HomeMy WebLinkAbout0030 SEAGATE LANE - Health 30 SEAGATE LANE, HYANNIS
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TOWN OF BARNSTABLE
TOX(t AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF'BUSINESS: 6V gc
q6,j
BUSINESS LOCATION: (` AS-S e oQ40 1 INVENTORY
MAILING ADDRESS: Se C 6m 6d ,6o k TOTAL UNT:
TELEPHONE NUMBER:
CONTACT PERSON: jbCS ire
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS:
INFORMATIONp/ RECOMMENDATIONS::
j Fire District:
(d-1 c �l'� � / n D Gil`/ `I a A
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
( 9 ) 9
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 oi ❑ NEW ❑ USED -
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives (creosote)
j t aulk/6rea4-- 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
1� ju aints, varnishes, stains, dyes Other chlorinated hydrocarbons,
4� 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)
pPe Oth F r cleaning solvents
I�aE. S
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials its
TOWN OF BARNSTABLE Date: /)-49/
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: �. rr : , t�.s ° :f\�i'� 3— ce
BUSINESS LOCATION: ` e. I o . ,tA U no 0,' 3 M CA O Z1,-G ( INVENTORY
MAILING ADDRESS: S " 1� 1 ' Y1C, -, 6 I TOTA OUNT:
TELEPHONE NUMBER: �L e- 1 — Z9g1 '
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: n1B tL 1 cf I-41 MSDS ON SITE?
TYPE OF BUSINESS:
INFORMATION / RECOMMENDATI S: Fire District:
i�Si� 1 c4i-r,� A ) 0 Q 1 00 0 11 (-A r i
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: h►%n i,% 1� v nn a 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 =b _ 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,
Ca A Lacquer thinners (including carbon tetrachloride)
z J Any other products with "poison" labels
❑ NEW ❑ USED (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
YOU WISH TO OPEN A BUSINESS?
x
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE. n Fill in please:
APPLICANT'S YOUR NAME/S:
BUSINESS YOUR HOME ADDRESS:
2Zf 2q 85.E
TELEPHONE # Home lephone Number ,
-
NAME-OF CORPORATION:
NAME OF NEW BUSINESS n TYPE OF BUSINESS_ ea infiVn
IS THIS A HOME,OCCUPATION? YE r NO
ADDRESS OF BUSINESS MAP PARCEL NUMBER (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 FFICE MUST COMPLY WITH HOME OCCUPATION
This individual has been i r d/9f any per uirements that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO
Authdrized Sign to e** CO PLY MAY RESULT IN FINES.
COMMENTS: U
l
2. BOARD HEALTH � - MU.S�:GC�M��ITM '
This individual has been informed of the per r is t ain t his type of busines+aAZARDOUS MATERIALS REGU TfO.'.
E
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:
lTOWN OF BARNISTABLE v'
�LCxATiON -�30 SEWAGE #
-'ASSESSOR'S MAP & LOTj ,"/,
INSTALLER'S NAME&.PHONE NO. �i�SG� S� tC ?? 5 7�L
SEPTIC TANK CAPACITY I Ocs 6
LEACHING FACILITY: (type) A c704i1 (size) x t3��5
NO. OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: /6 t COMPLIANCE DATE: �3 0/O f
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 byp -�'��i
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g`xF s it s'r� ate- 5 r-• t .. b
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s�L-, r `q'+•''�F.i��+ 5mL-a.. .� �'F .." -d" F'+^k,""-a' _. a'y..,... •
TOWN OF BARNSTAB.IE
LOCATION 3c) S<�4G1`fi� I`J4WF SEWAGE
VILLAGE J{� 2 J t E ASSESSOR'S MAP & LOT .-f
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o INSTALLER'S NAME&PHONE NO. gi�JS[�n� 77t
SEPTIC TANK CAPACITY 1._._¢C�, i
.
LEACHING FACILITY:'
_. (type (Size) XE .
t3 �.025
NO. OF BEDROOMS: c3
BUILDER OR OWNER
IL LL
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PERMITDATE': 6/.ag/c, 1 COMPLIANCE:DATE: r3 a Io t
Se "ara' don Distance Between the
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and>Leaching Faciliay (If any wells eztst..
on.site or within 200 feet_of leaching facility) Feet
Edge of Wetland and Leaching:Facility(If any:wetlands exist
within 300 feet of.leaching facility) . Feet
Furnished by - 't;0V
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LTH OF MASSACHUSETTS Entered in computer:
THE COMMONWEALTH
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Z(ppriration for Mfopogal Opotem Conotruction Permit
Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. = FO a'or16 Owner's Name,Address and Tel.No.
