Loading...
HomeMy WebLinkAbout0021 FOREST STREET - Health 21 FOREST STREET,HYANNIS A=266:006 - --- - / e v i i o a - . No. / Fee-- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVe[C Congtruct ion Permit Ap lication is hereby mad e or a permit to Construct (/,' Alter ( ), or Repair ( )an individual Well at: _fit--,�------- --ILOL �--- - � ----- Location — Address — Assessors Map and Parcel Owner Address ---------- 5r----`-�-lz ------ --------------— ------------------------------ - Installer — Driller Ad ss Type of Building Dwelling ------------------------------------------------ Other - Type of Building------------------------- No. of Persons----------------------- Type of Well �,K-- -4 ------- Capacit -- Purpose of Well--- �� �----------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Cert' icate . C m liance has been issued by the Board of Health. Signed ----- --- - --- date_ Application Approved B "" A��r�, -- i -—= � � date Application Disapproved for the following reasons: ---- ------------------------ --- ---=— --- --------------------------- ------------- — �j v � � Permit No. G -- Issued---�----��1 - ---------�� date----- ------ date BOARD OF HEALTH TOWN OF ' BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY at the ividual We In�j l Constructed ("tered ( ), or Repaired ( ) � Installer' at---- C� 67—/ has been installed in accordance with the provisions of the Town of Barnstable Board �ooff Health Private Well ro ction Regulation as described in the application for Well Construction Permit No.d�- —'K'!-ZlDated ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- _ Inspector -. ti� �� No.------- Fee-- BOARDOF HEALTH i TOWN OF `BARNSTABLE 21pplicationArVell Construction Permit Ap lication is hereby made or a permit to Con st uct (1-T, Alter ( ), or Repair ( )an individual Well at: i •;Location,=. Address. tf A`ssessors.Mep and Parcel ,• •� / . Owner — `• Address _ --- — �/� a �0 3 a a' y3��,. - - - ---------------------- -- ------------- - --- ------ - Installer — Driller Adds Type of Building Dwelling ---------------------------------------------- Other Type of Building------------------------- No. of Persons------------_______ Type of Well--- Yp e ifS d -- - - Capacity--------------------------------- \ Purpose of Well--- —Cam_1 ---- --- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees-not to place th-e well in operation untiLa Certificate f Compliance has been issued by the Board of Health. Signed -1C..�---- date �0-0.Z—9 Application Approved B -- --- date Application Disapproved for the following reasons:, ----- - ----------=---------___. _ —_ date Permit No. z Issued-- ` �' �� ----------------- date •:2vS:!aeM:.+�:a.:p:ea!aM:!w..:�GlLsiue:0.?i.:«:�M?.,�i�:•:ei+aNNeeesi.ire�vrfmTa.isi4Yer.i.isNeiaeSr•sNe::e:wN!ei•e[:wiO:.si�fi•GoaaaeiNlir.:l:ewae•.i's:..is�e:s Ef d4fc}M BOARD OF HEALTH TOWN, OF BARNSTABLE Certificate Of C mphance s THIS IS TO CERTI, hat/the In rvidual Well Constructed (64"Altered ( ), or Repaired by--- ----------------------------- �� -/ Installer at t,/ F'GicR�S� ST 7��J. 02 has been installed in accordance with the provisions of the Town of.Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit Nb. Dated i os 'F THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. `. DATE---- - Inspector-------- ---- —------- 1iliV:!1liSie:O:•iTitlil�'LeNi960ir•iiO:OGO:N•V^LN.GNNNNN04NPiNIKNOWOi•i06ViAi•i!i06fiT.Y_iOfl.i1i040i0i•Ov!Ni7i{�!i�6Nli!i!rlii�i!N�i1W0113.iliiiTi�.ilt�i!O!i�G'N2lG3r BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Construction-permit / No. �'-� !e�1 Fee " Permission is hereby granted to Construct ( Alter ), or Repair ( ) an Individual Well at: sheet �. Y as shown on the application for a Well Construction Permit } No.- � � Dated-- �� � ____--- ---/- ------ _74�'1 Boardfof Health DATE t i( , f 1 . x ! I Y rt t t q .. I x' I ff ! 1 ! r f t � i C t i v ! it i 1 q rr ! t ra i W E i i } " f 1 ! i N r s J l t a p �l ! t . I x S I , I� lr i "I r Y " , + 1 I � ' I . 