HomeMy WebLinkAbout0024 UNCLE WILLIES WAY - Health 24 Uncle Willie's Way
Hyannis :. -
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1, TOWN OF BARNSTABLE
LOCATION _\ ;i ` SEWAGE#aW
VILLAGE +` ASSESSOR'S MAP&PARCEL `fi -3
INSTALLER'S NAME&PHONE NO. ( nS ��lC�ilc. �1+$�j arc -1%k-W-w,%
SEPTIC TANK CAPACITY _,wo
LEACHING FACILITY:(type) 0.4).4, (size)
NO.OF BEDROOMS
OWNER - T%R-(ouZ
PERMIT DATE: ep' \\ ?�® COMPLIANCE DATE: 7 2
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) 1 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facili Feet
FURNISHED BY
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No. _ G l 2t Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Disposal *pstpm Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade 4 Abandon( ) ❑Complete System individual Components
Location Address or Lot No. �P � I ' Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Te.No. Designer's Name,Address,and Tel.No.
D
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building Hmf No.of Persons Showers( ) Cafeteria( )
1a Other Fixtures li
Design Flow(min.r qui d) gpd Design flow provided gpd
Plan Date I NurrLber of sheets Revision Date
Title
Size of Septic Tank ND Typ of S.A.S. ��(
Descri tion of Soil 1
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 the ironme 1 Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Boar of al
Signed /� Date
Application Approved by lc. Date
Application Disapproved by Date
for the following reasons
Permit No. t- a Date Issued
'i . ,v
i y
% t � A:✓� i s .M y
err - .. IT! y�
gy �!
-4 No. (j t • ��� Fee ll)
r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ;~
ltlYlLatlOn for"kspo�aY 6pstem Construction Pirmit
Application for a Permit to Construct( ) Repair( ) Upgrade 4 Abandon( ) ❑Complete System "```` � ndivida7`�tuplonents
Location Address or Lot No. 1 jl�/" '�1 �5" Owner's Name,Address,and Tel.No. ���►►►
(Jt�[,�• VV -�'" �?
Assessors Map/Parcel 0 c- [ KM 1117,
"+
Installer's Namd,Address,and Te. o. A Designer's Name,Address,and Tel.No. 214
il
_ _h � 1 V
Type f Building: _ 1
Dwelling No.of Bedrooms Lot Size 10 JAM sq.ft. Garbage Grinder( )
Other _ Type of Building No.of Persons Showers( ) Cafeteria(
e a
Other Fixtures .. .
Design Flow(min.r quired) gpd Design flow provided g { gpd
Plan Date 4 Number of sheets Revision Date 4t
Title t AA t dd _ A We I i{
Size of Septic Tank Typ of S.A.S. �j .
Lf
Description of Soil_
t i w Ka (A A-t J�
Nature of Repairs or Alterations(Answer when applicable) ,
J0
Date;last inspected:
Agreement:;£:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r
accordance with the provisions of Title 5 of the n ironme tal Code^and,not to placc`e,the sgStem in operation until a Certificate of t
9 r
Com liance� y oar has been issued b this Boar of
' p E.. n
Signed �"r r Date a.
` ,�+
Application Approved by 'J'p-.e�r Date
Application Disapproved by Date
for the following reasons
Permit No •�� t Date Issued �ta /' t
THE COMMONWEALTH OF MASSACHUSETTS
'r BARNSTABLE,MASSACHUSETTS
Certificate of Compliance '. y
'THIS ISTO'CERTIFY,that the Qn`site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned,( .)by e
at F " 'i JAYill P has been constructed in accordance
with the pro isions of Title..5 and the for Disposal System Con A iction Permit No.(.2o��`?�� dated (s/r t .l_
Installer.Tf��i[� in� IAQDesigner \ o
#bedrooms Approved design flow O gpd
v,
The issuance of this permit sha, not be construed as a guarantee that the system will function , d si ned�
Date tV'r / Inspector ( i
--- - ------- _ -__.-- ---- -- - -- - — -
- ---" No. cif Fee /(I�
THE COMMONWEALTH'OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS:.
11 A S Disposal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade`( ) Abandon( ) t
System located at a „;
;Q4 R C1 1A)f I hicd 14 VA
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty-to comply with
Title 5 and the following local provisions or special conditions. n'
Provided:Construction must be completed within three years of the date of this permit:
Date l �, I ! Approved by '4�, iF-
`` F d .�✓ a
A
Town of Barnstable
..�1WHE
1 Inspectional Services
Public Health,Division
• BAMFrABIZ
MASS
v� 0?q. Thomas McKean, Director
ArEp �a 200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: J21 IQ I Sewage Permit# Assessor's Map\�P arcel T� ,j2ka�.,
,S
InstallerDesigner: �5 ,Address: r20I �1\oc,.) Q� Address: kX
2, �Mruj ".�P, OAS --bli MA_a04
On O I[x � �itC�.xt -Was issued a permit to install a
(date) (installer)
septic system atc2- u n \e )Jcclyoabased on a design drawn by
(address)
rcon�_ dated
(designer) -
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. Strip out '(if required) was inspected and the soils
were found satisfactory.'
