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Home My WebLink About0002 HIRAMAR ROAD - Health 2-- 4. Hiramar,Road r -v Hyannis 292 144 1 i 1 i I a i i e C. TOWN OF BARNSTABLE G, LOCATION z44& 4e ed SEWAGE Jodo--MT 'VILLAGES s�Nw/i f /I4a4A.,� ASSESSOR'S MAP LOTLt�� INSTALLER'S NAME&PHONE NO. //�/i �A,fJ C f�.>D� J** SEPTIC TANK CAPACITY /Jpy LEACHING FACILITY: (type) f (size) S 3� d NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: oGU < Separation Distance Between the: , Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 t YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: " Fill in please: L4l4§�@utltl € ?€ " APPLICANT'S YOUR NAME S BUSI ESS YOUR HOME ADDRESS: 2 (, - in Mr. )2i7 k S�o .3 191 30 TELEPHONE # Home Telephone Numbe ( cyO `NAME'QF CPRPOpATIOhI 1 IUAME QF N 111/BUSINESS TYPE ORBUSIIVESS bi IS THIS A HOMEIQGC�JPl�XIOi�I? YE5 . IVO ADDRESS OF;I�U5.1155� F. 1QkAl , iyiAp%I?ARCEL NUIVi®ER [gssessing), j I When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth I Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. i 1. BUILDING Ctuale R'S OFF This indiv i ed f n er it requirem nts that pertain to this typeo i eJLU UU � COMPLY WITH HOME OCCUPATION ze atur , RULES AND REGULATIONS. FAILURE TO COM FNTS V COMPLY � t 2. BOARD OF HEALTH This individual hwbeen informe ermit e,,uirem nts that pertain to this type of business. Authorized Sig ture* COMMENTS: I ,2 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business_ Authorized Signature* COMMENTS: ci f,k1 i i Date:0�1-2-3 /?oVy TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 91*6 1(20 0 '1v7A1 1"G- BUSINESS LOCATION: (Z ffb Q Q/ INVENTORY MAILING ADDRESS: R U 02 duo/ TOTAL AMOUNT: TELEPHONE NUMBER: 0642 1 ®O CONTACT PERSON: �155, IO UIVA I A EMERGENCY CONTACT TELEPHONE NUMBER: S fS 7!!? MSDS ON SITE? TYPE OF BUSINESS: 441',-.,74f.'111_ INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY BUSINESS Applicant's Signature Staff's Initials TOWN OF B STABLE ` LOCATIO ? �a' '- � SEWAGE # VILLAGE S ASSESSOR'S MAP & LOT,2 a_!qq. INS&LER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Lt) (size) s NO.OF BEDROOMS t BUILDER OR OWNER PERMTTDATE: b `''' COMPLIANCE DATE: 0 Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 o �i 1 P 1 w No. c�bo 7 44 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for 33i6pozal 6potem Cougtruction Permit Application for a Permit to Construct( . )Repair NA Upgrade( )Abandon( ) O Complete System Andividual.Components Location Address or Lot No. -it l('q 14,raM,�c-RA Owner's Name,Address and Tel.No. �6cnn j 5t Mq l �"�""" W t►S€(L Assessor'sMap/Parcel , � 'P0-Z09 434 t 1{i�elillC'A t MR Caryl, Installer's N e Address,and Tel.No. Designer's Name,Address and Tel.No. �*5 ��FP�+Cv�c� 6 Tc+ r,k-OC-N S} �� S ® �0- �x coal t C. FaVo �K Type of Building: 539-��°� Dwelling No.of Bedrooms Lot Size �t�'a sq.ft. Garbage Grinder(Ali Other Type of Building No.of Persons -Showers( ✓S Cafeteria(V ) Other Fixtures Lem Q-:%P a tc St f�.k l g1tt 0 V Design Flow 4 IM gallons per day. Calculated daily flow O� {n.11S gallons. Plan Date Ck r31 ,Number of sheets Revision Date Title `1 Size of Septic Tank 0 X YkCASk-, Type of .A.S. Description of Soil AoL��C1[1 Nature of Repairs or Alterations(Answer when applicable) 'C�cgw- 4tj ��)M. Date last inspected: Agreement: The undersigned agrees to sure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions f Title 5 of the Environmental Code and not to place the system in operation u til a ertifi- cate of Compliance has been issu by thij Board of Ve Signe N Date Application Approved by Date G Application Disapproved for the following reasons Permit No. SM — Z � Date Issued 011 f) d �. � .K�'..ti.