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HomeMy WebLinkAbout0052 WAYLAND ROAD - Health 52 WAYLAND ROAD, HYANNIS A=271 195 f TOWN OF BARNSTABLE LOCATION �Z tAlaVle,4 ' A' SEWAGE,# VILLAGE �/Q/l�9/'S ASSESSOR'S.MAP & LOT INSTALLER'S NAME&PHONE NO. �t`DG� ��CQ6',S7 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) S1141-16n) �3� (size) // 421 l-.2 NO.OF BEDROOMS 3 1 BUILDER OR OWNER 5. )f r .4e?e PERMTTDATE: 'Y COMPLIANCE DATE: I Separation Distance Between the: I Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S� Feet Private Water Supply Well and Leaching Facility (If any wells exist ,I on site or within 200'feet of leaching facility) ��/ 09 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) f1L�°� Feet Furnished by d � � � r e. •r �. If Z 7/-ley- 9f's 7-6 3 -,No. Fee y " a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for �Digogar *pgtern _-Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(y)Abandon( ) ❑Complete System [A- dividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /—�ff Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(. 1� Other Type of Building ,;;ee No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /'/'fJ gallons per day. Calculated daily flow ,J 3 a gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ® �._5 Type of S.A.S. Description of Soil 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 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this Bo d of Heal Signed OF Date 2 r Application Approved by Date � Z T Application Disapproved for the following reasons -a Permit No u3 Date Issued ' Z 7 rr- Fee`�'�t / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migpogaf *pgtem1 Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(ti')Abandon( ) ❑Complete System Ey'Individual Components 3' Location Address or Lot No. Owner's)ame,Address and Tel.No. tiAssessor's Map/Parcel i Installer's Name,Address,and Tel.No.�l Designer's Name,Address and Tel.No. 7 7/ -931 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder /` ,ogres ( d Other Type of Building Ae_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //4 gallons per day. Calculated daily flow 3 3l� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank MAO,9411 1i�14 104 Type of S.A.S. Description of Soil 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 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d of Hea / Signed Date 2�< Application Approved by - 1 Date Z 9� Application Disapproved for the following reasons c Permit No. / `76-3 `Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CER IFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(k-< Abandoned( )by bol, DLO CO S at 1A) / �e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall notbe construed as a guarantee that the system will function as designed. Date_ G �1 , C�D Inspector No. / O (O� a�/ �7✓ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION:- BARNSTABLE., MASSACHUSETTS Migogar *pgtem Cougtruction Permit Permission is hereby granted to Construct( Rep4' ( )Upgrade Abandon( ) System located at Z W& � s 'S 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 must be com leted within three years of the date of this it. Date: Approved by �� 1019/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND A PPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) �D/� �1�1 , hereby certify that the application for disposal works construction permit signed by me dated , concerning the P g // property located at Je�Z La _Aax l meets all of the following criteria: There are no wetlands located within 100 feet of the proposed leaching facility /There are no private wells within 1-40 feet of the proposed septic system There is no increase in flow and/or change in use proposed /There are no variances requested or needed. If the proposed leaching facility wiil '-.a located-within =`o feet of any wetlands. the bosom of:he proposed leading facility will m be :ocatea less:han ourteen 1,1-1l feet above the maximum adJusteq groundwater table elevation. Please complete the following: l A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) C B)Observed Groundwater Table Elevation(according to Health Division well moo) DATE: SIGNED : LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. �b# q:health folder.cats, �t � t SS ` -U i A _ Vo— TROY WILLIAMS SEPTIC INSPECTIONS '�-'7 - 4 J Certified by MA Department of Environmental Protection V ro ro 19 Hummel Drive ®d hai7Ho 1SrAecf 9 South Dennis, MA 02660 -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Fly DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617.292.5500 WILLIAM F.WELD TRUDY CORE Govcmor Secrcun• ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION Property Address: S'2 Lj—y �Oi ct t?J- 14Y �� ' S Address of Owner: � i 1 /9B t Date of Inspection: a. / (If different) Name of Inspector: Troy Williams S� f„Jpk�(4 h ( R.A I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR /S.000) Company Name: Troy Williams Septic Inspections ��jr�.