HomeMy WebLinkAbout0228 POPONESSETT ROAD - Health 228 Poponessett Road
Hyannis
A= 019-070
' i
TOWN OF BARNSTABLE /
LOCATION o� O 033 2�R . SEWAGE# a0//-0
VILLAGE COu i ASSESSOR'S MAP&PARCEL O! -O?�
INSTALLER'S NAME&PHONE NO.-B./lace��s/� - SA8-5'dr9-35d
SEPTIC TANK CAPACITY/.�A?Es1 l �.CrJ T
LEACHING FACILITY. (type)/6/ A(, CA,,$.o Dizy. .) (size)c9.0 C Y3.7,
NO.OF BEDROOMS
OWNER 6 D� ee_, c2
S
PERMIT DATE: COMPLIANCE DATE: //
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
31
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
9pphLatlon for nispoBal 6pstrm ConstCUttlon i3Prmit
0\
Application for a Permit to Construct( ) Repair(k,"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. XLe T6 po Less eT7 Owner's Name 16Address,and Tel.No. SQS-yRo-
C.oTc,i? Z't M o 8-Tte.r
Assessor's Map/Parcel p(Q b y p =8 b e,etja r t& Q u i t
Installer's Name, dress anc�Tel No Designer's Name,Address,and Tel.No. �8'-3Q' a4 a'aL
rv�a gGCLIt. b f gam$- �Rrre n Mt�v.
Type of Building:
Dwelling No.of Bedrooms of Size 7 /cJ sq.ft. Garbage Grinder( Q
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures ' /
Design Flow(min.required) r L(y gpd Design flow provided `t J`-9 . ''1 O gpd
Plan Date �A rc.F4 a.R, @L o k t Number of sheets ea Revision Date
Title n
Size of Septic Tank /JrO D G61 revs lt,n Ty e of S.A.S. &.S W/-C9 /6 ~afroar��t+Srr Una J-
Descri�tion of Soil �.r' r- L o/}Y Srf C/o �3 d 3 R^oZ9, 6.4 4/aw C/o ,e S`
oc 9—/ a` " j7CZ op r7'� .Sh 3
Nature-ooff Ree airs or Alterations(Answer/��hheen applicable) T/IJT9I Ch1 DiS/r, -�ruvr oJ(/ ff rA�f e%c
1�1 / 2 1 o905 „��6 D r l yldtJ y9� V, l toel r
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 b ' Board o Health.
gn Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. ® Date Issued
r. r ry rY,
No. $ T Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN-OF BARNSTABLE, MASSACHUSETTS Yes s
\�? F
RppYitati011 for Disposal *pStelll CO11strUtt1011 Permit
Application for a Permit to Construct( ) Repair({Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. w;�e,,7 IZ�i Owner's Name,Address,and Tel.No. i 06 a 9aZ 9
Assessor's Map/Parcel C? I Q—' U "7 0
Installer's Name,Address,and Tel No. Designer's Name,Address,and`�•el.No. '�'�'.E _ R 9,
i�ry l e �ICtC.0 Il
Qbl
Type of Building:
Dwelling No.of Bedrooms — Lot Size it �_S3 sq.8. Garbage Grinder(16
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
1
Design Flow(min.required) Li (� gpd Design flow provided l 5 q ��O gpd
I Plan Date I I to c-c H Q P,. a O 1 i Number of sheets Revision Date
Title
+ Size of Septic Tank Type of S.A.S. /q&S V,-
Description of Soil �j=r +- �,3 n, c ,a=v /G 34
Nature of Repairs or Alterations(Answer when applicable) f6 o A - v✓'y?r. ( r 7c
.4 �ja./�°�� Jl � �1�,� iii6 �rflva�r`) s"if t•,1 /-I �� L�r x y� �'ij r �prs/
Date last inspected:
Agreement:
f
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
s
Compliance has been issued b, Board of Health. f U
gn ,/o- C Date Ol
Application Approved by a10 Date
Application Disapproved by Date
for the following reasons
ec
Permit No. / ® Date Issued
- -------- --------------------------- ------------------ _------------------------ _ - -------------------_------------Z Z-:
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V Upgraded( )
Abandoned( )by
at has been con"Welindancewith the-provisions ofTitle 5 and the for Disposal System Construction Permit No. dated
Installer 1 jc u C 1 lC ( C_� l,�e�? Designer e. Cr
#bedrooms I r"i r L(d,iX '!Cc.c;C�V\ Approved design flow (`j 0 gpd
I The issuance of this ermi shall not be construed as a guarantee that the system willPnc)on'as design
Date S i I Inspector o U -
, .. --- --------- --- - - - - _
No.