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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in compliance with the to rms of
the RA approval letters (if applicable) .'
Installer's Signature) E
SAS`
ao, 11
(De ' ner's i ure) (Affix N ere)
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.
WoWeptA\HEALTMSEWER connecASEPTIODesigner Certification Form Rev&14-13.DOC
g 'Date
,i- Physical Street Address-Check database to ensure it exists
Working Phone Number
Actual Amounts -( ie.gas being used to fuel machines, thinner to
clean brushes all count as hazardous materials-no blanks)
Storage Information - location of storage, how long is storage for?
,If nrsno, note that.
�/�� Disposal Information -where and who? If none, note that.
'� Applicant Signature -understand what is listed and noted
�—Staff Initial -any questions, know.who to ask
Vehicle Washing/Rinsing? -give a vehicle washing policy and
xplain it
Attach the Business Certificate with your sign off and comments
**The inventory form should explain what the business consists of and the procedures
they are doing. Notes need to be left to explain what you discussed with them.
___ 7;7_-trr]nnn Unfnrinlc Inven4i.ra Qke f
YOU WISH TG OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (which you. T
must do by M.G.L.-it does not give you permission'to operate.) You.must first obtain the necessary signatures on this format 200 Main St.,`Hyannis
Take the completed form to the Town Clerk's Office,-.1 st FI.,367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
s3d�A�,>fU SStis, ?'° ' , �W DATE: - _ `7 Fill in please:
APPLICANT'S YOUR NAME/S: e e s Fc-, eN,9t-Des
BUSINESS YOUR HOME ADDRESS: C-3 I-/ C)byCLC-' a/IG/C�S G✓4 Y
`719a
y�.... a an, ��y I-Iyi9�NL_s A - a�-Eal
TELEPHONE # Home Telephone Number
NAME:OF
NAME OF.N,EVI!BUSINESS:
TYPE OF..BUSLNE55
IS,THIS.A HOIVIE:OCCUPATION? �✓ YES
AODRESS:OF.:`$l�5 c,. w.. - .�
INESS ::.k� C,.L ltii.:lGlCs.'. :MAP/PARCELNUIViBER ` (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, au have the-appropriate ermits and licenses required to le all operate our business in this town.
l Yp q g Y, p Y
1. BUILDING COM SID ER'S OFF E
This individual h e in or o any pe it requirements that pertain to thistype:of business: °'OUST COMPLY.WITH HOME OCCUPATION
RULES AND REGULATIONS. FAILURE TO
MMENT Alit orize ignat r OMPLY MAY RESULT IN FINES
2. BOARD O .H L H
This individual has e infor e- requ' nts that pertain to this type of business.
MUST COMPLY WITH ALL
Authorized Si ature*
•HAZARDOUS MATERIALS REGULATIOW, w
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:
Date: �/ g / ,7,8/sr
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF'BUSINESS: W SP IV(� 16 Nc
BUSINESS LOCATION: JdYANNc S A4/9 INVENTORY
MAILING ADDRESS: fi Ll U dvCLF TOTAL AMOUNT:
TELEPHONE NUMBER: . ; y - g e
CONTACT PERSON: PC--t2i v-19 191&(Z7C �C'21ti�NO�S
EMERGENCY CONTACT TELEPHONE NUMBER: 15 p0 36Q >Cy / MSDS ON SITE?
TYPE OF BUSINESS: ry t'u,--G
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
v Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
o ❑ NEW ❑ USED Cesspool cleaners
G Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
d Hydraulic fluid (including brake fluid) Refrigerants
o Motor Oils Pesticides
G ❑ NEW ❑ USED D (insecticides, herbicides, rodenticides)
(j Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) '
D Diesel Fuel, kerosene,#2 heating oil 0 ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals(Developer)
lubricants, gear oil p ❑ NEW ❑ USED
Q Degreasers for engines and metal o Printing ink
0 Degreasers for driveways&garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
v Rustproofers o Miscellaneous Combustible
Car wash detergents O Leather dyes
Car waxes and polishes Fertilizers
0 Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
h Lacquer thinners O (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform, formaldehyde,
G Paint&varnish removers, deglossers D hydrochloric acid, other acids)
0 Miscellaneous. Flammables Other products not listed which you feel
6 Floor&furniture strippers may be toxic or hazardous (please list):
0 Metal polishes
Laundry soil &stain removers
0 (including bleach)
Spot removers &cleaning fluids
(dry cleaners)
O Other cleaning solvents
Bug and tar removers
m Windshield wash _
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS licant's Signat staffs Initia14.