30 Seagate. Lane, Geft"ef_V6 Jack Mee
Assessor's Map/Parcel V
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E., Robinson Septic Service Michael Ladue
P O Box 1089, Centerville 7 Kettle Pond Dr Harwich
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow °�_13ZO gallons per day. Calculated daily flow 1ka gallons.
Plan Date � /0 '� O Number of sheets Revision Date
Title
Size of Septic Tank J S'G-`. Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Tit 1 r .-1, 3each system to the
plans of Mike Ladue, dated 8-10-01
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 by this Board Health. _
Signed Date .50
Application Approved by Date
Application Disapproved for the following reasi6ns
Permit No. Date Issued _Y_— Z7 0
No: �..u�,� �"` s .� +►���axe $5 0 I
'•,_ __THE COMMONWEALTH OF MAS$ACHU'SE-TFS... Entered�incornputer:
PUBLIC HEALTH DIVISIONkTOWN OF BARNSTABLE., MASSACHUSES
P _ . _r_
Zlppri+catibn for Mizpogal *pgtim Construction Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System 0 Individual Components:-',„ a
Location Address or Lot No. �10 4101 X_ Owner's Name,Address and Tel.No.
30:- Seagate Lane, Centeraille Jack Mee
Assessor's Map/Parcel -0y !/
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service Michael Ladue
P O Box 1089, Cenbbrville 7 Kettle Pond Dr, Harwich
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building L D c_�,,. No.of Persons Showers( ) Cafeteria( )
Other Fixtures
} j Design Flow 3 gallons per day. Calculated daily flow 1 gallons.
i Plan Date *.. ,-,C) a cX� 1 Number of sheets 1 Revision Date
Title
Size oi"Septic Tank WIQ) �'C,_ Type of S.A.S.
Description of Soil
L itp A
YY &Nature of Repairs or Alterations(Answer when applicable) Title-5 1 eacb system tot><'.a p
_
•,,oP**P ans of Mike"-Ladue, datedAQ410-01
_ Date last inspected:
-"Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
im 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 by this and Health. 4�
i 'r �'Signed Date (� V
Application Approved by Date
Application Disapproved for the following rea ns
Permit No. ZOO -�"!�� �� Date Issued X- Z7-'
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-----------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
Mee BARNSTABLE, MASSACHUSETTS
4 Certificate of Compliance
,THIS IS`TO-CERT FFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( )
Abandoned( )by Wrd.&Z�.,-fobinson Seat-ir_ Service
at 30. SP_a eta t A T.n -� `.wit s� ✓" has been construe d inraccordance
v
with the provisions of Title 5 and the for Disposal'System Construction Permit No.00-0 dated
Installer Wm. E. Robinson Sri Designer Muse Ladue
The issuan a of this permit shall not be construed as a guarantee thjt„the�s i will function as deli ed.
Date '"'" �' ' / �
THE COMMONWEALTH OF MASSACHUSETTS-7 }" a
PUBLIC HEALTH DIVISION`- BARNSTABLE., MASSACHUSETTS
Mee
33ioposW *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ,)
System located at 30 Seagate Ln.
and as described in the above,Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction mu t be counpleted within three years of the date of this a t.
Date: � �� � Approved by
`. 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO dlM'+ f
Address of property 30 Seagate Ln. Barnstable (Hyannis)
Owner's name Vetrans Administration
Date of Inspection July 18, 1995
2 ! PART A qp 19
l � CHECRLIST
Check if the followinghave been done:
s,
_ Pumping information was requested of the owner, occupa Board of
Health.
Property vacant
_ None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during that ,
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not
available with N/A,
_ The facility or dwelling was inspected for signs of sewage back-up.
Y The site was inspected for signs of breakout.
Y All system components , excluding the SAS , have been located on the
site.
34 The septic tank manholes were uncovered, opened, and the interior of
the septic tank was inspected for condition of baffles or tees,
material of construction, dimensions, depth of liquid, depth of
sludge, depth of scum.