8 8 _ COMMONWEALTH OF MASSACHUSETTS ^ rp EXECUTIVE OFFICE OF ENVIRONMENTAL % AIRS' a -./� DEPARTMENT OF ENVIRONMENTAL PRO N "'"'��Y' ✓ ONE WINTER STREET, BOSTON M.P.02108 (617) 292-55 8cT 8 1900 � D N WILLI" F.WELD CORE Governor S �,, ecretary ARGEO PAUL CELLUCCI S B. STRUHS Lt. Governor Comm;��ioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION �+ Property Address: al S t• U.:; - 1WPIS i,bf-1 Address of Owner: � j'[�,..'��� /Nt cl Date of Inspection: q fj��� (If different) ,YttJIV/Q Name of Inspector: M t ynr.S_\ I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) 3 016 Company Name: r 1_ Mailing Address: 2 L) ,>< Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes ) Needs Further Evaluation By a pproving Authority 1 Fa'ls LInspector's Signatu '. Date: 4 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10.000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMDIARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any ���TTCCC failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y. N. or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. \ (revised 04/25/97). Page i of10 e—, . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A I CERTIFICATION (continued) . �Property Ad s ` r Ownere� � (� Date of Inspection:; n, a�V B] SYSTEM CONDITIONALLY PASSES (continued) _ Sewaget6ackup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due aflTroken. settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). �D tribe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed I C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health. safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETEP-%04FS THAT THE SYSTEM IS NOT FLNCTIONTNG IN A MANNER WH3,CH NNILL PROTECT THE PUBLIC HEALTH AND SAFETY A-N0 THE E,'%MONME?NT: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM NVILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETER,M1NES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (raised o,t/u/n Page 2 or to J i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DI SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System. cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet-but greater than 50 feet from a private water supply.well with no acceptable water quality analysis. If the well has been analyzed to be acceptable. attach copy of well water analysis for coliform bacteria. volatile organic compounds. ammonia nitrogen and nitrate nitrogen. EI LARGE SYSTEM FAILS: You must indicate either "Yes' or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design now of 10.000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary.to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. i (remised 04/25/97) Page 3 or to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property�Ad�dress: 2J jooees l Owner: t�l.lood Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ - As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, naterial of construction, dimensions, depth of liquid, depth of sludge, depth of scum. i —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is.at issue, approximation of distance is unacceptable) [15.302(3)(b)) i (revised 04125/97) P2ge 4 of 10 r • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION Property Add,es �) rC✓�S Owner: (NOQtC Date of Inspection: J I / FLOW CONDITIONS ? RESIDENTIAL: !. Design flow:��. d./bedroom for S.A.S. Number of bedrooms:Q 4 Number of current residents: , Garbage grinder (yes or noy Laundry connected to system (yes or no): +� Seasonal use (yes or no): 4 Water meter readings• if available (last two (2) year usage (gpd): i, Sump Pump (yes or no):_$--I y ' Last date of occupancy: ") r t COASIERCIAL/INDUSTRIAL: i t Type of establishment: Design flow: eallons/day } Grease trap present. (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ i Non-sanitary waste discharged to the Title 5 system: (yes or no)_ ' Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INUIVIATION PUIYIPLNG RECORDS and source Enformation. System pumped al part of inspection: (yes or no)_ If yes, volume pumped: Gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: to Q tL'— Sewage odors detected when arriving at the site: (yes or