o Fee
THE COMMONWEALTH COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstrm Construction Permit
Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( )
System located at
CU �U
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:Constructi m It be co ple d within three years of the date of this permit.
Date Approved by
�._ � Red✓ �aP 6E�8�`.�� -
fMI,
LI -
� - Pub&Health Mbion
— =a
iiv:ss�iapaa3+�eyi�.7g5`
`Y�i•a -tea N'ba tr39 i319^�"� "..A:w.iLFLT:.
l,Zlst Rer A Rges&Mgert:d= yae warm
Bate:�9�l�id isaW�Sewage�+er�tit 90/1— v96 :#,sSe�sor's Iap�arce o r�l—o'�
�____-__
Designer: 'ICLte c,� tl e er Ins slier. �uc� i 0.c�� ,s r
— - i_c
— �dtlress: t�Oo x�( - - Address: _ c,r.c( -
9
CAsTSAn,Ac..��edt ,�o•.. C�St r����e , �(�.
Or, -jjf�r-UCit 4.CC- 5 t cr was issued a permit to install a
(date) (installer)
septic system at�8 e�p o n c s e l C- - [-0-.�T based on a design drawn'by
(address)
M
JG,���n 1 ►em-t'k' - dated MRizC H Q6 ,o t l
{designer}
i cett4 that.dte septic system referenced above was ansralled substantially according,to
the design, which tray include manor approved changes such a., lateral relocation of the
distribution box andior septic tank.
I certify that the septic systerrr referenced above was installed with major changes (i.e.
water titan l0' lateral relocation of the SAS or anv vertical relocation of anY component
of the septic system)but in accordance with State&Local Regular' s_ Plan revision or
certified as-built by designer to follow_ � �jH OF kgsc
p
Y R V,
{jns er's Signature) No. 1140
�SorsTEaa
4ANTARP
(Designer's Signature) r (Affrs Designer's Stamp Mere)
I'LEr1 U TO 5T L t3B D I C gZ C
Cd P ! WdLl� Yt3T BE LSSU€D �. Btri`ii T�LS FORi�! t4i�€t2 AS_-$t�iLT C�Rfl �iRE
RECEIVED BX'TI�BaI NSI�►B�$���F�EALTH DIViBtON 'F�€4i+i14 YOU.
Q:Eie wdSeOdDesipa Cettifitatian Fam 3,26,WA,
I ,
Town of B A".Mstable P#
Department of Rektilatory.Services
Public Health Division DateErrABM
s63y tee$ 200 Main Street;Hyannis MA 02601All
-
prFD
'b ><u�
Date Scheduled Fee Pd.
i Time _
`oil Suitability AASSess ent fop Sewage Visposal
°°
Performed By:
Witnessed By:
LOCATION & GENE L INFORMATION
i
Location Address'.ZZ� Po p 0 e,S Q ` Owner's Name.-,�0 ?L
ry s 1
• O I vi r I Address,, Go l'b,tT A ✓j
Assessor's Map/P4rcel: �f b I Engineer's Name ,DCt'�I2/� ./v`� `�
/ 2
NEW CONSIRU Lf'T•,ION REPAIR , ' Telephone# ZZ
-..SQ$ :�6Z 5
Land Use IKLI Slopes(9'0) Surface Stones ?
Distances from: Open Water Body >Zoo ft Possible Wee Area 2-00ft Drinking Water Well 7 Z�!Uft
Drainage Way l 6b ft Prop^rty Linc ft Other
ft
SKETCH:($free,name,dimensiods'of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
0
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• - pgRC -
N SCREEN.
rn DECK
� DECK AC e 1 •
O
ya ex�s7- ,
. �OP�HMARK: AD -��� i. V COGT
OF �,
EtfV¢J8 � A y ;"g" 6t/' •{
IN
D rD- W '51
�17422'00"E--_107'00
�N �See.n AC /NG -
ote/O,
° EDGE OF PAVE.'