TOWN OF BARNSTABLE t�
LOCATION Un2�/� cy ; rIs�SEWAGE # - J��-
t
ASSESSOR'S MAP LOTA,3 3 �
INSTALLER'S N. E & PHONE NO. �/4S
SEPTIC TANK CAPACITY
i S ,
LEACHING FACILITY:(type) . /; (size) I®®� �/
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER �2 GG'!�P all-
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No i
� g
Ps 3a
a � �� a;
-_.
i
No..f�..67.......... Fmc .........
THECOMMONWEALTH OF
F!-iEALTH P T
APPROVEDse
BarnstaWe Connratian Department BOAR® 3 Z 5
r _ � JOWN OF BARNSTABLE
arco itrtt �r gifivniul Work.6 Cna�tt��r�tr�� ri motif
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at: - i
----
Location-Address or t N. �i�4�C �C_J6....---..�...
0o ft<r� ddres5�
-
,Wa �11-a `sr.�.... jPQ gCL' _ 1
Installer Address
Q Type of Building Size Lot................ q. feet
Dwelling.—No. of Bedrooms------------ ------------------------Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ................. ......... No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures ------------------------•-----.--.--------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
GG Septic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter................ Depth................
Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
Test Pit No. 1................nunutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a' -----------------------------------------------------------•--------------._.....•-••-------•----•-•---
-...
.----......
•.....
--------------------
-------
••••--
ODescription of Soil---------------------------------------------•--------•----•--------------•------------.....--------------------------••----...------------................_...........
W
U Nature of Repairs or Alterations—Answer.w en applicable._..... U ....5p7,' _ .........� .......... .__.....
Z-- --�----- ��31 -----_---� /........z
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 a /been issued by the board of health.
Signed ...... .... .. ----- ------- ....�.......................................
Application Approved B .................. . ........... ..........Q. .........................................................
Dace
Application Disapproved for the following reasons: ........................................... .......................... . ....... ........................................
C ........................ ................................................... ....................................................................:� /...�.......... e..................
Permit No. ! i.� ................... Issued ....... �'���� .:..:`... .......
Uace
--------------------
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Fmc
THE COMMONWEALTH OF MASSACHUSETTS
BOARD—OF HEALTH ,�� 9_192
3Z5—
TOWN OF-BARNSTABLE
Appltrtt#iott for Uiiipwial Workli Totto#r7an
it anti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ndividual Sewage Disposal
u System at: /
Z / Location- \ddr-ss
=------------------- -- .---•-•
OwrtrEr Add r
G
ress`
Installer Address I
Q Type of Building Size Lot________________ Sq. feet
__------
Dwelling— No. of Bedrooms............. ....._______-_.__--._-_._Expansion Attic ( ) Garbage Grinder ( )
aOther Other—Type of Building ____________________________ No. of persons....._______._.......___.... Showers ( ) — Cafeteria fixtures --------------------------------------------------------------------------------------------------------------------------------•-••-•---•••-•----•--
W Design Flow...................................:........gallons per person per day. Total daily flow---------_------_...........................gallons.
* Septic Tank—Liquid capacity-__--------gallons Length................ Width---------------- Diameter.........I-`__ Depth................
W Disposal Trench--No. .................... Width Length Total leaching p
x P g g area....................sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
0.4 Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water...
frq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ....---•••.....................••••••-•-•-•---••-••---•--••---•---••••--•--•--.......--•-•-•-_------.........................................................
0 Description of Soil.........................................................................................................................................................................
V .........................................................................••-•-•••----------------••••-••-----•--•-----•---•••••--••-••-•-----••----••-•--•---•----•---•-•••--...--•-•--•----..........
W
x --- •--•--•-----------------------------••-------••----•-•----------••..._.......- ---.......................................................................................... / ------
U Nature of Repairs or Alterations—Answer,when applicable.._... OU ..... . . :..........4 � .'.....��Zt, ........
� ? -
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 Complia::�n� as been issued by the board of health.
Signed .....-3/.. .. �..S - '... (�
..........��
Dace
Application Approved By------------ ------- .-- -- ------ .........
Dace
Application Disapproved for the following reasons: ........................................................................ ..................................
...... ............... -----------------
.....--------------------------..........-.........-.
