HomeMy WebLinkAbout0114 MELBOURNE ROAD - Health 114 Melbourne Road
Hyannis P
268 227
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ENVIROTECH LABORA TORIES,INC.
MA CERT.NO.:M--AM 063
8 Jan Sebastian Drive Unit 12
Sandwich,MA 02563
(508)888-6460 1-800-339-6460
FAX(508)888-6446
Client Name: Desmond Well Drilling Location
Address: PO Box 2783 114 Melbourne Rd
Orleans, MA Hyannis,MA
02653 Lab Number: DW-203221
Collected By: DWD Date Received: 09/02/20
Sample Type: Well Specs: Irrigation 35723'
_`� LOCat1011 SOt!/CC' � � DDate Co/lected Ti We-01/eCted a �x `Comments *�';�s 4 "
A`M 13:30'�
Analysis Requested Units Recommended Limits Analysis Result Method Date A a-l--.41 Analyzed By
Total Coliform CFU/100mL 0 Absent SM9222B 09/02/2020 KF @ 18:15
pH pH Units 6.5-8.51 6.1.2 SM 4500-H-B 09/02/2020 SD
Specific Conductances umhos/cm 500 228 EPA 120.1 09/02/2020 SD
Nitrite-N mg/L 1.00 <0.006 EPA 300.0 09/03/2020 LL
Nitrate-N _ _ mg/L 10.0 8.20 EPA 300.0 09/03/2020 LL
Sodium' mg/L^ 20.0 26 EPA 200.7 09/03/2020 KB
Total Iron mg/L 0.3 0.05 EPA 200.7 09/03/2020 KB
Manganese mg/L 0.05 0.019 EPA 260.7 09/03/2020 KB
Comments:
Nitrate level should be monitored periodically.
pH is below recommended limit and may have corrosive characteristics.
Sodium level is not a health hazard.
All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met,
unless otherwise noted at the end of a given sample's analytical results.
We certify that the following results are true and accurate to the best of our knowledge.
Water meets EPA standards and is suitable for drinking for.parameters tested.
Date 9/4/2020
Ro ald J.Saari
Laboratory Directo
BRL=Beloiv Reportable Limits *See Attached Page 1 of 3
nCertiftcation is not available,jar this analyte for potoble water samples..
Massachusetts Department of Environmental Protection
Bureau of Resource Protection
Well Completion Reports
Well Driller
Please specify work performed: Address at well location:
New Well Street Number: Street Name:
L
114 MELBOURNE RD
Please specify well type: Building Lot#: Assessor's Map#:
Irrigation j
Assessor's Lot#: ZIP Code:
Number Of Wells: 02601
Citylrown:
Well Location BARNSTABLE
In public right-of-way: GPS
#'Yes r No North: West: ,
41.64199 70.31184
Subdivision/Property/Description:
Mailing Address:
click here if same as well location address
Property Owner: Street Number: Street Name:
WILLER PINTO 114 MELBOURNE RD
City/Town: State:
Engineering Firm: BARNSTABLE MASSACHUSETTS
ZIP Code:
02601
Board of health permit obtained:
Ci Yes r Not Required
Permit Number: Date Issued:
W2020 22 107/28/2020
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Well Driller Program
l
Well Completion Reports(General)
Well Driller - General Well Form
DRILLING METHOD
Overburden Bedrock
Wug rere -Choose Bedrock WELL LOG OVERBURDEN LITHOLOGY
Drop in drill 'Extra fast or slow Loss or addition
From(ft) To(ft) Code Color Comment
stem I drill rate of fluid
0 I 15 Medwm Sand 'Brown +� C Fast:"Slow �Addition
!
5 —� ? YES NO
I
(15 (35 Fine To Coarse S: `Brown
Fj C Fast t'Slow.
k , � �_
` YES NO =Add,,.n
WELL LOG BEDROCK LITHOLOGY
Loss or Extra
Drop in ;Extra fast or j Visible Rust
From(ft) To(n) Code ;Comment addition of Large
drill stem 'I slow drill rate Staining
I j fluid Chips !
..........I
......................................................_..........................._..._..__............._...................._....... .................
......_.........._........._...._........_...._;.........._........._........._...................... ............_.._..........,
f;
(Choose Code� Yes YES NO I Fast Slow Loss Addition j L----j j
ADDITIONAL WELL INFORMATION
Developed Yes f"No Disinfected Yes No
Total Well Depth 35 Depth to Bedrock
Surface Seal Type one racture EnhancementYes No
CASING Is Casing above ground?
From To Type Thickness Diameter Driveshoe
............................ ......... ..'
........... ....,. .... ... ..... 4 .... .........
P: vn I Chlorde Schedule 40 j
!
SCREEN it No Screen
From To j Type Slot Size s Diameter
L32 35 ![Stainless Steel Well Point
J ;t...............__._........._.............__..._..._........_...__
WATER BEARING ZONES DRY WELL]
From To Yield(gpm)
,
23 i 35 ! 12
.._................................................................._....................
PERMANENT PUMP(IF AVAILABLE)
2 Wire Constant Speed
Pump Description Horsepower
Submersible 3/
L__......_............._..._....._....... �...._
Pump Intake Depth(ft) 30 Nominal Pump Capacity(gpm) 15
ANNULAR SEAL/FILTER PACK
i ! Water j Batches Method Of
From To Material 1 Weight Material 2 Weight
(gal) (count) Placement
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Well Driller Program
` Well Completion Reports(General)
s
Choose Matenal . Choose Material Choose One
11.. i
WELL TEST DATA
Time Pumped I Pumping Level(ft ;Time To Recover Recovery(ft
Date Method Yield(gpm)
(HH:MM) I BGS) (HH:MM) BGS)
................ ......_........................_..__........____.._.. -..__.._.._.._................._..._.................._............... ---------------- -- ............................._..-.._...._._.._-i
09/02/2020 Constant Rate Pump m 12mm 1:30 124 0:01 2=
WATER LEVEL
I
i
Date
;Measured
Static Depth BGS(ft) Flowing Rate(gpm)
O /02/202o F23 12
COMMENTS
WELL DRILLERS STATEMENT
This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete
and accurate to the best of my knowledge.
WILLIAM Supervising Driller DESMOND,
DrillerURQUHART Registration# 299 Monitoring[M] Signature THOMAS,E
DESMOND WELL
Firm DRILLING,INC. Rig Permit# 024 Date Job Complete o9/1v2o2o
.....................__..............
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
Not Fee 16-
BOARD OF HEALTH
TOWN OF BARNSTABLE
0[ppYicatiou _for 39ell Cougtructiou 3permit
Application is hereby made for a permit to Construct(p< Alter( ), or Repair( ) an individual well at:
IL tion-Address A sessors Map and Parcel
�f�iLGi� /'iN�D /1,4e/ u ,L04L �5 Qom/
Owner Address
Installer-Driller Address v *63--
Type of Building
Dwelling
Other-Typ//ee,of Building No. of Persons
Type of Well T <�G h VO 111(f— Capacity /
Purpose of Well
Agreement:
The undersigned agrees to install the afore described 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 Certifica of Comy nce has been issued by the Board of Health.
Signed -L/-L� z�
Date
Application Approved By
Date
Application Disapproved for the following reasons:
Date
Permit No. � Issued
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that
the indi idual well Constructed(&4,' Altered( ), or Repaired( )
by fyio� d fit/ // /1/L4i! y c-
D' Installer
at �I �`�jOGt R� /��- Y/`!iS �a d. 6 U/
has been installed in accordance with the provi ions of the Town of Barnstable Board of Health Private We 1 Prottction
Regulation as described in the application for Well Construction Permit No. Dated 7
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
No.