•.s`Y•..•y wry •....: r.., ....,_11 r. No . Fee THE COMMONWEALTH OF MASSACF TT S Entered in computer: s Yes PUBLIC HEALTH'DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yi ZippYication for Mi5po5ai 6P.9tem Congtruction Permit Application for a Permit to Construct( j Repair X)Upgrade( )Abandon( ) El Complete System Individual Components Location Address or Lot No. 'ft 2-£ 4 1 -c.Pllcc.'R-LN Owner's Name,Addre and Tel.No. WrN€'CL- Assessor's Map/Parcel 144 O.-6XX 4'5¢ ►•{ACW lCA', MA Q�,c}y Installer's Name�A�dress d Te_;Np�C. �� Designer's�Nam�e, ddSess and Tel No. G cj JCS s -Tc C. Fb\n,o,��n, MA �Ae-t\ou7N Mf% (n448"5310 Type of Building: - Dwelling No.of Bedrooms r Lot Size r °� sa.ft. Garbage Grinder(Al/&- / V Other Type of Building N E No.of Persons Showers( ) Cafeteria( ) Other Fixtures V a-cb2`� r k tct�r Stn k CGUC)6,M. a Design Flow 4 gallons per day. Calculated daily flow SCE gallons. Plan Date / 8 0 4" Number of sheets _ Revision ate `~ Title Siie of Septic Tank Obi Qr � kSae Type of C_ .A.S. �J V`r'�k&WS ,q'S j-,e Description+,of Soil '�� Nature of Repairs or Alterations(Answer when applicable) "_�Q)J�_ At P�> } 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 provisionstof Title 5 of the Environmental Code and not to place the system in operation until a i ertifi- cate of Compliance has been issued by t ' oard of S i g n e Date LJ "J t1 I' Application Approved by Date 6 Application Disapproved for the following reasons y Permit No. S)C"o Date Issued / U ` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTJfY,that `Ott-Fite se a D' 1-8 ste Construct ( )Repaire ( )Upgraded X) Abandoned( ��`)by Z, r {�(f _:r . � at /�: has been const ct td i s accordance with the provisions of Title 5 and the or Disposal System Construction Permit No. W �7 dated ! 0 ` `+ Installer Designer The issuance op t' s ,e�t all not be construed as a guarantee that the syst� ill unction a�esi. ed Date 1 1 " Inspector t No � r � � --.-----------------.--=--Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi5po0ar *pgtem Congtrurtion permit Permission is hereby granted to o`struct )Repair( )Upgrade Abandon( ) System located at y Y r'/ , d t�•� >/ I r. 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:Constructi n must be completed within three years of the date of thi .p t . Date:_ ' �Q�� Approved by TOWN OF B STABLE . LOCATION ' `' SEWAGE # Y72 VILLAGE S ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. 6S � % i SEPTIC TANK CAPACITY`' S �' �� w�— / LEACHING FACILITY; (type) PMe (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: jib JO)L---L-,.COMPLL4LNCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 14- t t4„3, .. ' Q3 IDV , Town of Barnstable �t"E Regulatory Services Thomas F. Geiler,Director + &UWSTABLE » MAM �0 Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Designer: 1 Installer: Address: Address: =VPJAV-�' _ On � was issued a permit to install a date (installer) septic system at based on a design drawn by (address) n dated q -0 signer) �'� '0XI-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. 