Permit No. -' ... `% Issued % re
.......... �,
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARl!..��NSTABLE
TErtifirate of Cantylianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by............__........ t............_._GL.w.. ....... ................. ....._............. --................ ........
at ........_........ - ....._C/f✓.C.,.G •:.....1-'tJ1. ..........._.............................................
has been installed in accordance with the provisions of TITLE Yof The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ,`�.- _7...._ dated .._7..r. ... .
THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE CONSTRUED AS A GUARANTEE THAT HE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................__ ......-. -��..-' ... .................... ............ Inspector ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE O
No.--• • e FEE...............:........
Romal or o �000#r r#ion rani#
Permission is hereby granted f.J. -`•�_. -7--�-----------------------••------------------_--..-.---------------------_-___-----__
to Construct ( ) or Repair ( /an Individual Sewage Disposal System
at No............. l/6 L 11 � �j �,1�
as shown on the application for Disposal Works onstruction Per •A No....s/.��,�Dated.___.�"egg_�...
..........................................
® ............................. Board o h
DATE-----------
. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
LOCATION SEWAGE PER NO.
--jVILLAGE
N S T Al L E R'S NAME & ADDRESS J. CRAIGMEDEIROS
Trucking & BulldRing
142 Corporation Street
Hyannis, Mass, US.DA28
B U I'L D E R OR OWN ER
DATE P CRMIT ISSUEDZ-
L
DAT E COMPLIANCE ISSUED
6
N
�Q c
�C ,k all
No..---.. ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......Town .. ..._0F:...Barnstable
Appliration -for Rapwial Worko Tianotrurtion Vautit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: 4}a Y
Lot #22_._Uncle-.Willies Way Hyannis
Location-Addr s. or lot No.
.Floyd__J._-_and--Ronald.:§ lv a______________________ __ 56 Linda Lane Pyannis
Owner Address
Y
Medea _os_.... Co Rd. H annis
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-----3------------------------------------Expansion Attic (no)ne Garbage Grinder ( T)One
Other—Type of Building n?n:e................. No. of persons............................ Showers T101t— Cafeteria (n9ne
a' Other fixtures .....none..................... ... ...
W Design Flow--------------50.........................gallons per person per day. Total daily flow..3.99----------------------------------gallons.
WSeptic Tank—Liquid capacity.-—p-Q 11ons Length.................Width_ Diameter........._.----- Depth.._...._...._..
x Disposal Trench—No..................... Viidth-------------------- Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No..............._--. Diameter.................... Depth below inlet.................... Total leaching area.....___......-_--sq. it.
Z Other Distribution box ( ) Dostn tan1
`-' Percolation Test Results Performed by:._8_ral *ederios see 4 attac"ae
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....__..._....__..__..
LL Test Pit No. 2................minutes per inch Depth of Test Pit.._..-..-- _--_----. Depth to ground water------------------------
-------------------------•--------..-....--•---•---•---------------------------------------------------------------------------------------------------......
0 Description of Soil------------ --------f.
x &...------... - ----- -----------------------•------------------
W --------------------=--------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------
UNature of Repairs or Alterations—Answer when applicable................::...........:.............................................................. ...
I
..................................................................................•.--•----------•---------........-............-......-....-.--............--.-........-._....--------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI 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 f,he th.
�� �Signed..:'/f/' = Date
ApplicationApproved By........... ....:-•---•------------------------------------------------ -----. ----------------
Date
Application Disapproved for the following reasons:----•-----------------------------------------•---------•-------..._........--•--........--------..........-----
.............................................................-------------------------------------------------------------------------------. ---�G------�- -----------------------------
Date
/� -
Permit No. Issued....... -----__ _..........
Date
No *' �?.. ► `w; e Flai f'!...................
u ' _ THE COMMONWEALTH OF MASSACHUSETTS"?
BOARD OF HEALTH' :1"::,<
TO . ... .....OF....Barn r'tabl'
r ppliration -for Uhip iial Morkii C o'nstrurtion Permit
Application is hereby"made for a Permit to Construct ( . ) or Repair ( ) an Individual Sewage Disposal
System at
Location Addre r
and
56 Linda Lan 0 m ya s �.
Owner Atiddress
r--------•--•--••-•--•----------------------••---• --�'�4$ 3 �OE a i2L27Y1
Installer Address
Q Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-----3_____________ __ _____Expansion Attic ( Garbage Grinder Ong
Other—Type of Building�fl�e_________________ No. of persons hoovers �g ;ne
a yp g -- - - p S 7 — Cafeteria
QOther fixtures -----none--------------------------------- ------------------------ ------------------- - ------------------ ----------
W
Design Flow.............�0.........................gallons per pet-son per day. Total daily flow- ....................................__gallons.
