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HomeMy WebLinkAbout0135 CARLOTTA AVENUE - Health 135 CNROL0KIA AVLI., HYAA,NIS A=248-M i ! f I No. (� V0 1 THE COMMONWEALTH OF MASSACHUSETTS FEE D BOARD OF HEA TH G 1 — OF APPLICATION FOR DISPOS L SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct Repair � Ugrade Abandon ❑Complete System Individual Components c y catio Ow er's N Map/Paicel# ` ress I�� VV AAA a C - ^,_ )Iw I,oy# /y,�, tG . Teleph e# �1x ) Installer's Naam—e —t/ `l—'V"•�`►T esigne ame Address Address /ems, y � Telephone# Telephone##` ` Type of Building: Lot Size Jt;/lam Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(mini re uired) gpd Calculated design flo%�__ _ pd Design flow provided5�gpd - Plan: Date Number of sheets Revlsion Da e Title Description of Soil(s) F _ Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation -- DESCR PTION OF REPAIRS OR ATIONS t The unde igned agrees to instal the ab a describ ndividual Sewage Disposal System in accordance with the provisions of TITLE 5 and er agree t to pl ce the sy to in ope n until a Certificate of Compliance has n iss by the Board of Health. Signed Date i31 Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM S/96 No. !/V 1 THE COMMONWEALTWOF MASSACHUSETTS FEE 00 BOARD -OF RHE . TH A Y C� APPLICATION FOR DISPOS •L SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct Repair U rade•( ) Abandon ( ) -.❑Complete System ❑Individual Components 5 C1.A a,• catio � 1 AG &i a I)OZr'sN l 9`�l a t,a '• Map/P cel# 1 /A,d�ress t�.a o # le le � Installer's Name �` -)-0besiignerrWarne � Address Address 1 r,�} Telephone# i Telephone# Type of Building: "` Lot Size X?//(15_ Sq.feet t Dwelling—No.of Bedrooms C Garbage Grinder ( ) Other—Type of Bu'iidrig" No.of persons Showers ( ), Cafeteria ( ) Other fixtures) I ti- 3n 41 Design Flow(min)required) gpd Calculated design flow« gpd Design flow provided5TJ gpd Plan:--Date / 1 Number of sheets Revision Date T7tleJ J (� » Description of Soil(s) 'C Soil Evaluator Form No. Name of Soil Evaluator 29, VqWZjDate of Evaluation DESCR PTION O EPAIRS OR ATIONS I/ t The unde igned agrees to instal the abl!Xe descri ndividual Sewage Disposal System in accordance with the provisions of TITLE 5 and er agree t to pl ce the sy te�in ope n unfit a Certificate of Compliance has n iss ed by the Board of Health. Signed Date Inspections It. i FORM 1`,,�APPLICATION FOR DSCP DEP APPROVED FORM 5/96 Nr° 0I 5 26 :I�� T COMMONWEA ' H OF MASSACHUSETTS �v FEE �����o• OARD OF HEALTH CE IFICATE OF COMPLIANCE Description of Work: ndividual Component(s) ❑Complete System The undersigned hereby certify t1haat the Sewage Disposal System;Constructed( ),Repaired GradedAbandoned( ) at has been installed in accordance with the provisions of 310 CMR 11.00 (Title 5) and the approved design plans/as-built f plans relating to app 'cation No. 01640 dated ('� 13 Approved Design Flow 54� (gpd) Installer Designer: Inspector 6, Date C41ZS The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. ail 26� THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF 'HEALTH C.. DISPOSAL SYSTEM CONS T CTION PERMIT Permission is hereby granted to Construct ( ) Rep it ( Up r e ( Abandon ( ) an individual sewage disposal system at as describi d in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this perm' All loca(e n i. olns)mus e et Date _ O_ Board of Health 0 i FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W Homs8 WARREN?M PUBLISHERS- BOSTON , Town of Barnstable o Regulatory Services ': Richard V. Scali,Interim Director • snnxsznBie. MAS& Public Health Division 1639.n�°i Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fact: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit#Z l - 7 g Assessor's Map\Parcel Designer: 1!