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. (fnsTallpT^s Signature) o CCi RM EN �N u SHAY N . No 1181 signer's Signature) (Affix De dqWNCFRTIFICATE re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVI 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:Health/Septic/Designer Certification Form 2 2133 502 681 US Postal Service d' Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse t[e� umber ost e,State,&ZIPC d/e / Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee LO Return Receipt Showing to Whom&Date Delivered Q Return Receipt Showing to Whom, Q Date,&Addressee's Address QTOTAL Postage&Fees $ E Postmark or Date tL a I I Stick postage stamps to article to cover First-Class postage,certified mail fee,and V charges for any selected optional services(See front). I I 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). R 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the I return address of the article,date,detach,and retain the receipt,and mail the article. cc n I! 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the _ gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the G addressee,endorse RESTRICTED DELIVERY on the front of the article. . 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 0 6. Save this receipt and present it if you make an inquiry. 102595-99-M-0079 � ,. Town of Barnstable Department of Health, Safety, and Environmental Services » IARMABIX 9� 1659. �0� Public Health Division IfDN � P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health January 11, 2000 Howard Weiner 3 8 Sisson Road Harwichport, MA 02646 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 2 and 4 Hiramar Road, Hyannis was inspected on January 10, 2000, by Jerry Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code H were observed: 410.601: Large amount of rubbish and garbage on the ground beside the dumpster(s) and scattered on the streets. You are directed to correct violations within twelve (12) hours of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF..,TM BOARD OF HEALTH omas A. McKean Director of Public Health. UNITED STATES POSTAL SERVIW,, First-Class Mail stage&Fees Paid k, PM , ,.� W Permit No.G-10 • Sender: Please prin your riNhe, address, and ZIP+4 in this box • Public Health DIVISICIR f,own of Barnstable P 0.Box 534 Hyannis. Massachusetts 02601 1 II�li3l1!lull!lIllit'!tl�fllltttll�iill'11�lfllliifllll':Jt�l1) 'dam 1 ■ Complete itei ns 1,2,and 3.Also complete A. Received by(PI e P' t Clearly) B. Date of Delivery I item 4 if Restricted Delivery is desired. 7� 1 /-/3 - l� ■ Print your name and address on the reverse so that we can return the card to you. C. Signature ■ Attach this card to the back of the mailpiece, X ❑Agent or on the front if space permits. ❑Addressee D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No 3. Service Type Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ' Da ❑ Insured Mail ❑=C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) t!f ! 4a f;Ft 'W; i!i f i PS Form 3811,July 1999'`'' ' '`r r'Domestic Return Receipt` '` ' 102595-99-M-1789 I .'J TOWN OF BARNSTABLE 420 LOCATION 8T %A SEWAGE # VILLAGE ASSESSOR'S MAP&LOT 70-f/-,s— INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY i 22 LEACHING FACILITY: (type) r��w S I (size) =gyp r-/l r flyi t size r l gV� NO.OF BEDROOMS m BUILDER OR OWNER 11•j1r"' PERMTTDATE: 7 COMPLIANCE DATE:. L 9 -9 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and,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 .