Y The size and location of the SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
na The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
- I
• s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
+s;s
FLOW CONDITIONS
If residentid
3 numb'er`of bedrooms
0 number of current residents
no garbage grinder, yes or no
. yes laundry connected to system, yes or no
?_ seasonal use, yes or no
If nonresidential, calculated flow:
Water meter readings, if available: 77S-0
063 ,4' y'o
over 2 MD. Last date of occupancy
GENERAL INFORMATION
Pumping record and source of information: 79�-6J�s
System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
Type of system
x Septic tank/-d-i-st�-i-bnt±=-bv-z/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection
records, if any)
Other (explain)
Approximate age of all components. Date installed, if known. Source of
information:
j,jo Sewage odors detected when arriving at the site, yes or no
9
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK: X
(locate on site plan)
depth below grade: 1f
material of construction: X concrete metal FRP other(explain)
dimensions• 1 000 Gal.
z� sludge depth
distance from top of sludge to bottom of outlet tee or baffle
0 scum thickness
na distance from top of scum to top of outlet tee or baffle
na distance from bottom of scum to bottom of outlet tee or baffle
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage recommendations f r repairs, etc. )
The tank is not full because it v;as Fume since the house was last occu ied.
ml,o 1 03701 ry-vi1 r1i nrll r-atP a slow leak at the seam hit this is not "substantial
DISTRIBUTION BOX: nri
(locate on site plan)
depth of liquid level above outlet invert
Comments:
(note if level and distribution is equal, evidence of solids carryover,
evidence of leakage into or out of box, recommendation for repairs, etc. )
PUMP CHAMBER: no
(locate on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs, etc. )
10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) : X
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods)
If not determined to be present, explain:
Type
leaching pits and number one pit found
leaching chambers and number
leaching galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool, number
Comments :
(note condition of soil , signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
The cover of this pit was tound butno .
CESSPOOLS (locate on site plan) :
number and configuration
depth-top of liquid to inlet invert
depth of solids layer
depth of scum layer
dimensions of cesspool
materials of construction
indication of groundwater
inflow (cesspool must be pumped as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
PRIVY: no
(locate on site plan)
materials of construction
dimensions
depth of solids
Comments:
(note condition of soil , signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
. 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100 '
30, Seagate In.
A B
deck
SEPTIC
TANK
in out
PIT A B
Tank inlet 17.5' 33'
Tank out 21.5' 27.3'
Leach Pit 35.5' 26'
DEPTH TO GROUNDWATER
4' + depth to groundwater
method of determination or approximation:
Plan for adjacent lot.
12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined" , explain why not)
no
Backup of sewage into facility?
_ Discharge or ponding of effluent to the surface of the 'ground or
surface waters?
na Static liquid level in the distribution box above outlet invert?
na Liquid depth in cesspool <6" below invert or available volume< 1/2 day
flow?
no Required pumping 4 times or more in the last year?
number of times pumped
no Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent?
Is any portion of the SAS, cesspool or privy:
no below the high groundwater elevation?
no within 50 feet of a surface water?
no within 100 feet of a surface water supply or tributary to a surface
water supply?
no within a Zone I of a public well?
no within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the SAS) ?
no within 50 feet of a private water supply well?
no less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis? If the well
has been analyzed to be acceptable, attach copy of well water analy:
for coliform bacteria, volatile organic compounds, ammonia nitrogen
and nitrate nitrogen.
13
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
Name of Inspector Barry Perkins
Company Name Barry W. Perkins R.S.
Company Address P .O Box 721
Mattapoisett, MA 02739
Certification Statement _
I certify that I have personally inspected the sewage disposal system at
this address and that. the information reported is true, accurate and
complete as of the time of inspection. The inspection was performed and
any recommendations regarding upgrade, maintenance and repair are
consistent with my training and experience in the proper function and
manitenance of on-site sewage disposal systems. This is not a guarantee that
this system will function properly.in the future.
C eck one:
I have not found any information which indicates that the system fails
to adequately protect public health or the environment as defined in
310 CMR 15. 303 . Any failure criteria not evaluated are as stated in
the FAILURE CRITERIA section of this form.
I have determined that the system fails to protect public health and
the environment as defined in 310 CMR 15. 303 . The basis for this
determination is provided in the FAILURE CRITERIA section of this
form.
Inspector ' s Signature
Date
July 18, 1995
Original to system owner
Copies to:
Buyer (if applicable)
Approving authority
.•••.. BARRY W.PFMKM C.E.,R.S.