no) tic) i (revised 04115/97) Page S of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Addres Owner: W Q('C Date of Inspection: J 7 FLOW CONDITIONS RESIDENTIAL: Design flow:Z23 0j.p.d./bedroorn for S.A.S. Number of bedrooms:Q Number of current residents:-&. . Garbage grinder (yes or noy-L Laundry connected to system (y s or no):4 Seasonal use (yes or no):1—j Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):_$_j Last date of occupancy: �� COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:__gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readines, if available: Last.date of occupancy: OTHER: (Describe) Last date of occupancy: ' GENERAL 11 tORIN ATIONN i PUMPV\G RECORDS and source LMiG& Me) System pumped ag part of inspection: (yes or no)_ If yes, volume pumped: Gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach pre-ious inspection records, if any) I/A Technology etc. Copy of up to date contract? j Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)�V (rerued 04/25/97) Page s of to 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addr s: c2 rdetsl Owner: Date of Inspection: TIGHT OR HOLDING TANK: " (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in workinc order _ Yes. _ No Date of previous pumping: Comments: (condition of inlet tee. condition of alarm and float switches. etc.) ►ISTRIBUTION BOX: ( (locate on site plan) J Depth of liquid level above outlet invert:llil( -//bc/a r—yNi1e&!I Comments: ote if evel and distrib to e i ual evide�jc-e of ssolids ca over, nce of leakare into r get of box, etc.) 9 C n•-1 �7 U\(oyj :eU �—b f/1_l 41 I.El'lL , 0 Cle PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (raised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM IIYFORMATION (continued) Property Address: t 0,0eS Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on'site plan• if possible: excavation not required, but may be approximated by non-intrusive methods) If not determined to be present. explain: Type: leaching pits, number: ( leaching chambers, number:_ leaching galleries, number: leaching trenches. number.length: leaching fields. number, dimensions: overflow cesspool. number: Alternative system: Name of Technology: Comments: (note condition of soil. signs of hyd ulic failure on• level of ding, ndition f ve tion, etc.) ,! T . r CESSPOOLS:.ff (locate on site plan) i iNumber and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) -Comments: .. (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) f PRIVY: (locate on site plan) t. Materials of construction: Dimensions: Depth of solids: Comments: ` (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) j.: (revised 04/25/M Page S of 10 _ I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORJVI PART C SYSTEM INFORMATION (continued) Property Addre. L Owner: VUIO CJ► Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks )' locate all wells within 100' (Locate where public water supply comes into house) jy a a I u' � a I ; -s7' 6Z-3r t t, e 3Y -4t3 , (revised 03/2S/97) Page 9 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addr ra��s Owner: LOOM Date of Inspection:/+��(�� Depth to Groundwater'�S Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on.record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators. installers Use USGS Data Describe in your own words how you established nhe High Groundwater Elevation. Must be completed) US, �,�o(vS ccQ 2vsG C�ro osI-C 0 7o t-4. 4. (� z t i (revised 04/25/97) Page 10 of 10 } i AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION 51 9-r—Sr ST SEWAGE # VILLAGE T` ASSESSOR'S MAP dt LOT d l- U coo INSTALLER'S NAME dt PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILTIY: (type) (sizzle) NO.OF BEDROOMS ��� o�R2 6o BUILDER OR OWNER` y Woo PERMTTBATE: `�1.5�1qS�'] COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 n• Z�er if°� , it Z 1 �-nAw 1 y � b3 03 , 1 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=266006002&seq=1 6/6/2012 TOWN OF BARNSTABLE hd LOCATION�V e • SEWAGE # VILLAGE bt,t,,jsQort ASSESSOR'S MAP & LOT Ob&.cc INSTALLER'S NAME & PHONE NO. 771— 10140 SEPTIC TANK CAPACITY 0 C01((Oyn5 LEACHING FACILITY:(type) 2 Leac.L Q, k (size) GOO, JtOJAs NO. OF BEDROOMS F' _PRIVATE WELL OR PUBLIC WATER - BUILDER OR O WNER S r ole �1��.