(� �' 1 ) � � � � y S� I i � ( �► -e � �) 1 � � t � s / ® Q _ � �. � Illy � N. 9 -7. Fee_ i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[p pYication for 33iP)Upgrade( of *potem �Con�truction Permit Application for a Permit to Construct( )Repair(( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.;�41A \1i re.W q-- 90 Owner's Name,Address and Tel.No. Assessor's Map/Parcel '4- 1�1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Qi-e�— -W,vA-_>c ab 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 YY O gallons per day. Calculated daily flow L`qD gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /SDI Type of S.A.S. Description of Soil a Nature of Repairs or Alterations(Answer when applicable) OCP-5012-I1 -) 6-" IrV 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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has issu is BoardpW Signed Date Application Approved by Date C �0 Application Disapproved for the following reasons Permit No. 7 3 6 Date Issued \\ TOWN OF BARNSTABLE LOCATION b�'f' �4 SEWAGE # . VILLAGE \ ASSESSOR'S MAP& LOT JQ l� INSTALLER'S NAME&PHONE NO. Q SEPTIC TANK CAPACITY ti LEACHING FACILITY: (type) �'wS -� (size) ?3Ur f!/r/711 OF BEDROOMS BUILDER OR OWNER 11•,1�er PERMIT DATE: -JG 't,/ 7 COMPLIANCE DATE:_ ,!"" — Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 0 Jr `�Vl � ..ro-rr•rrT^�.,,•iYt....-. • . ei..Fr+.r. .,F, .. ..! i,. /_tssY♦[,ems.'` -..... �I_ . r " . k r.� ,.,,ate.�. _ . _ . �-y No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Z(ppricatton for Vigo ar *pgtem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.a4'A -,u V-1 Owner's Name,Address and T'el.No. Assessor's Map/Parcel ,`,` Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 06 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 y O gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /5'QtV Type of S.A.S. Description of Soil IV 1 0 54,0 r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement:The undersigned agrees to ensure the constructio ' g'd.An�te nance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the)�i'Viirronmental Code and not to place the system in operation until a Certifi- cate of Compliance has een-issued_by card Heztth, Signed Date Application Approved by — z' Date G2 �O Application Disapproved for the following reasons Permit No. _ 3 6 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERjjEY,-t t th On-site S��Disposal System Constructed( ) Repaired ( )Upgraded( �) Abandoned( )by at /44.� aM K'�S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 7 . 'AhH dated Installer Designer The issuance of this permit shall not( _ construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Miopogal bpztem w5tructton Permit Permission is hereby granted to Construct( )Repair( U}�grade( )Aban n'' ) System located at `f' t+� 1 9, r`h we--v-" �- 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. t Provided:Cons ction must be completed within three years of the date of this_permit-. ._ 61161<-f'l Date: Approved by 1 J NOTICE: This Form is to be uscd for the Repair of Failed Septic Systems Only C_Clt'I'IrICA'T[UN OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION 1'EIZMI'I' (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by the dated 7 , concerning the property located at -►-`` P��^� meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: V DATE: 6 LICENSED SEPTIC SYSTEM INSTALLER IN T14E 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]. jxcrt r. _ r A �� i t @�� ALL OUTLET PIPES BM SMALL I r_..