WSeptic T'uk—Liquid capacity_-Z:o_®Q0lons 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 ( ) Dosin6'an � tiederios se,2 a,�traC
~" Percolation Test Results Performed by......------ ------ ------------• --_- --.-__-__ _._____-- a e_.--------•---_---._....- ----------- .
a
W Test Pit No. 1----------------minutes per inch Depth of Test Pit__-__________...____ Depth to ground water_-__-_-__________-__---
�Xq Test Pit No. 2................minutes per inch Depth of Test Pit- _______________ - Depth to ground water_..__-_-___-_______--.-.
a •-----•-••----------------------------------•-----------------•--•-•--•----------------•-----------•-----------------•---•--•-------------------------_--
D Description of Soil ------
-------------- a ----- ------------- f t--� ------;> ...............................I; G-• ---••-. - " - ---- ------_._._.. ---------------------------
w '
VNature of Repairs'or Alterations—Answer when applicable---------_---------------------------------------------------------------------------------
---------------------------------------------- .--..
--•-••-•••------------------------------
Agreement:...
The .-undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the prov..isions:of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until-a Certificate of Compliance''fias"been issued by t11e board,Vhb,.,
♦ Signed---- -�? --� "� -------------- `
Application Approved By........... •----A------------•----------•--•••-----•-•---------- =--•---
----------------
Date
Application Disapproved for the following reasons: .-----•--------------------•----------._.........---------._.--------------•-
---••--------------•------------------------------------•--..._..--------•-------•-•---•-----------------...------........------•-•--•-----•--------------------------------•----------------•-•-•_-----
�f'' _ Date
PermitNo.----................................................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
Y, BOARD OF HEALTH
.............r�...... ........OF.....
Trrtif irate of TlimpliFanrr.
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed O or Repaired ( )
jl� '' "u .&o
by...••-•---•.&-•---•. S -------------
ti i
Ins alter (........ / -----
has been installed in accordance with the provrsiotis ofrticl f11e State Sanitary Cod as desert m the
application for Disposal Works Construction Permit No._ '_ if ____. dated .---_-� .R. .... ..-_.. _•---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIO14 SATISFACTORY
DATE__ 4._ --
V �` ti f k -- Inspector......... � -----------•....._.
..... r
THE COMMONWEALTH OF M,A.SSACHUSETTS
--BOARD OF HEALTH
No..--•-- ---
_. " F ------- ------
�i�oo,� 1 ork.� C�oYa�tr�artioat r�uttat
-.--cap l�l ----Q----`-'----------------
Permissiony' hereby granted ._ .. -
to Construct ( ) or Repair ( ) an Individual Sewage Dis os 1 Systerg-
at No.--.• --------.---.._ _ - 3 fr f 5 C�+
................................ --- ------------
nK t
t � Street 'ti'+ ��I : .
as shown on the application for DI'sp'osaI Works Constructia 'eixriit N"o _________ ______ Dated-__.----------------------- __........
4 ._._-_-..--. ___________________________
r o d of Health
y- •
DATE................. - 1
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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CERTIFIED PLOT PLAN
LOCATION . . . .. . .. .
SCALE, . / .�=Z4. . . . DATE AEG .!7•!977
PLAN
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EDWARD
. . . . . . . . . . . . . . . . .
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+
SST/NG Fc�.vDAT7aN,`.4.=,...✓.,�o I CERTIFY THAT THE �?.'..... . . .... ..
sum SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
. . �.vsr,9O.Z.,&.. . . . . . . . . WHEN CONSTRUCTED.
SiL V A SiL V/r9 A 5-se c.
DATE RAC. /7 /!`Z 7
PETITIONER; /-/y/,?n,1n//.�., 11igSS. o Zoo/
REGISTERED LAND SURV OR
TOP OF FOUNDATION
CONCRETE COVER
CONCRETE (AVERS
e o 4"CAST IRON 10 MAX. 10"MAX. '
PIPE OR 41'ORANGEBURG(OR EQUIV.) ,
° EQUIV.)— MIN. PIPE- MIN. LEACH
° PITCH I/4"PER.FT PITCH 1/4"PER.FT. PIT PRECAST
° -� LEACHING
o' INVERT
` 4 EL.40.-F ... INVER INVERT ° . w e�� PIT OR
SEPTIC TANK EL�jrs ,3 DIST. ELF,6$ ; • >_ EQUIV.
, o INVERT BOX �� 3: .�.
/opo. GAL. INVERT a "
g INVERT w w 0: ::i; 3/4"TO 1 I/2
ELF .... i. o-O• WASHED
w :P: STONE
Did �� •i
' —WDIA. —� �—
DIA.—•� Non/
PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL LOG WITNESSED BY :
DATE A4.40,.11.77. TIME. 9%30 /?.4vL C- !� y , BOARD OF HEALTH
TEST HOLE 1 TEST HOLE 2 7.�fo!7�� . ,� ENGINEER
DESIGN DATA '.
