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Home My WebLink About0033 GROUSE LANE - Health 3 3 Grouse Lane Hyannis A= 268-254 l I 1 f Town of Barnstable P# 13 o o Department of Regulatory Services Public Health Division. Date •bsp ��e$ 200 Main Street,Hyannis MA 02601 Date Scheduled U Time Fee Pd. Soil Suitability Assessment for Sewage Pisposal Performed By:— _ Vvk Witnessed By: LOCATION& GENERAL.INFORMATION Location Address 33 /_route Owner's Name f e!��r5ot / / y�t�1�r j Address Assessor's Map/Parcel: (_ a CI..I Engineer's Name NEW CONSTRUCTION y, REJPAIIR Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way A Property Line / ft Other ft !17 SKETCH:(Street name,dimensions of toperc tests,locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: r " . Weeping from Pit Face Estimated Seasonal High Groundwater �y DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: __ _in. Depth to Soil mettles: in. Depth to weeping from side of obs.hole: _— in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level.tea Adj.factor— Adj.droundwater Level I PERCOLATION TEST Date x Observation Hole# Time at 9" Depth of Pen; r Time at 6" LL Start Pre-soak Time @ Time(9"-6") 1. End Pre-soak Rate MinJlnch 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:\SEPTICVERCFORM.DOC r— 106 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel D- 12 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gra I Flood Insurance Rate May: / Above 500 year flood boundary No_ s Within 500 year boundary Nda es Within 100 year flood boundary No= Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perv'ou erial exist.in all areas observed throughout the area proposed for the soil absorption system) If not,what is the depth of natur ly occurring pervious material? Certification J I certify that on / (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was perfo ed y me consistent with the required training,expertise .nd e n described in 310 CUR 15.017. Signature Date 1� Q:`SEPTIC\PERCFORM.DOC r / ASSESSQRS NAP N0-. PARCEL NO: Fss. ....�.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � TOWN OF BARNSTABL.E Appliration for Uiti-Vinial Works Toitotriir#ioti rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....�. �'2a c/S-�• .A --��'---.................P 15'.�111 �... •� --•---'--------•-----------•.................•-....-------- nn// Location::\ddress or Lot No. J...�........ ...................'-•--........... ............--"•---"-- ----'-.........----......•.......................... w r �G0<;ti Owner � J-/ /__ �C64eddre�y/ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.___.__.. ---------------__-__--_---Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building No. of ersons____________________________ Showers G� YP g ---------------------------- P ( ) — Cafeteria ( ) a' Other fixtures _______________________________ __ w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity��__..__galIons 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........................................ ,a Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-.___--_-____-___------. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit--------............ Depth to ground water........................ P4 ----------------- • 0 Description of Soil.._._.._...... . --- ------•-•-----------------------------------------------------------------------------------•------------------------- x w x _ ---------------•---' U Natur of Repairs orAlterations—Answer when applicable..... �11. _ �fi� _._.....�J-06____ ......................... � f� - -------•----------------------------------------'--------------------------------------------------.._.._..........------...................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environme ode—The undersigned further agrees not to place the system in operation until a Certificate of Complian e has ben 'ssued b rd of health. Signed ............... ....... . ............................... - �� _----------- ---------=------ Date p Application.Approved BY ( ``` -� - - - 3. =-......./✓� Dace Application Disapproved for the following reasons- ---------------------------------------- ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------.._..----------------------------------............---.........................._. . ........ .. --------.------------------------------ Dace Permit No. ............ ......... J~..:'. ------------------ Issued ----------- 3-7,--- "--1 `------------------- Dace 215 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Ubvi-p ottl lVorkl6 Tonotrnrtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .................................. .....