•. *NOTE: ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. VENT PIPE (O Least 24 Inches tall) SET LEVEL FOR A �� 12' - OONCltEW COVER 10' min. from Schedule 40 PVC w/Chorcool Odor Filter SECTION A -A BET LEbEI FOR AT LEAST 2 iT. house to septic tank 3 - 3'7(,j T . , � t • Existing Foundation P PROFILE YIEII OF LEACHING SYSTEM Septic tank covers mutt De _ - /' • _within 6 In. of finished grodeO-ade over Septk ToNn - 98.00 Grode ova D-Boa - 98.00 overSAS - ElEV- 98.00 1�od� 12 ET �� Akg; R• ♦'a r r • r■.A.s a.w►.e sr.. "�f r/M- r/s• ir..s.+14..•... r I e- / $ : S - 0.02 S-O.tO 3 HOLE H-10 Top of SAS-Elev.=94.75 t55' -+•• t.75' ,i' ��f >� �' t EXIST. OR GREATER p1ST. BOX S- 0.010' per foot 3' A 4' - SCH. 40 Tee- 10' _� • �' a� 3 1 $ , r N 1,000 GAL. 0 10, i PLAN SECTION CROSS-SECTION ! 2 J b` tl Ch H-10 SEPTIC TANK 10 of N C3 o Effective Depth o 0 0 r3 r3 o t•a I 1 f 1 l I ; e.Hite. 0) v o 0 0 C3 0 o i dy' I r .l 3 f FULL rvt,Tta«-� m p i rn a, 0 3 HOLE H-10 DISTRIBUTION BOX + t ' o 3.5� 3.5' �i 4 4. Y �g+t��'f• 1 l -- F l [y . o tl tl tl A�J On NOT TO SCALE gppR (( --J - 'p 6 kn.of 3/4"-1 1/2" at > > ®',OWiRanl WkNneyi:ni•".y®'.OM NAREO `L...�-� SYSTEM PROFILE ; 12' tl LENGTHS AS SHOWN IN PLAN VIEW compacted atone a o EFFecpve Vldfh Not to Scale - � i > o GENERAL NOTES SOIL ABSORPTION SYSTEM (SAS) 6 in.of 3/4'-1 1/2' 0 1. Contractor is responsible for Digsafe notification compocted atone m 500 - C H-10 LEACHING UNITS / WIGGINS PRECAST and protection of all underground utilities and pipes. NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE Bottom of Test Hole I Elev-_86.00- - 2. The septic tank on j distri ution box shall be set _ Not to Scale v Obs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED level of 3/4 1/b2" stone. 3. Backfi11 should be clean n sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance P E R C 0 LAT I 0 N TEST with Title V of the Massachusetts state code, the approved plan ---- --- --_ -- -- and Local Regulations. ------ --------- __---------------------- ------- 6. If, during installation the contractor encounters any Date of Percolation Test: AUGUST 04. 2004 r- - 1L soil conditions or site conditions that are different Test Performed By- CARMEN E. SHAY, R.S., C.S.E. i LOT #58 LOT 59 y # from those shown on the soil tog or in our design Results Witnessed By. WAIVER (per BARNSTABLE B.O.H.) i L Excavated By. SHAY ENVIRONMENTAL SERVICES, INC. I LOT #57 installation must halt & immediate notification be I 1 made to Carmen E. Shay - Environmental Services, Inc. Percolation Rate: Less Than <2 MPI I 1 L 7. No vehicle or heavy machinery shall drive over the j 11 septic system unless noted as H-20 septic components. -- -- I 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Test Hole r,r 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. No. 1 I 50.00' 10. All solid piping, tees & fittings shall be 4" diameter DEPTH SOILS ELEV. i Ir Schedule 40 NSF PVC pipes with water tight joints. 