Fee 7s
`BOARD OF HEALTH
TOWN OF BARNSTABLE .
ZIPPrtcattor A f or Delft, ongtructton J)ermtt
Application is hereby made for{aa permit* Construct Alter( ), or Repair( an individual well at:
Location-Address .? / Assessors Map and Parcel
e o u.
Owner " ✓ " Address
/� ��' a�
Installer-Driller Address
Type of Building '
Dwelling
Other-Type of Building ) ' �� ? No. of Persons
Type of Well T C h �� �, Capacity eS�P�
Purpose of Well
Agreement:
The undersigned agrees to install the afore described 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 Certificate of Compliance has been issued by the Board of Health.
Signed_
-�/• Z6 Zd
i Date
K
Application Approved By
Date
Application Disapproved for the following reasons:
10,
Date
Permit No. Issued
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate of Compliance
THIS IS TO CERTIFY,that/the individual well C.-on-s-tructed(-f, Altered( ), or Repaired( )
by e `rcn� d /rim 1/ ��/,-,.e. �7 7 . h
Installer
at // �`/�Q f f70Gc.2 x-c.. 1sL /�v
has been installed in accordance with the provi ions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No.lG- Z Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
BOARD OF HEALTH
TOWN OF BARNSTABLE
lVell Con5tructton Vermtt
No. Wes✓ "' Fee �s
Permission is hereby granted to
Installer
to Construct?( ), Alter( ), or Repair an an individual well at:
Street
as shown on the application for a Well Construction Permit No. �/"4 '`� Dated 7 a oll
Date Approved By
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. ,
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
aim
DATE: (0 O I / Fill in please:
APPLICANT'S YOUR NAME S: ce_BUSNESS-M YOUR HOME ADDRESS:TELEPHONE # Home Telephone Number O 2`-� 3 0
NAME OF CORPORATION 11 C
NAME OF-NEW:BUSINESS > TYPE OF BUSINESS C�� -
IS THIS A HOME OCCUPATION? YES NO ; - o?� a; � `�
ADDRESS'OF BUSINESS t l�-t 2 .. �a.v'C r._' �' . AP/PARCEL NUMBER ✓ti':� (Assessing]
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
v
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO MISS[ ER'S OFF f business. MUST COMPLY WITH HOME OCCUr ATION
d f jye r r re is th t ertain to this e oThis indivi ual h e n inforp tYp q RULES AND REGULATIONS. FAILURE TO
'Au hod to �— COMPLY M.qY HERULT IN FINE,
M ENTS: �-
J-�<1)Ll 10 lei # — 4 1Y) stlay
2. BOARD OF EALT
This individual 1&en�informed f the p equire ants that pertain to this type of business. MU$T COMPLY WITH ALL
Authorized Signature** HAZARDQUTA►1 ERIALS REGULATIONS
COMMENTS:
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Xvrru VL 1JQ.L11ALLLULU
¢� Regulatory Services
pF THE Jp�
o Richard V.Scab,Director
R&RNsMABIA ± Building Division
Paul Roma,Building Commissioner
200 Main Street;Hyannis,MA 02601
www.town.barnstable ma us'
Office: 508-8624038 Fax 508-790-6230
Approved:
Fee: 5,
Permit#: od- 4 7 / 7/3
HOME OCCUPATION REGISTRATION
Date: O( O1 l
Name: `vj`�C e— �`M�`��C7 Phone
Address:A'-A --- Village: �i �l`rl �•S
Name of Business:_'
Type of Business:
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor,no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carved on by the permanent resident of a single family residential dwelling unit;located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there
is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involverhe production of offensive noise,vibration,smoke,dust or other particular
matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such-use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up track not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling mmit
I,the undersigned, ve read e with the above restrictions for my home occupation I am registering.
Applicant t Date:
Homeoc,doc Rev.06/2011b
' Date: / ( / 2-o '
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: 00S <z C-0
BUSINESS LOCATION: I VENTORY
MAILING ADDRESS: . ' c� 1 TAL AMOUNT:
TELEPHONE NUMBER: 5 o
ECONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: SDS ON SITE?
PE OF BUSINESS: CA'p am k�(1 2,
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
t
Laundry soil &stain removers
(including bleach) �K
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
9
i
File No. 020 6039
SKETCH ADDENDUM
Borrower or Owner Pinto
Property Address 114 Melbourne Road
city Barnstable county Aawahtw state MA Zip Code 02601
Lender or Client Compass Bank
1
- fir )-0IG(3
Deck-
14'
Dining Bath
Master
Kitchen
Room
.. Bath Bedroom
Garage
24' 26
Living Room
Bedroom Bedroom
14'
48'
E
R _
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• ..s:` ..
_ `/�
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�'9 ..
`9ai� � - _
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+ 111
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-- YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the 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" Fl., 367 Main St., Hyannis, MA 02601(fown Hall) and get
the Business Certificate that is required by law.
C
f DATE: J � I'O I
.,i Fill in please: �^ 2�1
APPLICANT'S YOUR NAME:
BUSINESS YOUR y � r, •r:�+�;�� UR HOME ADDRESS:
TELEPHONE # Home Tele hone Number: 5Q ��` Zgc.S\b
NAME OF NEW BUSINESS 'O �� TYPE OF BUSINESS
1S THIS A HOME OCCUPATION? V YES NO
Have you been given approval from.the building d i jon? YES NO
ADDRESS OF BUSINESS �` ���n� v 4 i5 ��- c) MAP/PARCEL NUMBER
When starting a new business there are several things you must do in order to be in compliance with the rules.and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of .
Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this
town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has-been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
2. BOARD OF HEALTH
This individual has be n informed o e mit r.q irements that pertain to this type of business.
1 ' Authori� ed_Signature**
COMMENTS: 1(-1�2 . Ts�►-r i=i►2,4o IAIA-,_� Ce QQU Ac 0A0-1 of L4U_k C_1 H 5 "V1 c.#}
ti�� S�-t�r.9t,- �oi.iL�y q��D <k-DUtS�7j
IN I t.�1ASl W/�Trf� l �O r3� 1)ISI��SFI� OF �ICUP�'i2G4 f��T� K ZO' �-S Ol= 1njA-ST7�JA&Tr=�2,_
3. CONSUMER AFFAIRS (LICENSING AUTHORITY) /
This individual has been informed of the lice
nsing requirements that pertain to this s type of business.
COMMENTS: Authorized Signature**
Places where business will be taking act (will be working):
ill serve all over cape area where work is allowed to be performed such
residences, commercial plazas and office buildings' parking lots.
List of chemicals used and respective quantities:
Car Wash Express Detergent/Shampoo (SOAP) - 3 gal./month.
Glass Cleaner by Johnson Wax Professional (WINDER) -2 gal./month.
• Leather conditioner by Prochem- (Leather cleaner and conditioner)- 1
gal./month.
• Polishing Wax Compound Rapid Wax by ARDEX-2 gal./month.
Odor Neutralizer by Prochem (Car Fragrance) -2 gal./month.
General Purpose Cleaner by Johnson Wax Professional-for Upholstery,
Vinyl and wheels- 3 gal./month. _
Start to finish car washing procedure:
.. Set up the containment mat on the ground;
Pull vehicle over the mat;
Wet the vehicle's surfaces;
Hand wash vehicle with detergent;
Clean wheels with General Purpose Cleaner;
e Rinse the vehicle;
Dry it out;
Vacuum inside-carpet and seats (including floor mats);
Wipe dashboard;
Clean'windows using Windex;
• Spread wax on;
Wipe wax off;
Spray car fragrance inside;
Pull vehicle off the mat;
Suck the water on the n'iat with an appropriate Wet-Dry vacuum;
Fold mat and put away in the trailier;
Dump dirty water in the dirty water container; dispose of dirty water at the
Town of Barnstable Water Pollution Control -whenever container gets
fully loaded.