�.�;sA� CO. -7 o�9� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� l �- w. � J J+ p .�' � .hl � 1 S 1 �-1 a� b� �� - ----� I G1 S ' 1 � . • i Df����_� _ TOWN OF BARNSTABLE LOCATION 01 k �v S� ST SEWAGE # Vi''.LAGE �►-�• �"� 't`'�S u�� ASSESSOR'S"MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) X1. NO.OF BEDROOMS J�lil��1- 0�Y BUILDER OR OWNER t io. OJ PERMITBA`FE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ('E! Feet Edge of Wetland and Leaching Facility(If any wetlands exist f within 300 feet of leaching facility) . N L Pam' Feet Furnished by �I � � 4 r N r sCA 74 Z THE COMMONWEALTH OF MASSACHUSETTS '., • •� L,`GINEER MU5 i BOARD OF HEALTH 'STALLATION AND CERTIFY IN WRITIN,_ +-IE SYSTEM WAS I TALLE__D IN STRICI' `` .14 � � �E PLAN. Applirtt#ioo for 14opoottl Works mitr4dwit rrmi# ST Application is hereby made for a Permit to Construct or Re ai afi fn 'pp y ( /f p ( ) -I di dual S!tt%isposal System at: ( Amal-sp,.....--•--•--..._....___..... •---- - ............ . ---•--\----- A 1G y.•�ation:Address , . F3A St�Dr=......InoILx_>-ems........................... 0_.. K_ ......... "' ��'�/i�.L .M.s, . _ caner Address. a �7 ...�. .� ? ......-----•................................... .....Y.4.4.b .......:► - ................................ Installer Address d Type of Building Size Lot___...f: '..� `Sq. feet U Dwelling—No. of Bedrooms......:........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g --------•------•--•-•------• P ( ) — Cafeteria ( ) dOther fixtures •---•••----------------••-•••••---•----.....••••--•---.--••...-----•-•••-•.........--•.....-•-•-- ......................gallons per person per day. Total daily flow........... Ions. W Design Flow.-•-••--•-...J�� g P P P Y Y I WSeptic Tank—Liquid'capacityrz.-_..�..._.gallons Length t l.fP>'.:.. Width.l°'..-P". Diameters.........--. DepthB.-_at" x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No............I....... Diameter.'.-:V.:..... Depth below inlet.__4x........... Total leaching areai'•5S7...... �+�D Z Other Distribution box ( < Dosing;ank ( ) aPercolation Test Results Performed by.._,�...R-1'4!�1....EE.J � 6._... Date... :. .:. ,1�............... a Test Pit No. 1.....:rL-._...minutes per inch Depth of Test Pit 14' '"......... Depth to ground water.OP. ..... Gi, Test Pit No. 2........N.....minutes per inch Depth of Test Pit.....t`........._.. Depth to ground water....................... 9 3 Ic O Description of Soil..Q,:7.Z40 Coy,-..° gu►35o}l ' "-?2a S� 4Jc:>'r._�ur !L �Q"-14d." Ffil.� _b r......-----•-•--•-. ---------•-•••- t --•--- x ....Q°.-6''_L.oA1'1 sc Sc, il, btu.- .:..�- +-�.QT._susotL -� 4���Lt=�.I.lt ►.l)� . . ....... . . . . . ...12"-100.".......•-----••-- ••-• . r „ U Nature of Repairs or Alterations—Answer when applicable.................. ..._-..-.�.,���r. Ur�nvl... :+ tv• JG E,I�aI►V t��q�+rr_ra�s!G1(..IW. l'lvv .-_ 1��_Vl,�u d rt ---------------------------- - Agreement: -STALLATION V V IN SY'f"C; c�,rsn AS INSTALLED The undersigned agrees to install the aforedesccibed)�Indi-' Va ez Dis osal System in ac rdance with the provisions of TITLES 5 of the State Sanitary Code=�TheAune=signedfurther agrees not to pl he system in operation until a Certificate of Compliance has been issue by the board health. % Signed.............. --..... .... ..... ". - ••-. . .._.� .. Application Approved BY............... .....••....•• ••--•... ......... ---- .......................... -••••-•--_...1- Pte kl� -- Application Disapproved for the following re ons:.....................•-••--••-••--•-....••--•-•.....----•-....--......-•--....•--•-•..............--•........_ .........•----•------------------••-•------..._..-----••-•-••-•-•----...._•----•••••••...__._....... ........................ ....... Date PermitNo......................................................