8•
�uDsaic. NUMBER OF BEDROOMS 3. .
TOTAL ESTIMATED FLOW . . . GALLONS/DAY
30"
CoAZ54r S#VD BOTTOM LEACHING AREA . . . SQ.FT. /PIT
SIDE LEACHING AREA SQ.FT./ PIT
C6"
GARBAGE DISPOSAL (50% AREA INCREASE)
TOTAL LEACHING AREA ,.26�00 SQ.FT
PERCOLATION RATE 445,5. 7Y'!!. z . MIN/INCH
LEACHING AREA PER PERCOLATION RATE SQ.FT.
N.O. .WATER ENCOUNTERED /
NUMBER` OF LEACHING PITS . . . . . . . . . . . .
APPROVED . . . . . . BOARD OF HEALTH
DATE . . . . . . . . . .
AGENT OR INSPECTOR
OF M4ss�
Lo7�'zz THO
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THOD4AS E.KELLEY CO: Mo.11280 H
ENGINEERS—SURVEYORS o �O
4� L/ND� GA"Jl/E 346 LONG POND DRIVE /STEQ`
• SOUTH YARMOUTH,MASS. ASS/ONAl.Ea6
PETITIONER 02664 7�
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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, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE:06 h 5 Fill 'n,please:
APPLICANT'S YOUR NAME/S: .
BUSINESS YOUR HOME ADDRESS:
' TELEPHONE # Home Telephone Number O� 3 F
E-MA I L: ✓1/l c ��-
NAME OF CORPORATION:
NAME OF NEW BUSINESS L0 TYPE OF BUSINESS Lo LIP V1 J 4
IS THIS A HOME OCCUPATI ? YES NO /�f
ADDRESS OF BUSINESS Z L 7 /'''x MAP/PARCEL NUMBER Z (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 T0.200 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 COM ISSIO_ ER'S OFFIC
This individua n in r o y p it r uir ments th t pe ,tain to this type of business. MUST COMPLY WITH HOME OCCUPATION
RULES AND REGULATIONS, FAILURE TO
Auth6fizeA-0g9p ture�* COMPLY MAY RESULT IN FINES.
lrrM M N I ��
2. BOARD O HEAH
�
This individual has.bee in orme of the permit requirements that pertain to this type of business.
Aut ed Si ature** MUST COMPLY WITH ALL,.
COMMENTS: HAZARDOUS..
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.,
Authorized Signature*
COMMENTS: -
TOWN OF BARNSTABLE Date:Db/ 1,9
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF"BUSINESS: , LON,Ny-�&,
BUSINESS LOCATION: Z C�
��5 INVENTORY
MAILING ADDRESS: Uvti \�C' a t 3,o V1 S TOTAL AMOUNT:
TELEPHONE NUMBER: ��( - lj?�L{ - foZ 0(�>
CONTACT PERSON: ;\
EMERGENCY CONTACT TELEPHONE NUMBER: 7360 JZ - 55 MSDS ON SITE?
TYPE OF BUSINESS: V C
INFORMATION / RECOMMENDATIONS: Fire District:
ge40v1 e+nca 'a4—s v✓, -;(
✓i cJc °a
�a�X� Ma�ec�a1 P V� des � Inau -�
ste Transportation: Last shipment of h�zardoi�s was�e:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
. Gasoline, Jet fuel,Aviation gas
Photochemicals(Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED -
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives(creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
-
Metal polishes
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers ;
Windshield wash Y
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINE fip scant ignature Staff's Initials
-
i
GENERAL NOTES
LOCUS MAP 1• Contractor is responsible for Digsafe notification, Verification of Utilities
and protection of all underground utilities and pipes.
2. The septic tank angi� distribution box shall be set
level on 6 of 3/4 -1 1/2" stone.
3. Backfill should be clean sand or gravel with no
" Rou stones over 3" in size.
TEST HOLE #2 &M setts'
Maw 4. This system is subject to inspection during installation
ELEV.= 98.50 ..--� , `- by Carmen E. Shay - Environmental Services, Inc. ;
Tropical Smoothie Cafe +� 5. The contractor shall install this system in accordance
100.01 Takeout Delivery ��
/j r ® with Title V of the Massachusetts state code, the approved plan
INSPECTION INSPECTION1 ��, ,�.,
PORT 1 5, PORT 7, s 1° F ' l 7 H&R' and local Regulations.
1- /,' 6. If, during installation the contractor encounters any
3' 3 O Y�r AI�,and soil conditions or site conditions that are different
8' from those shown on the soil log or in our design
installation must halt & immediate notification be
O 3 HOLE -H 10
TEST 1
D-BOX FAILED HOLE # _ `� rw made to Carmen E. Shay - Environmental Services, Inc.
