HomeMy WebLinkAbout0165 SCUDDER AVENUE - Health 1�65 Scudder Avenue
289-076 Hyannis
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for,4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M:G.L.- it does not give you permission to operate.) You must first obtain the' necessary sign�rtures on this forip al: 200 h11-lin St., Hyannis.
make the completed farm to the Tot�;,n C k.rk's Office, 1 st. FI.. :367 Main St., Hyannis, MA 02601 (.1own Hall" and get theBusiness Certificate that is
required bylaw.
DATE: 3 Fill in please:
APPLICANT'S YOUR NAME/S: C- I ow /�-
m BUSINESS YOUR HOME ADDRESS: S
TELEPHONE # Home Telephone Number__-6-0 -2- -1 3
NAME OF CORPORATION:
NAME OF NEW BUSINESS /V TYPE OF BUSINESS w eZ Pf- i- -2 5 t G i
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS 15 S c v cb. A v 2 - MAP/PARCEL NUMBER _G -7 (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
4
Authorized Signature**
COMMENTS:
2: BOARD OF HEALTH
This individual has bee o the permit requirements that pertain to this type of business. MUST�;OMf�L`tiriiUIT H ALL,h r . Tcr. �F7^r nT
„I @.., n.-. ,. ...4.1 ..
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Q�,��SS3C�lUSBIis1s
s
- �M •HoliFcallon Form= ANF-001
��'f f F"$'�q.-•tip ,r hI.Y..'���YYdr5v� fi knx�S
Asbestos Abatement Descriptionr �saf � rX
1. Facility location, RECEIVED
......... ...Yt...............� 0&95...
15 ._.. ._....1...
otmucnolts rum. . Adar=
° UN 10 2004
dons of pia ............... .. ...
t mwi be computed Gry/raa Ilp code Ideplone .
idetto comply with _ - TOWN OF BARNSTABLE
Oo;srtmWof -L���j•��'•--- •--•--•--••-•-•••- -- — HEALTH DEPT.
Ironmenlal WU U Oo W&I14 lraeanl taco V am,/,.k4 mor.Maus
lectfon notification 2. Is the facility occupied?" Yes El No
liemau o1310 CW r
S(ten wohup days
Y neltlt7bon is 3•
ured a"any abaleme�r Naafi /1�/] /}� _ ' ( S L v CA �/C�-7v G'
'u a ud the mL_ r=
p ertmenl of Labor
AdWaz
lndustrlaa 1
liaion tepuianerts •---�-------•_-- -•—••-- -._...._..._�._- —____.—.._-- -•—
l5.'.CtrA 6.12 (tat Grylro�.a Zip Code Idepnau .
h prior nodldion is
luiai"ANY N __............................ ..............rmtwtra+Nra�............................................_.........................................__.
m"nwd propd pra" ntl L / C-&Jd 1
V1 Wee linear a
Lreled)• 4. On-Site Project Supervisor/Foreman:
SLbmi Ctlginal Fo m
den. DU Caldmd o/
mmoo>,.altk of
aesaehus.tt: 5. .Project Monitor.
shaetoa Prograze
.0-1.120097 —�
idea,11A 02112- rGme CU C&14c9 n/
C81
6. Asbestos Analytical Lab:
R s lotm maybe
sad to(notifying Cx -
S.Envionmental Prn ..................... CY/GAeracon/
tax:lon Aodxy Region 7
alasbeuasdamoltioN `7 �Prolect;starl:date / �nddate / (�Lpecifteworkhours:(Moru-Fn}/rr -7 (SaLSun.) D
...... 'mil
mcymon opaatioru
Wig m NESw1PS(40 8, What type of project is4h(s7.(circle one):• dsaocaoo neut t; ,my!fa�l
Subpart f).
9. Describe the asbestos abatement procedures to be used (circle): pb.etnp Thera tugwarnand d-4
anc�pwlaba dspaw'aJy orrw aaphh S�t•vCs(•1°S
��. ��
n0°CA 10. Is the job being conducted ❑indoors outdoors?
... ` �0
11. Total amount of each type ofAthestosContaining Materials(ACM)to be handled an pipes or ducts(linear ft.) ar other
sudaces(square ft). 9J VV to be removed,enclosed or encapsulated,
"m^� linen/square feet
boiler,breedtino,duct Wit urtace coatinp... rwMal,sold rare ppe insaidon......—J
cmupated a layered paper pipe lrtwla-...' insulating ceawar..................