- Iss .._ed ......................................Date....... Date V i {340 THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH " t.G�.1!J.. ................OF............. ... Appliratiun for Disposal Works Tonutrnrtion Prrutit Application is hereby made for a Permit to Construct ( ✓for Repair ( ) an Individual Sewage Disposal System at: A .&=-�-•-L•-•---------------•-•----.._... �A IG.. c--���..:.'�._._.-•--•--...._..........-- ... _ .................... .....__._.... '2 oc,t n-Address a111....>JI o lot No. / � • caner ................ ---------- .......................................... --••---•---•............................ ............. r...... Installer Address Type of Building Size Lot.....:......................Sq. feet Dwelling—No. of Bedrooms.._..__- .........................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building No. of persons............................ Showers YP g ................•----------- P ( ) — Cafeteria ( ) Otherfixtures -----------------------•---------------•---•---....---.---•••••-•-•-----•--•••-•••----------•-•---•---------•---•----..... •--....... g ----------------------- P P P Y Y �.....- Sgallons. W Design Flow.............S° lions per person per day. Total daily flow..._..__._... W Septic Tank—Liquid'capacityg��gallons LengthA i:.-�':_. Width__'�__.�_-PL Diameter................ Depth�_•_..•S x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.................._.sq. ft. Seepage Pit No-------------I------- Diameter.. -3...... Depth below inlet...._.G_:©._.. Total leaching area!?!5 7.....sqet. G,' Z Other Distribution box Dosing tank ( ) aPercolation Test Results Performed by__.._.�_�__.r�- �!��.... !_�G t►.`C � C..... Date... �_:.. ......... .............. Test Pit No. 1....... per inch Depth of Test Pit.14-4'.__....... Depth to ground water.. Gr. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rx ..--•-----••-•......•-••-•-•---------•-•-------------••------....-•---•--..........--•---------•-•................................... .D Description of Soil a :.. 'L", c �V scolt_.�04'-7?.-s-e-t..:+>y... ��It_:f72 t�r1t'��.�!. t�+l�I V ° •-Su?3�csfit_ _��--..-./ .._` 6ti�„��:�S--SU55oiL.6�6 144:�'---_ -A_,- ItED:.sA0 W U Nature of Repairs or Alterations—Answer when applicable....................................:.......................................................... ---------------••-•--•---•----.....--------------------....------------•---------------•---...._...-••-----........-•-••--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac rdance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to plc he system in operation until a Certificate of Compliance has been issued b the boar health. Signed......................................�`:� Application Approved B .1•�------... .. -------•--•-- PP PP Y ... ............ ) ace Application Disapproved for the following re ons:.............................................................................................................. _ •........................................•--•------•----------.........------•--.....----•-•-••------••--.•-•-------------•---•-•-•••----------------••-----••-----•---•----•-----------------•••......._ Date PermitNo.... -�---•.•.�`� •----------•----------_ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ate_ ......... !' :°%+1 -..............OF........ ..� 2L iQ:zr-- ............................. .. TIntif irate of Tontplianrr THIS-IS T ERTIFY, That the Individual Sewage Disposal System constructed (�or Repaired ( ) bY.......:.r -............c �I-e-04G:...................................................--•-•---- OAKT ....................................r� T has been installed in accordance with the provisions of TITIE. 5 of The St S fa,r Code as,described in the application for Disposal Works Construction Permit ed_ ..... .___. _ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE.® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. ._'.....40-:'.___/:.�............................... Inspector...�............... A- -•.......---------...--•--•----._...... THE COMMONWEALTH OF MASSACHU SETTS _ BOARD OF HEALTH' J .......I..1;..... ........OF..........