•___.... .......-.--.....--........-..... .............................. n/ Location-Address or Lot No. ------ ---------------------------•--------•--------------------•---------------- !�A Owner 1 / Addres ........................•----------•-•......---•----•-------- ---------------------------------------------------••------ Installer Address UType of Building Size Lot-------------------- Sq. feet UDwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------............................................................................................... W Design Flow............................................, gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityl _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 ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit_____________-..____ Depth to ground water........................ fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_-___--_----_____. D Description of Soil___......�?C xU------A W x ---------- ---------------------------------------------------- U Natur pof Repairs or Alterations—Answer when applicable._-___ _�_ ! �_____--- l&Z- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmentaal<ode—The undersigned further agrees not to place the system in operation until a Certificate of Complian e has been ssued by.the�oard of health. Signed /` r .- ------ �- ------ - -- ----=------ Dne q Application,Approved By .. .... J � - -..._... - � F......-r---— •�' ne Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------_----------------------- ------ . ...... ..................... .. . -- ---.....................-------...----.........-----------------------------------------------------------------------------------..------------- --...-------------------------------- Date Permit No. ...........L.. q _...'..-- ...(n------------------ Issued .. .--tj -?�------------------- Dace � THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE C11ez#tftca e of C�omplinure THINS 0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by -------------: ------�--------/Vv Insmllrr/ ' at ............... .._- ..._......1,r"'1�1'�'vC1. ------------------ -------------------------:�i`..'/7�.1//5---- '2� ............................._..... _.. has been installed in accordance with the provisions of TITLE 5 of The State Envi/nmental Code as described in the application for Disposal Works Construction Permit No. ... —.-...� .. __.. .. dated ---------------------------------- ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..-- � �' - " �- , Inspector 's----- F ------------ � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9 f TOWN OF BARNSTABLE No. 1.. .`. . tom FE ....................... Biupnoal Worb Tono#rudion "permit Permission is hereby granted-------- C_l?'` ---------•-----------------------------------------------------------------------------•----- to Construct ( ) or Repair (✓'j an Individual Sewage Disposal System at No........._�� Street g pp as shown on the application for Disposal Works Construction Permit No._/� '. _ Dated..3__U_...F�................. ()/ Board of Health DATE................<.�------------------•--------•---......._.....-•---------•------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS • TOWN OF BARNSTABLE LOCATION.3V GDZO SEWAGE VILLAGE , yI iX y,4,I r ASSESSOR'S MAP&PARCEL-�� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 41119 LEACHING FACILITY:(type) (size) 3 X SX NO.OF BEDROOMS OWNER PERMIT DATE: ?b� ® COMPLIANCE DATE: Separation Distance Between the: ® ��7�� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /o7 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 �e,4or. � � - 31 o el - 31 , 31 3 - 6 01 _ el sa � I 'S 7 y l O t ` .9 dPlst"AS O i✓ � � t rr11 r 1 l No. 'y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ` 0[ppricatiou for Thwgal *raem Cougtructiou Per "t Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) El Complete System Individual Components Location Address or Lot No5.�r62 4✓fE �-A,' yy Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)� d gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 4 5(::'Jj7-o0— 67 /TO o Type of S.A.S. of Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title f the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi oa It Signed old diDate Application Approved by P Date f Application Disapproved by: Date for the following reasons Permit No. 0'010- 91fo Date Issued 77— C '7) p 'No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in,computer: PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for,Ti!5 ogai * gfe&ee0n1d7tUc rn er ;t Application for a Permit to Construct( ) Repair O Upgrade( /, Abandon O El Complete System ndividual Components Location Address or Lot No5�6:16Z 0`'Xe' C A,. yy /! Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f Type of Building: { r Dwelling No.of Bedrooms Lot Size sq. ft. Garbage,Grinder ( . Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)�J d gpd Design flow provided �0 gpd' Plan Date Number of sheets Revision Date Title Size of Septic Tank �✓'T�"' 6, /7-0 o Type of S.A.S. 616 Description of Soil r Nature of Repairs or Alterations(Answer when applicable) f 4 Date last inspected: Agreement: i 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 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi oa dCjSv lth�,, ,Signed �}J� j Date Application Approved by Date 2 " f Application Disapproved by: ; Date for the following reasons Permit No. 01010- 9ffo Date Issued 77~ C /� THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS <` Certificate of Compliance ` THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )bye' at J ( !/f� !1/ has b en constructed in accordance n with the provisions of Title 5 and the for Disposal System Construction Permit No. WO I dated 7- r��fv Installer /I?f cOp �/C Designer s//� �' tO 1P- #bedrooms .� Approved design flow O gpd The issuance oft is pe it shall not be construed as a guarantee that the system wi fun i L as desi ned. Date (_ Inspector U(i —.—.—..--.—_--yy------- ---- -- ----- { No. �(�.�� "� t � -__ _.___- __-_ - ------•- ------------ Fee THE COMMONWEALTH'OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS lwigool *p!5tem Construction Vermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) y System located at &f'6, iv 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 thi -7^ Date Approved by Jul 26 10 01 : 46p p. 1 oft Balrnsta le o SHE P � Regulatory Services '3'iramas T.CYeilcr,Director DAWScn� = M� a Public Health Division Pen a Tbom-is McKean,Director 200 Main Street,Hyawds,NIA 02601 (Whim: 508-902-4644 Fax: 5UR-790-63W Installer&Designer Certification Form Date: —.u, 2) AP IV Designer: Address: _ `�j � `'�-�r��;�C-r I ,address- 4 huff t)ii was issued aper m to install it (date) — —� (installer) septic system at '77 l'�'`` !�'based on a design drawn Ni y (address) dated (designer) _ I certify that the septic: systani reSormiecd above was installed substantially amonl-ing to -%lie design, which xnay include minor.approved-ch es such as latca-i1 t0location of the distribution box and/or septic tank. .l certify';that the septic System referenced above was installed with'rni*r chingess greater than. 10'10' lateral relocation of the SAS or-any vertical r0loration of any component of the septit system)but in accordance with State &Local :lteg,,ijations. Plan revision or certified designer to follow_ �N 4FMgs pAVID (islstallex s Si 1a h3ASON No.1066 O sgN1rAR�P� __ - (1J ner s Signature) --- — (Affix er°s StampXezc:) YLE, SJ? RETURN TO BARNSTADL*X"PUBLIC MALTH AIYX,SIiON. . ,1t HFICA,`3 E OF COMPLIANCE WXLL NOT Sk__tiS><J7�:D�1�4311 T�_E.)"M STORM AND Ati- I3UILT CARD ARE RECI TVED i3"Y:'�'1E�F B�►'R $'TAI#TS TIMUUC&W_l jklY SION.- THANK YOU. , Q: C:roiEicatipu Foruni i I TOWN OF BARNSTABLE LO N 6'11zUvs a 1,4we SEWAGE VILLAGE JL) ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. V 40 tke 2 rvO 1 0 CA5 SEPTIC TANK CAPACITY P LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: '� C VARIANCE GRANTED: Yes No W 'may, 1 ' o � J � L A A.J ION SEWAGE PERMIT NO. -o VILLAGE I N S T A LL JE R'S NAICE a ADDRtS-S CAL-6(2--- c� BUI DER OR OWNER DATE PERMIT ISSUED �T«l2 DAT E COMPLIANCE ISSUED _ ,_ �� H{, �� . N�i— r . a ,. � cr- _ ' �N �� No..-...... FEs...$.5.x.QQ......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF- HEALTH • Town oF.... arns.table... Appliration for Uispnaa1 Works 'Tumitrurtivit Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 33 .............. ................................ ............. .. d11s-----------------.---.-.----------- ..................... -Location-Address or Lot No. June Custer• - ...................... -----•-----Hyannsport.....--•--- -..... ..........._.._......... ------ u e..._..__.... Owner Address a JoseP.h..P.:..Macomber..& Son,....Inc.:_.... Centerville . ............ --... Installer Address d Type of Building Size Lot............................Sq...feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building ....._..... No. of persons............................ Showers YP g •................ ------. ..... ( ) — Cafeteria ( ) �. Other fixtures .----"---------------------------------•• ----------------"--"--------------"----.....--------------•---........-•--•-...........•--• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......--................ LX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •--•----•••------------••----•--•-•---•-•---................................................................................................................ 0 Description of Soil:-----Sand... --g1 ygl............................................................................................................................ V .....•---•--••-••-••---•••--••••••-----•-••-•---••••..........-•-••-•....--•---•-•--•. .............&-------------------------------------------------------------------------"--------------------------.-...-....------------------------"---------------------------- --------- U Nature of Repairs or Alterations—Answer when applicable..... _-1000__&_jj:on overflow___(pit)________. .................---------- -•---•---------------•----------•--------•-•--------------.......-----------"---.....------------------------------------------------------------------------.._............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiTIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in , operation until a Certificate of Compliance has b ssued by thg board of health. —' ?, t .....-- ._.. 8/16179 - '�. s ..._ Date" Application Approved By.-f . _ -- - -- -•---••--•--......••--- --.�---.I .`.7. Date Application Disapproved for the following reasons----------------------- --------------------•----...---------------------------------------•---•---------------- ..........--•--•-----------------------------------------------------------•----------•--------•------•-•-•----••••--•--•--•......--••-----•••...... -••-••••----------------------•--•--....----- 7 Date Permit No......................................................... Issued_......R..... ....................................... Date �c fry n . i No..........V�.vy FEE...S N QQ...,..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OFHEALTH' ........ ...... .'�,' ...........OF.... M.0011........................---.......................... Appliratinn for Uiopniial Works Tonstrurtiun ramit. Application is`hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at .-----•-------------- .................................................._.......... T /�`�y�Aa Location-Address �q /� or Lot No. ... Juno Cub ter ---••....................................... SY ® ; ._......... .................. ......................._....... Owner --Address ................C9 ��..�g._MEbC l.'tb$: '..�..�LDI"�. .• 1110........... ...........�►�� •$ �� ----------•---------------- .... ......... Installer Address UType of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms..........:.................................Expansion Attic.( ) Garbage Grinder ( ) Other—T a ype of Building ....:....................... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ........................................................-•-.-- ......-----........---------......_........---••---- WDesign Flow.:....................................:...:.gallons per person per day. Total daily flow............................................gallons. WSeptic Tank' Liquid capacity............gallons Length................ Width................ Diameter---_............ Depth................ xDisposal 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 ( ) aPercolation Test Results Performed by.. Date = .................... Test Pit No. -1................minutes per inch Depth of Test Pit.................... Depth to ground water-,.---____-_-_--:-----. (s, Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water_y....................... W --- . ...............................•-----_... .... ..-••••-.-•-......_...._----.........-• --••-•••••--....-- D Description of Soil...... 1l ` + 1 ..............••-•.....-----•-__---. U . ......•--.------. •----------------------•--- W UNature of Repairs or Alterations—Answer when applicable.... `" � 1 ..........................................................•---•-••-•----------------........_.....---•--•••-------------•-•-•••---------•------•--•-------------•---•------•-•---•----••--..........