POPONESSETT ROAD
Parent material(geologic) I f Depth to Bedrock ` ,
Depth to Groundwater. Standing Water in Hole: N Q i Weeping from Pit Face N
Estimated Seasonal High Groundwater - A 6 A
DI TERMINATION FOR SEASONAL HIGH wAT•''R'T"LE •a
Method Used: ( Jn,
Depth �b�served standing'tn obs.hole: in. Depth 10 Sall lnOttles:
Depth toweeping from side of obs.hole: In. Oroundwnter AdJuetAm�entGundwaterl.ev�l it .
Index Well# _ Reading Date Index Well lev6l
PERCOLATION TEST Datp.. . Time—.
Observation Time at 9"
Hole# i
t Gy
Time at 6"
' Depth of Perc J - , .
Start Pre-soak Time.@ [y o 3 I Time(9"���)
End Pre-soak
Rate MinAnch
Site Suitability Assessment: Site Passed
Site Failed: Additional Testing Needed(Y/N)
original:.Public v':'e'�Ith Division Observation Hole Data To Be Completed on Back—
***If percolatyibn test is to be condT icted within 100) of wetland,,you must first notify the
Barnstable Cdnservatiert,Division at least one (1) week prior to beginning.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
.Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel
Vtt— rl 60 1l31Y N
2.5 'ly
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon.. Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel)
toy y
8''- 2g'' � GSM S' l R-s� •
29''- '' Sa-d 2 5,y 7/
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (S cture,Stones,Boulders.
Consistency.%Gravel
HOLE L
DEEP OBSERVATIONG Hole#O
Depth from Soil if ' on Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consisten Gravel)
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary • No Yes
Within 100 year flood boundary No/ Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? C
If not,what is the depth of naturally occurring pervious material?
Certification
have passed the soil evaluator examination approved b the
certify that on date I y I rt fy (date) P PP
Department of Envirofimental Protection and that the above analysis was performed by me consistent with
the required trai ing,expertise and experience described in 3,10 CMR 15.017.
h4Signature U Date L
Q:4SEPTIC\PERCFORM.DOC
AsBuilt Page 1 of 1
TOWN OF BARNSTABLE
LOCATION oZ J e. P72Q . SEWAGE# 2011-096
VILLAGE CO J(>> ASSESSOR'S MAP&PARCEL 01 -O O
INSTALLER'S NAME&PHONE NO. fS.ftaco-//.sJ 1 - ,y-1, y-,Tsa 9
SEPTIC TANK CAPACITY XlWcw.
LEACHING FACILITY.(type)/d fir_cu$,v (size)c9-,'f/,P rX y3 1%r
NO.OF BEDROOMS HJO a�)
OWNER O d D6 eert c2
PERMIT DATE: y--(-T-a COMPLIANCE DATE: r; /
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
i
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r '
31
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I, l�T�fpJk� ��•
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http://issgl2/intranet/propdata/prebuilt.aspx?mappar=019070&seq=2 5/3/2011
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367
'Main Street, Hyannis, MA 02601 (Town Hall)
� DATE: Fill in lease:
APPLICANT'S YOUR NAME/S: p/
s � ;` USINESS YOUR HOMElegy
� l
ti a c, jai Ra TELEPHONE # Home Telephone Number
NAME OF CORPORATION: 14l 6C`i
NAME OF NEW BUSINES ? S PE OF BUSINESS S Sc_�
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS AP/PARCEL NUMBER (Assessing)
When starting a new business there are'several things you must do in order to be in compliance with the rules and regulations.of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.'- (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S ICE
This individual has bee ed of agyermit requirements that pertain to this type of business:
MUST COMPLY WITH HOME OCCUPATION
t rized Signatur ** RULES.AND REGULATIONS. "FAILURE,TO
COMMENTS:
2. BOARD OF HEALTH
This individual(has 9bj3e i fn arm gf.t�r ?it requirements that pertain to this type of business.' < MU l ST COMPLY WITH ALL
COMMENTS:.
Authorized Signature** HAZARDOUS MATERIALS REGULATIO^iS
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed'of the licensing requirements that pertain to this type of business.
COMMENTS: ,
Authorized Signature**
TOWN OF BARNSTABLE Date:
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS:
BUSINESS LOCATION: �S'C �� INVENTORY
I MAILING ADDRESS. ,0 � s7-� 6; ✓-Zg 7 G 2 ro-�—� TOTAL AMOUNT:
TELEPHONE NUMBER: 5j�;E
CONTACT PERSON: gr�
EMERGENCY CONTACT TELEPHONE NUMBER: SDS ON SITE?
TYPE OF BUSINESS: S —S' Af
INFORMATION/RECOMMENDATIONS: F' a District:
Waste Transportation: Last shipment of hazardous.waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers
(including bleach)
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS:
BUSINESS LOCATION: h
MAILINGADDRESS: Mail To:
TELEPHONE NUMBER: L9
Board of Health
Town of Barnstable
CONTACT PERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601
TYPEOFBUSINESS:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing
address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
1� Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor & furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS a'
�77 106 c 0
Date: /—2- cp
TOXIC AND HAZAF DOUS'VATERIALS REGISTRATION FORM
NAMEOFBUSINESS: �br -iC ��� �. i��/C _izz
BUSINESS LOCATION: 6�� �f0�l�iGc��Sr�� f
MAILING ADDRESS: ej X S7_5 �/7it/J` Mail To:
TELEPHONE NUMBER: —6 Jc 4 Board of Health
Town,of Barnstable
CONTACT PERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: 7A_tcMyannis, MA 02601
TYPEOFBUSINESS:
15
Does your firm store any of the toxic or�hazardous materials listed below, either for sale or for you own
S use? AYE . NO !
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your"convenience.
If you answered YES above, please indicate if the T,gterials are stored at a site other than your mailing
address:
ADDRESS:
TELEPHONE: '
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity ` Quantity
_�A�Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW ' USED Cesspool cleaners
Automatic transmission fluid Disinfectarts
Engine and radiator flushes Road Salt (Halite) -
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer),
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink.
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (elect'rolyte) Swimming pool chlorine
' - Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
6eWS Paints, varnishes, stains, dyes PCB's
a Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners p
(including chloroform, formaldehyde,;
Floor & furniture strippers hydrochloric acid, other acids)
Metal polishes
_ C Laundry soil & stain removers Other products notf-fisted which you feel
(including bleach) may bfe toxic or hazardous (please list):
Spot removers & cleaning fluids hg '" •-p ',,
(dry cleaners)
r Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY;BUSINESS + '
11 r
f
TOWN OF BARNSTABLE
LOCATION FO&O�l P Sf SEWAGE #
VILLAGE O cl i ASSESSOR'S MAP & LOTOIR"OX)
INSTALLER'S NAME PHONE NO.,%� /� tG(1is � y�3
1-1
SEPTIC TANK CAPACITY� 0 0
LEACHING FACILITY:(type)EZ )h ('WlL1ei/size)
NO. OF BEDROOMS 'PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: A�p
DATE COMPLIANCE ISS/ED-
VARIANCE GRANTED: Yes No
� ��,�
� � , �-
�\� o A
qq ov
No....l. ."f(- Fr:t?........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Diinpnuttl Workii Tunutrnrtiun rrrntit
Application is h 75Ymade for a Permit to Construct ( ) or Repair Individual Sewage Disposal
System at
a�� �� Q �i
----�........55 .......................................... Lot Noor .
��1J an��— rOwner ----------------------------------..........Address
Insta elTer '� Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms._-_-- J...•_______________________----Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures __________________________________
W Design Flow............................................ per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacitv........___gallons Length................ Width----...__-_-_-._ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No.............. ...... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
p4 .---....--••--------•---•----•--._......--••------•-----------------------------------------•-•-•---.........................................................
0 Description of Soil........................................................................................................................................................................
x
V
W ----------•-----•--•-------------------•---•-------.....------........---•------•----------•--....•- ---- ---
UNature of Repairs or lteratio —A wer when a licable.... . /"yl.__ .____....Z7—
.....
A reement-. 74/
g
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance as beee :eied by t oa of health
Signe ram- g
d.. �—.." ®....
_. ... .. ................_......... __......_... ......_......_Date ....--.
Application Approved By ---------- ............... .............................. ----- .......?e......
Application Disapproved for the following reasons- ------------------------------- ------------- ----------------------------- ----------------------------------------
-- ......_..... ............................ ......----------------------- ---------- ----.............------------............------------------------------------------- ......................................
Date
Permit No- --------------ce?6'r---.------------- ..... Issued ................. ---`--..�...-.g..�:....--..........
Dare
No....1`r.-//. Fas .O..v.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Di-tipw3al Worlai Ton.itrur#inn rrrmit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System
ys �/� fU��rs� f i "
��. -----
' ..........................................
ton. o\ drz•s or Lot No. •--^-'-•-'----•--..........•..-
...-__. ..._....._..T...................e---_.._....._._......___.......... ......__._............____...._........___......._--.
- Owner '` Address I�
� Installer •.> Addres-
s..........._.....__.._._....................
UU Type of Building Size Lot Sq. feet
Dwelling— No. of Bedrooms._...._: ____________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
al Other fixtures ------------------------------- --
W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity___-_-._---gallons Length---------------- Width---------------- Diameter---------------- Depth................
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................
`-a Test Pit No. 1-_-________--_.minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----------------------------------•-----•---------------------------------------•----'--'-:-...........---........---.......---•-•'-•••'--•----------'-.-----
0 Description of Soil........................................................................................................................................................................
x
W •---••-•--------------------•----.......-----------.._....-----------------------------•----•-------------------.:- =- --------••••......-•-..............------
U Nature of Repairs or Alterations—Answer when applicable------_ ------ ____________________
.... .._..'v' __ -•------•-_:%•__�.. , . ............ ...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System"in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been>issued by the-boardaof health
SignIV
ed .:� �. (:/ems..._:�.. .�
fir ......
p` �.... Date
Application Approved By ............. a N.,J...1 .: ,,� ..Y -� ..._./-------��+ �p----------------------------------------------- ------------- Dare
Application Disapproved for the following reasons- ---- --------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------- ------------------------------------------------------------------------------------
Dare
Permit No. ------------------ -� Issued ........ - ? `-----------..._..
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Complianre
THIS IS-TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )`
by .... r -- -------- al`--� J � ----. ...
�r� y5._S r`- 7-- --------------f.....-) i
has been instal ed in accordance the provisions of TITLE 5 of he State Environmental Code 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:
DATE... ;-t-. - Inspect r � % : �' `" ` ���
.... .. -- -------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH G>
TOWN OF BARNSTABLE
No......................... FEE: )............
�i ,ii Tunutrur#ion rrrmit
Permission is hereby granted / �— - f -------------•---•-------•------•-----•-•------------•--••--.............
to Construct ( ) or Repai-`(' an Individual Sew a e Disposal System —
1jk / J _ .. � � r '�......"=•--J----' Street
as shown on the application for Disposal Works Construction Permit No... r./l___�Dated___....�_.._".�__��. .......
--------------'---•-•--'•--•-'••-••-•---- oard of Health
.....--1"
�
DATE............. `� ���L ---------------------------------
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
COT O Sb
NOTE
LOT'* `1 �-
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--'�- - --POP N,EYsETi - �QD."_- - y:-----� -- i G�F�Tr�-��D PLOi PLAt�/
-- -f�' - - - - - - - --- =riati ,2�N►�.__ .. _._ [ 7o R"r� ;OP r 14AP� 1
2Z8 Fo �eTr R�,��L, MA:
�h Or FR5PAQQ Foe: -TEA + ,
EVOMAD L
$ CIVIL SG^L DAT4 INA, Im ay:
' OMAI �• � P�SG� C�SN NG PUP-
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PARCEL ID:' t ' COTUIT
19/50
PARCEL ID: N�1°��'4c
19/51 SCHOOL ST.
PARCEL ID:
r'0, 19/47
� N
POpONE ETT
� �P�P� ROAD 2
Q
PARCEL ID: o�, \ LOCUS
19/70
AREA=27,753t S.F.
LOCUS MAP
LOCUS INFORMATION
PLAN REF: 94/47 & 151/135
i TITLE REF: 7489/145
U: PARCEL ID: MAP 019 PAR. 070 NOT IN STATE ZONE II
PARCEL ID: sy ZONE: "RF"
' 19/66 Fp `. FLOOD ZONE: "C"
O� SHED I COMMUNITY PANEL: 250001-0011—D DATED:07/02/92
SEPTIC SYSTEM
`L REPAIR PLAN
GENERAL NOTES: CO- LOCATED AT:
a o
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL O= 2 2 8 P 0 P 0 N E S S E TT ROAD
BOARD OF HEALTH AND THE DESIGN ENGINEER. (n PARCEL ID:
2 OF ALL
THE RSTA EDENV RONMENTAL CODE,SHALL NTIITLE V,AND AN QAPPLICABLE THE RUIREMENTS ' 19/71 CO TU I T, MA.
LOCAL RULES AND REGULATIONS.
PREPAR99E,D FOR
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TIMOTHY CSC COLLEEN
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER. POTTER
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING ���%"
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ;;"' •,.
ENGINEER BEFORE CONSTRUCTION CONTINUES. MARCH 28, 2011
5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. O p�G :. tt%�� �` O
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. c9 ;, F :, ��� O
8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED OEGK •:'•: �•:: #228 EXIST. I ,500G A M.
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. % } 'l SEPTIC TANK . EYEfY-
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY ...:•"�' TOF=41.72' No. 1140
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING (GISf)
CONSTRUCTION.
10. EXISTING LEACHING TO BE PUMPED, REMOVED AND FILLED W/ CLEAN MED. SAND G�STE �
rgNITAR�a�
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION /��
12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY ; 360
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 40 G N; PIN
13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING14. ALL ;
15. THE DIPE TO ESIGN OF THISSSYSTEM DOES NOT ALLOW SS SPEC. OTHERWISE) O0 vN i' T"o' %�4 , `` EX15T. LEACHING D A R R E N M. MEYER, R. S.
FOR THE USE OF A GARBAGE GRINDER BENCHMARK. Z' 7 i
TOP OF GAS VALVE -- — � , 4j (see note I O) BOX
16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING ELEV.=38.00(GISf) `Z ram° 43. "Insp00 tij P,0. BOX 981
G
" EAST SANDWICH, MA. 02537
(508)362- 2922
POP - SHEET 1 OF 2 J#1316
NOTE: TO%PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS :FINISH GRADE'SHALL NOT.BE < EL:35.50
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. I
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OF Mq
T.O.F. EL.=41.72 OUTLET AND SET TO 6' OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND .SET TO 3" OF F.G. �� s`s9�y
F.G. EL.=39.Ot F.G. EL.=38.5t F.G. EL: 38.5t F.G. EL:' 38.5(MAX.) o DA ✓
Y R\
o. 1140
9" MIN COVER/
L 1 O't ` 36" MAX COVER L = 30' L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN'.) C'
® S=1X (MIN.) EL. _ 37.72 ® S=1% (MIN.) ® S=1X (MIN.)