������•��l�C. ly No.............. FEE FEE.........`.'....--•--- ��- i3v Disposal_ orku Tonutrnrtion prrmit Permission is hereby granted......... .:... ........ . to Construct ( Vor Repair ( ) an Individual Sewage Disposal System � at No.... ---.......0�J1K..•--•-�}..�...........1' � / /:'`J.. .... qL2 �treet '� _ f 2- � ' _ )j as shown on the application for Disposal Works Construction Per � •t N .'............... . ated...... ._____...___......____._.... _ '�!... DATE----------� ---_P Board of Health-------•------....-•---._......-•-•------------•--•--•• ' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS CABLE PAIL y SHINGLE® LANDING 1/2 WALL a � N ° 4 24" BASE 33" SINK CAB BASE — ��� W/13" SINK W w 1b.5" BAR 0 W/18" RAISEt RAISED BAR W V UJ BASE CAB. SHELVES ;o N W/3 DRAWERS ABOVE _ 0 - 0 1 101- 1 --F L k�-J TEST PIT,-*I TEST PIT -*2 GENERAL NOTES 0 F-L-E ii: 45x-4 ELEV7 2kx-3 im T,> r ALL ELEVATIONS SHOWN ARE BASED UPON 71-j i -- i z'31 0 2. PITCH ALL LINES A MINIMUM OF 1/8" /FT. UNLESS 0 OTHERWISE SPECIFIED 1) 0 @ 0 0-' 0 C. 0 0 000 0 0 0 0 @ 0 0 0 0 000 3 ALL PIPES TO AND IN THE SYSTEM SHALL BE CAST _0 000 @ 6) 0-00000 !RON OR SCHEDULE 40 PVC. 000 ') 0 () @ (D 0 0 0 000 4. ALL SEPTIC TANKS, DISTRIBUTION BOXES, AND 000 0 0 0 @ 0 �D 0 000 LEACHING PITS SHALL BE DE 000000 000000 SIGNED FOR H-20 WHEEL 0 00000 () 00 o 0 0 0 coo LOADINGS WHEN UNDER PAVING 000 ID 0 a @ 0 0 0 Clooc 5 REMOVE ALL UNSUITABLE MATERIAL BENEATH THE CA 000 ') O '� @ @ C) 6) 0 C\0 00 INVERT ELEVATIONS OF THE LEACHING PIT FOR -.77- TYPICAL DISTRIBUTION BOX 000 0 ,j u 00 0 io 0 A DISTANCE OF IOFT AND BACKFILI WITH CLAY -- 4'-0" LIQUID LEVEL FREE SAND 8 GRAVEL HAVING A PERCOLATION RATE NOT 70 SCALE 6 OF 2 MINUTES PER INCH OR LESS. -1-44 D N07-,�--- DISTRIBUTION BOX AND 6. THE F, tSf-TAE5Lie5 BOARD OF HEALTH MUST GAL. REINFORCED SEPTIC TANK BY BE NOTIFIED WHEN THE SYSTEM IS NEAR COMPLETION OBSERVATION PIT TYPICAL - GAL. SEPTIC TANK ACME PRECAST OR EQUAL. TYPICAL LEACHING PIT AND PRIOR TO BACKFILLING. 7. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS PERCOLATION RATE- NOT TO 5CA/-E ,VC)r To SCALE7 SHALL BE INSTALLED IN ACCORDANCE WITH TITLE OBSERVATIONS BY IV07-,�-- TANKS REINFORCED THROUGHOUT WITH OF THE STATE SANITARY CODE AND ANY LOCAL BOARD OF t4tAf.T,4- ELECTRIC WELDED WIRE WITH 24-1/2" RULES WHICH MAY APPLY. ENGINEER ARROW ENGIlq�ING INC. BEDDED STEEL RODS IN TOP B BOT- 8 CONTRACTOR IS TO NOTIFY ENGINEER, PRIOR TO THE , -To—m-.- RETE IS 4,000 PS.I. TEST. facr"-ST ;�=Ae i4i�kx� PIT- INSTALLATION OF SEPTIC SYSTEM , OF ANY DISCREP -- ANCIES BETWEEN TEST PIT RESULTS AND FIELD DATE : iZ 2- 10NA sy,srsm vo CEFI-riFr CONDITIONS DAP it- ---- - �'^OORCANCE INS-r&LE, 4 JA,1Rj-r1Nc lN STRICi 9. ACCESS MANHOLES TO SEPTIC TANKS AND LEACHING PITS TO BE BUILT UP TO 12 INCHES BELOW FINISH GRADE. (t TOP OF s LeV FOUNDATION ELEV= —FINISH GRADE FFiNISH GRADE FINISH GRADE OVER LEACHING FINl*;H ;3RAbE OVER TANK OVER VER "D" BOX AREA ELEV. = ii--S ELEV. ELEV. Z-041 ELEV.= ji EXIST. GROUND 7 �C=V -T-WASHED STONE INV.= .......0 Gc> GAL INV.= ooa T BOX 3 DIS /4 X 11/2 REINFORCED I (TO BE LEVEL CA CONCRETE i 8 STABLE) WASHED STONE "517F- NOI�lr, Z, TANK BOTTOM OF PIT It To HF LEVEL- a '--')TABI F INV. = ELEV. 8to IT PPOVIP�.�> TYPICAL SEWAGE SYSTEM PROFILE PRECAST LEACHING PIT (TO BE LEVEL 8 STABLE) _ /s f �'%J NOT 70 SCALE LEGEND MAP SECTION 15A--F' LOT ADDRESS=PARCEL I EXIST CONTCUR —-- ------- 8 _j PROPOSED CONTOUR _j EXIST SPOT ELEVATION 8 X 0 PROPOSED SPOT ELEVATION 8 + 0 PERCOLATION TEST ZONING DISTRICT FLOOD HAZARD ZONE OBSERVATION PIT DESIGN CRITERIA NUMBER OF BEDR(.)OMs 4- PROPOSED LOCATION OF DWELLING PERSON PER BEDROOM —2- 8 SEWAGE DISPOSAL SYSTEM GALLONS PER PERSON PER DAY zz�z- --- - 55 LEACHING REQUIRED LEACHING PROVIDED n..,k z- At 4 Z DISPOSAL. APPLICANT ENGINEER : e� 4r A I z lf ARROW ENGINEERING INC. * "7, � SEWER DESIGN 10 CAPE DRIVE SUITE B MASHPEE , MA 02649 SIDEWALL= 271Y4 x.4 k 2, BOTTOM = x ex Irk s )I -t>. l SCALE : DATE SHEET : TOTAL= 6,7j.G p D 15 j SHOWN DRAWN BY. CHECKED BY Appr BY PLAN NO Pt-AN SCALE SEE /'-)E M