LEACH PIT ELEV.= 98.50 7. No vehicle or heavy machinery shall drive over the
FAILED O �l t, septic system unless noted as H-20 septic components.
LEACH PIT s f l
EXIST. TANK �� l 8. Install Tuf-rite gas baffles or equals on all outlet tee ends.
y 1000 gal. , Ma$aSAI �° ', ' ,�� 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
O
DECK Septic Tank {' a
10. All solid piping, tees & fittings shall be 4" diameter
O Schedule 40 NSF PVC pipes with water tight joints.
11. Municipal Water is Connected to ALL OF The Residence and Abutting
Y � Properties Within 150 Feet.
9 9 r� ° o EXISTING
99 THE PROPERTY LINES ARE APPROXIMATE AND
I 8 BEDROOM PROJECT BENCH MARK COMPILED FROM THE SURVEY PLAN BY EDWARD KELLEY, RLS
HOUSE ?TOP OF FOUNDATION ENTITLED: "CERTIFIED PLOT PLAN -24 UNCLE WILLY'S WAY, HYANNIS, MA"
'ELEV. = 100.00 (ASSUMED) DATED AUG. 17, 1977
AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
#24 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
r THE SEPTIC SYSTEM INSTALLATION.
ASPHALT EXISTING LEACH PITS TO BE PUMPED OUT AND FILLED IN PLACE
I DRIVEWAY ( LOT #22 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
FROM THE EXISTING SAS TO BE DISPOSED
\.O"
10,200 Square Feet +�/- OF AS PER BOARD OF HEALTH SPECIFICATIONS.
98— I — I I o �— 98 REV.: 6/21/2021—Bottom SAS ELEVATION CORRECTED
GRAVEL
DRIVEWAY
I
i
I I
I 100.00' I I 2' Wooden Relkainina Wall P LOT P LAN
OF PROPOSED SEPTIC SYSTEM UPGRADE
96— — — —96 PREPARED FOR
-- - JAK TIEROUZ
AT
UNC'L�' F �_F ' ,S' � 24 UNCLE WILLIE' S WAY
r (40 FOOT RIGHT OF WAY) PARCEL ID: 292-325
HYANNIS MA
WM o o . o .�Of 41- `. PREPARED BY: .
C14I HEW E. SHAY
ENVIRONMENTAL SERVICES
ving Room
Bedroom No
o �'
Li m P.O. Box 1576
c: ,
' 0 20 40 50 i51 MASHPEE, MA 02649
s NI"T TEL/FAX : 508-294-7498
3 BR HOUSE FLOOR SCHEMATIC '
" SCALE: 1 "=20' DRAWN BY: CES DATE: 6/1/2021
(Description Provided By Owner) Y 1PROJECT#24 UNC. WILLY FILENAME:24 UNC. WILLY. WG SHEET 1 . OF 2
SCALE: 1 "=20'
*NOTE. ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C.
10' min. from Grade over Septic Tank- 98.50
Existing Foundation house to septic tank Provide Risers if necessary
TOP OF FOUNDATION = ELEV. 100.00 to bring Se tic tank covers D-Box cover must must have riser and be LEACH TRENCHES CROSS-SECTION (2 TOTAL)
1� � within 8 in. of finished grade Wish Glade = Elev 98.50
within 6" o finished grade
Grade over D—Box—98.50
4-PVC(CAPPED)INSPECTION PORT TO BE 4' PVC(CAPPED)INSPECTION PORT TO BE
INSTALLED'AND TO BE WITHIN 3. OF GRADE
INSTALLED AND To BE WITHIN 3"OF GRADE
S e. p,02 S-0.01 or 3 H — Top Of System = ELEV. 96.00
PIA-1 J DIST. BOX �003 3� N1ds
16' EXIST Greater 5=0.01 or Greater a'Perforated P.V.C. r-1/8'-1/2' Washed Stone Or Approved FEter Fabrk
EXIST. PIPE to 1000 GAL. 20' 2a" Invert Elev.=95.34 Y of
FRON EXIST. FOUNDATION a SEPTIC TANK O n 00
t0 5' O
3/4'-14-Washed Stone 4 Washed Fba Slane
vI Bottom of Leach Facilit Elev.= 93.34
CONCRETE FULL 0) H-10Gae Baffle rn rn a 5, —�'— or Approved Flier Fabric
4 > II 11 II Note: All leach lines to be capped at ends w/PVC cape. V PROVIDED
� o !
6 in.of 3/4"-1 1/2' d m > Bottom of Test Hole 2 Elev.=87.50
°' LEACH TRENCH T74•-17/2""�°°Stone
compacted stone "' (1 TOTAL) .tone
C -perforated SCH 40 P.V.C.ppe
6 in.of 3/4"-1 1/2- NOT TO SCALE
compacted stone NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE SYSTEM PROFILE 2 FOOT EFFECTIVE DEPTH FOR LEACHNIG TRENCH
Not to Scale
i
2-18 DIAM. ACCESS MANHOLES
6' PERCOLATION TEST ALL OUTLET PIPES FROM THE
R ;,.:, .... : . ,o - s: DISTRIBUVON BOX SHALL BE 12'
• u•••�::=••' :':`::' • SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER
Date of Percolation Test: MAY 27, 2021 ;.. ..
° Test Performed By: CARMEN E. SHAY, R.S., C.S.E. n KNOCKp OUTLET
`'* b•` ' +'
`•1� Results Witnessed By. DAVID STANTON— (BARNSTABLE BOH) _ ' as' �2• nuEr
EXCAVATOR: Shay Env. Svcs. ouRFr
OUTI ET Percolation Rate: Less Than 2 MPI ® 30" { 6-
_ r a J h. THE ACCESS COVERS FOR THE SEPTIC TANK, Test Hole 1ss- 1.75
4
DISTRIBUTION BOX AND LEACHING COMPONENT Test Hole 4- - SCH. ao Te
: ,,:,«�z.�;:�".��—^^- -";�`• SET DEEPER THAN 6 INCHES BELOW FINISHED NO. 1 No. 1
L '`' •' '"'� ��' '_"'•t` �''' GRADE SHALL BE RAISED TO WITHIN 8' of PLAN SECTION CROSS-SECTION
STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE DEPTH SOILS ELEV. DEPTH SOILS ELEV.
PLAN VIEW INSTALL TUF-111E GAS BAFFLES OR EQUALS o 98.56 0 98.50 3 HOLE H-10 DISTRIBUTION BOX
Sandy I Sand
3-24' REMOVABLE COVERS
Loam Loamy REV.: 6/21/2021—Bottom SAS ELEVATION CORRECTED
10 YR 3/2 10 YR 3/2
0 6" 98.00
:. .' i:•. .::"t 5..•e' • 4' r. A° 98.00 O"— 6" Ap PLOT PLAN
3"_min. clearance "' _
8' min 2- min. inlet to outlet 13' T '' Lamy Loamy
� b'min. WT -p}r{}p. Sand Sand
LJquld level 74 I I 10 1R 5/6 10 YR 5/6
5' -T :a, - A :� Ll 5 —,. 6•-30• 96.E 6"-30" A 96.00 OF PROPOSED SEPTIC SYSTEM UPGRADE
�g 4'-0' min.
`� a°•� ~ UQukl depth COARSE SAD OARSE SAN PREPARED FOR
Z5Gravel ; W.5 J A K T I E R O U Z
' 2• 2
a� / /
- .
SY74
30" 60" C, 93 50 30" 60" c 93 50
L AT
—°- 4 -' ` — Meg Mod. 2 4 UNCLE W I L L I E' S WAY
CROSS SECTION END—SECTION Sand sand
2.5 Y 7/4 2.5 Y 7/4
TYPICAL 1000 GALLON SEPTIC TANK 60"-132" C2 87.50 60"-132" C, 87.50 PARCEL ID: 292-325
NOT TO SCALE H YA N N I S MA
Design Calculations Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day min per Title V) PREPARED BY:
Garbage Grinder: No
Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) 3 OF /� �{ �/ u/
Septic Tank - 2 x330 Gal./Day = 660 USE EXIST 1,000 GAL. Septic Tank. FIMI,� �, Crl�Mli N lie A�ll1Z l
Pere #1 o C
SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Depth to Pere: 30" to 48" E ENVIRONMENTAL SERVICES
Proposed Leaching Trench Dimensions: 1 TRENCH TOTAL-3' Wide by 65' Long by 2' Depth Pere Rate= 2 MPI -
Groundwater Not Observed 1 P.O. BOX 1576
Bottom Area: 0.74 gal/sq. ft. x 195 sq. ft. = 144.30 gallons No Observed ESHWT �o MASHPEE MA 02649
Sidewall Area: 0.74 gal./sq. ft. x 272 sq. ft. = 201.28 gallons ADJUSTED H2O Elev. = None .131
'
Providing: = 345.58 gallons
a �,a���' TEL/FAX 508-294-7498
Use: 1 TRENCH —65'L by 3'W x 2'D EACH S N/A DRAWN BY: CES DATE: 6/1/2021
i [PROJECT#24 UNC. WILLY FILENAME:24 UNC. WILLY.DWG SHEET 2 OF 2