4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVCNITAR��'�10" vo
a" a 11.2" TO �
\INV.=36.77 M.LIOUID INVERT
LEVEL �INV.= 36.52
PROPOSED INV.=36.0
GAS BAFFLE D-BOX 3 ROWS OF 7 UNITS AT 6.25'/UNIT = 43.75'/ROW
AM M AMINV.=36.2 DB-5 INV.= 35.11 SOIL ABSORPTION SYSTEM (PROFILE)
' EXISTING 1,500 GALLON SEPTIC TANK
RESTORE VEGETATIVE COVER
EXISTING SEWER OUTLET
BACKFlLL WITH CLEAN PERC SAND 75"
TO TOP OF CHAMBERS
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING f
PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.=35.50 -
2) D-BOX SHALL BE SET LEVEL AND INV. ELEV.= 35.11Mal
TRUE TO GRADE ON A MECHANICALL COMPACTED BOTTOM ELEV.= 34.17
SIX INCH CRUSHED STONE BASE, AS SPECIFIED EXISTING SUITABLE
IN 310 CMR 15.221(2) 2.83' MATERIAL
3) REPLACE EXISTING 1,500 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF \ I 76» -
T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 3 x 2.83 = 8.49 �
TANK WITH NEW 1500 GALLON SEPTIC TANK (6.67' PROVIDED) USE 3 ROWS OF 7 16"-HIGH CAPACITY
IF FAILED, DAMAGED, OR UNDERSIZED. ADJ. GROUNDWATER EL.=27.50 ADS BIODIFFUSER UNITS-NO STONE PROFILE
4) INSTALL INLET & OUTLET TEES
AND GAS BAFFLE AS REQUIRED
SEPTIC SYSTEM PROFILE TYPICAL SECTION
16„
N.T.S. N•T% 11.2"
i
DESIGN CRITERIA---_-- - SOIL, LOG P#:13225
NUMBER OF BEDROOMS",-- 3 BR DWELLING/4 BR DESIGN DATE: MARCH 29, 2011 34"
SOIL TEXTURAL CLASS:\-.__C_LASS__I_._.-___._ _--- __-__.__..._ ._� SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 SECTION END CAP
DESIGN PERCOLATION RATE: <2 MIN/IN
WITNESS: DAVID STANTON, BARNSTABLE BOH
16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT
DAILY FLOW: 440 G.P.D. Elev. - TP-1 Depth Elev. TP-'2 Depth
DESIGN FLOW: 440 G.P.D. 38.50 0" 38.75 0"
GARBAGE GRINDER: NO NOT DESIGNED FOR GARBAGE GRINDER A LOAMY SAND LOAMY SAND MODEL 16" HICAP
( ) tOYR 3 2 10YR 3 2 ��
PROPOSED SEPTIC TANK: 440gpd x 200% = 880 gpd (USE EXIST. 1,500G CAPACITY) 3s.00 B 6" 3s:os B 8" LENGTH 76, NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
EFFECTIVE LENGTH 75 " TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
LOAMY SANG LOAMY SAND DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
LEACHING AREA REQUIRED: (440) = 594.59 S.F. 10YR 5/4 10YR 5/4 SIDE WALL HEIGHT 11.2
.74 OVERALL HEIGHT 16"
DISTRIBUTION BOX: DB-5 (5 OUTLETS (MINIMUM)) 36.17 28" 36.33 C 29" OVERALL WIDTH 34" I 4640 TRUEMAN BLVD
PRIMARY S.A.S. C 13.6 CF HILLIARD, OHIO 43026
USE 3 ROWS OF 7- 16" ADS BIODIFFUSER H-20 UNITS-NO STONE MED- i MED- CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC.
COARSE SAND COARSE SAND
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF BIODIFFUSER)
E3y.zs 2.5Y 7/4 2.5Y 7/4 PROPOSED SEPTIC SYSTEM SITE PLAN
(BIODIFFUSERS) 21 UNITS x 6.25 LF x 4.73 SF/LF = 620.8 SF 27.50 i32" 27.75 132" 228 POPONESSETT ROAD, COTUIT, MA
TOTAL AREA = 620.8 SF PERC RATE <2 MIN/IN. (*Cl" HORIZON) Prepared for: TIM POTTER
DESIGN FLOW PROVIDED: 0.74GPD/SF(620.8SF) = 459.40 GPD > 440 GPD req'd NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN
DARRENM.MEYER,R.S. J180DOW&H surrey NTS D.M.M.
1, Darren M. Meyer, R.S., CSE, hereby certify that 1 am currently approved by MADEP pursuant to 310 CMR 15.017 po BOX 981 (508) 419-1086
to conduct soil evaluations and that the above analysis has been.performed by me consistent with the EASTSMDVWCH,W 02537 DATE: CHECKED SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Evol. Exam in October, 1999. 508-362 2 0330 11 s2z / / D.M.M. 2 of 2
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