� t • S A4I Mailing Address: _19 Htrmmpl Drivp _ S oti ,h D-nnjs MA 02660 Telephone Number: _(F3 g 5-13 0 0 . CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage.disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's �f Inspector's Signature: J i1�az, !ti/ Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the repon to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AJ SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: 61 SYSTEM CONDITIONALLY PASSES: 11//1 One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If'not determined',explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (anached) indicating that the tank was installed within twenty(10)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. I r•�1••d 0�/7S/f7) p•q• 1 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 52 Wayland Road,Hyannis,MA Owner: James Sherman Date of Inspection:February 19, 1998 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed Pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A'1,4 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. . The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER' (revised 04/25/97) Pao• 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 52 Wayland Road,Hyannis,MA Owner: Date of Inspection: James Sherman February 19, 1998 DJ SYSTEM FAILS: )/// You must indicate ei;,,er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is 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 analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: /V/19 You must indicate either "Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone It of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) - Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 52 Wayland Road,Hyannis,MA Property Address: James Sherman Owner: Date of Inspection:February 19, 1998 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. 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. 9C _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. All system components,.excluding the Soil Absorption System, have been located on the site. _ 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. / The size and location of the Soil Absorption System on the site has been determined based on: The facility owner'(and occupants, if different from owner)were provided_with information on the proper maintenance of / Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)J. (revised 0{/7S/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 52 Wayland Road,Hyannis,MA Owner: James Sherman Date of Inspection: February 19, 1998 RESIDENTIAL: FLOW CONDITIONS Design flow: ' 3 G p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: + Garbage grinder (yes or no): No Laundry connected to system (yes or no): 7 6-3 Seasonal use (yes or no):AV D Water meter readings, if available (last two (2)year usage (gpd): c17 3� do6 w//o, s 96 -3C d J 0 p �, //,4., f Sump Pump (yes or no):­Ajo Last date of occupancy: Uc c ��> COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if.available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and� source/ of information: J�`4-h -s p r r 6 A $!o L KJl p N v� t .r'. i �l 7'�+�a• H.P r+.L C7 �nJ h t✓ . System pumped as pan of inspection: (yes or no).�Lo —' If yes, volume pumped: eallons Reason for pumping: TYPE 9F SYSTEM _V Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) '(if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: ��— h / cx Sewage odors detected when arriving at the site: (yes or no) E/V (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 52 Wayland Road,Hyannis,MA Owner: James Sherman Date of In February 19, 1998 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron_40 PVC_other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:, (locate on site plan) Depth below grade: / Material of construction: _1,/concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions:_ Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle:02 Scum thickness:i1/6tiC Distance from top of scum to top of outlet tee or baffle:-LV-1J_J 4- "1"^ Distance from bottom of scum to bottom of outlet tee or baffle:5 C How dimensions were determined: ro c Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles depth of liquid level in relation to outlet invgrt, structural inte ity, evidence of leakage, etc.) Cc,h w`r ✓� o Y c-i /�U / tca P.o- 2a a✓ '%' v� h/ri n J h v� G✓� o GREASE TRAP:—L-/�/9 (locate on site plan) Depth below grade: Material of construction: _,concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: 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, etc.) (rw1sod 04/25/97) Paq• 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 52 Wayland Road,Hyannis,MA Owner: James Sherman Date of Inspection-February 19, 1998 TIGHT OR HOLDING TANK:A4 (Tank must be pumped prior to, or at time, of inspection) I l ovate on site plan) ) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; No Date of previous pumping: —" Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:, (locate on site plan) Depth of liquid level above outlet invert:]v� Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) V \/ti L,).off G L. i ,,.J o t� r 0✓ c.� t H U _S% vl S b c- ✓ r o v�.r.. d r R c- 12 PUMP CHAMBER: -- I119 (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) P (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: 52 Wayland Road,Hyannis,MA Date of Inspection:James Sherman February 19, 1998 SOIL ABSORPTION SYSTEM (SAS): (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, number: C>�. �- b x L 4- leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) c.l 6 t .S.V• 1�t df < - fL I ) I t Jl, r ✓ L -�7 l u r O✓ .a r J [ c^ S �- /h U � � JtCaLL�TO � � J CESSPOOLS:11/�i9 (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, etc.) PRIVY:-AIM (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, etc.) (revised 04/75/97) Page C of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 52 Wayland Road,Hyannis,MA Owner: Date of Inspection: James Sherman FebmUaty 19, 1998< SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supply comes into house) I ya16 l wa C4.1[o A, �S ' (r r i6 3s 39 ' (revised 04/25/97) - Page 9 of 10 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 52 Wayland Road,Hyannis,MA Owner: James Sherman Date of Inspection:February 19, 1998 Depth to Groundwater — Feet adjusted high groundwater level Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) rah- At� S h o w t s�` h o w�,..�--�-� �-D� �. ✓( .c.� �- �• c� eyo �. o T� )� .�_ (revinod 04/25/97) a laqo 10 or 10 . // TOWN OF BARNSTABLE Q SrZ G✓lr�/lQI1GI'/`� SEWAGE # LOCATION k VILLAGE!- AY Y ASSESSOR'S MAP& LOT Z� INSTALLER"S NAME'&PHONE NO. �l`DCOTf�! SEPTIC.TANK CAPACITY 410,1 6 C.- LEACH NG FACILITY: (type) 1;A1eu 4,) (3 (size) NO.OF`BEDROOMS BUII.DER<DR OWNER :PrW4V ' PERM I.DATE: tl 7 COMPLIANCE DATE:_ 4 —q8 Sepazation:Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S f. 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 Furnishei;by F i i ;! LOCA�ON SEWAGE PERMIT NO. VILLAGE INST L R'S N E i RESS 11 U I L DE It OR OWNER DATE PERMIT ISS-U E 0 9AT.E C 0 M-PL I A N-C-E ISSUE-D V !t r 1'� I I, �� II �r I ........................ Fmg....... ......... THE COMMONWEALTH OF MASSACHUSETTS vv BOARD OF HEALTH .................TDWn.............OF.....Z krn.StAble.................................................... Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct (K ) or Repair an Individual Sewage Disposal System at: 1 ^&I ( A &L.,............... ..MA........................................................ -Location Address or Lot No. .........gap (Z.9.K:L - 7 ...... _y..TjZUS.t.......................... ......6.5..jaj=U. Owner Address 04 ........Ste.ve...Lalme I.......................................................... .................................................................................................. 1-.4 Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms---3......................................Expansion Attic Garbage Grinder ( 1.4 P4 Other—Type of Building =Ch............. No. of persons............................ Showers (2 ) — Cafeteria ( Otherfixtures ...................................................................................................................................................... Design Flow.................5.5.....................gallons per person per day. Total daily flow...............3.30.....................gallons. P4 Septic Tank—Liquid'capacity:LD.0.0.gallons Length..82L."..- Width...4.1,1.0." Diameter................ Depth...5.. ..... Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........I.......... Diameter........