0 98.00 ' i � i 11. Municipal Water is Connected to ALL OF The Residence and Abutting Sandy ' ASPHALT CV Properties Within 150 Feet. Loom ASPHALT - ' DRIVEWAY 10 YR 3/2 i DRIVEWAY �t 0'-e' A, 97.25 I ^�.1 r_ THE PROPERTY LINES ARE APPROXIMATE AND I Lill loamy l / �� 1 COMPILED FROM THE SURVEY PLAN GENERATED BY Sand �� BEARSE & KELLOG, BARNSTABLE, MA ENTITLED 10 YR 5/6 I / ' "SUBDIVISION PLAN OF LAND IN BARNSTABLE, MA" LC 17786-E a"- 40' Be 95.75 TEST HOLE 1 I DATED MAY 21, 1954. IT SHOULD BE USED FOR NO PURPOSE Mee li i \ ELEV = 98.00 Jf �n OTHER THAN THE SEPTIC SYSTEM INSTALLATION. SAND 2.3 Y 7/4 ' i - 13.6 �E4' _-------- lI� L-------------____ _ _ _ 00 40 144 c f/ 4" PVC EXISTING LEACH PIT/CESSPOOLS TO BE PUMPED OUT AND trj 1 • - 1 Vent Pipe #428 & #430 FILLED IN PLACE OR REMOVED TO FACILITATE INSTALLATION OF NEW SAS. 1� `� 2 � ., Z 2• NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE I I cry FROM THE EXISTING L.EACHPIT/ CESSPOOLS TO BE DISPOSED • __ �2• �I OF AS PER BOARD OF HEALTH SPECIFICATIONS. O O NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY --► ," L EXIST. 1000 G LON ASSESSORS MAP 292, PARCEL 144 12' SEPTIC TANK Perc #1 I LEGEND Depth to Perc: 40' to 58" i y Perc Rate= Less Than 2 MPI 71#V I Q <L j _ I = w I #2 & #4 Observed ESHWTO - NONE OBS.- 144" Assumed i a- 2: I DENOTES PROPOSED Q o i EXISTING 104X 1 SPOT GRADE ADJUSTED H2O Elev. = NONE OBS. - 144' Assumed i 4 BEDROOM( co LOT #60 HOUSE k6 DENOTES EXISTING CONCRETE SLAB X 104.46 SPOT GRADE LOT #71 I i FOUNDATION PL PROPERTY LINE LOT #70 96P PROPOSED CONTOUR ,' �r 7,512 Square Feet - - -- - - -97 EXISTING CONTOUR 80.41' � �� 2-18" EXAM. ACCESS MANHOLES ' \ ___ -'/// � DEEP TEST HOLE & - - --_ --- _ , - ----------- -------------- PERCOLATION TEST LOCATION 6 ------------- 6 FOOT STOCKADE FENCE PROJECT BENCH MARK � �LR14 MAR R OA -0 TOP OF FOUNDATION MET �1 _ / ^ ELEV. = 100.00 (Assumed) OUT (40 FOOT RIGHT OF WAY) P LOT P LAN ' THE ACCESS COVERS FOR THE SEPTIC TANK, LET DEEPER tax AND LEACLEES WIG W FINII VENT O F PROPOSED SEPTIC SYSTEM UPGRADE SET DEEPER THAN 6 INCHES BELOW FINISHED - '' GRADE SHALL BE RAISED TO WITHIN 6' OF STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. PLANVIEWA! INSTALL TUF-TITE GAS BAFFLES OR EOUALs PREPARED FOR P � 3-24' REMOVABLEV L�� H O W A R D WINE R i AT #2 8c #4 HIRAMAR ROAD 3 min. clearance I 1J PKET-r. hPILET L-�'FJ '� to o tkk e-f ' - H YA N N I S , M A - - OUTLET 10'min. Lk1u1d level s -r ~5' -'' Desian Calculations - - E A 4'-0' min. 3 0.er.. r Liquid depth Number of Bedrooms: 4 Bedroom EXISTING a�r c` "v"q PREPARED BY: y's Garbage Grinder: No s Leaching Capacity Required: 440 Gal./Day (MIN. PER TITLE V) ? CA E CIl R1I1L N E. Sl l Cl l Septic Tank - 2 x 440 Gol./Day = 880 USE EXIST. 1,000 GAL. Septic Tank. F B'-D" f ` r 4' -1O • SOIL ABSORPTION AREA: Usingpercolation rate of <2 min. inch S ENVIRONMENTAL SERVICES, INC. CROSS SECTION END-SECTION p /• 0 20 40o Bottom Area: 0.7E gal/sq. ft. x 444 sq. ft. = 328.58 gallons ' Sidewall Area: 0.7E gal./sq. ft. x 200 sq. ft. = 148 gallons -- .p �O P.O. BOX 627 Providing: a 476.56 gallons STEM EAST FALMOUTH, MA 02536 �P TYPICAL 1000 GALLON SEPTIC TANK Sq/VITAF '� NOT TO SCALE Use: (3) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, SCALE: 1 "=20' TEL/FAX : 508-548-0796 TO BE USED MATH 3.5' OF WASHED STONE ON THE SIDES AND SCALE: 1 "=20' DRAWN BY: CES DATE: SEPT. 8, 2004 3' OF WASHED STONE ON THE ENDS. UNITS TO BE SEPARATELY PIPED AND TO BE SEPARATED 2' APART. - _PROJECT#SD628 FILENAME: SD628PP.DWG SHEET 1 OF 1