZ�roperty- showing the existin /4,V L7,2.15( rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. (' 3. Is the dwelling connected to public sewer? YES or NO If the dwelling is connected to public sewer,skip questions##4 through#9 below_ 4. Location of dwelling is INSIDE or OUTSIDE a Zone of ConLribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to pU C TER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms.. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO FOR OFFICE USE ONLY The Public Health Division has no objection to_` be ooms at t s property. Special Conditions: WA2Z 6- i 1 P&AIV log Signed: Date: Q;/healeh/wpf les/amnesryapp o AN. 2 6. 20077 4; 2 4 P My BARNSTABLE BOARD OF HEALTH 'NO. 7561 `P. ? I ...oausm•1 1 �n CN �� JJ M ° � r .� C>Ll e93 T7 r, -T 10 OF r � • a.1 r 0. 53AM NO. 690 P. 3 v r H ll 1 i f C t . ". !001 0 ; 53AM NO, 690 P. 2 CN ui j r - - �I .__- - __ �= __ ' i.. _ r � � 1' Ij -.__ . ^_ r C � .. - J - - , �. __ r �. ' L '� r- __ ....___ n (((7 9 c ti` (� Efl F; j .. ..ax.i �...; -.__._, - -- - L k4YPfv t`) C L` !d t V _y i f � ?A ��1 a Y S r Lan Y p Iz 3 ....s ;o•.y a e B , F. i _ a _ �i d✓� s cis cL.__ - _.___- ---_.. __--_-__ _--- -- ----.____ ----_. ._.. __ --_ ___ . __ ,__ 1 Cf, _- ------ +T- �'0.p���C.a{. 1� .� a' �,•�'W � ��"4 r ..F � � � .r^ �'.'�'k'"„-;r'�e i rFs '�Y.,,� f. Fes- a��-."6...k�•'A...._� i*• �_.ly�•,�., _ i :. . '. TOWN OF BARNSTABLE ' LOCATION 04NC: SEWAGE# Z60 r �D VILI:AGE f�l 1 r"t �. (� ASSESSOR'S MAP & LOT z, Z."l S INSTALLER'S NAME&PHONE NO. /'J'� 6 Cp,�co 568 7 S—"2�00 SEPTIC TANK CAPACITY C 1 S I i° .5 �G rig LEACHING FACILITY: (type ��� f4.�ha Ckl CS (size) Z� -I�� � "X�� NO.OF BEDROOMS BUILDER OR`OWNER � PERMITDATE: COMPLIANCE DATE: S 6 r ' I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Phvate 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.ezist within'300 feet of leaching facility) Feet '. Furnished by J. f yywp�6}yr 4 z 1 32- i � Z t r • v 1 c _ _ . � s _ ..�� ' � Y -. � e ` V I 1 �. - •_y�. k .. r ' V`. q .- • � —^ (\��( �� �m. � � a 3 -� � � � � _ - � � ` � � M �. -. .,. .. �3� .. A, �. � , J �� . �� . . . �- � - .. � M o -� YOU WISH TO OPEN A BUSINESS? For Your Information`. Business certificates(cost$30.00 for 4 years). A.business certificate ONLY REGISTERS YOUR Kin in town (which you must do by M.G.L.-it does not give you permission too operate.) Business Certificates are available at the Town Clerk's Office, 9 Y p P abl h f e 1 F). L., 367 Main Street Hyannis, M - v A 02601 (To wn Hall) ) DATE: 1t a ME M a W Fill in please: APPLICANT'S ,YOUR NAMEM-lor Pui BU I.NESS YOUR HOME ADDR S.S: 337 ZI TELEPHONE # Home Telephone Number -7 7� NAME.OF NEW BUSINESS ALL. ZV_.1q- PfG vclrw%;�0 TYPE OF BUSINESS r c.Yyy,, u CP IS THIS A HOME OCCUPATIONS YE5 N Swc ' `G�' Have you been given approval from the building division? YES.'V NO ADDRESS OF BUSINESS / l G,L) MAP/PARCEL NUMBER /5 When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFI This individual has n infor of any permit requirements that pertain to this type of business. Authprize natu COMMENTS: 2. BOARD OF HEALTH This individual has VnCmed of th rmit require en that pertain to this type of business. W-14 u oriz d Si rat re* COMMENTS: o4�2.v►t�, �► �e �►zw,�► rf � S t-e � c. p��� me � ' 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Date: 7 /'�2/ /06 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 't. , S Eswlle .Q BUSINESS LOCATION: INVENTORY MAILING ADDRESS: St"M e_I f TOTAL AMOUNT- TELEPHONE NUMBER:(S-I)k) -7 37-03�P/ CONTACT PERSON: dVl Ar1,P1 Al- Ftrre'yol EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMME DATIONS: Fire District: 4 Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides . (, NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) . lubricants, gear oil NEW USED Degreasers for engines and metal, Printing ink Degreasers for driveways &garages' Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine - - Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes • r Z' Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED = Any other products with "poison" labels Paint&varnish removers, deglossers '` (including chloroform, formaldehyde, Misc. Flammable§ hydrochloric acid, other,acids). Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please"Fist): Laundry soil & stain"removers (including bleach) v Spot removers &cleaning fluids �e 4 Q�n�h (dry cleaners) Other cleaning solvents 14 ; 2 Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/C COPY-BUSI 4. Health Complaints 18-May-06 Time: 2:40:00 PM , Date: 4/13/2006 Complaint Number: 18752 Referred To: DAVID STANTON Taken By: SHARON CROCKER Complaint Type: CHAPTER II HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: 1 No. ?i � �V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for Mi$poml *patent Cow6truction permit Application for a Permit to Construct( )Repair( Upgrade Abandon( ) 1:1 Complete System El Individual Components Location Address or Lot No. l3 R SLR O ngF's Namce�Address and Tel.No. h�rAn/liS ! <�/�v�rt25 �/7• (oI8 •`�ta`� Assessor's Map/Parcel Installer's Name,Address,Ad&0oCANC0 Designer's Name,Address and Tel.No. 350 Main Street W. Yarmouth;1MA 02673 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /OUP PX%r in Type of S.A.S. Description of Soil Nature of Repairs or Iterations(Answer when pplicab e)2 75-m l t • 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 EnvironmWital Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of 1 Signed 6� Date S ?"O 1 Application Approved by Date S` O Application Disapproved for the following reasons Permit No. t— 26 Date Issued g A .. _ ..... - , - ., _ •_. . �` - �ram-.:�, .� _ :.. r:,:,;,:i. No. y —�b e� \ Fee �lJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migpoga1 *psSter ,C_ottgtruction . Permit-, Application for a Permit to Construct( )Repair( �Upgrade( )Abandon( ) ❑Complete System ❑Individual'Components Location Address or Lot No. 3 G> �4 1,L k. O n is Na Address and Tel.No. L a q Assessor's Map/Parcel a�a _ �S�. Installer's Name,Addres rC.AN C 0 Designer's Name,Address and Tel.No. 350 Main Street W. Yarmout� ��A (j - r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /QOIJ (eA`ir r.z Type of S.A.S. Description of Soil Nature SG o f Repairs or �terations f(Answer _whenlplic �be�) 2, 5/ y -.5 IQ , 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 Environm tal Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of )al Signed Date Application Approved by Date Application Disapproved for the following reasons Ir 5 Permit No. "Lvm t— ZC Date Issued b a' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired Abandoned( )by ,_1 0 C at ; '¢4 / ,` �9/1/7/ S has been constructe4 in jaccordance with the provisions of Title 5 and the for Disposal System Construction Permit No.?XV 1-zG dated S 9 0 Installer Designer The issuance of this pe shal}not be construed as a guarantee that the system, ill 7.K dew /p Date 3S�/©/ Inspector No. ZCJO 26,� ---Z 7 Z —LS—t,?r----------Fee — S Q— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Miopool *potent Con.5truction Permit r Permission is hereby granted to Construct( )Repair( 