�SHOFMgs��,
RARRv ` HEALTH INSPECTOR
PE 1. SEPTIC SYSTEM:
NS
No.1016 1,sp ction,Certification,
Pero Testing and Design
RED
P.O.Box 721 Tel.(508)75&2511
Mattapoisett,MA 02739
o SEA
L0CAT10,�, � ^ SEVACE PERMIT q0.
Y1 L L AG E
NA)16
INSTA LLER'S NAME fa ADDRESS
0 U I L D E R 00 OWf3 ER
DATE PERMIT ISSUED
DAT E C 0 M P L I A N C E ISSUED
..
C.n
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No.......................:. Fps...:�......................
• THE COMMONWEALTH OF MASSACHUSETTS
BOAR® HEA Th.
_.O F......... .__.... �' ..... .., L
Appliration for Uiivusal Wvrk�i T. ultra Lion rnmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: ,
.3 O
................__ l... ...-•----•---� - ---
Location-Addr o Lot No. r
�,� L ......................, hen, Pl �s2 , r _...� "e............. ....
_......... ..... ................................
/ Owner Address
a e�.•• ... ...... ............................................................ .....••...--•••------•--..............•-------••--•---•-----•------------......•••-•••-•--••••.
Installer Address
dType of Buildiryg/ Size Lot.................... .....Sq. feet
U Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`14 Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures --__-_-------------- - --- --
W Design Flow......................................... gallons per person per day. Total daily flow............................................gallons.
WSeptic rTank/—Liquid capacity/...Y_...gallans Length................ Width---------------- Diameter................ Depth................
x Disposal Trench—No._-__---_-----__- Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..-•__-_.-..-_--_--- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by...............................................••--••......••----------.. Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................
a ----•----------------- --------------•-•------------------------------*..................._....__........_......... -------------------
•..............
Descriptionof Soil----------------•••` ............................. ................-•-•--•-•-•••.......
x -
W -------•-------• --•••.• .
-
V 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 TL I TL 1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health. '
Signed .. ......_:
Date,
Application Approved By....... �—• . --•-= � . - �-•-------------- '
^ t Date iR
Application Disapproved for the following reasons-----------------------------•-------•-----------------------------------------------------------•••••...........
ti
1
• Date
i
PermitNo......................................................... Issued- .. ._�!---------------------•---•--•------------
Date
ox,
No..-•-=................... �' FEs...: ...................
R THE COMMONWEALTH OF MASSACHUSETTS
BOARD H EA H
..OF........ .... ... . ... y
,f
y
Applir�afiian for Disposal ork i C�nn6,trnrtion prrnti
Application is hereby maderfor a Permit to Construct ( ) or Repair (''., ) an Individual'"Sewage Disposal
System at
%.... ........
t i ocation Addr s ( % hS cy Lot No.
--- ----- •... .......... ........ ......•- ----- ---•-.. .........-•-•--•. ......................
Owner Address
Wr ---------------
Installer Address„
dType of Buildi� - Size Lot............................Sq. feet
Dwelling No. of Bedrooms,................ _.---___-___Expansion Attic ( ) Garbage Grinder ( )
a :r:
p-, Other—Type of Building ............................ No. of persons-----__--___-______-•______- Showers ( ) — Cafeteria ( )
Q' Other.,.fixtures j __ '
W Design Flow................... ............gallons per person per'day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity......-.....gallons `e-rigth..:............. Width---------------- Diameter---------------- Depth................
Disposal Trench No Width Total Length..«..... Total leaching area...... sq. ft.
x r :
Seepage Pit No..................... Diameter...... ......_..... 'Depth below inlet.................. g ----sq. ft.
Total eac >� area
Z Other Distribution bx (¢: Dosing tank ( ) Date________________
Percolation Test Results P,erformed'byr............... .........................................:..... . ""
-•--
,� Test Pit No. 1...................minutes per inch Depth of Test Pit-----_.............. Depth to ground water.........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
ah ...............................................................................................................................................................
DDescription of Soil----------------------------•-•---------•--•-----------------......-----•-•-----••----------•------•-•-----•---•---•--•--•----•--••-•-------••----•------.........•-•--
W •-•--.____-•----------------•-----.•-•---..•--------.-•---.•--..------.-•----•..-•----•----••-•-•-•----•----_-.... ____ : ::::::::::__::- -
x Nature of Repairs or Alterations—Answer when applicable.______ Iriv i
U P .et + ..