/ 1 Installer: (ZYII G Address: �%tt�1 ��"` '� Address: C On ?A? ( was issued a permit to install a (dale) (installer) septic system at 2C;j G✓CQLOTA AAJ6� based on a design drawn by (address) dated f (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was construc ce with the terms of t pproval letters (if applicable) DAVID g MASON m ' ignature) v 9 No.1066 0 �N �C'�STER� /TAR\P� (Design 's Signatu (Affix Designer s Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc E ! � I*� V. Town of Barnstable P# �� ` Department of Regulatory Services . .AMMOLI Public Health Division Date 200 Main Street,Hyannis MA 02601 �VDate Scheduled Time d Fee Pd.� Soil Suitability Assessment for Sew ge Disposal �Performed By: Witnessed By: ,� LOCATION&GENERAL INFORMATION Location Address gp,� Owner's Name 1� �� M � E:- Address �s Assessor's Ma iarcel: � I �// Engineer's Name � ry w� J NEW CONSTRUCTION REPAIR)+� Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body It Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETC H:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) =----------- I ' Parent material(geologic) Depth to Bedrock - Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date Time Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ jaer Time(9"-6") End Pre-soak Rate MinAnch 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:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munse ) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 3 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Stricture,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No ` /Yes_1,/ Within 500 year boundary No✓ jres Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery o s enal exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth f na By occurring pe 'ous material?�4 Certification I certify that on l© (date)I have passed the soil evaluator examination approved by the Department of Enviro a tal P ction and that the above analysis was pe o ed by me consistent with the required fining,exp se p ence described in 310 CMR 15.) Signature - Date Q:\SEPTIC\PERCFORM.DOC I f_ 77 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �L1 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for �Diopooal *pztem Cowaruction-Permit Application for a Pernut to Construct( )Repair( )Upgrade('11 abandon( ) ❑Complete System 24ndividual Components Location Address or Lot No.13,5 6A1- `j Owner's Name,Address and Tel.No. Assessor's Map/ParcelI C.V �U v� Installer's Name,Address,and Tel.No. ++ Designer's Name,Address and Tel.No. �AirJ -ci4 Sip �t 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 :::; 30 gallons per day. Calculated daily flow ` gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank n`S;Y 1 A COO Type of S.A.S. 3Ai cl r Description of Soil Nature of Repairs or Alterations(Answer when applicable) ST1tJ-�\ 0� ZC Sal 1 t O Sf o e. fft lwl' 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 E ironmental Co and not to place the system in operation until a Certifi- cate of Compliance has been i,�ted"by t is o Signed Date Application Approved by Date Application Disapproved for th following reasons Permit No. �K — 7to Date Issued TOWN OF BARNSTABLE LOCATION SEWAGE # nl�- 7/O VII,LAGEI��;�r)e^� ASSESSOR'S MAP & LOT'7-`4 0'-Z45- INSTALLER'S NAME&PHONE NO. IS nr_ Z.Q , ,��e-y SEPTIC TANK CAPACITY It2ov LEACHING FACILITY: (type) (v1 ( (size) Sim4- NO.OF BEDROOMS 3 i BUILDER OR WNER a.vi S p''� PERMTTDATE: l=f'�� COMPLIANCE DATE: 6 '9,,?- Separation Distance Between the: i 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 i within 300 feet of leaching facility) Feet Furnished by Al 2 i ' J Q3 - No. 79- 77 t 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: --,j Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS iI application,for Ziopoeal *p6tem Construction Permit Application for a Permit to Construct Repair Upgrade abandon El Complete System 254ndividual Components Location Address or Lot No. Vr Owner's Name,Address and. l Tel.No. — i Assessor's Map/Parcel 92y_? A i Z�a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. OA cA K-- 5 F P11 C :__)-o T W, Type of Building: Dwelling welling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers Cafeteria( Oder Fixtures Design Flow 30 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 4 1_Cy SS-T t /I- (7h 0 ---Type of S.A.S. _Ui C6, bQ Description of Soil