(a......... Depth below inlet.......L.......... Total leaching area..2j66.......sq. f t. Z Other Distribution box ( ) Dosing tank ( ) 1­4 Percolation Test Results Performed byFLdXP_dge...Fm&ineeLr.Ln&............... Date...U.=2.5:.%f11 .............. 1.4 14 Test Pit No. 1.<.2...Q...minutes per inch Depth of Test Pit......12......... Depth to ground water-nana...encounte Test Pit No. 2..N/A.....minutes per inch Depth of Test Pit...N/A......... Depth to ground water.......N1.A........ e 19 ............................................................................................................................................................. 0 Description of Soil.............0....... ...........Loam..&...to.psc i 1...................................................................................... �4 2 ' — 10'"' medium vellow sand 10 — 12 ' med. white sand/tM4.Q.etfs...af..ZrAval/=....WaAar....at 12' ------------- ---------------------------------------------------"...."---------......*...­".....*­..............."....... .................. ­------------ - ---------*....................................................*------­...*....*.........­----­.. ....*---- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL ITI 11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep 1 beep by thVebD and of health. ........................... .... e ApplicationApproved By..... .... .................................................................. ........... .... ................ . Date Application Disapproved f t ollowing reasons:.............................................................................................................. ----------­- .....................*..................­*------*-----------------*-------- ..............-..........-----------.--------------- Date PermitNo......................................................... Issued...................................................... Date R¢a " Fps .. .�t _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town•--..........O F.....Barnstable...--.....................................................r Appliratiun for Uiipusal Works Tumtrur#iun rrntit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: rl ...........L0 t..fir....... ...... �!�:a--- -�:�•-------------- -•manna t-•-'!'�.--------•-•---- --------- ---•--•-•-•--•-----.----------- Location-Address or Lot No. a1 ter.--r2x')i t-------------•-----------.: 6,)r•-- ''c�. QaF r 4 �s ................ Owner Address W ate.mr:6...Lehe.L..............•.. Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms..3.......................................Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building ranch.............. No. of persons............................ Showers (2 ) — Cafeteria ( ) QI Other fixtures .................................. W Design Flow.................5,j......................gallons per person per day. Total daily flow............... . gallons. G; Septic Tank—Liquid capacityl.000.gallons Length.$!.6?1.... Width..Lh 10" Diameter...... ......... Depth.51.an-__. W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No........1._-------- Diameter-------6.......... Depth below inlet....... Total leaching area..�........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed byElddre4ge--Engiawaring---------•------ DateA,1,:..Z5_.8j............... a Test Pit No. 1<2A---minutes per inch Depth of Test Pit.....1..2_'_....... Depth to ground waternorle...p .I00L1Ylte�- Test Pit No. 2-.N/A......minutes per inch Depth of Test Pit..LJ/JL......... Depth to ground water.......1i!/A......... .. •-••••••• ... -----•-----------------------------------------------------------------------••---.........................---......-•-....-- Description of Soil......._.....Q. _—.._'. ......1oam..&.-to S41l-------- - Ux 2+ 10� m d m . e. aw..sand...............••-•----• •-•••-•-•--•....---•••......••...--------- 1©t 2- m -----•----------------------------------- ••••• .. ...•••.. sax><.d/tra:ces---of... vel/_.no._.water_..at 12, U Nature of Repairs or Alterations—Answer when applicable.............................................. .............................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITl:a. y g g p y of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been i sued by thard of health. r� r ' 4'igned ............................. -).. ... ....... ApplicationApproved By...... •.• ........--•----••-----------------------••-•------•------------•-------•----- r Date Application Disapproved r t following reasons:-------•-------------------•--------•------------------•--•••---------------------------•-......