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Date: d3/1 O
TOWN OF BARNSTABLE .
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: Cc.,IpQ. Cr-n��
BUSINESS LOCATION INVENTORY
MAILING ADDRESS: \1`1 �F��,�C.t� �.�.0 ; ��, �r�n�i , , o c, t TOTAL AMOUNT-
TELEPHONE NUMBER: 2$(-_� Sl Cpi lL
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: 5o% 'Z$O Sw l MSDS ON SITE?
TYPE OF BUSINESS: / (017L CQ� t.1_36.5VA
INFORMATION/RECOMMENDATIONS: Fire District:
I I SPo - - E- hod
/vet
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
7Mo or 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 BA.RNSTABLE /
LOCATIONf/`� e��Ov -G �� SEWAGE #
VILLAGE H`��/�-/i'/ma's n�i�-'� ASSESSOR'S MAP &LOT,Z6d'i2g1>
INSTALLER'S NAME&PHONE NO. f 05-r0-
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) y 3�� 6 AI 14% (size) do�n ,?!(
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: f f"0 JK COMPLIANCE DATE:
— VIVO
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet.of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
ISO
�.
No. 7 v Fee d�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pplitatfon for Mgoml *pgtem Com5truction i3ermit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. i J y MF_L 3 c)u1e N 6 IZ D Owner's Name,Address and Tel.No.
/Jyrtrrn�,s�r� Mq MKau.t�� A,..t�o
Assessor's Map/Parcel Z Z
Installer's Name,Address,and Tel.No. 5os-`I28-93 a"o Designer's Name,Address and Tel.No. -7$1—585— OZ43
Pa'STart' E-,t c-r0v A'rl a-',j b n R2x-r.► M Y Sft5
83 13a1A1Z0L6'r t'Z.D SA?4V%.01"Lt1 43 VtNtr sT, Du%ev2Y A44�
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building T1Nat_r6 'Pam. No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow .3 q3-• 306 gallons per day. Calculated daily flow 330 gallons.
Plan Date "7—1— 04 Number of sheets Revision Date
Title
Size of Septic Tank 106o g! Type of S.A.S. 4 506 g1 C 4r4V4 6YZ!5
Description of Soil 3'*,' "3 S M F-0 5YWO
Nature of Repairs or Alterations(Answer when applicable) at:PLA C,t N& LZA to T:1 Q.V
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 been issued y d of ealth.
Signe Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
No ; _ Fee
THE�COMMONWEALTH OF MASSACHUS ETTS
Entered in computer: ,
Yes � ;1
• PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,WA-SSACHUSETTS �
Zippricat on for Migpool *pgtem Construction Permit
f j
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. //L/ MIE L l3 O vQ w 9 tZOV Owner's Name,Address and Tel.No.
14Ya r..rt 907ZT J-44
Assessor's Map/Parcel 2 4r8/ Z Z 7
Installer's Name,Address,and Tel.No. Svu �a '�1S'GtiL Designer's Name,Address and Tel.No. -7$1—5 g5_ 0793
J74Si'a72� 'C-�,C_VNJ,r�1-+ a"'- j flU rif i' t i MYEr25
CX3 SCIAIZOt_>`-r rZO 443 V�Nr -ST 0UJr3v2Y gyp,
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building T' 6L- Vnm- No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 3 gallons per day. Calculated daily flow 350 gallons.
Plan Date-' '7"I Number of sheets Revision Date
Title
Size of Septic Tank /000 9 Type of S.A.S. 14 5O6 9/ CF 0"13645
Description of Soil 3*-83 38
Nature of Repairs or Alterations(Answer when applicable) LX_-A 4L u T:!GA_0
i
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 been issued y d�L. ealth.
Signe Date
Application Approved by Date 5 c�
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CEIaTaIFY 4tat then,.-site S. age DisDoral ysy}��rtt C nstructed( )Repaired ( )Upgraded( )
r
Abando ed( )byI (✓ V ,I I! ,n
-
at ! �`�T' 1 .L� 0 V > Kv, � f h b en-constructed in accordance
�s
with the pro "sionsooffiitl 5 and the for Disposal System Construction Permi o. J _ dated r�
,f��c
Installer / 1� �-/K_ t Designer r1V 1 (7
The issuance of this permit sh 11 not bf/rco1ns rued as a guarantee that the sys 1l function/as designeTYJ
Date / �� /(J Inspector r (/ rl � 7/ EV
1
I'
i;
No.
' `3 q' 5 Fee/ ��
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
wi!5pogal 61p5tem Construction Permit
Permission is hereby granted,to Construct epair( �Upe )Ab on( )
System located at f el 1-7 J1�
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:Constructkon 4t be completed within three years of the da of this p r +t.
Date:_ II //0"Y Approved by
t
a t
Town of Barnstable
�pFTHE r Regulatory Services
h,f. yvrP �O,n
Thomas F.Geiler,Director
IIAMWABM
HAM Public Health Division
ATFI3. a � Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer &Designer Certification Form
Date: A UST Ili ZOO+
Designer: DMAeA 1q, Installer:
Address: . ���� X � � Address: C) 601,
On Pis►of2Z D— C, was issued a permit to install a
(date) u �A ,� (installer) �j
septic system at �l �I ��' Rz0V1Q-�� 4 - based on a design drawn by
A� y� (address)
E-f— dated 7 — t— 0 q
(designer)
!� ?,=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.
-,�,N OF Mgss
o� DA R sm
(Installe 's Signature)
. 1140
I S4NITA?0' \
(Designer's Signature) (Affix Designer's Stamp Isere)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
TOWN OF BARNSTABLE
� LOCATION �� '�e �Ov�-G SEWAGE# .
VILLAGE H y,O�AI.71 P ,,,,r ASSESSOR'S MAP &LOT
INSTALLER-S NAW&:PHONE NO..
SEPTIC TANK CAPACITY
'r Y.—t �,fCC��4 �X
LEACHING FACILITY: (type) (s•ize) 3401
NO.OF BEDROOMS `
BUILDER OR OWNER---
PERMTTDATE: f"�`►� COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility. (If any wells exist
on site or within 200 feet.df leaching facility) r Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
i
within 306 feet of leaching facility) Feet
Furnished by
t
2
e
5
f
fe
L JUN
-- 2rowvor 2000
Aw
Pr
COMMONWEALTH OF MfASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFP AIhSa
DEPARThMNT OF ENVIRONMENTAL
ONE WINTER STREET,BOSTON MA 02108. (617)292-5500
TFtiJM' COME
ilr�crstaty
ARGEO PAUL CELLUCCI I)XIM B.9'MUHS
liSllMMACE UWAQE DNPCIAL BYSTM MPECTlofd ROidie Casamissumar
PART A
CEI!11PiCAT1�DiM '
Pa+�iwW Adinoes: 1, �c ( eebc� +.w.c RsQ-
g`l,,� Addinowe0ownw. Q,r HQL
!la a s irtlf1c�11o�,A, llv,55 oao 4'�.>
I atu a,DEP -system Mrepaater purtwant a 16.30 of.Tltlls 6(310 CM I5.0M)
c"romw ILma: ti (�cac`)cco r g
iMdit AM ons: ht5 M ►-sue o oZ. ,A t
Tsiaptrane IIMti1«: 4 Q�3��� 7[�Q 9
I denft that I hevo':personally inspectioJ the 8Gwsge disposal system at this address and that the information roportad belo+k is tine,soeunue
sold ceonp6 O ap of the thrfe of inspection. Ths inspection was performed based on my training and experience In the propts fun,t on end
mabylonanoo of.on-sFte @swap disposal systems. The system:
Passes
® .CondhionaNy Posses
Needs Further liralustlon BY the Local Approving Auttwrity
FsMs
iresp.asa.�e s1,9.�rre: ,. Dena: l
The fy$"Inspector shell submit a copy of this inspection report to the Approving Authority(illoard of Health or DEP)whNci i$&.1,(3014ayn of
eorrtpleting this Inspection. if the system is shared system or has a design flow of 10,000 gpd or greater,the(espeetor and ehii systsnrl ownar
shell submit tho report to the appropriate rogiorw office of the Department of Environmental protection. The original should boo iiu,►4 to#0
system owner snd coples sent to the buyer,if apslieaMe, end ths-approvWg aritFtority.