-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage-Disposal System in accordance with the provisions of'ITL p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation-until a Certificate of Compliance has bee ssued by thi board of health S h' - ---- Date Application Approved By.... . •---- - . ........................ u,. a Date Application Disapproved for the following reasons----------------------- ------------------- '__._.___..__.___....._._._.______._..._......._....__. ......... .............................•---•--------..........----------•--•--•-........------....---•--•------•----------------....----------------------------------------------•-------------------•--•----_ Date Permit No.. ---------------•--•----------- Issued_`................................................... Date THE`COMMONWEALTH OF MASSACHUSETTS a BOARD OF HEALTH ' ( To- ............. . ....... ......... .. ... .. ..................................................................... � f�rr�if irtt�r�"nf.(�unt�li�aaTrr . THIS IS 0 . E IFY That t e dividu Sewage Disposal System constructed ( ) or Repaired (�}' ) e + acc b on - by t Installer has been installed in accordance with:the provisions of T T r f The State SanitaryC.de as described in the application for Disposal Works Construction Permit No. _.. ...... ._._. date( ....'.�.� THE ISSUANCE OF THIS-CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL UNCTION SATISFACTORY. 7 Inspector v x -y _..____.. ..'� ............... ......... ..... DATE............................./.....-•...... � __ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �O OF...B� 'fl . ... � f ...... y a IV . FEE..... _... �i��rr��a1 nrk� �aaat� nr#iniTrani# J6040 3 P. Xswftbar & get e. Permission is hereby granted•... ........ ......... .........••• ---• --------- -----_... •---•-•-------............................ to Const. or,Repair ( ) n.Indi idual S wage Disposal System MIApor at No. Cuatok ..-•-------- -----•--._.....•--••------.--•-- -----•----------•-•••---.--•------------_.... --- Street as shown on the application for Disposal Works Construction Pe No .. ............. tedF r f-/y- ��/e�KF- ... .. __ _ •___ .... Board of Health DATE.. r� f' ' . �.,. FORM. 1255 HOBBS- & WARREN,`INC., PUBLISHERS _ ' AP : ASSESSORS M8_.__._a�....__ TEST HOLE LOGS NOTES: Uv PARCEL: w (� SOIL EVALUATOR: f �� I � FLOOD ZONE: �� I��-�C��L� �. _ __.._4 _._...__,_. . .,� _ WITNESS - �I 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE: _ j�0/ G kjv�f �' t. �'7 . DATE: JOL Health Regulations. t/ h'J��21T� 12(-, PERCOLAT I 0 RATE: G Z.041 I 2) The installer shall verify the location of utilities, sewer inverts and septic / -- - - -R --- -- - - components prior to installation and settingbase elevations. `t► ry c/ �4'e Z / � � � � 3� ' ) gravity P piping p y w _.._..µ.,� __._...: ,.__.,.�..._..... _�w.___..�_ ._. TH_2 3 All rravit septic i in to be 4 inch Sch 40 PVC at 1/8"per foot. The first TH- two feet out of the d-box to the leaching shall be level. R Lflgry+^ L A b 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. 1, 1 5 �1 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. 7) The property is bounded by property corners and property lines. LOCATION MAP 8) The property owner shall review design considerations to approve of total 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 t I approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material bD per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per 5+ W►1 �` . W Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the + waterline shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service SEPT i C SYSTEM DESIGN line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the FLOW ESTIMATE owner to ensure such. BEDROOMS AT GAL/DAY/BEDROOM GAL/DAY 12)The installer is to take caution in excavation around the gas line if such exists. SEPTIC TANK 13)The installer shall verify the location, quantity and elevation of the sewer lines exiting the dwelling prior to the installation. GA /DAY x 2 DAYS - GAL 14)The septic is designed to accommodate the total number of bedrooms as provided by the property owner. USE 1156DGALLON SEPTIC TANK PU`5r U Cq SOIL ABSORPTION SYSTEM i r/ 0 `SIDE AREA: ZX -� �2j X. 2X a► BOTTOM AREA: Z41 X 0 , TIC SYSTEM SECTION ILI c1 1 4QF v WAY - 2��a�' ` Sra►�t o2 T"�p,�tl G IrJt?p GAL 1 __ � I I/ PE�I �� ► \ ?C 1 11 SEPTIC TANK �� U4Nii'I.I J?Z� kk OF 00 DB ID 9�G SITE AND SEWAGE PLAN I o� N s LOCAT ION :: JP? DUEL 15i � _.� rAR PREPARED FOR : :j OF L T I I SCALE O W DAV I D B . MASON DATE: 0 Z DBC ENVIRONMENtA DESIGNS DATE HEALTH AGENT EAST SANDWICH MA W ( 508 ) 833- 2177 Z