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HomeMy WebLinkAbout0059 WAYLAND ROAD - Health 59 WAYLAND ROAD,HYANNIS A= 271230 f - YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGSTERSYCUR NAMEin town(which you must do by M.GL.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main R.,Hyannis. Take the completed form to the Town Clerk's Office, 1st R.,367 Main a.,Hyannis,MA 02601 (Town Hall)and get the Business Certificate that is required by law. DATE APPLICANTS YCUR NAME/S. i-sa0/� � J( 4sOM Fill in k v BUSINESS YCUR HCM EADDRESS: .5 TELIEPHCNE# Home Telephone Number 3�?V3— 92-7 - :7�7 NAM E OF CORPORATION: NAMECFNEW BUSINESS i4N c�I� Q TYPE CFBUSINESS / Lt�LfS IS THIS A HOM E OCCUPATION?. YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER c9 1 r� / (Assessing) When starting a new business there are se-eral 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 GDT0200 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. BUILDINGCOM ION 's MUST COMPLY WITH HOME OCCUPATIO This indhAd ha Zpy r r n t t rtain t this type of busi%, LES AND REGULATIONS. FAILURE TO Auth rimed n tur •*' OM PLY MAY RESULT IN FINES. M ENTS: 2. BOARD OF EAL Scd r11(YL. a�tan � This individual ha� n inform of the r it r rement hat pertain to this type of business. J4� horized Signature** 6 G'n t l OOM M ENTS: 3. CON SUMER AFFAIRS(LICENSINGAUTHORITY) This indndual has been informed of the licensing requirements that pertain to this type of business. , Authorized Signature*' COM M ENTS: Town of Barnstable R�ECEIP 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-1294 Date Recieved: 5/1/2017 Job Location: 59 WAYLAND ROAD,HYANNIS Permit For: Building-Home Occupation Contractor's Name: State Lic. No: Address: , , Applicant Phone: (Home)Owner's Name: MASON-ARGIE,ALLISON Phone: (Home)Owner's Address: 59 WAYLAND RD, HYANNIS,MA 02601 Work Description: boceans of cape cod-allison mason-argie Total Value Of Work To Be Performed: $0.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make.this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: MASON-ARGIE,ALLISON 5/1/2017 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost: $0.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $35.00 5/1/2017 $35.00 1253 Check 1..............................._........................._........_.... .............._......................_....................._..._.............................._..................................................._......................................................_........._........... Total Permit Fee Paid: . $35.00 Regulatory Services OF THE Tp� o Richard V. Scali,Director t Building Division a.MsrwEM MASS. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us' Office: 508-862-4038 Fax:. 508-790-6230 Approved: /- Fee: �S Permit#: 7 _ / Z 9 y HOME OCCUPATION REGISTRATION Date: 4 Name: i 11.5 G7 Q Sr�YI" L� Phone#: Address: \!5y ' �tJQ L Q./�G� `�G/ Village: G'I CCh�is Name of Business: -&Ceans' C) h1122 Type of Business: �-�G�C.I Grp 1`1 � �!�Y►�l 7 c{MS Map/Lot: a 36 WrENT: It is the intent of this section to allow the residents of the Town of Bamstab]a to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling- there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes,and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the. following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within than dwelling unit.' • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does notinvolvefhe production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such-use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one tan capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. . • No sign shall be displayed indicating the Customary Home Occupation • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with a restrictions for my home occupation I am registering. Applicant: Date: 4/ Homeoc,doc Rev.06/20/16 TOWN OF BARNSTABLE LOCATION �� d�ily�/9/�.b A49', SEWAGE VILLAGE �yji'I�/�/�(' ASSESSOR'S MAP.&PARCELr�? INSTALLER'S NAME&PHONE NO. (%/ Q�® �� SEPTIC TANK CAPACITY -'Xl1-75ri 4,-4 e LEACHING FACILITY.(type).*reW-44reo NO.OF BEDROOMS 3 OWNER PERMIT DATE: COMPLIANCE DATE: —i 3 Separation Distance Between the: J"— o Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Oe�Feet Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 00 � NN M to b Y ► � 1 VIE Town.of Barnstable P# 5( , Department of Regulatory Services v L+eNari+er� Public Health Division Date MAWL �A 0:19. �e,� 200 Main Street,Hyannis MA 02601 �/,�y/y► Date Scheduled_ �\ /J Time ]Fee I'd." Spoil Snita ' f' A.s,ses,s ent,i'®r° Se e Dis ® l j Performed By: Witnessed By: 1 i LOCATION& GENERAL L\Tt'ORMATIO�T Location Address �— 5;, ��Al Z �� � Owner's Name jJ�'J`P�✓ 4 Address Assessor's Map/Parcel:��� — J a Engineer's Nameje::�We e NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands{n proxinilty to holes) t 2 n CV 6. cc, U_ rn d N Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping ftoin Pit Race Estimated Seasonal High Groundwater DE TERMINATION FOR SEASONAL HIGH WATER f AB L,E Method Used: Depth Observed standing in obs.hole: In. Depth to soil tnottles: Lt. Deptli to weeping from side of obs.hole: _ _ In, Oroundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor- Adj.Clroutidwater Level e PEI RCOL,ATION TE ST bate_._�_ Ttwe Observation Hole# Tillie at 9" Depth of Pere Time at 6" Start Pre-soak Time @ V Time(9"-6") _ End Pre-soak I Rate Min./Inch 21 Site Suitability Assessment Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division: Observation-Hole Data To Be Completed on Back----------- ***lf percolation test is to be conducted within 100' of wetland,you moist first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\s EPTic\PLRCFO R M.DOC I DE,EP OBSERVATION HOLE LOG .Male#�— Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsi tency 96 Gravel) V� E2 DEEP OBSERVATION MOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in,) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. - onsisten % ravel - 1 DEEP OBSERVATION MOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) ' (Munsell) Mottling (Structure,Stones,Boulders. Con i to cy.%Gravel) DEEP OBSERVATION MOLE LOG Tole# Depth from Soil Horizon Soil Texture Soil Color soil Other ' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, 6(hayoll Flood Insurance Rate Map: Above 500 year flood boundary No v es Within 500 year boundary No r es Within 100 year flood boundary No—. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious inkerial exist in all areas observed throughout the area proposed for the soil absorption system? L4 11 If not,what is the depth of naturally occurring pery us material's Certification t /� I certify_that on `® vI (date)I have passed the soil evaluator examination approved by the Department of Envir mental Protection and that the above analysis was perfcfm by me consistent with . the required tr fining,ex is a ex eInce described in10 CIVIIZ 15.017. Signature Date Q:\,5 EPTIC\PERCAORM.DOC (� // �i, .► /ram l No. V ✓�v Fee (v V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitation for Nsposal �6pstrm ConstrUttiott permit Application for a Permit to Construct( ) Repair(Afllu'pgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. �"9 G"W/Al d Owner's Name,Address,and Tel.No. /#1YXe-w10 Assessor's Map/Parcel 9 —.._? O Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. .00 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(min.required) ® gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tankn/.d��i�' 4T /O 0 ype of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) --P44';O� �'`id t'•� 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 Certificate of Compliance has been issued by this Boa ealth. p. Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 9-013 i)5 o Date Issued —G .; No. e� G 13' �v Fee ,A y THE COMMONWEALTH OF MASSACHUSETTS Entered in PUBLIC HEALTH DIVISION - TOWN OF'BARNSTABLE, MASSACHUSETTS Yes 21pplitation for Misposal 6pstem-Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System glondiidual Components A Location Address or Lot No. 6"-9 lfi�J'1�I�Q (.Z�j 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. e e6,41 &vim'- 77 S- 0 70,1 -!!�t4 4'le> G'-oO /,4 J'0— 11 ? or7 Type of Building: 1 Dwelling No.of Bedrooms -� Lot Size sq.ft.� Garbage Grinder( ) Other Type of Building �ef >No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 ® gpd Design flow provided y o gpd Plan Date Number of sheets •00, Revision Date Title a Size of Septic Tank c�'�si.1'T/�'' t� �0 0 ype of S.A.S. Description of Soil 45e-4¢ d"-A41 x Jt4/4'140T Nature of Repairs-or Alterations(Answer when applicable) —3'�'G�` '•�jd�'' .� 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 Certificate of Compliance has been issued by this Board- ealth. Signed �'" n Date Application Approved by Date Application Disapproved by Date for the following reasons E Permit No. , a-o 13 _ 35 y Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by 17�.!!! �Gs�l7 '61 Pe. -T><' P.: /r 1. G �" at S" 1�/l // has been constructed in accordance �+ with the provisions of Title 5 and the for Disposal System Construction Permit No.%3 -35o dated Installer Lj'irfj' ae eAt9G+E`41,00<" Designer L14vl.4) AL #bedrooms 3 Approved desi flow a 00 j // gpd The issuance of this permit shall of be c St as a guarantee that the system i fun do de igne . �. Date Inspector p � - ------ ----0013 n- ------- - -------------------- -- - ------- - ------------------------------------------------ -- --- - ,-------- No. 0 U 13 ^ 3 S 0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construttion permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 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. Provided:Construction must be completed within three years of the date of this permit. n Date ( G r 3 Approved by 1/ / SEP/11/2013/WED 08: 14 AM FAX No, P. 001 Town of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division �pr�o s:19. �� Thomas McKean,Director s 200 Main Street, Hyannis,MA 02601 Office. 508-862-4644 Fax: '08-790-6304 Date: —���� Sewage Permit# o�` �aAssessor's 1VIap/Parcel I d Installer&Desiener Certification Form Designer: � Installer: --�► 4 "1� Address: Address: On ��� �, �za 00fwas issued apermit to install a (date) (installer) septic system at � � based on a design drawn by u� (address) L`L V i"' O( ,Qb dated CI ZO, (designer) certify that the septic system referenced above was installed substantially according to the design, which may include manor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (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 P- '-rions. Plan revision or certified as-built by designer to follow. St6pout (if r- acted and the soils were found satisfactory. IDAVID B. nstaller's Signature) MASON m} 9 N0.106U 0 ►ST e 4 ( Y eSl er s Signature) PLEASE RETURN TO BAIZNSTABLE PUBL,,, OF COMPLIANCE WILL NOT BE ISSUED UN x tL nu i n l kilb b O t NI AS- BUILT CARD ARE RECEIVED 13 Y THE BAI2NSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q;lot�ce tonns\desi;nercertiiication fonn.doc ' J TRANS. NO.: CITY/TOWN: APPLICANT: ADDRESS: DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale?(1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220(4)(f)] VA daily flow septic tank capacity (required and provided) soil absorption system(required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) 310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? 310 CMR 15.242] ,r Certification statement by Soil Evaluator[310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR VZZ 15.220(4)(n)] Address Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211 1) 1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR. 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate(two in each of the primary and reserve / unless trenches as permitted in 310 CMR 15.102(2) or as / approved for an upgrade under LUA at 310 CMR 15.405 1)(k) VVV Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1 b)] Address Sheet 2 of 7 N/A OK NO SEPTIC TANK Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5"per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter 310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.22 7(2)] Inlet/Outlet elevations at least 12" above high groundwater / (except as described 310 CMR 15.227(5)) or permitted for / upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1 000gpd, two fors stems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation[310 CMR 15.211 1) Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Multi-Compartment Tanks Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and 3) "U"pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided? 310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/(leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b) Minimum sum 6" 310 CMR15.232(3)(e) Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PUMP CHAMBERS Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible(not too deep with piping, disconnects accessible) Alarm floats- alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buo ancy calculations needed?Provided? 310 CMR 15.221(8)] Address Sheet 4 of 7 N/A OK NO SOIL ABSORPTION SYSTEMS (SAS) GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] �./ Inspection ports specified and within 3"final grade? [310 CMR 15.240 13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] GALLERIES,PITS,CHAMBERS 310 CMR 15.253 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate 1' minimum-4' maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(l)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] TRENCHES 310 CMR 15.251 Width T minimum 3' maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours 310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document BED SAS (Maximum size of bed or field 5000 gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252(2)(g)] Separation between beds 10'minimum. 310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address Sheet 5 of 7 N/A OK NO DID THE PLAN INVOLVE Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gavelless system- make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems< 2000 gpd) or quarterly (>2000 d) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall? [Guidance Document] Impervious barrier installation must be supervised by designer[310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer[310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gravelless System[I/A Approval Letters] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Alternative Septic System[I/A,Approval Letters] Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits , Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Variances Are the variances listed on the plan? [310 CMR 15.220 4)( ) RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414 Address Sheet 6 of 7 N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone 11 for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such 1/ existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Miscellaneous Pumping to septic tank? [ 310 CMR 15.229 Shared System [310 CMR 15.290] Address Sheet 7 of 7 TOWN OF BARNSTABLE LOCATION S 14A'O A(j SEWAGE#,�0/3 - 3S o VILLAGE ASSESSOR'S MAP.&PARCELc�2 17/-oZ�' INSTALLER'S NAME&PHONE NO. 77.,' 0 7G7 SEPTIC TANK CAPACITY (!5 LEACHING FACILITY: NO.OF BEDROOMS 3 OWNER J'�; iJ'O� PERMIT DATE: 9 --i COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility O Feet Private Water Supply Well and Leaching Facility(If any wells exist On site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ALJT i i 77 f 3 3 e fig. 6 ©EL 3 0 la s � i LO CATI N � S-EWA G E PERMIT NO. - 1 VILLAGE O\j Av�rili Z5 I N S T A LLER'S NAME 6 ADDRESS 6 U I L 0 E 0 OR OWNER n i v c DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i ,. �'� �� -�. �„ r � �,, � � f`' �, _ � t; ��� �� ;, r.r �, 80 &11-01 atop Commonwealth of Massachusetts MAR 1 9 ... ..... t K4—. ! Executive Office of Environmental Affairs .1996� � � � r Nw Department of Environmental Protection ` WIINam F.Wald Govenor Trudy Coxe Argw Paul Celluccl S—ewy u.GaNroer David B.Struhs SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a 3 d PART A CERTIFICATION Property Address: Sy w'°yJ-Awq R O- f� I/�NNIS Address of Owner. /yOC1 MAR/l�i'T ST_ Date.of Inspection: 3 '-/a-46 (If different) P C1/m 3 Name of Inspector. i9�►grG/}S" R�'vtT� l Company Name,Address and Telephone Number. 13RlS70k CnVN1 y RACXj10/i" /ItI !f2/Tivl? No. tvsq, ?,r—,MA vd.7y� 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 9ignatuie C�%r/vt�W V1 '�yc-vim 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 report 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: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria ss defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below, B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. 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,cracked, structurally unsound,shows substantial infiltration or enfiltration,.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. (revised 11/03/95) 1 One Wlnter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292_SSW Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: S9 wA'0-4-0 RIO Ny�►w+ti!'S Owner. F2A ivAr-. MoR i- 4 SSA Date of Inspection: 3_ia.-9 b 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): 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(a). The system will pass inspection if(with approval of the Board of Health): broken pipe(g)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 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. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and 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 is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and 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. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 6-Cl WI4 Lp. N(fA,,-,,_5 Owner. Fi!'q n14 i --T001r /1 SS/ Date of Inspection: 3_ _9 DI SYSTEM FAILS: 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. 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.ceaspool 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: 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: 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 H 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 CMB 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addreew..5 9 Why 4Ar✓q Owner. `Ea •N47-. MOP-1 - 11 SS/�' Date of Inspection: 3 Check if the following have been done: Pumping information was requested of the owner, occupant, and 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. y .L--"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. The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. vAll system components, excluding the Soil Absorption System, have been located on the site. 4g.-�,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. L--�_The size and location of the Soil Absorption System on the site has been determined based on existing information or appradmated'by non-intrusive methods. !The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. a (revised 11/03/95) 4 SU13SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ...,._Pmperty Address: .6�J ►N�y��'"Q RA /)y/)".n�rS Owner. I-go -IVAT• MORI, Date of Inspection: '2 is_9 FLOW CONDITIONS RESIDENTIAL• Design flow: ,1aO lions Number of bedrooms: �, Number of current residents: O Garbage grinder(yes or no) NO Laundry connected to system(yes or no):`tfS Seasonal use(yes or no):NO Water meter readings, if available: /// 9 SO Last date of occupancy: D aC 9 S COMMERCIALAND USTRIAU 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: System pumped as part of inspection: (yes or no)NO If yes,volume pumped: eallons Reason for pumping: TYPE OF SYSTEM Septic tank/distnbution box/soil absorption system Single cesspool Overflow cesspool Privy Ain Shared system(yes or no) (if yea,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: /c?- `1 f 4/?S O Wrti r3 Sewage odors detected when arriving at the site: (yes or no)A"O (revised 11/03/95) 6 • � G'1` 7 G-Ra n,Z T 10 CUVti/� o �� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) I i gAe -v-s Property Address: 6"/ Owner. f<RQ• Nr1T• v,00 HISS✓✓ Date of Inspection: f 'd7 L SEPTIC TANK:_ (locate on site plan) Depth below grade: ) _ Material of construction:—-*'concrete_metal_FRP—other(explain) Dimensions: &c J,O Nb-X 'r'��1 �W�'/�1"�X S p rr-&-p Sludge depth: I Distance from top of sludge to bottom of outlet tee or baffle: 3 3 Scum thickness: O" io Distance from top of,scum to top of outlet tee or baffle: � 6� _ Distance from bottom of scum to bottom of outlet tee or baffle:-9 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.) GREASE TRAP:_ZV�,4 (locate on site plan) Depth below grade: Materiai_of construction:_concrete_metal_FRP—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: 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.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5'9 W A 114AN0 R 0- H y/MVNJ•S Owner. F?A. +vAr, SS✓v Date of Inspection: 3_,a_9l. TIGHT OR HOLDING TANK N/A (locate on site plan) Depth below grade: Material of construction:_ooncrete_metal_FRP_other(e:plain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee,condition of alarih and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: d Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box,etc.) PUMP CHAMBER.�A (locate on site plan) Pumps in working order-(yes or no) Comments: (note condition of pump chamber;condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ? PART C co arc s' U SYSTEM INFORMATION(oontinued) ti ,a Property Address: Owner. F/jro• NOT r�OR"i NSSr�. i��C�h i Date of Inspection: 3-,a-9 b n' 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: 74 N D 76 s Type: leachin6 pits, number: 1 leaching chambers, number._ leaching galleries,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,etc.) R h y 6 — CESSPOOLS:�jF} (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:-L/A (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.) I (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Sq W A y4)ti4 RO, H yAn/rv,'S Owner. 1vt9-. M 01P i- (70R Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' FRowt gn�a 0 DEPTH TO GROUNDWATER Depth to groundwater. 4f feet method of determination or approximation:(V O u./a,-r-- I n/ e h c y1 Q — nv a w,1 rsw ;w f-I. ,n V (revised 11/03/95) 9 c/ THE COMMONWEALTH OF MASSACHUS!r}ETTS /(� BOARD OF HEALTH "1 .......-Town.................oF...........Barns_table--.-----.....--------------------.............. AvOr�ation for UhipaoFal Workii Tonitrnr#inn Vanfit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ..........Zot... ....�. ..... �... �°1''�`� Yax�x�7.; .,...MA...- ----•-•----------------------- ocati -Addr s or Lot No. Capricorn k'c TI y 'gust t.._...... 765 Falmouth Road: Hyannis_................. •---•-•---------------_..........•--..--•-• - 1 Owner Address W -----------------------------------------------------•-----•----- Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........3............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building __ranch----------- No. of persons............................ Showers ( 2) — Cafeteria ( ) Q, Other fixtures ---------------------------------------•----------------•------------------------------ ----------------•----••---------------------.......--•------- W Design Flow.............5�r.........................gallons per person Ve day. Total daily fl1.ow.............am.......................gallons. WSeptic Tank—Liquid'capacity1000 gallons Length 8__. Width_:........___. Diameter________________ Depth.............. x Disposal Trench—�No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter....6........_.... Depth below inlet...6.._........... Total leaching area....266......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results_ Performed b Eldredge._.Enginee-rin9........... Date.ti1_-25-.$i................ Y---------------- ►� 2 0 1 none encounterd- ,� Test Pit No. 1..__.... minutes per Inch Depth of Test Pit.... Depth to ground water Test Pit No. 2__..NZp'.--minutesper inch Depth of Test Pit_NI..A.......... Depth to ground water na P� •----------------------------------•-------•------------•--•---••--•----•-------.................---........................................................ 0 Description of Soil..................0.•--•— 2. ...... om--&...tQPSo I---------•---------------•-------------------•----------------------------•------ 2 ' - 10 ' medium Yellow sand - v 10 ' - 12 ' med. white sand ---------- g l UNature 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 TITS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issyed b the board of health. �f _ ; aim&; -• 1 Signed.- -- - -.�fie1!1.�--- ate ....__... / D Application Approved By..... `^i �Q• .................................... j` L......----------- Date Application Disapproved for the following reasons:.............................................................................................................. ............................••--••--•---...••-•--------------------------•....•--•----•••---------------•----------------------------------------•----------------------•------------------------------- Date PermitNo......................................................... Issued..................................................... Date No. .............. Fps................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............To{lV ................OF............Ba.ms.table............................................. Appliraatiun for Uiipuoal Works Tomitrurtion ami# Application is hereby made for a Permit to Construct ( x) or Repair ( ) an Individual Sewage Disposal System at: (� ..... �1 ....... J�..... - .................................. �,o-t.#..............Location ess_........... Byarnrf��I o Loca -�ddi• ...........Cages,morn--,Reaity---Trust----••---------------•- .......76.5--.Falno� i��ec�i �IyMM1s............... Owner A ress a -•••--.... ........................................................ ----.................................................5 -.-----------------... *-------- .•...:. 7 Installer Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........3..............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria 1 a Other—Type gae�t._... P ( 2) ( ) dOther fixtures -----•--•---------------------------------------•--•--•-•-•-••-•----••-•••-•---------••----•-----•---.......•-•--...•-••---------•-•......-•-_----•- W Desi n Flow.............. ............................gallons per person per day. Total daily flow................ ......................gallons. WSeptic Tank—Liquid capacitylOGo .gallons Length_$_ (!!._.. Width..4A.10.!- Diameter_............. D-epth..5-1-811_.. xDisposal Trench—:No. .................... Width....................Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....1............. Diameter.....(p.......... Depth below inlet----(.t........... Total leaching area.....266....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by------Eldredge...Enginee _._ __ Date... 1._25_$j--_---._--__ -- Test Pit No. 1.<...?.Q.minutes per inch Depth of 'Test Pit_.___JL4 epth to ground water-none---encoun'terr Test Pit No. 2----V/A---minutes per inch Depth of Test Pit__N/A___...... Depth to ground water.... $........... eQ a ----.....••-------------------------------•-•------------................--------•-------------.--•--------------------------------------------------------- 0 Description of Soil.................. 'I...,.,....2.1L........... 2--!------•10'------medi m--- a �oW---ofind--------------------------------------------------------------------- W -----------------------------------------= 1.01------ 1.2-!-----:-medw mite se�c�/tra ced Q� gavel/no water at 12' UNature 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 TIT1,,�. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed b the board of health. ign�d_ 1 �=1.:✓.__✓ /...f � ...<- , f�'mate `... TL. ApplicationApproved By----------•-•-•--••--------••..............�� ................................ ........................................ Date Application Disapproved for the following reasons................................................................................................................. ----.......••---•----••-----•••••----••-••-•------•----•-•-•••-•••----•---...-•--......••--•--••-•------...-----•-••--•--•---••••--•---------•---•----------------••-----------------------......•-••---- Date PermitNo......................................................... Issued....................................................... Date s •3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ Qwil OF..........:..Ba stab:e........................................ atifiratr of Toutplianrr THIS IS TO CERTIFY, That the Indiadual Sewage Disposal System constructed ( X) or Repaired ( ) by = --------- �. Installer --------------------- at............ 0.�.. F �/ -&' -� .• -:n._� xya=ta----- -. has been nstalled in accordance`with the provisions of TI2y j_'3-o5 he-State Sa.mta e as described in 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. w a DATE........................................ Inspector. ' r 1 THE COMMONWEALTH OF MASSACHUSETTS s BOARD OF HEALTH 0 2-` 'POiA�Y2..................:....0 F............B�MS table........................................ 3 ........ FEE........................ Disposal WorkV wunotrnr#iog rranit Permission is hereby granted.......... -•------------------•-•---•---•----------......................_.. to Construct (X ) or i ( ) an Ind•vidua ewage Disposal System at No `- -----•---•-------•------.- --Y�... , --------- • -- --- - --------- -- ��� Street Hyanni►�� 1riL-1 ' as shown on the application for Disposal Works Construction Pe �iit No----- .,-,Gated.......................................... A. Board of Health DATE...... �6 � ................................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS EPA•M' U O / rc«r�e FSEr '00 K 27 t I . m 1 o Q 0 Ul m l� -nL.5ePnI cc m �� ' l9 kdo ,car !] J ( -, Za,i t= J3 o � fob t to oaf S. Q N OF f fin/tI�T1-1 q . i 8 � No.29V4 c LQ-r LL N� SURD 1.E6EMD �H°FXf4 CERTIFIED PLOT PLAN 141146 ,4POT . ELEVATION; :Ox4 iElS't'INA CONTOUR —" 0.. .. ;ALB �� LfT 19 . W �LAt..,D I�ll #SIED .BPOT .ELEVATION �tdffitIEQ:'CONTOUR 0--=-•'-: of 9 No,1095`1 N OLEOS 80&RD OF HEALTH °,p* GIST�P�\�� FS-..0NA1 A.OENT sCALE e - 3n DATE At 1fe .:L NOINEERINS CLIENTS I CERTIFY THAT THE PROP ,. EG , TE . REO18 @4RED g NO, l!!05 BUILDING SHOWN ON THIS PLAN CIVIL : LAND, CONFORMS TO THE ZONING lAWB R . C►R.ey-i OF ,BARNS E, ASB. ?'12 MAa 1i 'STR.EET CH. by - (o82 H.YANN.13, :kAA88 SHEET.1 OF:. '� DAT O. LAND SURVEYOR �t �'•I E,4 ,rI- S=G:! ... i_EAC/+'/ivG P/T .4,TZ— MORE49PEL0W /O -r- W./Al. ' 4.�OEM � 24 �O/A Al E TER G�ONCR E TE CO!iE P � tie------ S.NALL BE BROUGHT TO GRA Z>E. ,�- ,✓ t CONCRETE P/TCN /�EAVy Cif ST /RO.Y GO � 4 L L �� US 6: j T i♦. L IG3.3 COI✓E�' �9"PE.PFT. til IF/N DR/vEyv,ay tw 4'•: 4"CAST ��•:.� /RCN P/PE f (�OCS o a o T � � ��� G1F !�8• _•�,B i '-:'b M1N.P/TCAI GAL. • a r • . . •e�i ' '•7 %4 Pew fT SEPTiC TANK o/sT. • s t • « • • • • • .� • ;yASHFD $Tv;vE BOX o ° tr •18 • . • . • i .•• �• _.: a.• - • • t • • DEP7® • • • i ' I •e e WAShlED STONE . o. , . • . • • • • • . o •o , PREG4ST SEEPAGE INYC� ELEYAT/DNS (89.5 x l-S - 4� 1 %D • ,. . • . . . . . . o air cR Epu/v. 78•S x 1 .O _ -78 G/I] � ' a T EL= 93.3 /NYERT,AT 4l//LD/NG I04.3 FT G� D/AM. 1 /HEFT C.,OrA TANK 100. f T•' PIT CAPAc1T-( �4-9 6/D 10 FT. ®/AM- ; C+%SEE TABUL.4T10N� OtlTLET'SEPT/C 7ANX 99 -9 FT, //v,LFT D/STR/D!/T/ON BOX q9.-7 FT, SECT/O/V OF GROUND W,4 rZR TABLE OUTLETD/STR/B[!T/ON BC�X 99, 5 FT IM4,Er Lg r ACHIM PIT 99.3 FT. SELVAGE y O/SPOSA L SYSTEM L EACH//VG P/T 'rAdULAT/ON i s ALE D/MEN-v/ON A 3 FT. c / o -4 DES N •CRl TER/A r D/�fENS/ N $ Co T F Nl1MCER OF®EGROOMS 3 D1�yEN5/ON C�_FT. �M.li.)� �- �,.ae,AGEo�sPosw.�uN/T NONE SOIL. LOG } TGTAL E3T/MN'T'ED. FLOW '�A G.AL-1,DAY SO 1 L TEST 0/ SO/4 7EST402 SD/L TEST ;NUMBER GF 40ACarNG P-/r.S_ F f'ELE✓. 101.5 _,^-EZArJo DATe OF SO/L TEST SIDE LGACHING PBR P_/7' SCE PT. .90TTOM LF�ICN/NG PER P/T �O��u RESULTS H//TNESSED dY r ,� N6i SQ. FT Q-IB L PtRC.t�L.4T/0J1• RATE�IE/ AI/N,//NCHr 7*07',4.L LEACH/NG AREA 54) FT. AERC0, AT/CNRATEIk2 R S6RVEGE.4C.'NN6 ARE/ SQ. FT. tN F 'CN OF h/�ss 1 18-12� M ��Ati LoT I.R wa- 1). 2�/kD w T)4 •• r '1�A4RSE o, 8 p A �No.ioes EL DREDGE ENGINEERING Ca,/NC. 4hOIgTEa p4` 9o�Fss I5T�N��� gq 3 71Z 141A/N ST- , AlA.c/n/i.S, ivlAS.s. S ONA Cl/ENT: i=QA-�,eO DRTE <0 22 &2 (� GRO U VO ;-VA TE.P AT ELCf! JOB NO: r312os SHEET?OF 2 ASSESSORS MAP : --- O--------- _- ______.. ___.._____ TEST MOLE __L 0 C S - PARCEL : —� t � SOIL : I _--~ _ - FLOOD ZONE EVALUATOR��' l�Q���� t� � 1) The installation shall comiA.; with Title V and Town of�d b3oard of. - WITNESS : Health Regulations. REFERENCE v _ 1 FlED � �(,,l�C...�_ _ ___ _ _ DATE: I 2) The installer shall verify the location of utilities, sewer inverts and septic PERCOLATION RATE 4 � {� � ! , components prior to installation and setting base elevations. ` � 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first two feet out of the d-box to the leaching shall be level. TH- I TH-2 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. 5). All septic components must meet Title V specifications. r 6 Parkin shall not be constructed over H10 septic components. g P P 0 �D �� (�� 7) The property is bounded by property corners and property lines. a — 8) The property owner shall review design considerations to approve of total LOCATION MA � �, _ design flow and number of bedrooms to be considered for design. Receipt W �/JV ,I of payment for the plan and installation based on the plan shall be deemed to 0 approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall p p P P ` }} be removed along with contaminated soil and replaced with clean sand per Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the ZO water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if. LIP applicable. The proposed SAS is being installed below the water service o SEPT I C SYSTEM DES I G N line. The line,is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the /V owner to ensure such. f 2- L, , /p FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such 1 �► - -- — 22 l� .:���717 exists. v BEDROOMS AT GAL/DAY/BEDROOM GAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer ; lines exiting the dwelling;prior to the installation. ! 'r SEPTIC TANK 14 This plan is representative only that a system can fit on a property meetin ) p P Y Y p p Y g Title V requirements. i 22 �2ti2 C"a AL/DAY x 2 DAYS - 4��bGAL s ! / S, �� C USE P DOGALLON SEPTIC TANK p °M° ' S01 L ABSORPTION SYST EM2.90 4. OF SIDE �r�[�E A: l'..!"`w.�+� ".`4. ^""'f'' �.✓ �i > R /�'�,;✓ /!� DA �� a• VItJ I BOTTOM AREA: M C N 9 6 o� SEPT I C SYSTEM SECT I ON �.� ,J,� /8 b1b - — ----- - -- -- &'(z r ,, L-D trio b Ox . l 0_-SAL O i SEPTIC TANK �- SITE AND SEWAGE PLAN L0CA'1' I ON P_o L, PRE-PARED F 0 R : � �I IFMA1 SCALE: DAV I D B . MASONAS DATE: o � �`r� �� •� -___________.. .- � D E3C EN V I R O(JME NT AL DESIGNS a LAST SANDWICH . MA DATE 11EAL111 AGENT ( 508 ) 833- 2 177 a u s w z _ -7 —