MOTES AND COMMENTS
revised 9/2/98 pop Iof11
�rintrd on Rocy�kd hpn /
r •
SIBSILMACE SEWAGE OISFOSAI.STSTM N3rECTM FORM
PART A
CM714CATU M(omdrawM
lrnparty
13ianer: b o u A"
IN*of : 6-1 ots ao
1018"C" M S MeflAlllf: C, or D:
A., STS7IFSII►Ash:
_ I have not found any Infarrwon which Indicates that any of the failure conditions described In 210 CUR 15.3103 exhit. Any•failure
Snarls not evelaated are In,Scated below.
CORUNSM: _ ----
®. sTST�!CONOfT10MAIlT PA'i1iES:
One or more system comiranents"described In the"Corm"ansviss"&salon need to be replaced or r"Wr4d. 11-e systarr.,span
completion of the replecein,ent or repair,as approved by the S •d of Health, will pass.
Indicate yea,no, or not determined(11,M,or MO). Describe of determination In all instances. if "not detenNned",s)Iptuis• why not.
— The septic tank i*metal,unless the ow or opwator has pravhkd the system Inspector with a copy of a is wilifft:ate of
Compliance(athschaM indicating the tank woo Installed within twenty(201 years prior to tha data of I:w iriepwlicn:or
the septic tank. whether or not ,is cracked,Structurally unsound,shows subatential infiltration of erNltradoih, -or tank
fewre is Imminam:. The sys '"M pass inspection if+Ae existing septic tank is reputed with a conip�tyinil septic:tenk as
approved by the ioard of H Ith.
Sewage backup i breakout or high static water level cftsmed in the distribution box Is due to broken or ctistructa�i pfpetsl
/-Mlon
n, seeded or uneven dhrMbution box. TM syste n WIN pats InepaCtion It(with approval rr!the c @4 s�f
broken plpala)are ralilaoed
obstruction Is►omoved
distribution box Ie levegad or repleceif
re4 pumpingmoh than four times e epp►ovd of tM Board of ywM duetobrokenorobetructodpipets). TPoerynterr� wir(broken p4Ma)are r Mil. �se obstruction is ramowod�ed
reviDed 912198
=of11
r
M
s1u1111SURFACE SEWAU DISPOSAL SYSTEM NIISPECT10M FORMA
PART A
�!!1 CM I WATM(oamolinu dl
Prapsrly � (0��P.I.CP O�f•w..4
Dais'ef boil 0 err: S I.2�(Oa
C. IW MrA EVALUATION NR RMMED BY THE BOARD OF HEALTH:
M Conditions exist which r"Wro hr Ow evaluation by the Board of heatdi in order to date ne if the system is falling to f idtect tivr
"Ibilio boom,softly and the ermfonrnent.
/1 SVSTENA WLi.PASS WARM BOARD OF HEALTH DETiR�N ACCOR MCS WITH z10 CMR 15.303(lXb) THA1' iW..Sy'N'rlai!
it NOT FUNCT10NM N A lbkIrI M WHICH WILL PRO IOCI THE PU HEALTH AND SAFM AND THE ENVN11i(NON tVT-
Cesspool or prhry Is vrihin SO fact of surface water
Cesspool or privy is within 50 het of a bordering ad wetland or a salt rnarsh.
2) SYSTHA WILL PAIL LN&US THE OF HEALTH(AND PUBLIC IMATER SUPPLER,IF ANyl DrnL4NNNES TNkT 111,11: SI�t111a!IsRX#C w%N MlQi IS A MANNQd11' PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE IMNMIONNAENT:
The system has a sop is tank and soil absorption system(SAS)end the SAS is within 100 feat of a surf*.-*will or"ply, It
tributary to a water supply.
The system hoe sep+ic7teak and soil absorption system and the SAS is within a 2ona I of a public water:Puppy, wolf.
The systam a sepkie tank and soil oboe.ptWx system+anti the SAS is within 50 het of a private waai suippl 1,won.
The system s a sep+tc tank and soll absorption system and the SAS is less than 100 feet but 50 feet or mope from a
private w supply well,unless a wall wear analysis for otdiform bacteria and volorde organic compounds q-1E,1:8as that Ow
well is it from poNulion from that faciNty and tM presence of ammonle nitrogen and nitrab nitrogen Is n4►ud-a or Isss
than 5 Method used to deterrrkane distance (appradrnaYon not v",
3) OTHER
revised 9/2/98 Pgs3011
!IUNURFACE SEINAOE DISPOSAL SYSTM INSPECTION FORM
PART A
— . C0fT1FICATION(se!raNmq
Dena of Inspoam1ft
D. VVIS I N FAU:
You rrunst khdkew okher "Yes" w"No" to soeh of tdhe fopowing:
I how daterminod"tow or irore of the following failure conditions octet as described in 310 CMR 16.303, The basin,•!or!thin:
... deterenlinetion is idsood below. The Soard of Health should be contacted to determine what will be necessary to i:onvi:ct eta lailure.
Yes No
Saekup of sews"iennh facility or system component due to AA overloaded or clogged SAS or cesspool.
Discharge or pending of effluent to the surface of this
ound or surface waters due to an overloaded or clotigs I SAS m
oesepeei.
Static liquid level in the dlotributlon box outlet invert(ius to an overloaded or clogged SAS or ceselsool.
Liquid depth in oessptol Is less then below invert or available volume Is less than 1l2 day flow.
Required pumping mcire then 4 e In the last year JW(bit to clogged or obstructed pipo(sl.
Number of times punq»d
Any portion of the Sc4 beorptlon System,c*sopool at privir is below the high groundwater elevation.
/ortlon
f a el+ool or privy is within 100 feet of a surface water supply or tributary to a surface wsmu•n!.pply.
a cesslrod or privy is within a Zone I of a public wolf.
f a csompoel or privy Is within 60 feet of a privity wow supply well.
f a cesspool or privy Is lose-then 100 hat but greater then 60 fast from a private wetw wipply vvrn I with vho
ater quality aneiyale. If the well hem been ansltned to be acceptable, attech copy of well wsnw-&.4ysls for
erie, veiatlie orosnic compounds,wnn►ania nitrogen and nitrate nitrogen.
E. LAROE SYSM FAU:
You nwet indicate either"Yes" or"No" co each following: e
The following crltarle apply to l;nrge ems In addition to the aMwis sbove:
The system serves a faellity a design Now of 10,000 gpd or greater Urge System)and the systsm Is a sl gMHt:a!ht!great to public
health and safety and the vh+;+nmeM becsuse or»Of non of the follawMe conditions exist:
V" No
the a am Ia within 4 00 feet of a surfeoo d0nking water supply
r system Is whNn 200 hat of a tributary to a surface drinking water supply
the system Is located In a nitrogen sssnitive am(Interim Wellhead Protectim Area-iWPAI or a mopped 7!:orle 1' of a pilelic
water supply weiq
The o+m►nor or opero w of sny such system*hall uporada the system in soeordernce with 310 CMR 16.304(2). Pleas@ conwh tin I icei reglorel.
*Mae of the Deparmont for further irelorrnedw.
revised 9/2/98 h r4oftl
r
N,t BMINVACE SEWAM MPOSAL SYSTNSN SNWEC' ON FORM
PART S
CIECUST
pr.p.n.Addraea: t�Y/�1e�1 bo�I"ne.
oo r.,btep e�ire li
Check of the following hove been done:You must Indicate eider"Yes" or"No" as to each of the following:
Yes No
Pumping information tvas provided by the owner,occupant,•or Soord of Heslth.
• _ None of the systems coivoonents have been pumped for at Isest two weeks and the system hoe boon 1eca101111 MorMai+Aqur
rates during that perh►d. Lars*volumes of water have not been introduced into the system recently or an is*tt a f this
_ As built plans he"been obtained and examined. Not*if they are not available with NIA.
_ The facility or dwelltrsll was inspected for signs of sewage bex*•up.
_ The system does not esoceive non•eankary or industrial waste slow.
TM site was Inspects it for signs of bretkeut.
_ AN system component,,excluding the Soil Absorption Systen,have been located on the site.
The septic tank menhess were uncovered.opened,and the Interior of the septic tank was inspected for caniY,sl;ut of bedfh►e
or toes, material of construction,dimensions.depth of liquid,depth of sludge,depth of scum.
The alim snel location tot the Soil Absorption System on the site hen been detsernined based on:
Existing intormsedon. For exemple, Plan at S.O.N.
Determined In the fiold (if any of the failure criteria related to Part C is at issue,approxinstion of dtstence it,tme;eeptalaei
116.301113011
_ The feci ty owner(sntl occupants., if afferent from owner)wets,provided with Infonrsdon on the propsr mains, once oI
SubSarfaco Disposal Systems.
revised 9/2/98 regr9at11
f
:3YOBURFACE SEWAGE DISPOSAL SYSTFd1 IMSpfiCTIOIU FOPRA
PART
SYSTMI Sf/+OIIMATIOM
DOW of S7�Y40
FLOWN cnl,-n R s
mon�Aow� p.p.d./ladroan.
Rimier of bodrooms Idsdgn):g Umber of bedrooms tactual):3
Tow DESIGN flew j3�
umber of current r"Menb
Garbage lrbww(I"W no).
LaWdry(separate syetent Iyss or no):,,.&*If Yoe,separate inspection repriced
Laardry$veto inspected_Eno ev me)
us SMWW e(yes or not:A-V .
Water meter reedhp,N able(lost 1we year's usage(gpd):
Sump Pump Ives or no):
Last date of oeoupanoy:
Type of estsbWe"ont:
Design flow. cad f S&dQ on 16,2031
guie of deolgn flew
Grsaa trap present:Ivaa
kWustriel Waste Noklln ank present: lyres or no)_
NonKe Mwy waste charged to the Title 6 system: (yes or no)_
Wow motor ,if ara6alile:
Lest date of y:
OTIM.IOe"
�'.ast date of pency:_,,.. '
�f OBIEf1Al SI!'GRA611TIOM
/1iM9 1r�f x�'nedon: v
T�. l�---
System pumped topaR of inspection: I "os or )dt<L/
M yes, volume P.,IV d: ._gellons
Meson to pump":
��OF STSTYI
Septic tank/dbtifbntlon box/so! Wwonnica sysbm
slope cesspool
Overflow cesspool
_ POW
Shared OVatom lyes at no) IN Wee, attach provlous inepacOM reowds,if any)
I/A Technology ate. Attach copy of up to date operation and mdntem tra.nee conct.
nom Tank Copy of DIE►ApprovW
Other
APPRINAMAT11 AGE of dl cornImw nts,dote Installed(it known)and scope of informatlen.
Sowrile odm detected when arriving at Ow eke: (yes or nee r
revised 9/2/$8 fMr6at11
MIOSMACE SEWAGE OWPOSU BYST6M NBPECTIOM FORM
►ART C
SYST M fMFO11111MI M 4esndmis.s4
Prap� n" jlqr/%e&A,1 ( /
rEf Ouue-C
SULSIM.E1Ai.R:
M000to on of pion) i
Depth below grade
Materiel of gonevuetion:_*set iron t 40 PVC,other(explain)
Distance pl)vsto wow suppiy well or suction line ——
Dismotor
Coearonts:Isort ell tion of)*Into.verdliv,evidence Of Isokmie.stt.l
Meome on We pion)
Depth below WN RO
MoterW of eeraiteuctl geonerete_itwrtsl,flberaless _Polyothylene_,otho►ioxpisin)
If tank is metal,flat op is sot conilrmed by Cortiflasa of Compliance_(YesAya) .r. '.
Dims Wen h:�
sirdiie depth: (�
Distsnee from top of to bottom o!'outlet too or boffls 2E
Scum thiaknoso: I
Distance from top scum to top of oullst tos or boffle:�-2
Distancs fr*no boetnm of scum to bottom Of�befgs:1�-
'%w.dn.erwlone were Asks mined:�1
Carernarats:
(mcaimnandaden for pumping,a W—Mon of Inlot a outlet toes or baNlan,A..ih of liefuid vel In relation to outlet Inv ,stnicturi I integnty,
ert evldee o4"op. JJI.
i
(iecato on alto plan)
DOOM below grade:_
Material of Bona riation:_eonerea—r"W. FII wfl+ ,PolysSINVIO s_odwNiexplain)
Dimsneisne: ---
gaun.tofaknsa:
OW WO*from top of sewn to top of a baffis:
Dbtooto from batten.of scum to be of cope!too or baffls:
Onto elf hoot pumping:
Con.rrento:
("Oem nsndatlon for pu ng, oonditiOn tf W"and outlet we er baffaa,depth of Hquid level in rMatlon to outlet invert,stnuapwsi inteyrkty,
evidence of hulk"(,
revised 9/2/98 rase7ofit
uISSuAFACE SEWAGE DISPOSAL SYSTh7M OSPECT10M FOAM
PART C
/ SYSTSIM INV OAMATION soormbo"a
strtesrtyA�- !'4��/yjp�C�J0 t!Nham. ypj
S 457�0
T04T OR HOLOMlO TANK: (Tani:must be pumped prior to, or at time nf, inspection)
llocete on alto plan)
Oep"MA&,slow Poch:_ �
Material of eonetrucdon:wooncreto_,instal_111berelsss_Pmtl af6Iw%*other(explain)
Coptolty. geRons .
Dealgn flow• aallom/day
Abo m level: Ahrm in workin Zder-ye"sNo_
Dab of previous pumping:
Comments:
(condition of bilat tes.eonditl of aktrmi end.flow switches,etc.)
it _� •___•� .._.�,._.....,.�
MI>OF!sox:
ascots on one plan) —
"Vaptb of Nquid level alcove outlet lavem.,
Comments:
(note M level end distribution Is• M,sv dens} of aoiEda arryo r,evi nce of look into qr out of box, etc.)
PUMP -.—
(kt me on nits port)
Ptrmpa In wor0big order:(Yes or Nolte.
Mrms in working order(Yes or No)_.
Comnrrrte:
(note eondltlen of pump chsmber,conditi of wwos nd opurtnenese.etc.)
revised 9/2/98 pariah
f
I;NSSU1W^CE:EWAGE DISPOSAL SYSTEM INSPECTION FOAM
PART C
SYSTiM S PDOMATION loafrllrwodl
IRA
d aj ire(A
aoa A�SofI�oN sYs�ww:_.
now*on ske pin, If Possible,excavation not required,location may be appre)Wmatod by non-intrusive ntsthods)
If not located,ispeln:
Typo:
taooNng ph$,mr '
Ieao dev dwnba . number:_
III1 gee•nwnbe:—
WonalM rwmbor,Ianllth:
looafdeeg flolds,number, dimemiions:
overflow eaepoof,nu mbor:_,_
Altomeffve system:
Nam of Technology:
Corrsa�ams:
(mete condition of j i r signs of Rtidrswac are,isvN a pending, damps ,candition f vegetation, ate.) f
(locate on efts plan)
Number and cafture8an:
—Niptfatop of"to Smelt Invert
opth of soIlda layer:
Oopth of OVA"M"r.
ofn+ansians of coospoel:
MaarlMs of oarrspuoo":
h ikolon of growrdWOW:
1"%w(oestpool must be mW'd as part of Inapseftn)---
Conrmsnts:
(note conNtlon of 4 Zi
of hydrouNt I sputa. level of pending, condition of ve gelation,etc.l
(laoate an she plan) /
Materhl0s of*wwbvodm,
aimemNom:
oopta-ef seYda: .
Con mw ts:
(note oa+dltior,of sell,signs of sulk fOWN,level of pond of Gandhian of w galalia►.a".)
revised 9/2/98 PW0Of13
MURFACE UWAGE DOPOM W'$TR A INSPECTION FOAM
PART C
. S"TM MMOAIM?Wal IMrrllRMS4
�•s�rA�.. � �lCt�fklr�
Owaa.: f3 b oo ztU9
Dane at I MPIN --:S'.jasl o0
ulc ICH OF SMA®E OUPOSAL SYIMIM:
WISMIo toss to of least two ponnanent reference landmarks or bonchmorks
loaato aN wept within 100'(Luaats where pubpc wotw Supply comas,Into house)
i
l
revised 9/2/99 Pap 10stil
I
I USSURFACE SEWAGE DISPOSAL SYSTEM INISPECTION FORM
PART C
v/ SYSTEM NFONMATm Ioworwea
hoP.m►A�.s /N ,'�P.{Govr� PCQC
0WIN et
am of
NRCs Report
so Type
Ty0ow depth to proundwaar__
Usas Dow webaka visited
Obeorvatlon Walls Chocked
Oreundwetor depth: Shallow Moderate �poap
SITE EXAM Slaps
Surhos water
Cheek Collor
Shallow wells
Estimated Depth to Oroundwater 12Fiot
Plesss indicate all the methods used to dortormine High Oroundwatsr Elevation.
Obtained from Design Flans an rocwrd
'Observed Vte(Abutting property,observation hole,basso sort sump etc.)
T_Determined iron+local conditions
Chocked with local Soord of hNitF,
Chocked FEMA Me"
Checked pumping records
Chocked local excavators,kistagorr
Used USOS Date
Doscrdbe hbw You established the High Uroundweter Elevation. 1
fto be Cempletod}
Q� �► ( -a 4
}
revised 9/2/98 pop It of II
TOWN OF BAR�NSTABLE
LOCATION 1 I j/ ^��D D 2� )ZOO SEWAGE # 5 y 7 l-2
VILLAGE 7JY/�itir/ 's ASSESSOR'S MAP & LOTZG;8' 02�7
INSTALLER'S NAME & PHONE NO. I�IJ/��a/�i'� s o,✓
r
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ? 6,4.5T%T (size)
NO. OF BEDROOMS ,�, PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER L'7 �1/� .0w4/ �
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No /
I
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TOWN OF BARNSTABLE
LOOATION` it /y �e 1 Anar-n e SEWAGE #
c VILLAGE k!1c K" 6 ASSESSOR'S MAP & LOT
-r
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK.CAPACITY
LEACHING FACILITY:(type)-aZ 7-5 (size),
NO.OF BEDROOMS
BUILDER OR OWNER .J0-5gph
PERMTTDATE: COMPLIANCE DATE: S/�S7'dy
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet_,
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
4j) ,
f
O
s
lk CATION SEWAGE PER IT NO.
VILLAGE
I N S T A LLER'S NAME i ADDRESS
`fw � --�
ell
UILDE R OR OWNER
DATE PERMIT ISSUED rl o?� 7�
DATE COMPLIANCE ISSUED �_ �c�
6(7� a S
_a 96(abf,.9
�� S�/wn�rsil/Y 1Sarh Cf d°c' geVW79L'7:'W
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Mopo Sal Murkii Tomitrnr#inn ranmit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at: ,
�J!! �Locatioc Address J - ___ -•-•or Lot No.
.1 .. -�_oc----------------...................------------------- ....................................................
Owner
hcstaller Address
QType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms________ ________________ _ _ _____Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures _______________________________............
d ...
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 ( )
aPercolation Test Results Performed by.................................... ------------------------------------- Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--.-_.--_----____----.-.
pc Test Pit No. 2----------------minutes per inch Depth of Test Pit_................. Depth to ground water........................
04 ----- ---------•---------------------------------•-----------------•-.-----.........................................................
0 Description of Soil.. ,
x
U •-•-----------------------•------------•--------------------------------------------------------------------------------------------------------------------------.....................................
W
x ----------------------------------------------------------------------------------------------------------------------- -------------------------------------------• --------------
U Nature of Repairs or Alterations—Answer when applicable----Sew.1?.J7__.... .......
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersignedfurther agrees not to place the
system in operation until a Certificate of Compliance has been ' sued by4fe"boa—c4rof health.
Y .
Signed �G:�� ...:.......... - ......................... - � ��-
�`'`^--�� Dace
Application Approved By ------ (J' v--� - =' ............................... "Date
Application Disapproved for the following reasons- -------------------------------------------------------------
--- --------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dare
Permit No. ...—.�.j........
`.Y^ !/ a-- - ........ Issued ..... - - - -
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF jHEALTH
TOWN OF BARNSTABLE
, pphratinn for Diti-pn!itti Workii Cnnntitrnr#inn ramit
Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal +,
System at: ,
... •�b...rr.........lav........2 41 5..................................................................................................
nN Locali ), Address or Lot No.
.. �-�-�r.....•.................//---------------- ................. •-----•---...-•-•------...........:.....---^.......
W ✓� '_ .... .,,_\ v -- Dvn�r _ �.JC/ �(1�r �O dres /��r .i
Installer Address
UType of Building 7 Size Lot............................Sq. feet
Dwelling— No. of Bedrooms._...--.....................................Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Building No. of ersons---------------------------- Showers
YP g -•-------------•------------ P ( ) — Cafeteria ( )
dOther fixtures --------------------------------------- --------------. ...............................................................
W Design 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 ( )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................
W
Test Pit No. I----------------minutes per inch Depth of Test Pit---------------.-.-- Depth to ground water........................
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit...--.---........... Depth to ground water........................
a -- -----------------------------------------------------------------------------------•---•--------.........................................................
D Description of Soil.. � �
W
U ----------------------------------------------------------------------------------------------------------------------------------•-------•----------------•-------------------------------------•------
W
x ---------------- ---------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- ..........
U Nature of Repairs or Alterations—Answer when applicable-_!� h ---------�f�e-��-� ....RUC✓���
Agreement.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned urther agrees not to place the
•system in operation until a Certificate of Compliance has been ssued b e boa of health.
Signed ...- ...... ....... - -- - --------------
Date �
Application Approved BY --------- ------------ -------- --------- ------�---..-�G
Date
Application Disapproved forthfollowing ----------------------/--
------------------- ------------------------------------------------------------------------------------_-...---------..----- -----------------------------.-------------.------------------
........................................
Date
Permit No. ��^ ...1 --------\ ....... Issued --------------------------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�eztiftcttte of Cgoznpitttnce
� ��T/H/ IS S T )CERTITY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�)
Installer > /
at .-. ........m. :../ �/ /'f.---------J_ZV----------- _.....-----------------_...------------.....___-------- ----- -----------------------`-----
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ------- .11_::-/.;- L dated ..........................................THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
�. -�..... -----------
DATE .�Jf- -- ------- .......... Inspector- _... -......... - -
�-- -
THE COMMONWEALTH OF MASSACHUSETTS -7
BOARD OF HEALTH
g TOWN OF BARNSTABLE
FEE : .....
�i��n�tt1� ,, ��anntr�rtinnprntit,.
Permission is hereby granted = �/�`1.�G ;'�J `' .............................................
to Construct ( ) or Repair ) an Individual Sewage Disposal System
at No..J 11 r l fi ---�� ����11�/�5----------------------------------------
as shown on the application for Disposal Works Construction Permit No.-�Y-l/.l-- Dated.....--- .......
.C._ r ................................. Board of Health
l
DATE ---- 7
FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS
{
_ THE COMMONWEALTH OF MASSACHUSETTS
a� _„BOARD OF/HEALTH
141,
--------OF................. ...... ........... . .......................
Application is hereby made for a Permit to Construct (- <Or Repair ( ) an Individual SeViage Disposal
•�-
Syat:em
....Z07n_-A. ,-•Me L..-Ro __RL1.1
Location-Address VnIll or No.
------------- Address
----------------------------------- •-•----•-•-••-•-•--••----•---•-•••••••------•••--••-••-•••••-•-••-•-••••......-••-----------•-•---
r Address -•
Type of Building Size Lot_fOt.3.00-----___Sq. feet
Dwelling—No. of Bedrooms-------3---------------------------------Expansion Attic ( ) Garbage Grinder ( )
P-4 Other—Type of Building ____________________________ No. of persons_.._____-__--_•__-____-_.__ Showers ( ) — Cafeteria ( )
da' Other ores ------------------------------
!� ---------------------------------
W
Design Flow........_ --------------------------------gallons per person per day. Total daily flow......3.O'-- f_.—_ ----------
WSeptic Tank4 Liquid capacityld gallons Length---------------- Width................ Diameter___--_..__....__ Depth____._-___-:...
x Disposal Trench—N _ _________________ Width-------------------- Total Length................ Total leaching area..-._-__-___..._____sq. ft.
Seepage Pit No_______ _____________ Diametetlp*__.__ Depth below inlet.................... Total leaching area-------___:__>,_sg. 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------------.._.__..___.
rXq Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water__._._.________________.
P4 -------------------------------------------•-------------•--•--•--•--------------------•--------•--•-•-------•-•-------•-•-•-----••---•---•---••--•----------
0 Description of Soil------------------------------------•-- -
xs vF�- i _i r ASP"- 4�� Y_ ,c:.
c.� ----`------
_-
w
x ----=---==:-------------=------------=------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable:-..:_________________________------------------------------------------------------------------
----------------------------------------------------------------------------------------- ----------------------------- •-------------------------
Agreement: ,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has keen issued tV the board of health.
Signed-----Ze •-•----------------
Application Approved By..__ .`_.!
-------------------------
Date
Application Disapproved for the following reasons-------------------------------------------------------------------------........................................ :.
....................................................... --•--- --
• / Date
Permit No._____ y� Issued.._.... _
t t --
D
---- --- - - u - ----- _
No........./ .............................
THE COMMONWEALTH OF MASSACHUSETTS
, ,, 3, OARD O ��,L.TH
Z;P_wx.-�
------- OF..................................... ...................
Appliration -for Di!ipviiat Workii Towitrurtion Vrrmft
Application is hereby made for a Permit to Construct ( voyo`or Repair an Individual Sewage Disposal
System at:
......... .............A. ............................a) ...
...................... .44 .........r.
Ow er Address
................. .......................I ..#+ ........................................ ..................................................................................................
staller Address
Type of Building Size Lot../_0,,_J0,0......Sq. feet
U
Dw@ling—No. of Bedrooms._."._----- Expansion Attic Garbage Grinder
Other—Type of Building --------_---93--------------No._------of----persons----.-..._-:--.------------.---------------------------- Showers Cafeteria
Other fixtures ------------------------------------------------------------------- ---------------------------------------------------
-----------------------------
Design Flow----------------;;;,-:A-------------_----gallons per person per day. Total daily iow............$ --...._gallons.
P4 Septic Tank—Liql_4 c4A.city............gallons Length---------------- Width---------------- Diameter-----_----:--- Depth------------- ..
xDisposal Trency—No_-----------------/omtli.................... Total Length_._-__.__.---_..---- Total leaching area--------------------sq. f t.
Seepage Pit No___________________ Diameter_--_.__-_-_------.-. Depth below inlet............._...... Total leachinc, area-----------------S(1. it.
Other DistributionAl"Vowl nk y...........
Percolation Test Results Performed ormed1r.-T& -------------------------------------------------------------- Date.........................................
Test Pit No. I-----------------rninutesper,"in—ch -Depth of Test Pit.....................Depth to ground water......-._..-...__... -
fXq Test Pit No. 2----------------minutes per inch Depth of Test Pit.--...-_....._...... Depth to ground water--__-------------_
........................................................................................................................................... ............
0 Description of Soil------------------------------------------------------------------------------------------------------- --------------- ---------------
xy Vic:
U ------------------------- .............................?�....................................................------------------------------------____#--------------
--------------------------------------1------------------------------------------------------------------------------------------------------------------------------------------------------------Nature of Repairs or Alterations—Answer when applicable-----------------------------------------..._------------------- ------------ ------------------
U
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement
The Pn&rsigned agrees -io install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
'fi by 4e�,operation until a Certificate of Compliance' `�Is *, p
Signed...
- .................
Dat
----------- ------- ............Application Approved By-- ---- ------------I----------------
-7 Date
Application Disapp""Oved for the following reasons:---------
.................................................. .....................................
......................................................1�------------- .................................------------------------------------------------ -----------------------------------------------
Date
PermitNo.----- .............................................. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
e.
BOARD , OA HEALTH
............... ..1110. 0. .......OF..... ... .................................gf Tomptia'Urr
Qlatifirate
C IEY EAT ,,_That the Individual Sewage Disposal System constructed or Repaired
A
b 0.................:V. � ............
.............................................................................................................................................
Installer
.at......... AR---f.. ------------------------------------------------------------------
Ila's been installed in accordance with the provisions of Article I of State Sanitary Code as dpscribed in the
__7Y...........
'application installed
Disposal Works Construction Permit No..-- ................. dated..............
ThE,-ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
f
STSTEM"WiLL FUNCTION SATISFACTORY.
AT Inspector.
............................................... ------------ ------
Arr�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7 ....................................OF_-..... 1;
000(
............. .............. FEE..... ...........
Permission is hereby �nrj---- --------------- .... ....................................................................................
to Construct or Repair an Individual Disposal System
.. .. .....401. --------------------------------------------------at No.: . . .... .......
St
as shoWh on the ap Permit . ...... . ...... Dated_),,p)..p.ication for qisppsal Works Constru ---- --- -
. ...........
. . . . ...........................
o H
........... ........................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
," Po^° ASSESSORS MAP : NOTES:
MA v
TEST HOLE LOGS
tlw `
�, • „{, •*�{ r N '� PARCEL '�,2-1 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH
f� M1 .,
THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF < _
,p - SOIL EVALUATOR:=�_.
FLOOD Z0 NE . �ot, �a
Q„ „y WITNESS : �((7T I �VI - BOARD OF HEALTH REGULATIONS.