4_<P`irade( )Abandon( ) System located at /? ��e f`7 �if d1 Q / 1•- , and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mus be ompleted within three years of the date of this p Date: 9 v Approved by 1/6/99 NOTICE: This Form Is To Be Used.For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, C64 XbI-0, ` , hereby certify that the application for disposal works construction permit signed by me dated �- d / , concerning the property located at l3 -� � I, ,,- meets all of the following criteria: This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. / The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. /There are no wetlands within 100 feet of the proposed septic system / There are no private wells within 150 feet of the proposed septic system / There is no increase in flow and/or change in use proposed /• There are no variances requested or needed. / The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen (14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) . B) G.W. Elevation S.3 +the MAX. High G.W.Adjustment.Q.(I DIFFERENCE BETWEEN A and B J7 SIGNED : DATE: - < —U [Please Sketch proposed plan or system on bacl<]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert 1 0 d a. No------------ ..... THE COMMONWEALTH OF MASSACHUSET •TS ®®AR® ® TH f.. - ..... ...................r --------------OF..... ...... .... , ppliration for Uigpniia1 Works Tomitrurtiun ramit Application is hereby made for a Permit to Construct (/<,) or Repair ( } an Individual Sewage Disposal Syst44 em at X11........ s L a• n- ddre or Lot No. �3 ..., ......Z�;:Tk� -•A1.?.l_.------••---.............•--•-----------•--•---...------ wner Addr ss ............................................ ......... Installer Address Q Type of Building Size Lot___ ........Sq. feet U Dwelling—No. of Bedrooms._..._...%?................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................. ( } ( ) ._._.._ Showers — Cafeteria QOther fixtures -----------------------------------•-------------------------------------------------------------------•-----•----------------•--•------------------- W Design Flow...........rJ'—4��........................ per person per day. Total daily flow-------------?3®.....................gallons. WSeptic Tank—Liquid capacity/®----gallons Length____9=_____ Width....$_ ___ Diameter________________ Depth.__Ez..._.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../.......... Diameter./__Ua. ____ Depth below inlet___ t_O..... Total leaching area.A;?Y......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.._ 4_ PftfIS3RN_44........................................ Date..... ....................... a Test Pit No. l.4_6�.......minutes per inch Depth of Test Pit...../3........_- Depth to`ground water___.60TFoceV,0 (i Test Pit No. 2................minutes per inch Depth of Test Pit.../I............ Depth to ground water__eVAZ_FGt^/,V P4 ---------.•------•-------•-••--•-•-•---•---•---•---•-------•--•----•----.-••---------------------------------------------•-------------------------•-•---- 0 Description of Soil........MU:jo--_n�!�25�__-_-_ �i51Q_ e2 f!� ---------.REF.---- ?_#__ _ .3- --------------- 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'TT LE E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ApplicationApproved B Sig ----- --- -------------••---•-•-----------•-----•---------•---•--------•----- --•-----------------....._.....- Date A PP PP y-•-••• I L y � 1 Date Application Disapproved for the following reasons:--------------•---•-----•----------•-----•----•--•-•----------•-•-••--• ........................................ •--•----•-•---••-------------•---•------------•--------•--------..._.........---••--•----------------•-----••-••------•-••--------•-------------...---------•-•--------.............------••---...._.._. Date PermitNo......................................................... Issued_....................................................... Date COP/ No.--•-•----- .. Fmc...:�..4................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T , Applira#ilan for Elhgp a al 10orkii Tonstrnrtalan Prrutit Application is hereby made for a Permit to Construct (X,) or'Repair ( ) an Individual Sewage Disposal System at ............ •-••••-----------LU-......----.-.'-..-. ------------------------------------------ 4- XL a ddre or Lot No. —= g�TH LAt�1� ss W_et._....--•--•------•-•--------•---------• �-!�t�✓l���S d7S � staller Address Typ of Building Size Lot__'�_evaU__.......Sq. feet U Dwelling—No. of Bedrooms_______ .............____________________Expansion Attic ( ) Garbage Grinder ( ) aa e of Building ersons_________________ ________ Showers — Other—T Yp g ---•--•-------•------------= No. of P --- ( ) Cafeteria ( ) QOther fixtures --------------------------------•---------------............... ------------.._..._...._..--------------------------------------..___....__......-•-- Design Flow..........5`+.........................gallons per person er day. Total daily flow-----------3_ &....................... WSeptic Tank—Liquid capacitvA'�q.....gallons Length._. Width---5_.F._.._ Diameter________________ Depth...S x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage,Pit No-------e----------- Diameterl�'.y__:_----- Depth below inlet__G"..v_______ Total leaching area-'l;�y_......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed A�Rt3As.?k•_-•••---•••-••••....................... Date_____.3_�_3l_�$__0................. Test Pit No. 1 ------minutes per inch Depth of Test Pit-----/3_._.______ Depth to ground water_. GTfo�N/� Lz, Test Pit No. 2................minutes per inch Depth of Test Pit--- ............ Depth to ground water. a ...................................................... ---•••-•••--•-•--••••••--•.........••••-•••--._.._.__......••---•---- O Description of Soil------�YJ£/J - e o/�2. f------S ti�,J- G/I r t- Rr BEST = ....... ------------- V --------------------------------------------------- •----------•-•---•-•---------•-----------------• •------=----------------------•------•--------•------------------•---•------•--- . VW ••--------------------------------------•---------------._..._._.:•-----------------••---••••-•••--------------=--•---...--------••------------•-•-•-----•-------••-•-__.._.------...•••-•-......... 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:T`:?., 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sigd ••• ••• --••••-•-• ...................---•••-••••--•-•-•••••- Yi(,Aj �� (io' uu Dat Application Approved BY 7 -�.". D_..••---•-- �� Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________. -----------------•-------....----•-----------•---------------•-------------------._...--•--•--••-••••-•-•---•...................................................................................... Date ^_. Permit No......................................................... Issued_..............................._.............. --------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............i/..( d(/.V%..........OF............ . ...... r..... ................... - � Tr�i�irttt.e off�rrntpli�anrr • THI IS TO CE IFY�: hat the Individual Sewage Disposal System constructed r Repaired ( ) ' by........... .. _ -..._.{ .�-Gs1��G�=` -••-- - Inst----- 21- at....."' eft > 16 L4at d p�� lcL.�' has been installed in accordance with the provisions of mT 5 of The State Sanitary Code as des r bed in the application for Disposal Works Construction Permit No.- ._�.__.__/y�.�_'________________ da.ted___._.y:. _."1 ...._____.____._.,_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS.A GUARANTEE.THAT THE SYSTEM. WILL FUNCTION SATISFACTORY. DATE.................._ _/_�',�___- I f� ........ ............---------- Inspector__ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH OF............... .i ,` .. = ..................... e.. ..... No _- ..._>17y... FEE..............:......•.. vp Permission i he granted---••-• d ------••--- ___...-•-•••-•-----•--••-••- ;.° Q • .. ......-- to Construct or Repair- ndivid al Sewa Disposal System j�Jf*/ /��j Street as shown on the application for Disposal Works Construction Permit ............______4,,ate .....+�_/__.____.... _ 3d -•--• r ....... �- / Board of Health DATE-----------------•-----....----...----------................................... ,\ FORM 1255 HOBBS & WARREN, INC.° PUBLISHERS - r SECTION - SEWAGE SEPTIC TANK - "D" BOX - - LEACH TOP OF FDN 70.13 (MSL)r "2"OF I/8TO 4z" - - - - - - NOTE: WASHED STONE _________ REMOVE ANY UNSUITABLE MATERIAL FOR A DISTANCE OF 10 FT.AROUND ENTIRE LEACH_ AND REPLACE WITH CLEAN COARSE SAND. G7 f f i N OUT IN- OUT- IN- _- Ic' r-- I 00c) G J _ SEPIAL 0. r TANK ..ELEV., ELEV. ELEV. -�:lL•_���/ P; ,\ i ELEV. Qo ;) - /J E 5.87 / ELEV. ELEV. _L.. lov a 1 NOTE: — Z BRING ALL COVERS To WITHIN ELEV. - - OF 3A" 14.+' ! FT.OF WASHED STONE — `J f 14 ~ FINISH GRADE. TEST HOLE LOG w. P-2-g8 __ E-LF V.' i y o . PAUL I1(I('RRAY TEST BY hr FHR�fl+=yl`i)'9 BMN5 TAFAL F 5QARD _QE__L-IE:ALTh-4 TEST DATE NIAR. 31 i 138( W1'TN SS DESIGN BEDROOM HOUSE1CC'q, T.H. # 1 T.H. �/ s� -w1rFk PROF'�SPA '15; pfT 'y 0 -- �G l ELEV. 68.G2 Q ELEV. laf.u� NO / f`I'Vi(^f$ JLM9 w �.,�'• DAM Loaµ DISPOSER � h� _p0• ugcol� PERC RATE 4-_2 MIN/IN. 1,01P Fow. 2 I 56 OL 2 66 at FLOW RATE 330 (GAL.�DAY) 3 O E4 '�G'g a i'aw-SANDra„es SEPTIC TANK 330 11.51= 49'� !mow `M� °po 6'.8 it �FrM' 2 N REO'D SEPTIC TANK SIZE GrEAr,�ql(� r o a QRAilFL G rq FZS rtq- *9I 6 G2.o'- 6 - rc2.o L LEACH FACILITY / ! ^� 67 - �Qa SIDE WALL . IL. 1f' 2.5 ) 5 G/D. MED � cpN Ly 5AN p BOTTOM (I(L 9)2('74) ( I.Q 1 _ 8 14P G/D. \ 1;'vmg 1 SOME TOTAL - 580 G,/D. f za I O f ' USE: ONE LEACHING P I T 13 —'- —55.ot; -- N WATER ENCOUNTERED 6 DEPTH x 10.5 EFF. DIAJYIi~TEf�, NOTES: (UNLESS OTHERWISE NOTED) / 1. DATUM(MSL)-TAKEN FROM._ Lj_YAN1.,kj_L ...............QUADRANGLE MAP tµ OF 2.MUNICIPAL WATER-------------------_ A .__.........AVAILABLE 3. PIPE PITCH: 1/4"PER FOOT , 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO- -44 � ; 5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. '' DISTANCE AS CERTIFIED LOT 31 6. PIPE JOINTS SHALL BE MADE WATER TIGHT " 7. CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS.STATE ENVIRONMENTAL CODE TITLE 5 . 1 HEREBY CERTIFY THAT THE BUILDING WE PLAN {51' SHOWN ON THIS PLAN IS"¢5'�✓' GROUND AS SHOWN HEREON& THAT NITHE_. _ LOCUS. BE'TH LAN I- ONAL CONFORM TO THE ZONING BY LAWS OF THE TOWN OF —_-- H`r'ANN IS (BARNS 1-AUL.E) MA55. REG.PROFESSIONAL ENGINEER WHEN CONSTRUCTED. DATE REF —PO LAN 1 QK 271 1, PAGE 83 down CApe engineering PREPARED FOR: BILLY E. CAI I-HF N4 CIVIL ENGINEERS LAND SURVEYORS BOARD OF HEALTH REG.LAND SURVEYOR CONTOURS ((EXISTING)------------- III:: 3cI 4 I (PROPOSED)—O—O—O--O— APPROVED -----DATE MA Yarmouth&Orleans,MA SCALE DATE Ri- n