Agreement:
The undersigned agrees to install the aforede.scribed Individual Sewage Disposal System in accordance with
the provisions of TITLE: 5 of the State Sanitary Code—The undersigned,furd.er.agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health..
gSigned - -------------------------- ............
Application Approved By_.....r -`r �.1 � � �'...:.:.......... `` `� D t
Application Disapproved for the f ollowingi'reasons---------------------------------------------------------------•-=-•--------•---•----------••---------------••-
w
............................•--•-----•---••----.......•--•--`.....---------------------•-----------••------•------•-------
a" ! _ Date
. - - � x .. Issued
`�}---
Date.............•......_..._......
Permit No.............................
THE COMMONWEALTH OF MASSACHUSETTS
"" y BOARD`, OF EALTH
. ...OF................: . �'^".............................
(Irrfif"ratr of ToutpliFanrr
THIS I T C TIFY hat I al Sewa e D' posal System constructed ( ) or Repaired ( )
Installer
.Y-6
has been installed in accordance*,with the provis ion sf T ``jof.The State anitary C e as described in the
application for DisposalsNygrks Construction Permit No _..-`�!--7r--------_- da.ted_.... _--" -- ..............
THE ISSUANCE OF THIS'CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEA+! WILL 'FUNCTION SATISFACTORY
DATE... t: "inspector
- -.-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0)1 HEALTH
No.•---•-y S• FEE...---
�
Permission is hereby grante
to Construct o Repair ( an Indio ual rage Dis al Sy tem
•
at No.---"` - •-- �?_ ...."...+ ��'j._.: ...+ �'" % t..>.. ........................................
..
- Street
as shown on the application for Disposal:Works Construction Permit N'14_
:.___ �!,l 11,A ...................
�----------------------
,'
Y 7
r, Board of Health '
DATE....... - ••.........••••. ..........................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
t
LOCUS MAP I
SECTION DETAIL - COMPONENTS
NOT TO SCALE
TOP OF FOUNDATION
SEAGATE LANE EXISTING SOIL ABSORPTION SYSTEM EL 50.0't
Eh50.5't 2 500 GALLON LEACH CHAMBERS
SEPTIC TANK _ > _ _ _
EL 51.62' t DISTRIBUTION BOX ,_-T-
- - _ - - - _ _ - r�t�- -IL-_1-III-III-III-III=III=:III-11-11_; 1'j'a I"-111 111-__I_=III-.11-11
= W MAC —i__iTi_i—i i— n_a i—iTi-_ i i I I—r _
r b ST, =III-III-III -I L I I-1 1-III-1 -I I L-I I-III- 2- of 1/8
' ro r/2
JLOCUS ( DOUBLE WASHED PEASTONE�
w
m EL EXIST.
pINE ST ' '.
�Of
Of �. .. y
EL 48.25' EXISTING 48.0'
ISTING 1000 GALLON
EL 47.27' "•�•
EL 46.9'
INSTALL GAS BAFFLE AT OUTLET /
NOT TO SCALE 25' LONG x 12' WIDE x 2' DEEP
EL. 44.9'
DESIGN CALCULATIONS DOUBLEBLE AS 1/2"
WASHHED STONE
FLOW RATE:
3 BEDROOM DWELLING = 330 G/P/D REQUIRED PCL. 37-A
(110 G/P/D PER BEDROOM x 3 BEDROOMS)
NO GARBAGE GRINDER - NOTES
SEPTIC TANK: N ; 30"E ___ -=
_= 660 G/P/D REQUIRED N7g50, 1. ALL PRECAST COMPONENTS TO BE H-10 RATED. ALL
330 G/P/D x 2
Tn 152.26 COMPONENTS WITH ANY ANTICIPATED VEHICULAR TRAFFIC
USE EXISTING 1,000 GALLON SEPTIC TANK __ ---_ -- TO BE H-20 RATED.
D STONE DRIVE 2. ELEVATION DATUM IS FROM USGS QUAD MAP.
-� ---- 3. MUNICIPAL WATER IS AVAILABLE.
SOIL.ABSORPTION SYSTEM: m }. ___—_— —�� PCL. 141 4. ALL CONSTRUCTION TO CONFORM WITH 310 CMR 15.000
PERC RATE _ <2 MIN/IN - CLASS I SOIL --3 -- �+ AND ALL OTHER APPLICABLE. LOCAL, STATE AND FEDERAL
SIDEWALL = (25+12)(2)(2) = 148 S.F. ��o to CODES AND REGULATIONS.
