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HomeMy WebLinkAbout0148 SANDALWOOD DRIVE - Health 148 SANDALWOOD DRIVE, COTUIT - - - __-�_ - - --- A= 010042 - T---- `i i TOWN OF BARNSTABLE L{l7CATIONSW,5& SEWAGE# C ' jVILLAGE /` ASSESSOR'S MAP&PARCEL --+� INSTALLERS NAME&PHONE NO. 1<Rt'upyj .(V\Cnw� i SEPTIC TANK CAPACITY ®®0 &C,, iD oto LEACHING FACILITY:(type)(p, /yrf (size) NO.OF BEDROOMS OWNER S ��0 � PERMIT DATE: �m fr/Qc COMPLIANCE DATE: Separation Distance Between the: `� �� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Wit/ 1 Feet ,Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of-leaching facility) MOAA Feet Edge of Wetland and Leaching Facility(If any Wetlands exist within 300 feet of leaching facility) n��P �►.., Feet FURNISHED BYeC ( � e 4 k j Mi Sia Li ��. A I T AAOk .1 4 fy Q ib Q c (0'7 tin Town of Barnstable • of� Department of Regulatory Services auwsr,�stE Public Health Division Date 200 Main Street,Hyannis MA 02601 • ren trt�" Date ScheduledO /o 6- _ Time '/0 Fee Pd. a Soil Suitability Assessment for wage D' osal Performed By: Witnessed BY•LOCATION& GENERAL INFORMATION Location Address C/ 7 Owner's Name CDO 33 Address `-1 �v�'� W.d cl CJ v J Assessor's Map/Parcel: O Q1--( k Engineer's Name ���� (�C— NEW CONSTRUCTION REPAIR .Telephone# Land Use- %Slo es �" P ( ) �' Surface Stones �V Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well Drainage Way ft Property Line /,U+ ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands n proximity to holes) APO( 707 //,4,f 7, Parent material(geologic) Depth to Bedrock 4 Depth to Groundwater: Standing Water in Hole: AjA Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE A Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor, e„t,_ Adj.(lroundwater Level PERCOLATION TEST bates $ 0� Time Observation Hole#: Z Time at 4" Depth of Perc Time at 6" Stan Pre-soak lime @ b t• d a`' 'lime(9"•G" End Pre-soak I� Rate Min./Inch Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICVERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) `Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones;Boulders. qq o i to v 2-e. g— S DEEP OBSERVATION HOLE LOG Hole# De pth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. I L S 1,o ons' e e 1�'�'/� e. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C i to c oO DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture HOIe#-------- Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones;Boulders, s to f Flood Insurance Rate Man• Above 500 year flood boundary No Yes V 11 Within 500 year boundary No t1 Yes Within looyear flood boundary No ✓ y es Depth of Naturally Occurring pervious Material Does at least four feat of natural! occurring I' Y pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? les If not,what is the depth of naturally occurring pervious material? Cei•'tification I certify that on I fig (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tramin ,e • rtise'and experience described in�10 CN M 15.017. Signature Z a. Date Q:1$Ep"C1PERCFORM.DOC Comm wea,. - of Mr assachusetts Exect,ltiv�e�`Ofic e of 'Environment I / a A l ffC7►fS ��! Q, , Department of ' Environmental Prote= n rulkifu W HIM F.WoW kior. ; DEC 1 0 1 Trud c� n,p. �� y Cox• W Cai A+ Palueci s � IL Struhs OqSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMS— PART A CERTIFICATION Property Address: 148 S a n dq'Irle w o o d Dr. C O t u i tAddress of Owner: Date of Inspection:l l/13/9 6 Dennis l u c h t a Name of I (If different) 2Q4 Mill Crossing Company Name,Address and Telephone Nuerick mber:Environmental Reclama02693 Tabb VA Inc. 446 Waquoit Hw Wa tion, Inc. Y• quoit MA 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: XM Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority f _ Fails Inspec:toes Signature: Date: 11/13/96 The System Inspector shall submit a copy of thisCiwsl)ect�on report to the A inspection. If the system is a shared system or has a design flow of 10 ppp proving Authority within thirty (30) days of completing this , gpd or the report to the appropriate regional office of the Department of Environmental Progte ttion the inspector and the system owner shall submit 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: XXXX I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 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 exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 On Winter Street • Boston, Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5sW w Pnmeo on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner. Date of Inspection: 81 SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) 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(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cj 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. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT 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 (reviaed.11/03/95) 2 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: Dl 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 dogged 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 — tary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysts for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El L E SYSTEM FAILS: 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 II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 CHECKLIST PrOP"Address: Owner: Due of.lnspection; 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 during that period. Large volumes of water have not for introduced t two into the system and i recenhe system tly or as receiving normal flow ral Y As built plans have been obtained and examined. Note if they are not available with N/A. Part of this inspection. �[The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. septic tank manholes were uncovered, opened, and the interior of the septic tank was ins 1 tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. Peered for condition of baffles or The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. facility owner(stem occupants, if different from owner) were provided with inform he a Disposal pose! System. aeon on the proper per maintenance.of Sub- h (deed 11/03/9s) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: RESIDENTIAL: FLOW CONDITIONS Design flow: ?sib Ilons Number of bedrooms: Number of current residents:..Z_ Garbage grinder(yes or no):�,; Laundry connected to system (yes or no): k g Seasonal use(yes or no): Water meter readings, if available: Last date of occupancy: COMMERCIAUIN DUSTRIA L: 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: f '.ast 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)_ If yes, volume pumped: Qallons Reason for pumping: �T TYKE OF SYSTEM Septic tank/distribution boxisoil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) 1, (revised 11/03/95) 5 I r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ` Owner- Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: Xconcrete _metal _FRP _other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 17 Distance from top of scum to top of outlet tee or baffle: _ Distance from bottom of scum to bottom of outlet tee or baffle: Z Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outle integrity, evidence of leakage, etc) �1 T t invert, strut;u[ �G \ N..N�' G _ (I Ksite plan) Depth below grade: Material 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, strur.,v _.. integrity, evidence of leakage, etc) (revised 11/03/95) 6 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Inspection: TIGHT R HOLDING TANK:_ (lost on ite plan) Depth below grade: Material of construction: _.concrete _metal _FRP—other(explain) Dimensions: Capacity piIons + Design flow: pilons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) r Depth of liquid level above outlet invert: •5 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc) PUMP I BER_ (locate -te 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 L r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. • Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: i leaching pits, number t 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 gn y raulic failure, level of condition ponding, of vegetauon,etc.) CES OOLS: _ (I �I e n site plan) Number and configuration: Depth.4op 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.) P _ (I -on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition-of vegetation, etc.) (reviaed,11/03/9s) 8 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Proper"Address: � • Owner: • Due of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent references landmarks or benchmarks locate all wells within t 00' r- I �8 S �CZvao ,q o a � DEPTH TO GROUNDWATER Depth to 9roundwater:-4,Q_qeet method of dem mirtmion or aPProximation: based o n the surface wa t gtk elevation of S a n t u i t Pond and Lovels Pond as re erence on t e map . o ui ua lstivlsed 11/03/95) 9 > LO,CAT IONS EW A E P RMIT- NO. :. VILLAGE _ 00-2" r INST LLER'S NAME & ADDRESS �tcrG"� vim" B UILDE R OR OWNER lo DATE ' PERMIT ISSUED DAT E COMPLIANCE ISSUED /% 1 77 A '� h� r O '�� -� , ,.:° '�._��_-- - -.__.____._ _.. � I� 71. o� No............ �...... Fizs.............. ........ .THE COMMONWEALTH OF MASSACHUSETTS .-•= �C BOARD OF HEALTH J ES..GC?.^.. OF..... G/�•d�•SU-� G� ................ Appliration for Dispati al lVorkfi Tnniirnrtion ramit Application is hereby made for a Permit to Construct (pQ or Repair ( ) an Individual Sewage Disposal System at .............4.f-.-........3-3............. /01 \kje.....--l-. ...................... Locatio ddress �— or t No. .........--•- 1=e� ... � `°`gin P is - �...............�v� ...... ..... Address Installer Address Type uildin Size Lot............................Sq. feet a well' No. of Bedrooms................. 5........................Expansion tic (/'� Garbage Grinder Other—Type of Building ---------------------------- No. of persons........... Showers ( ) — Cafeteria (v(� Otherfixtures ...-•-•--•--•-•-----------------•---------••--••--••-- ------------------ ----- ---- ----------- W Design Flow................... . . .............gallons per person per day. Total daily flow__._.._......_._. ..�-�----•----.gallons. WSeptic Tank—Liquid capacity./jO.0 gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Widt�.