*myo ArwooGrp..................... trarellsWayw=aorigs.............. J
ciahs,wow tabri3....................._/ transNe baart;tra0 board.............—_J=
outer(pkase describe)...................._J
12. Describe the decontamination system(s)to be used:
--`-L -
13. Describe the containerization/disposal methods to comply with 310 C R 7.15 and 4E CMR 14(2)(g):
r y N' 14. For Emergency-Asbestos Abatement Operations,the DEP and DLI officials who evaluated-the emergency:
y cif.
p Pme 01 CC?oady; 't°k'Iv V :[.a. R., t:. itf,
Purr d au aadal ntte
_............................_..._....-- --- _...... ..........._.........__. __...__.............................._.._.............—.........
par d,wtnertrarbn wa�Kr/
451 Do prevailing wage rates apply as per M.G.L.c.149,§26,27,or 27A-F to this project? ❑Yes No
d r
FacHity Description
1. Current or prior use of facility.
r ----
2. Is the facility owner-occupied residential with 4 units or kss7 Yes ❑ No
3. Facility Owner. /\
ct4/ror0 lb md,
4. Facility's Owner's On-Sits Manager.
rt+me Aodrea .
Gry/To.n lto mi, rrepAa.
5. General Contractor.
xrme AddtW —
ayRorn lb codr T,Ypnon
conrrrroer worba Cana.kUUM1 voxy/ fxp.Dia
G. What is the size of the faeRW' (sq ft)_(t of floors)
Asbestos Transportation and Disposal
1. Transporter ofasbestos-containing waste material from site to temporary storage site(ii necessary)to final disposal she:
�L�-' � � W��11N��/U S
Ado=
--._..._.. ._..._01 ......_._......
Gy/ro.n lip mde rreptme .-• --
2.- Transporter of asbestos-containing waste material from removal/temporary storage sith to final disposal site:
Add is
Nola:Transfer C41ro- Itamde 7rrerra�e
Slatfons must
comply wdh the 3. Refuse transfer station and owner(if applicable):
Sofid Waste -
Division regula- Alarm Aoaea
flons 310 CUR
18.00
Gy/rowa 1p ma rrgr=
4. R Disposal Site:
V Ara
lAA�A Cr- (-,,A /V
kf i a)44�)
Add=
FA/!ow m mde rr p(ae
CerflflcatiDn �
The undersigned hereby states,under the penalties of perjury,that he/she has read the Ccmmor'rwWh of Massachusetts Regulations
tar the Removal,CoAtainmant a Encapsulation of Asbestos,4S3 CM 6.00 and 310 CM 7.15.and that tha irdonnatlon can Lain ad In
this no iratlon Ic Use d correct to the bast of fils/her knowled and beLrf
Nola:Contractor must sign this
form forOU _ 6rt�plu>. 'rl 7�(lY- (�3�I
a::rkxvne,
notiTration nwe�rrky �• -- rrephone
purposes 16 SCu 6 Dl A / V&A)L)'
r I
Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less) yes ❑no
- -_ Sticker/(from front of form)* 7
t,
x ,:TO OF,BAI NSTABLE v
LOCATION � � f�� I/���..•. SEWAGE #
VII.L�zGE � �V^^�1` ASSESSOR'S MAP & LOT 2�`
,INSTALLER'S NAME&PHONE NO. /t7iut/J
p y j
SEPTIC TANK CAPACITY ,/ artn
r
LEACHING FACILITY: (type) (size)
NO.
NO.OF BEDROOMS { }
1',3UILDER OR OWNERS®MO% -/_��%�L
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
�r
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility lG Fee►, ;
f ,
Pnvate Water Supply Well and Leaching Facility (If any wells exist w"f
ff } on's�te;or within 200 feet of leaching facility). 1 Feet_
•'Fkdge of,Wetland and'Leachsng Facility(If any wetlands exist
witivn:3.00`fee f,ieac ng"tacnili�t`) "" Feet
Fdrnisheed by
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FEE
Board of Health, MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct(/Repair( ) Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components
Location 1�j Owner's Namej. — ;�j J.,CIliR�L of
Map/Parcel# 2 Address (p r)
Lot# °, Telephone# $
Installer's Name Designer's Name ..�
Address Address
Telephone# Telephone# AA
Type of Building �-,t AQ,- ► Q Lot Size mot— Ct7 sq.ft.
Dwelling-No.of Bedrooms Garbage grinder ( )
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures
Design Flow (min.required) gpd Calculated design flow Design flow provided -�gpd
Plan: Date Op Number of sheets Revision Date
Title F c �
Description of Soils) q a 4..,`'
Soil Evaluator Form No. 1 t Name of Soil Evaluator V Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS 1[�O ' �
A- \
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further a s to of t place the m in operation until a Certificate of Compliance has-been issued by the Board of Health.
Signe .� Date "o
Inspections
FEE
No. V
i:•cil_ .. ... rr:wry
COMMONWEALTH Of MASSACHUWTT
Board of Health, MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct(/Repair( ) Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components
Location ) C "f" V� Owner's Namet.,p�, 't
Map/Parcel# Z� Address (p
Lot# " Telephone# CS�� S 4,33k
Installer's Name Designer's Name
Address e Address
f Telephone# Telephone# C� 3� C
Type of Building +� l Lot Size cz';, sq.ft.
Dwelling-No.of Bedrooms ✓ Garbage grinder ( )
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures
Design Flow(min.required) gpd Calculated design flow 3 Design flow provided 3155 gpd
Plan: Date 2��DI O5 Number of sheets ` Revision Date
Title 4a)Y ,lf(_ C v —s
Description of Soils)
Soil Evaluator Form No. 1 t r t� ( Name of Soil Evaluator ��. 0 V\ti Date of Evaluation ' f i3In S
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigne agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and, „
further a s to of t place the sm in operation until a Certificate of Compliance has been issued by the Board of Health.
Sign e // r..-�" Date /70 (�
J
Inspections
p p
No. COMMO1� LT14 OF MASSACHUSE TS FEE
t Board of Health,2:bL --v;�8 Q MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑Individual Component(s) ❑Complete System
The undersigned hereby certify thj4 e Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( )
by: o dt�/i✓
at SGLOAEr Ave! „ mow
has been installed in accordance with the provi ions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No.o2' .r7 II-7 , dated 3 AVIe-6. Approved Desi n Flow 33 o (gpd)
Installer
Designer: AtW e+vSu ,N Inspect . Date: / Q
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. Cnw 5 I FEE 00
C'®MM®NWWTII OF SSACH SETTS
Board of Health, MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) RA,0
air( - Upgrade( ) Abandon( ) an indiNridual sewage disposal system
� �
at �2. r, t"1 l S as described in the application for
Disposal System Construction Permit No. 9,00 5 47,dated 3)3JA
Provided: Construction shall be completed within three years of the ddte—of thi p r it. All local conditions must be met.
Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 3/ !/U Board of Healtji_
i
TOVqN OF BARNSTABLE
SEWAGE #
LOCATION
.nr:y ASSESSOR'S MAP & LOT
VILLAGE ` 15
INSTALLER'S NAME&PHONE NO. -
SEPTIC TANK CAPACITY lac
.14
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER S6 Q. o`
PERMITDATE: —��� COMPLIANCE DATE:
Separation Distance'Between the: f/
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �G ., Feet
private Water Supply Well and Leaching Facility (If any wells exist
Feet
on bite or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility (If any wetlands exist Feet
within 300 fee f leac 'ng acili )
Furnished by �'Z
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Town of Barnstable . .
NE Regulatory Services
Thomas F. Geiler,Director
sn[iN�rb�e.
Ate. Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 5087790-6304
Installer & Designer Certification Forth
Date: ALcA O`er
Designer: �� Installer: V. A A . `^—'
Address: ?10 7k3Q1-- r-7)03Z Address: FAD. - 1 �
On was issued a permit to install,a
(date) (installer)
septic system at based on-a'design drawn by
(address)
i/•A►���t.� ``�o►J�Z dated V:�v) 2V0`=J-7
(designer)
W/I certify that-the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
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.
A
� � �10F�jyssq�
alley's ign ture DANIEL
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A.
O 1z
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A
esi er's Sign e) (Af e)
PLEASE RE TO - ARNSTABLE PUBLIC HEALTH N. CE CATE
OF COMPLIANCE YML NOT BE ISSUED UNTIL BOTH THIS FO AND AS-
BUILT CARD APXRECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Desiper Certification Form 4
9/16/03
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems. Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
I, hereby certify that the engineered plan signed by me
dated 2a ,concerning the property located at
6�j SGy�t=� ,QV�1�1v� meets all of the.
following criteria:
• This failed system is connected to a residential dwelling only. There are no commercial or
business uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes
per inch. The applicant may use historical data to conclude this fact or may conduct deep
test holes and percolation tests at the site without a health agent present.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will-be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the.
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) k
B) G.W. Elevation t2l +adjustment for high G.W.4.0 = 161
t
DIFFERENCE BETWEEN A and B 3
SIGNED : DATE: !qe �45
NOTICE
Based upon the above informatio epair permit will be issued for bedrooms
maximum.. No additional bedrooms are authorized in the future without engineered septic system
plans.
gASeptic\percexemp.doc
TOWN OF BARNSTABLE .
LOCATION I(!�� �l��c C,etr A,(�, SEWAGE # SS- �Ja
VILLAGE J` G.v�/�+S�a r J ASSESSOR'S MAP & LOT O
INSTALLER'S NAME & PHONE NO. (f," P- r LO vVQ
SEPTIC TANK CAPACITY 1 CTU� 1�-��5� vu
LEACHING FACILITY:(type) f2(f�-C451-P (size) Qti--ru.(a�
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: L .3
DATE COMPLIANCE ISSUED: 43,
VARIANCE GRANTED: Yes No t-1---
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THE COMMONWEALTH OF MASSACHUSETTS /�
BOARD OF HEALTf- amsi to PR at Dpeps
TOWN OF BARNSTABLE anent
Appliration for Di�ipwial Works Cnowitru rrnti -m
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
.................11.0. ...... �! ....------------------...... --•---.....-----------.....--•-•-......----•-.
Location \ddrrss or Lot No.
Owner Ad ess
a .............. '�.:�A .D.. f - y�.-.... .(e-..... � Lf..
Installer Address
UType of Building Size Lot............................Sq. feet
.., Dwelling—No. of Bedrooms-----3------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons-_-__--_________--____--.-_ Showers ( ) — Cafeteria ( )
d Other xts
------------------------- ------------------------- ------------
- ---------------
Design Flow........: . .......................gallons per person der day. Total daily flow............... ......................gallons.
W O�
Septic Tank-—Liquid capacity gallons Length .......... Width..... ......... Diameter................ Depth............__..
x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......L........... Diameter----P ti,:_C?`........ Depth below inlet....(a.......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I----------------minutes per inch Depth of Test Pit-_-_--___--____-___ Depth to ground water........................
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Q+' ------•--------------------------------------------------------•-•-•------- •---............---•.....................•...................................
0 Description of Soil.........................................-........................................................................-.....................................................
_ _
------------------------- --------- ---------------- -------- ---------------- -------------------- _ ..........._.
U Nature of Repair or Alterations—Answer when applicable_-__= a�-' _ ��......L.� __. -..�.1 ....
J_�..:. ,, ..............•...
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 further agrees not to place the
system in operation until a Certificate of Compliance has been u e oard of health.
Sign-�... .. ..... . ............ ...... --- -------: ...................... .....��-P---13,.....
Dare
Application Approved By ... �� .. ......................... . ....... ,............ ........................ ... ...... .1....��to
Application Disapproved for the following reasons:. . ............................................................ ...................................................................
................................................... - - ..................... ..............-
Permit No. .... � ...... ........ .................. Issued ...........�..:.. .�.................
........................... Dace
------
c�
..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applirativit for Diripwial lVor1w Tows rurti , anfit
Application is hereby made for a Permit to Construct or Repair (\_.,e-)"an Individual Sewage Disposal
System at: 61
................. ....... .................................................................................
Location-Address.. _V or 1-t No,
................................... .............. E01.)N.<.......................................
owner Ad
............. ........................ _---------PA-C
V ............................ ---------------------
Installer Address
Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms-----K-----------------------------------Expansion Attic Garbage Grinder
a
Other—Type of Building ---------------------------- No. of persons---------------------------- Showers Cafeteria Other fix.tu_res\.................................. ------------------- ...............................................................................................
Design Flow........... ..........._........_...gallons per person per day. Total daily flow... ......................gallons.
WI -------------------------
9 Septic Tank-V Liquid capacity,0(12gal Ions Length..:��...... Width--.'.'-;;--------- Diameter................ Depth....._..........
'T'
:V4 Disposal Trench—No. .................... Width_..._......_.__...._ .Total Length.____......_...._._. Total leaching area....................sq. f t.
Seepage Pit No......I............. Diameter----1---(7)......... Depth below inlet.....(r.............. Total leaching area..................sq. f t.
Z Other Distribution box Dosing tank
1 4 Percolation Test Results Performed by.......................................................................... Date----------------------------------......
1.4
Test Pit No. I................minutesperinch Depth of Test Pit...__.___.___....... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit._._..__............ Depth to ground water..._._................_.
tx ............................................................................................................................................................
0 Descriptiot% of Soil........................................................................................................................................................................
U .........................................................................................................................................................................................................
.............................................................................................................................................. .........................................................
U Nature of Repairs or Alterations—Answer when applicable--------�.
I..............
P.,rl-41 <7- ......... .A4- J ..............................................................................
.......... ...........V.-N..
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 further agrees not to place the
system in operation until a Certificate of Compliance has been is-sved-bythe board of health.
-
Signed ....................... ........................ .......................- -Z------
nli�-7�
;wIPt--------------�,�_A
A
ApplicationApproved By ................ -- ---- - ..................................:. .......... --------- ----------------------------------------- ... ------F--------
-e following reasons: -------------------------------------------i .....................................Application Disapproved for th ... ...................... . ............................
....................................................9. .. ..................................................................................................................................:......... ...................
Dare
Permit No. ............... Issued ............ w_-
................................... ..................
-------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(VII-ertifirate of Tamplizinre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by ---------------------------------------4t..A0 1-0M17. 5 ,/7 71- --- ................. . ......... ... ................................ ...
------------
at ............................. ....... --- I - . ...................... .... .........
has been installed in accordance with the provisions of TIT I S5 of Thn State Environmental Code as describe-4 in
the application for Disposal Works Construction Permit No dated ,Wo r
THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE C ST
CUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
Inspector ... .........................
DATE....................2---------40........ ---------------............. .... �1 )
0"-**.... . .... ------------**-*,** -------
---------—------- -----------I--------------- I I-------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
VS TOWN OF BARNSTABLE
......- FEE...I...........4.3.�
Permission is hereby granted------------_---------! .0.421::e.��_4�.'111)
V, I 1 6........................................................................
to Construct or Repair ( L),-a-ri-175clividual Sewage Disposal System,
at No............................. ...... --------------1,14"Ie,//1_/_LJ C. z4l"V
................................
Street
as shown on the application for Disposal Works Construction Permit Nf�q, �j�Aated----
............. - -------
Board of Health
DATE.... ...............................................................
FORM 36508 HOODS&WARREN.INC..PUBLISHERS
TEST RESULTS: GENERAL NOTES :
N
I PERC RATE _1:_ <2 Minutes 1. All workmanship and materials shall conform 00
I SOIL EVALUATOR:_-D niel A. Moniz to 310 CMR�tle V rules and regulations for the V N o c0 0)
I TEST PITS OBSERVED BY:_ Unwitnessed ----- Subsurface Disposal of Sewage. W
18 005 O N rn
Test Date : 2. No change to this system shall be mode - -p
unless approved by ADM CONSULTING SERVICES. coo °o
R_3� '>F SIGN CALCULATIONS : o 0 00 U)
o�c 00, 3. A copy of these plans shall be furnished )
�G L=59.09, DESIGN RATE 1" = 5 MINUTES to the installer and kept on site during construction. O 3
/ No. OF BEDROOMS •j _ AT 110 GA BR/DAY U ut
'i DESIGN FLOW REQUIRED t59' Z
4. All components of the soil absorption system
'p SEPTIC TANK SIZE _�66 GALLON �� Shanl be capable of withstanding H-10 Loading
LEACHING PROVIDED ---------------- ap ,g g
6 �• I� e �. SIDE ____ _ unless placed under/within 10 of drives or �}
J a BOTTOM : 16 W 0.74 =_ 355.2 Gal parking area, where H-20 Loading shall be c
G. END ________________ used. Piping under driveways shall be Schedule 4U
yA
TOTAL : 355.2 --_ GAL/DAY 5. All covers to sanitary units shall be raised
-- 0
0 -----480----- S•F• to within 6' of finished grade and mortared
\� d NOTES:TES: EXISTING GRADE to provide a watertight seal.
--------------- 55 ------------ 6. A certificate of compliance as required by a
O Q J`0. I ° Z PROPOSED GRADE Title V, section 415.201 must be obtained by
\ Gravel Driveway �., G S6 the contractor upon completion of the work. �U
JO \ Before backfilling, the installer shall notify ADM WI'
I
She g = TEST PIT Consulting Services to inspect the constructed system UTILITY POLE 7. Existing and final grades shall remain cn , c
essentially the some unless otherwise noted. Z
,s' occ• \L� r SOO• ` O Loam to be stockpiled for re-application. O _
/ F
� � Wale 1Aetef s'- -- --
SCL
Awl Q \ r \ 8. Heavy construction equipment shall not travel 1�
over the system during or after construction.
(n �.
9. Contractor shall excavate all unsuitable material < .O CIO
within the S.A.S. and backfill with clean grovielAoarse J
Map 289/Lot #76 fph sand capable of having a percolation rate of 1' in W
14,300t SFt \�00� 1 \ co less than 2 min. and not contain fines, silts, clays, I W o
+�5 .t18 des d)° 00 CD organics, stumps or stones. W' O Q
•� refrio'� [Fill must meet sieve analysis Spec 15.255(3)] Q
Ito , Lk- O Q :
�� �' .,' '•�� /° 10. Contractor is responsible for verifying the actuo� v felt location of any existing utilities. He shall also be pre
N
BG�' o%Rode pared to adjust existing soil pipe elevation if neede
• jw o
11. This system not designed for garbage hinder. �' ���,
12. Septic tank shall be embossed with a seal
stating that the quality assurance is consistent
with ASTM Standard C 1227-93. Tank shall be I o
\ °/0 6T5 fitted with inlet/outlet tees as per Title V. 1 �i r`
o r-
�o, /o/ 13. Erosion control barriers if required shall be stake: m
prior to any excavation and shall remain in place o Lj o ~o
until all construction, grading, planting and N U I -�
Lot 91 inspections are completed. w = v
Lot *167 # 14. Septic Tank outlet tee to be vented with a gas r100
baffle as required by 310 CMR 15.224. `14
15. Benchmark is the top of a concrete step next a
to shed as shown above. (Elev. = 19.3) a
GRAPHIC SCALE
Li
Z o
20 O +0 20 40 e0 0 o
SOIL LOGS CN Q o �
o �
Lt+ 0 a
( Ffl FEET �. TEST PIT #1 COMMENTS `` ` J
1 inch = 20 ft• 0" Layer'Ap' 19.3' 0" r4 m J 2 m
Fine Sand ° E a ~ o
Loamy Very Friable � Z
10 YR 5/3 4 Q w a w
O 0 U L, m a'
PROFILE PIPE CROSS SECTION
SCALE: None
(Not to scale) 8e Layer'Bw' 18.7'
�
Septic Tank outlet tee to -20'±-' Loanty Friable
5Y 5/4
be equipped with gas baffle. - u N cv
Finish Grade ( 2%min.) r ✓
Finish Floor -24' DIA. CONCRETE RISER AM. 2• Washed Stan* 9' a
MATH COVER TO WDIA 12' Z 4 Z
Q 2
S
Outlet pipe shah rerna}n L
22't �-GROUND O 20't OF r+NIStfED GRADE AS REQUIRED. �.* 4'Diameter Pipe r) z
� MAINTAIN 1 x SLOPE S.0 -2.3 �
.�man> :rmc.rartvn level for initial 2.0' OVER LEACHING FIELD ® - 20" 17.7'
i + 6' Mink'nun ENecthie Dspth Layer'
Cl'
o S. tz "135 2' urEst or I/4' - 1/�
Layer C1' Loose
r.s't 4- scn 4o rc s' m woe 9' wAs► n sTa ' Pere-38" Very Gravell48.5'
SAND
18't 17.9' t3JL EFFEcraveElev. at system subgrode = 16.7' Mottling Observed 0 80'-Elev.=12.7' 2.5Y 5/420%4' PERFORATED RIPE SLOPE - o.Oos wA9irED TEE mm 3/4' ro + +/2' Sto►� DEPTr+ Remove oU silty/organic mdterial encountered.• Remove all fines encountered Cobbleso cnoN (to El. 17't) and reploce with clean, granular sand/gravel as required by TITLE-V • o _
TAIL( 355 s.f. LEACHING FIELD 120 9.3'
"N Gal SEPTIC TANK L 17.2'
olo� Elev. at system subgrode = 16.7'
BOTTOM OF INSTALLAATIONICONSTRUCTION Q``