BOTTOM: (25)(12) = 300 S.F. r n o 62.20 15,412 S.F.t AREA �' 5. INSTALLER/CONTRACTOR TO REVIEW & VERIFY ALL
�
(148 + 300)(0:74) = 331 G/P/D PROVIDED
Z a
o z 57g50 30 I 0.354 ACRES \ STONE ` ELEVATIONS AND DETAILS AND REPORT ANY DISCREPANCIES
\PARKING\ BENCHMARK TO DESIGNER PRIOR TO CONSTRUCTION OR ASSUME ALL
USE: (2) 500 GALLON LEACH CHAMBERS W/ STONE Fr1 \ TOP OF CONC. FND. RESPONSIBILITY.
EL. 51.62' M_S.L-±
AS SHOWN IN DETAIL 6. INSTALLER/CONTRACTOR IS RESPONSIBLE FOR MAINTAINING
SAFE WORK AREA, VERIFING ALL UTILITIES AND NOTIFYING
EX15�N�G DIG SAFE PRIOR TO CONSTRUCTION.
DEEP HOLE DATA 7. ANY CHANGES TO OR DEVIATIONS FROM THIS PLAN MUST
\ O�oFC�N �/� BE APPROVED IN WRITING BY LADUE LAND SURVEYING AND
�' OHW
BOARD OF HEALTH.
PERFORMED BY: MICHAEL LADUE, S.E. EV -
WITNESSED BY: ED BARRY, BARNSTABLE BOH / u' 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'
N'o PER 310 CMR 15.000.
TEST DATE: AUGUST 2, 2001 DISTRIBUTION LINE PCL 38
�/ n 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE
� E� �
In
PUMPED DRY AND FILLED WITH CLEAN SAND OR REMOVED
DEPTH #1 ELEV. \ o AND REPLACED WITH CLEAN SAND.
0.0' A 49.9' \\\ N 10. ALL COMPONENTS TO BE PROVIDED WITH WATERTIGHT
LOAMY SAND LEACH CHAMBER 050.5' ACCESS PORTS WITHIN 6" OF FINISH GRADE.
7.5YRa/3 - SHED ✓ EXISTING 11. ALL SEPTIC TANKS, DISTRIBUTION BOXES AND PIPING TO
0.58, 49.32' EXIST NG 4 LEACH PIT BE INSTALLED WATERTIGHT.
o u� 1000�GAS (ABANDON) 12. NO KNOWN WELLS EXIST WITHIN 100' OF PROPOSED
LOAMY SAND O c0 o SEPTIC TA'K'y LEACH AREA.
o
1OYR4/2 o,N 13. THIS IS NOT A SURVEY PLAN AND UNDER NO
0.83' 49.07' o 1 CIRCUMSTANCES IS THIS PLAN TO BE USED TO ESTABLISH
e �, O Z 5 �� LOT LINES.
SANDY LOAM 6, O 'S, PCL 42-01
1DYR5/6 PROPOSED �(� o j
2.41 47.49'
C f S.A.S. -. #1` `
MEDIUM— 49.4'
COARSE SAND 50;1_,_ - �v-
2.5Y5/6 Z� 49.9' R�S�
PERC ® 59" (SPOT EL. SEPTIC SYSTEM UPGRADE. PLAN
<2 MIN/IN TYP.)
10.0' 39.9 NO WATER ENCOUNTERED S.A.S. DETAIL SUBJECT:
' 30 SEAGATE LANE
N f CENTERVILLE, MA
tN OFs9 PREPARED FOR:
5 MICHAEL Oy 74.15'
H ISTON R "2 S. °' 5785o•30� JACK MEE & LINDA SETHARES
o LADUE
cn
�o y 98 HIGHBANK ROAD
is 11 S. YARMOUTH, MA 02664
PCL 41-01 ASSESSOR'S
LADUE LAND SURVEYING gA117 �a MAP 249 PARCEL -140 SCALE: 1"=30'
7 KETTLE POND DRIU DATE: AUGUST 10, 2001 SHEET 1 OF 1
HARWICH, MA 02645 645
(508)-432-1197 ASON C. ELLIS, R.S. MICHAEL DUE P.L.S. REVISED: