Loading...
HomeMy WebLinkAbout0035 FORSYTH COURT - Health 35 Forsyth Court Cotuit F/R A 055 066 I �.h 1 TOWN OF BARNSTABLE LOCATION /M!�—fo 0—S-`I-14- C-�• SEWAGE # VILLAGE ASSESSOR'S MAP & LOTcS��w INSTALLER'S NAME&PHONE NO. 'IML 71-4-1-11 SEPTIC TANK CAPACITY A-L-• 65'y r-S-/uel- LEACHING FACIL=: (type) (size) ld 6/k — NO.OF BEDROOMS BUILDER R OWNER Go PERMIT DATE: 6-J�0-3 COMPLIANCE DATE: 2 S D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by o f7 No. 2W 3_2/ v Fee `�" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _Z/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplitation for Mi5pool 6potem Construction Permit Application for a Permit to Construct( . )Repair(pQ Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. 3 "- 7A S`fL C�i Owner's Name,Address and Tel.No. Assessor's Map/Parcel LAB.,OA ��� � - �� r Installer's Name,Address,and Tel.No. V'"n�S�C�II VN Designer's Name,Address and Tel.No. �a/�'►LJ W'S� � �I /Z6 ✓vl r,44 c L(/ 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) l� Ck- 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 E iron fmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board ealtill Signed Date �--3/03 Application Approved by Date ®3 Application Disapproved for the following reason - Permit No. 'LQ© Date Issued O --------------------------------------- No. _""" 3 Fee s J 4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIppYication for Miopozar bpotem Construction Permit Application for a Permit to Construct( )Repair(p<)Upgrade( )Abandon( ) D Complete System D Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel r 3�' yL��-1-{,s� C_7- �j AA/LA-S Installer's Name,Address,and Tel.No. V t0 Designer's Name,Address and Tel.No. W7 �,,.IS i/W c7T1L^! AA( �y Type of Building: . Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Y Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil , R Q �,/} Nature of Repairs or Alterations(Answer when applicable) 1�.-CJ'(/l�C�� ,� ! S'T` /S U°L Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board;f Health. Signed Date 1c Application Approved by - .� Date 3 v 3 Application Disapproved for the following reasons- . Permit No. ?-00 3` Date Issued 6, 2316 O 3 ----------------------------------------- �- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-'site Sewage Disposal System Constructed( )Repaired(W)Upgraded( ) Abandoned( )by at 3s has been construct e in a Iordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Zf?O 3-2'/6 dated tr ?v? G 3 Installer I Designer The issuance t rtpi shall not tie construed as a guarantee that the system n ti. esi d, D --.i ate y Inspector No. �-V�`��27� —---—-------^-- _ Fee . THE COMMONWEALTH OF MASSACHUSETTS <• (Act dfoL� PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSE x1h6po5ar *pgtem Congtructcon Permit :C) r Permission is hereby granted to Construct( )Repair)Upgrade( )Abandon( ) System located at - 7�9 cam— AA �✓) i l l -a f-n 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: Cons ction ust be completed within three years of the date of this Date:_ 2 3 C `t Approved by J s � z A Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of,the sewage disposal system including dies to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where•public water supply enters the building. .7" 10 r -\ COMMONWEALTH. OF MASSACHUSETTS { EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION. MAP m ��►,'�"� PARCEL LCT •�Z.. .Y-.. _ TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Al Owner's Name Owner's.Address: ` RECEIVED Date of Inspection: Name of Inspector: leas print). Company t JUN.1 7 2003 any Name: p TOWN OF BARNSTABLE Mailing Address: V A �j Q HEALTH DEPT. Telephone Number: 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: i Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Z• Fails Inspector's Signature: - -Date:. a�a3 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system i,s 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 DEP..The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and CommentsyQL,�, U I `****This report only-describes conditions at:.the time of inspection and under the conditions of use at that time.This inspection does not address how the system.will perform in the future under the same"or,different conditions of use. Title 5 Inspection Form 6/15/20.00 page 1 Page 2 of l l C OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL S OSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address: Owner: .0 Date of I,nspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. S stem Conditionally Passes: One or more system components °� »y ponents as described m 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. Answer yes,no or not determined (Y,N;ND)in the for the following statements. If"not determined"please explain. Na The septic tank is metal and over 20 years old* or the.septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration ontank failure is imminent:System will pass inspectionif the existing tank is replaced with a complying septic tank-as approved by the Board of Health: *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: SObservation:of sewage.backup.or break out-or high-static water level n—the-distri.hution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed ,A/ distribution box is.leveled or replaced ND explain: NO .The system required pumping more than 4 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 ND explain: 2 Page 3 of.l I . OFFICIAL INSPECTION FORM -.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE:SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: j A Owner: Date of Inspection: 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 isfailing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in.accordance with 310 CMR 15.303(1)(b)that the . system is not functioning in a manner which will protect`public health,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 any).determines that the system is functioning in a manner that protects the public health;safety and.environment: _ The system has a septic tank and soil absorption.system(SAS)and the SAS is within 100 feet of surface.water supply or tributary to a surface water supply: _ .The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS.and the SAS is within 50 feet of a private water supply well _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a. private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified.laboratory, 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 ritrogen_is:equal.to or lessthan 5 ppm,provided that_no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 • Page 4 of 11 OFFICIAL INSPECTION FORM-:NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM `PART A CERTIFICATION(continued) Property Address: '- Owner: Date of Inspection: 1.91 Q G� D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No i/ Backup of sewage into facility or system component due to 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�/z day now 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 SAS,cesspool or privy is below high ground water elevation. !/ Any portion of 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:1 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. [This system passes if the well water analysis, performed at a DEP certified.laboratory,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,-provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be.necessary to correctthe failure. E: Large Systems: To be considered a large system the system mustserve a facility-with a design flow of 10;000 gpd to 15,000 gPd• Yow m.bst indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 II of a public water supply well If you have,answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes"°in Section D above the large system:has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15:304.The system owner should contact the appropriate regional office of the De.parttnent. 4 ; Page 5.of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: S 7 Owner: Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping.information was provided by the:owner,occupant,or.Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? i/Have large.volumes of water been introduced to the system recently or as part of this inspection? _✓_ Were as built plans of the system obtained and examined?(If they were not available note.as N/A) Was the facility or dwelling inspected for signs of sewage back up _ Was.the site inspected for signs of break_out? Were all system components, excluding the SAS, located on site Were the septic tank manholes uncovered, opened, and the interior of the.tank inspected for.the condition of.the baffles or tees,material of construction, dimensions,depth of liquid,depth.of sludge and depth of scum? V*�-_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes. no Existing information.For example,a plan.at the Board of Health. 4/_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] M 5 a + Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: , j FLOW CONDITIONS RESIDENTIAL !/ Number of bedrooms.(design):� Number of bedrooms(actual): DESIGN flow based on 310,CMR 15.203 (for example: l 10 gpd x# of bedrooms): Number of current residents: LZ jb2CQ.,�s� Does residence have a garbage grinder(yes or no):Zkla Is laundry on a separate sewage system (yes-or no): ',[if yes separate,i►nspectioi 'requir-ed]' ` Laundry system inspected(y s or no)��{f Seasonal use: (yes or noLL4. Water meter readings, if available(last 2 years usage gaPd)) ( Sump Pump.(yes or no):A& 4 Last date of occupancy�-MhUA it 21, 4-kg4c' COMMERCIAL/INDUSTRIAV/, Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank rpresent(yes or no):_ Non-sariitary waste discharged to the Title 5 system (yes or no):— Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system.pumped as.part of the inspection(yes or o If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYF F SYSTEM eptic tank, distribution box, soil absorption system Singe cesspool Overflow cesspool _.Privy —Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from systemowner) _Tight tank —Attach a copy'of the DEP approval _.Other(describe): ApproxiT te age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): �- 6 r � t Page 7 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEMINSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: Owner: Date of Inspection: BUILDING SEWER(locate on site pla � Depth below.grade: Materials of construction:_cast iron 40 PVC_other(explain): Distance from private-water supply well or suction line:. Comments(on condition of joints,.venting„evidence of leakage, etc.):. SEPTIC TANK: locate on site plan) .r grade: below Depth ade S P • Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee.or,baffle: 2.12 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: How were dimensions determined: U � �nc�1. Comments.(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc. -44 GREASE.TRAPJ�6-(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(on'pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTIONFORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART C . SYSTEM INFORMATION(continued) Property Address: 5".c A Owner:. Date of Inspection:Wa,4 AA TIGHT or HOLDING TANK: �(tank must be pumped at time of inspection)(locate on.site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm.present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: V `(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert W'"U Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of kage into or out of bo etc.): / PUMP CHAMBE bcate 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,): 8 f T Page 9 of I I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'C SYSTEM:INFORMATION(continued) Property Address: Owner: Date of nspection: 3 SOIL•ABSORPTION SYSTEM (SAS): ✓(locate on site plan,excavation not required) If SAS not located explain why: Type. __."....__ ✓leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: _ innovative/alternative system Type/name.of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, e r J CESSPOOLS (cesspool must be pumped as part of inspection)(locaie 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(yes or no): Comments(note condition-of soil,signs.of hydraulic failure,level ofponding,condition of vegetation,etc.): PRI .`\Y ``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.): 9 Page 10 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: OwnerJZY& A Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100'feet.Locate where public water supply enters the building. �a a o 9AW Paa�_ 10 Page I I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: Owner: Date.of Inspection � SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check).all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abuttin6.prop erty/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: /Checked with.local excavators, installers-(attach documentation) __Accessed USGS database-explain: You.must describe how you established the high ground water elevation: r ` 11 Permit.Number: Date: Completed by: � HIGH GROUND-WATER LEVEL COMPUTATION. Site Location: 3L�r� ��sy/ Lot No. Owner: (,(f/®"l �/�r� — Address:. Contractor: T�l� / ® ✓`/ Address:: A& Notes: /lfl� fC� Yam/l O�c ' STEP 1 Measure depth to water table tonearest 1/10 ft. ................................................................:.............. .Date month/day/year. STEP 2 Using Water-Level Range Zone - and Index Well'Map locate site and determine: " OAppropriate index well............:.....:............................. .. OWater-level range zone ...................................................... STEP 3 Using monthly-report "Current Water Resources Conditions" determine current depth to water level for index well .......::.:............:... month/year _ STEP 4 Using Table of Water-level Adjustments for index well (STEP.2A), current depth to Water level for index well (STEP 3)., and water-level zone (STEP 26) determine water-level adjustment ................. .......................................................................... STEP 5 .. Estimate depth to high water by subtracting the water level adjustment (STEP 4) from measured depth to water �i 7 - levelat site (STEP.1) .....................................,........:................................................................ Figure 13.--Reproducible computation form. 15 i ...•. .:...,.T..�,........�,..,,,._-�.�...wl � '°"�'a.'_.`._.... M-- .-�.�.^...m.»j .».,....,..�d.�a..:,.e.�•M...�.......�,.,. r l,'l t Alp All . l/. i z Fim�i� ............................. THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH 3 �tp ........Town. .of.............OF......Barnstable................................................... ,�I�r�tration for Utnpniia1 Workg Tontrnrttnn Vamit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an,Individual Sewage Disposal System at: Old Post Road Lot 2 ................_.....--•-•---_--•. ..... •-••-----------------------------•---- --......-•-•--------._...........-•----.4 "�' • � .. oc lion-Address ,.� or Lot No. Owl Address X..'.................................... ...................................................... Installer Address 1.0 ae. d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__........................................Expansion Agic ( ) Garbage Grinder (yos '04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ................................. . W Design Flow.........5..1`...................:..........gallons per person per da Total daily flow--33 5_.......gallons. De .6_.. W Septic Tank—Liquid capacitygallons Length_10. '._-_..r�Vidth__51.- th.�?Diameter.............. . pr _ rr x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ Diameter.....10.1-----... Depth below inlet....6.........._ Total leaching area.....2.6_7.....sq. ft. Z Other Distribution box (X ) Dosing tank 6 ) '-' Percolation Test Results Performed byC3Pe-_----Od•-Su Vey-•CQr� llJt.aln�Date___......11/1.7478......... as Test Pit No. 1........z-----minutes per inch Depth of Test Pit........1 '.... Depth to ground water....none......_.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_--•-_-_ �,,c:.;,v x ----•----------------------------------------------••••• ......••••..........••....---------_........................................ F M s O Description of Soil.®-0-0.5 wood loam,t 0.5-2-5...subsoil_,__._2.•5--6_,•0_.M d.,•--- e______... ° RENWI�K ti v •••••...•••••••-•••••--••••••••..san .rcotult)..---...Itp .0 med ...white---sand-• �cotu� '.)..... ................... mi -- -----------------------------------------------------------------------------------•--•-------------•------------------------------------------------------------ ---- U Nature of Repairs or Alterations—Answer when applicable------------------------------•--__.____-_--_______-----.------_---__ O •• `- ©IFS TV A Agreement: "--ZA 1�1e_ ONAL The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor the provisions of iITi i 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. SignO_A. Date Application Approved BY = ---------- Application Disapproved for the following reasons------------------------------------------------------------------------------------------- Date ........__.... ••••••••-•-•••-••••••-•-•---••••••---•-•••-•-•-•-••••••••••-•--•--•••••••-••-•••.._...------••••••---••-.••••••--•-•-•-••---•----•-•---••••-•••••••------------•----•--••••---•••••-•-•---••-......_..-- Date PermitNo......................................................... Issued--- .................G........................ Date No........ 2....p.. FIms.A� _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town: of............OF.....Barnstable _''... ..A" , lirFatiou for Disposal Works Toustxnrtuaat Wrwt Application i hereby made for Permit to Construct (K ) or Repair ( } an Individual Sewage Disposal System at: Old Post Road ................__............................................................................. .............................. or ff No. ,�.t/ +�+ .. O r Address .........in......................................... ..................................................... Installer Address 0_" ` ... U _Type of Building 3 Size Lot----1.0 .ac feet a r Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (yos pI Other=Type--of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) Other fixtures -----=--------------------• . W Design Flow........55..............................gallons per person per day. Total daily flow..3.3.OXl_.,5#.J4.G_5........gallons. WSeptic Tank—Liquid capacity1500-gallons Length.101.-6ttWidth..5.1.-811 Diameter_............. Depth_4?_M6 .. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area......................sq. ft. Seepage Pit No 1------------- Diameter-___10.1_....... Depth below inlet....61........... Total leaching area....267.....sq. ft:`, Z Other Distribution box (X ) Dosing tank ( ) 2`� yC P p g . -----•-- a r �` Percolation pilestoRisults-- - m nutes p e Depthncha of Test�Pi�y_._�,.�.�5• Depthate Ai�Lt --A__... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wat �+ ........................................................................................................._.................. aa_. .............. •n\�, 0 Description ofSOile-8-0.5 wood lom,._02. _subsol;:_.2.,5-6,0---me_ P.K-___y� x � san (cotuft )...... .0-:12.,-0 med. white.-sand-- (-eotuit -g- c, CHAPMAN cn W ---•-•----------- -•--- A ,p lVo:•Z7M-6- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------- �, _-__•---��r �<v ..ro.._ Z 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 issued by the board of health. Sign ---------- --- ---------------•----------- ,C- /� Date Application Approved BY- -•--• - (...... ....'7 --................................. 4..-V1--7---•-•--•--- r Date Application Disapproved for the following reasons:-------•--,-----------------------------------------------------------------------------------••..............._ ....-----•......................................................................................................................••---••---••----------•-•-•------•--•--•---•--•--•--••-----•--...._..._ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA , ,fH . •'l �l............OF..... ........................ r, t Trrtifirab of Toutplianrr THU IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( )' .. V------- ... .......... ......X.-in;taller r a has been installed in accordance with the provisions of �5 ssoff The State Sanitary Code as described in the application for Disposal Works Construction Permit N ------Q`._Z... ............ dated...., .�.f./..=.7 '_......__..._:_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT+THE .-' SYSTEM WILL�UNCTION SATISFACTORY. DATE.....----•-..---•- --......... ....`..7��-.......................... Inspector ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ` 7 ........... ......0` o✓f 7......OF........ ... ..: yid ................. Y.... FEE.i: .............. Disposal Works Tonotrudion Vprrmit �'.' Permisslo a Iiy granted 11 i . ---•-----------•-----•---------- Sem e DI pos ystem at No s_..0 oar airnnfdival ,�1 � _ .1! .. Street as shown on the application fo Disposal Works Construction PVnyt No.. ............. .................... ' Board ofealth DATE................r - Y. FORM'1255 HOBBS & WARREN. INC.. PUBLISHERS 7T _ 2"PE=5'O«E L.O=Y • FILL ! milk, � I [LI ox • ' .• . . �O YEN - 1'OV ICA 6 N MIN • 1000- GAL. I ' GAL. ' PRECAST OR 14 S I K 6 � ;' .�,� BLOCK .. TAN " •. •� SEEPAGE PIT ` �, �, o `•I I a !mot o ° 20' MINIMUM FOUNDATION I %_" WASHED STONE { I R ELEVATION S K E s, - - - ---- 10 -- —i 5L ALE - 4 ,ISXj ., +�.. ,id�,`IO`•. i 7 3g v y. L, x -11 116 ou�✓c I 17 ul 3 a, rz. r ��o.9.�a.a� 3 3 0 9.p.e1. � '�� ,► o . -'"r �d � 4d�samx CiR 140E 4�j y 9,p.d• �t-...... � �� --- -•.�_ ....,r � � /off � � ''� --.,,, 1 � --•,,/o� � �� c t / 2.} MAY. Adt�c•�.odLL FLocv /-oK TNiS Sf�ST!►'/1? � --. b~/� T--_ A� P ` SIADAFW19445 S.t y2.S d s /o do7'"Tb�l1t y9 s.�. k o y•j d f s,f 71 g d• C Q�..� f- S `'~ `' - j W f mot: Zc 7 s,F, s49 yP.d. _- _. _ ,o•s --� �._ �. . -~ _ �Ira I S 1_ ` \ \ 0 0 /a v -- __ r, v,ON O 4 7. i Ec: loa eo /CLcl�ICfa r D Q .5 7- SOIL LOG k 3 0 • S �sso� i P�ec . �H oks ELEVATION SCHEDULE PROPOSED SITE PLAN FW57- SID �(GoTy' I INV AT FOUNDATION = � SEWAGE SYSTEM DESIGN w,y+f ip 9 �a N 2 1 NV INTO SEPTIC TANK a io 8 y� ��ryNSTi91,SL� �Ca7'ui�'.} l`'1 AS 5 . 3 1 NV OuT OF SEPTIC TANK . NO tuq r� _ O$•oo SCALE = ZO ' No V. 19,714 4 INV ',TO DISTRIBUTION BOX SCALE I'' : 4 5 1 N V OUT OF DISTRIBUTION BOX CAPE COD SURVEY CONSU0fANTS i !►SRC. RATE � 6 INV INTO SEEPAGE PIT ROUTE 132 TEST BY C• H/T//y-�- - - Ip0 00 HYANNIS,MASS. t TOWN INSPECTOR x4FIN (• 4A ?,Y-9 - — 2 BOTTOM OF PIT • e1�nor wsTON �wvt. eer�darern, prK BACKHOE OPERATOR ___ - - VEST MADE ON 1ZB !. BOTTOM OF STONE LAYER - �Oo w3 l J 1