� el R REFERENCE: _
a"PENA�� IRA ems \ �j� ,Zj� (� DATE-: U 2- 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES,
' fa 1 �$ �' " " PERCOLATION RATE : ILMrrJ N SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO
v�b\ / INSTALLATION.
Jx�t C��ss SOIL, LT�t,2
� Y• .� �r �I^�. ` Ali .
n TH- I ��(✓'. � p TH-2 3) THIS PLAN SI-IALL BE USEDFOR SEP
TIC SYSTEM INSTALLATION V
ONLY,. AND SHALL NOT BE USED FOR PROPERTY LINE
mcm ` RT �'1411 _' ' Gj'"' DETERMINATION.
A U�XMy 4) ALL PIPINGTO BE d" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS
S�M►Y� SPECIFIED OTHERWISE)
L O C A T I ON M A PCB_-T-_S '/ B L.b I 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A
GARBAGE DISPOSAL.
32•X3
6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED)
HE�>l v.NM MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON
A BASE OF 6"OF CRUSHED STONE.
� '`� c 31 �� 7_ Iy�IN 1,r✓ -?tr -m t�E -Py pep
Z4 7 S PLA"o WI 6Lf NAt5lpt V AN-0.
No �uJ a 656eu4_�
—1 btq To� Gam
- SEPTIC SYSTEM DESIGN
U66s 10) No
J FLOW ESTIMATE 1?i) vF kfAty
3 BEDROOMS AT I �� GAL/DAY/BEDROOM - 330 GAL/DAY
M EL S OV 1`rl `D � C�1�`i SEPTIC TANK
�.� 330GAIJDAY x 2 DAYS - �6b GAL
87 32 1 N USE (_,Q00 GALLON SEPTIC TANK —E?QS77A)� - tZ&pLA-cz wf I56o 6„/ S-T-
(N�� Ic F�w�-�.o� OR-N�gCl�a aR-. VNt?��SIZE�O.
SOIL ABSORPTION SYSTEM
34.
k_ + Ins-pw�on E-ti.�S .I,5'SToN w
3G.z
E eu 1PCs 3(.LY $' x2',�)
W i t r
SIDN AREA.
tpc;oC,pe- Zo I t POTTOM AREA: 36 x $ x t7► 7Y = 2.13
S.r, o
e ' 3 .6 GPI
EXI 5t7 I 33v G
3 SEPTIC C SYSTEM SECTION
3 _�3717
j
T-0 f= 3 7.17
CD/�G• �'+�'iIO (oar 6 U60
+ '�ISti q Yaa�•c, q�Mt / -- "_._.___..�..........__..._... ..,_ II
!4-" \J
Gas $"t-He i► 33,56
GAL 22 17 D-BOX 33,E =
GV Q C1 DI CT
33. L, Q fcS>� L`� t� C1 3O.7S
\ SEPTIC TALK /cvc(nPss� 32,7S
-.. as Qd Sfxm
12,ss Zz zq 8 .o r 26
OF MASSq
0
DARK SITE AND SEWAGE PLAN
N
0. 1 0 LOCAT I ON : I I Maumur_. 46 7-,oA
GISTe
� n��SporeT
"NI TA
1 _2� PREPARED FOR : AZJ 7-E "JTD
M
[BARREN M. MEYER, R.S.
SCALE : l ZQ r_
o _ 43 VINE STREET DATE: ?- ,-0 4
-N� ��U� (_ C v bv�L. IZ.LS
z � ,.1 DUXEURY, MA 02332
-� 0 0
DATE HEALTH AGENT (781) 585-0293
z
�'V Mu fn
AssEssoRs MAP : 2�� TEST HOLE LOGS NOTES:
_ :_
:36PARCEL : ��.� 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH
SOIL� EVALUATOR :_�. WIt�{�, � �E•5•�e' THIS .PLAN, 1995 MASSACHUSETTS TITLE V &, TOWN OF
FLOOD ZONE : dC � W 17NE-SS : N07- LE
r Q I P_W �14R1�5?7gr$(,�, BOARD OF HEALTH REGULATIONS.
��]6 `MA AV REFERENCE : ,:
I �^� `� 1 2) THE- INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES,
�> �o�U DATE: u >= 2
�AxA ' ,, p PERCOLATION ON RATE
R++� I L 2 M I nl r SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO
t "I �6� Gt,/kS5 Co( [ 1 /� n1� INSTALLATION.
J +� "3r �wrn fr✓.19r J 7 V 1 V /i „Y
o cog „� rar� 0" TH- f � '. �, p TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION
ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE
DETERMINATION.
qfi TexST
A N RT ram' I ''-- '2-� 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS
„A o I a� -�( SPECIFIED OTHERWISE)
LOCATION MA PCN.-7-S) B (-UO�MY Ioy P'br 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A
s{M1 b
� GARBAGE DISPOSAL. --.
6) SEPTIC TANKS AND -DI$T MUTTON BOXES (WHEN INSTALLED)
MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON
C � 2 Sy k1 c 31 A BASE OF 6"OF CRUSHED STONE ,
2.475 w ctew "mm !w ,N-o.
TBII,( = Toe
No w o� e� >. �;ISO Y. 6w o PY-�Vkm ►
P�4P-
�~-- , I q� �v wrri,��i:W �.n1._(�7_._-. G�rhr► .
SEPTIC SYSTEM' DES I GN
ViUs Dh�iJ�-( ►4�S(ltitED (D) 1'10 VMS-IA►J 69-5. f �'I fn
_T. _Y�O�' f)
FLOW ESTIMATE of �� ➢-
__�lrt�Tti=.Q�E�1LkT'N�r�S
3 BEDROOMS AT 110 GAL/DAY/BEDROOM - 33a GAL/DAY
l L S OL) 1�4 E �dl�� SEPTIC.-TANK
Ci�J� _ 330GA,L/DAY x 2 DAYS . (jL(b GAL
15 prr 16.9fl 87:32' 1 ti USE .1 0OWGALLON 'SEPTIC ;TANK --F-VS-R w 15W
C� "1°'� I 1c F�4i'- o� O� fao sR. uN�tS2Ed.
lo' �� SOIL ABSORPTION Slr`STEM
A
MIN
r6`xlST' I SIDE AREA: C(36JZ-..+.(P,)Z-jx2 ) y = (3G.Z1
Jxn0Art- Zo J BOTTOM AREA: 3(o x $ x O, 7Y = ',I ;, (2,,.
1�j
fo
7 330 G PC)
SEPT I C SYSTEM SECTION
30 e�.
_ 37 17
Tod= 37, 17
COAIC. P+-170 I raw V,e� ;n'v' qY-"( / K
w,s Fal t V /-m
', \ � � G K � - gas Ba��P ,,► 33.S� c z„_31 •'bt, ,� ft.rsti�d s
_11 00o GAL 33.17 D-BOX 33, Q Q L� Q El
SEPTIC �� nP� ` 32, 7S t� t� � � � 2D.7S
\ TANK (�levelness) 3 t
20
� � Ij(�a stied S fvn-�
6'o g 9.o Z� ��N OF ly gs .�� (J1J � dry L�S^ O�i�i JC�• �T`7 f
�o DR 51 TE AND SEWAGE PLAN
In
8. 1140 LOCATION : I I V -Boy,e. E 7_,VA-L>
GISTS
"NITAR�P
PREPARED FOR
1-467-1 ZE Fl AID
a
a DARREN M. MEYER, R.S. SCALE : I Zo,
4F 9A�NC G, .
DATE:
-7- !- 0 4
_ 43 VINE STREET
v �� N , ��Ul. - .b Vr ice. T�lrtj
U
- DUXBURY, MA 02332
Z
DATE HEALTH AGENT
w bP��C�•. � -� - do (781) 5$5-0293
Z