k�idzo (/u Nature of Repairs or Alterations(Answer when applicable) c_,70, X j_<Ij S) ocs 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 Erwironmental Cod and not to place the system in operation until a Certifi- cate of Compliance_ as been j5suedZ—ythis ITkd of_Uea Signed k Date Application Approved by 5�. ' Date I I - Y Application Disapproved for thPollow"ing reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired Upgraded _C pfV� Gr_Abandoned by— M 10 - at 1 77> -5- C_C;,,A(AAc, Q0 "�:j4"N�i�has been constructed in accordance with the provisiong'of T.itle 5 and,e- e for Disposal System Construction Permit No. &--716 —dated Installer Designer The issuance of this ermit shall of be construed as a guarantee that the syst 'll func 4 a d signed. Date Inspector —— —————————————— No. 26 -771d Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Mi5po5al *p5tem Con!Arurtiott Permit Permission is hereby granted to Construct Repair Up rade( )Abandon System located at a-, 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 must be completed within three years of the date of this permit. Date: ti- T!a Approved by • ~� - 10/9/97 I 7 � r i NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION,FOR A l .1 DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated l!� �{`�� , concerning the �I ed at �u s�ce UTT� c1�" c� dt,r ' meets all of the property local r following criteria: ". ere are no wetlands located within 100 feet of the proposed leaching facility ` •I C//. There are no private wells within 150 feet of the proposed septic system I • There is no increase in flow and/or change in use proposed There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will nZ be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER _ (Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be.submitted). ^• F q:health folder.cal i /i- /_ 711 No...._.•=•-/ s ---- f daa c /� /�J .F�s.... s................... THE COMMONWEALTH OF MASSACHUSETTS r BOAR® OF HEALTH ...............................--.---......OF................................. ..----------•---------..............----------------• Appliration for 11ispasal Works Tnnitrnrtiun Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Sys 1 � ............. . ....... p 1 Locatlwnier Ad�yes or Lot No a Address e-- ------ '... ---•.............................. ...................................•----•-.- .......•••---------------------...--------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling°�No. of Bedrooms...............3--_-_--.__--____-___Expansion Attic ( ) Garbage Griner ( ) Other—T e of BuildingNo. of persons............................ Showers — Cafeteria Otherfixtures ......................................................................................................... Design Flow.................. -:-_...........gallons per person per day. Total daily flow____-� ...__._.._.._.___ __.....gallons. W Septic Tank -Liquid capacity/til)J._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 leac 'n r , .... ._.._.._.sq. ft. z Other Distribution box ( ) Dosing tank ( )^ PC ram'. ._ bl ✓y41 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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 O Descri Description of Soil ^t'' ......G . x P ----.- '. � .._.. 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 iI'1'iE 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. Signed.................•--....................:-------------..........---------------•----•• ................................ Date Application Approved By.......................���� � '� �� Jl� Date Application Disapproved for the following reasons---------------•-----------------------------------------------------------------•-------------------•.....------ ......................•---------•--•-••....-----••--•---------------•----------------........---•-----------...-------•-------•------------•-------•-----------•---------------••-•----•--•-•.......... Date Permit No............................................•-•••---.... Issued-......�I�_j Date No.............. 1..:.. ,1 . .F f.................... THE COMMONWEALTH OF,MASSACHUSETTS BOARD OF -HEALTH .....................0 F...... .......................................... Appliration for Uhip sal Workii Tumatrartton ramit Application is;hereby made for a Permit to Construct (4) or Repair ( } an Individual Sewage Disposal syst. t - ------- --- •-••----•--•--•...... .._.. Loratio Ad s� or Lot No. "-ner Address -•-• a °` ----------------------------------- --•---•------••-•----..._.....-•----- ------•----------:......... Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling AeNo, of Bedrooms______________............._..........Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building ............................. No. of persons____________________________ Showers — Cafeteria - Other fixtures ------•----------- Design Flow...................., 5~ .....____gallons per person per day. Total daily flow..__:':_ � ...____gallons. W , f4 Septic Tank. Liquid capacityk-d.o gallons ' Length................ Width-.............. Diameter------------ .L,Pepth................ Disposal Trench No. __._.__.Width.................... Total Length................... Total leaching area_.__. ---------- ft. Seepage Pit No. `:.: ._____. Diameter.................... Depth below inlet...... Total lea* �' sq.jt. r Z Other Distribution box ( ) Dosing tank ( )�"` ` t Percolation Test Results Performed by.. x = .................................. Date........................................ aTest Pit No. I________________minute's'per inch Depth of Test Pit____________.I._____ Depth to ground water........................ (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water:-__.__________________- D Description of Soil..........................a._ ._._.c .�, �#... _ '` -�'Z" x ; -W ---------------- -------------------------------------------------------------------------------------------------------------------------- ---------------•-----•-- ............................. UNature of Repairs or Alterations—Answer when applicable.________________________________________,_...................................................... yI: , Agreement The undersigned agrees to install the aforedescr-ibed Individual Sewage Disposal System in accordance with - the provisions of TITLZ 5 of the State Sanitary Code4'— The undersigned further agrees not to place the system in "•„, operation until a Certificate of Compliance has been issued`by the board of health. Signed............................................................................ ---__•-- Date Application Approved BY ----•--------- C .., ..` /l'%71 Date Application Disapproved for the following reasons_________________________ ___ ___________.__.____':_` -------•--•---•.................•--••--.... -....-• • •• •- - _ -- - --- ---•----•--•--•-•-------•• ..----------••------.•_--- ----------••-•- zv. bate PermitNo................----------------------------------------- Issued---•--./_ ...--...- 7-,.................... Date THE COMMONWEALTH OF(MASSACHUSETTS �]Ay BOARD OFIEALTH ..... :..';otip.............oF....... 6.444. . :................................................... Trrfifiratr of (6mpItanrr THIS. iCERTIFY, T` '� the.Ind vidual Sewage Disposal System constructed ( r Repaired ( ) bY '�- ------_. _ �1...... •-•-------•-•--••-•••---•--••----._._._ ..... .............••-•-•••--------•---- al J 6st 1 at _ �' _ - = " .. ------•-----•------------•--------------•--••--•---------------- has btxen installed in accordance with the provisions of T ` of The State Sanitary C de as described in the application for Disposal Works Construction Permit No__� ____. �---------- dati ________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION 'SATISFACTORY DATE jf-J ... ...... __ r Inspectors �/r* � /j _.... ...... dam"S'""� � � - d r � +ca• ,.�.F3k:?:G i( a� $k'� rr1�,�#r T F � a�l 6�,a3a"`lr:. {'+� �� y:, ,w..,..'i.:s�.��"w"�cK.arx,+.ru,..:aJ:d_:.s..-l`��.:.,v,'r. � ,. -. ._..,..,..._...................._,-.-.....�...w.t,Y•t �' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................0 F.................... No......................... FEE........................ Okirrntit Permission is hereby granted-----------------------------------•-•----•--'-----------•-------------------------------•---•--'=-•-----•--•••-•--•----•••-••------•---•--• to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo --•-......................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ..................................••-_•----- •---------••----•••------..__.. Board of Health DATE. h-------- FORM x s fFt 1255 HOBBS & WARREN. INC.. PUBLISHERS z ,, L TOWN OF BARNSTABLE `s ,`,1 06.TION �rN'JO-'Tl.111- SEWAGE # 7/ [ .VILLAGE �L441 10 5 02iC ASSESSOR'S MAP & LOT"L L4 7 ZS INSTALLER'S NAME&PHONE NO. r _�'C��✓ SEPTIC TANK-CAPACITY 1000 LEACHING FACII.ITY: (type) t dl —(size) size 67f'S'i�.s .� i`f v�nt(,8ti NO.OF BEDROOMS 3 ` BUILDER OR OWNER,_,) �aM S o PERMITDATE: COMPLIANCE DATE: ��6 9� 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 If. Edge of Wetland and Leaching_Facility(If any wetlands exist within 300 feet of leaching facility) `. Feet. Furnished by j� b 1O=C4TION i � � SEW AG .E ��MI� NO � (�q r VIVIL GE tfr�IV#ems INSULLE NAME & AD,DRE S B U I'L D E R OR OWN E DATE PERMIT ISSUED �_ \ \ --, DATE COMPLIANCE ISSUED r�,� .*� \•� - �� �c �r k�� �� C, F � � � � _ TOWN OF BARNSTABLE LOCATION /3 SEWAGE# 7d/ ice- A 6 V1 LAGE ASSESSOR'S MAP&PARCE Q JS�J' INSTALLER'S NAME&PHONE NOJ�?j `o 1,4 J de. SEPTIC TANK CAPACITY A900 g4J1 ,,r,' LEACHING FACILITY:(type)Z- -!52& Q,d( C'✓_14A e) NO.OF BEDROOMS 7 OWNER PERMIT DATE: V/. / COMPLIANCE DATE: �T— 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 3 �_ �. � � � w o W �.,C ASSESSORS MAP : TEST HOLE LOGS 4- PARCEL : l} The installation shall cotr�t�l� ►with Title V a�sJ "Town u�k5ftlluard of FLOOD ZONE:- SOIL EVALUATOR: -Wig C f lealth Regulations. l ���uf`� WITNESS : 1 Vet 2 The installer shall verifythe location of utilities sewer inverts and septic � REFERENCE: �" ) l j�'���— �L=__ IZ�_ Q----- DATE: fv l components prior to installation and setting base elevations. PERCOLAT liON IRATE': 2• OW, t , 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first C, F � Y, '� R two feet out of the d-box to the teaching shall be level. — 4) This plan is not to be utilized for property line determination nor any other TH- I TH-2 purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. 1 6) Parking shall not be constructed over H10 septic components. �{ �o 7) The property is bounded by property corners and property lines. Io Jull by tp I� 9 I �` 8) The property owner shall review design considerations to approve of total LOCATION MAP ' design flow and number of bedrooms to be considered for design. Receipt (� of payment for the plan and installation based on the plan shall be deemed k 60jo approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per ( D *It / 11 �W�. ( { ZZ Title V specs. 10)System components to be 10 feet from water line. Sewer !fines crossing the water line shall be sleeved with 4 inch SC1140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place. _ 16 1 z 0 y� Z _ _ SEPTIC SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. 10 �1►�, 01 FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such exists. . 13)Tae installer shall verif the location, quantity and elevation of the sewer 10 � BEDROOMS AT I (� GAL/DAY/BEDROOM -�GAL/DAY Y a Y A0 = lines exitin? the dwelling prior to the installation. SEPTIC TANK �11 i 14)This plan is representative only that a system can fit on a property meeting () Title V requirements. ` I �LGAUDAY x 2 DAYS - GAL = Q I USE GALLON SEPTIC TANK �.1Liv l i t SOIL 4801IPT I ON SYSTEM UT 15co Lf At., S i DE AREA: Z•X 2 fi �2} �� X I �,Q7 �•���" DAVID (y� BOTTOM AREA: J] Z?j7jtAsort ,� � l �4u SEPTIC SYSTEM SECTION , ►off oC -- , Z Io I� a �BJ51qj L 100 GALADA SEPTIC TANK � I —------- -00mlvt Vr4�r HoLt, Ro. 17 t 3�vA� SITE AND SEWAGE PLAN LOCAT ION : PREPARED FOR : C2pi11Wa M O. 0 SCALE: o DAV I D B . MA S O N S DATE: olS g DBC ENVIRONMENTAL DESIGNS W DATE HEALTH AGENT EAST SANDWICH . MA Z ( 508 ) 833- 2177 -