--.........._.._ -•-----------------------•-•-•---•----•-------------------------••--------....._..-------------------••--•-••-•••-••••...•-•-_._....------•------•.................................................... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. own............OF...B.a..�^na t.'�..ble.................................................. �rr$ifirtt�r of f�unt�rli�nr� THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( ) SteveLebel ----------------------------------------•----------------•----------------------------------•---------------- i� J Installer at-•-•••......LO't �......_�v _c�i -- �-••.................------------•--•-•-----------------•�I�ai'iY11��• IU�A--........ ------------ has been installed in accordanc with the provisions of , ��* le State SanitaryCod s d cri din the application for Disposal,Works Construction Permit No.....""'. `.............. dated ^�__ ._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. 7:.?-ta. '1-----•---. Inspector ---1,��•---.....•......----•---•-•-----•-. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..own Barns ta.ble •................ No ..... ... ....... ....................T..................OF....................... - .............. FE ._...................... ;%jingat urkv Tunotr iun antic Steve Lebel Permissionis hereby granted................................................------------------------------•-----• .................................................... to Con trrucct � ) or Repair (( ) an Indi :idual Sewage Disposal System at No.L-•••••••-••......_.1�.-_: 7.sj.4G`- v - -•K....Y1111S•.. .-- �'` .... Str as shown on the application for Disposal Works Construction Permit tI �_'� -------- Dated r/�'$ '') --------------------------•------------------------------ Board of Health DATE.........................................../ 1., FORM 1255 HOBBS & WARREN. I•NC., PUBLISHERS . .. n F.^ 00 Ln o S �fl" /oZ �� Z� p v i 0 ( .auto b; N 47 O 49/577. �D` sT 26' 1 23.E �. 2/1 tN L tN OF JOHN Lp aq. � R R .29874 @I Tg��pQ` -LEGEND . lN11M® SPOT ELEVATION CAA �N Mq OF' CERTIFIED PLOT PLAN v ss9�.." r .a `l ,,f =, 777 WiSHEO' SPOT ELEVATION La TISNE@ "CONTOUR.--�-0--•— ; . M0 SE I N VLDs,ewo; •OF HEALTH No.1os51 o J� SATENA 'AGENT ' SCALE$ =3 o DATES s/izJv'2s_ E'Db� ENOINEENINS Cal CLIENT I CERTIFY THAT THE PROPOSED REOLSTINFSD d011.N0.. yes WILDING SHOWN ON THIS PLAN C1V1L. .: : . LILND q , o CONFORMS TO THE ZOOM LAWS fY, Ctlf,��' .. C A Of ®ARNSTAI� , SS. . nd •�' 7`F2 "NI•�I f1f -6,TREET:::' � :, CH. dY� d ..1Z_.�' : � , ����__�� . M.Y�►.NN:1 S* IN.ASS. :.: 4AI SHEET..I Of ZE RE®. LAND SURVEYOR 20 FT. M/N. r, NOTE /F E/TNER THE SEPT/C TAN/< DR I+E--- l —=ACJ�///VG ?/T ARE MORETH.4:4� /2'"BELOJt/ �,4AOE, 24 'O/AMETER CONCRETE COVER SiyALC BE BQOUGNT TO GRA oE.��-;,v•EXTRA CONCRCTE i 4'PVC P/PE �yE,gVy CA ST L 4- 3E.USED P15Q FT.. ' o: ii�. GR.�oE CU VEfZ CLEAN .SANG 1 __ LQU/D LEVEL - ; ILA q^ 4"LAST Y 2+LAYER IRON P/PZ,,. 00`D o a o `�� o °� GLF /8 -318 .:.A M/N. P/TtN G.4 L. . . 1 1 • • • • • •9 0 •4° Is `'%4'Pit JrT; SEPTIC TANK D I ST. • s • • • • 1 • , , WASHED ST'JNE a BOX e • e� 1 1 •EFFECT/VG' 'i ; �i 314 a.. v 1 • • DEFT: • • • I ° IWAS.YEO STJ1V C o e s o • /�/T v• 1 • . • r • • • p .°v PREG45 T,SEEPAG E _lNfiBR7. CLEY�LT/ONs f 8��r� z� �? u • • • • . • . • • s e o P/7 OR EQUJV. • E� 93•S /NYERT AT OU/GOING �OD.S FT cf C� L•/D�y 6 D/AM. JNL ET. SEPTIC TANK DO> 3 F7 ! — FT. 01AM. � C SEE TABUL4 TJ ON� r- -� Dl/TLE7'SEPT/C 7ANK -/QO l fT, _ %NLET D/STR/B!/T/DN BOX 9 FT SECT/Q/V 4F GROUND 1�XfTER TA9LE Ol/TLET D/STR UT/ON /NLEr I.ZACHIMa PIT 99.S FT. .SE' AGE D/.SPO-SA L SYSTEM LEACJL!//VG PIT TABULAT 14 / n DIME/V.S/O/V A .3 FT. DES/GN CR/TERM SCAT-E 10/mx-N5/ON $ (, FT. NUMBER OF BEDROOMS 3 D/HENS/ON C_�FT. /lv'' G.!ReA�Ea/sao w� uwJr �O SO/L LOG TOTAL EST/MA'TED FLOW 330 GgL.IDAY SO:/L TES�,it°S So/4 TEST 2 SD./L TEST G NC/MBER OF L0ACN/NG P/T'.S_ f"ELG`✓. / /. A- g/ Z_ A?Z_ ,DATE GF SOJL TEST S/OE_LrAGH/NG PER._P/T,. �Sq� FT. O. Z ' RESULTS H//T/VESSED ByJRE 67bf zfl Bo T7OIy4'I:.Ey9CN%NG PER P/T L'k $Q: FT. Lvs}>vj .�'rRCOLAT/oJV �IATE,:)E/ ��s s ly/N�/�IVCK TOTAL. CEACH/NG AREA FT. Sv/3 S014- IcWRC0,LA7'/ON RATE/k2 TrfR�✓ M/nr.�/NCN: RE3ERYEGEAG'N/N6AREA $Q, Z:•O" Zr- /2 tVt of ��5�� - Sep�l U TIs �.4 y �- p , g v ORSEcn ca 29874 C No.10951 O F - A �� ELORE�GE ENGINEER//VG CO,/NG. r Q�3TB�yp�` 7/2 MA//Y ST. 4,YAA1N/S, /MASS. • ND SUR�f' �FSSIpNAL a� ND GRO[JN�7 YY�4TL•R ENCOUNTL�RE� CL/ENT:F,eAA1c,0 DRTE : r' • Q GMO UND PvA TE.P AT EL Et! JOB /VD: �l 2tiS- SHEET?OF z-