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.... _ __ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (6 Dosing tank ( ) aPercolation Test Results Performed bY........................................................................... Date......................- Test Pit No. I................minutes per•inch Depth of Test Pit.................... Depth to ground water...... rl, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ........................................... Q Description of Soil...............h,,,Cel- aG y..: S� ....... - - - -- -- - - -- V ...---------•-----•-------------------------•----------•-•------------------- ��� T -------••••--•-•--••-•-•-•------------••-•-•-------------•-•••-••----------••-----•-------. W 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 TITIE 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. Signed- . ................ Date Application Approved BY ------/�--•• •-----�/.-�7.-_7_7- Date Application Disapproved for he following reasons:-----•--------••-----------•----------------------------------------•-------•--•----------------...------...-- ----------•------------------•---•.._...............----------•--••---.......---------••••••--------•--•-------•--------------•-----•----•--•----•------------------....-----•••------------•--•••--•--- Date Permit No ZJ?37 --•---------------- Issued-.......................................... at...----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH/ ..........•rt'�-.5-?2.�....OF....... /`:N- .fe............................... TWrtifiratr of f ompliFatta THIS IS TO CE IFIY That h Individui�age Disp ste onstruct. d ,(�) or Repaired ( ) i by---------------------------------- . -•-•.----•- ------ = ----------------.----------- --•--- --- -- // (7� Instal at.............................................f�-•+-- ...... 3----•----•-- f _.:�' .l n _.._.... ` has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the / application for Disposal Works Construction Permit No.--...................................... dated---------- ..................................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................; .. ...................... Inspector.. ----••--•-------------............................. S , , , THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ............. /�&w........--.-..OF......-... C'{••�- lg..�,�7ct ..................... Appliration for Uispoii al Works Tonstrnrtiun Vamit fY;4 Application is hereby made for a Permit to Construct (V,.) or Repair ( ) an Individual Sewage;'D}§posa1 System at s Location,-4ddress a — or of No. ...............• -- ---{ - =-a------ .. = •-- '�€ . ice;` ..arse'................� C.ts...... � tc`: :::�:.t.`�� ff� _••.--.•r.� T.......•_...... .......•__ A• � wner - --- Address ........................ ?.M?_ .... t_!_/. .. . C. _..................• ......_....._._`.1::��.�.t S1t.0 1.._..-.--•••.._..-•----...............................__ Installer Address UType .of Building Size Lot............................Sq. feet —g— Expansion ttic (l'�( Garbage Grinder a iDwell No. of Bedroom s________________� :----------_----_-- p•, Other—Type of Building ____________________________ No. of persons........... ............ Showers ( ) — Cafeteria (4� Design Flow_________________ gallons per person per day. Total daily flow..._.______.__ Other fixtures ................................ ________ _____ g �-� g P P P Y Y --`..�'---t--�----`�---=----------melons. WSeptic Tank ' Liquid capacity�!��c�gallons Length................ Width................ Diameter---------------- Depth_________.___.-- x Disposal Trench—No_ ____________________ Widtji.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit.No-----------------_... Diameter...._._ _ --- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( rj Dosing tank ( ) aPercolation Test Results Performed by;- ;. Date ------------------- - ,4 Test Pit No. I................minutes per inch 'Depth of. Test Pit____________________ Depth to ground water... , . (z, Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water------._________..._____ �+ .................. r•---••----•-•------------------••--••••••••-•----••......................................................... 0 Description of Soil_______________416d1 l!! .......f (� --------------------------•--•--------... e�ae W 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 TIT11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate Tof�Cott2pliance has been issued by the board of health. , Signed' �rC' L+ � -�1"� _... . Application Approved By..... /�- t Date Application Disapproved for he following reasons:.................................................... ................................................. •••-•-----••----•-••-•--••--••---••••----•-••------••-••-•--•---•------=------••••-••••••--••-----._......••-----•----=---------------•-•---•••-•---.................................................... Date Permit No..... rt... Date � THE,COMMONWEALTH OF MASSACHUSETTS BOARD/!OF HEALTHj. �. '?:...OF......k;...4' €... . .7 ................................ Tatifiratr of Tuntplitanrr THIS IS TO CE FAY That t,e Individu�a17Sewage Disposa Y c strutted (,K) or Repaired ( ) by .............................. =f.._. ._�.... --•------ ,�! ��.............. �-✓0- Installer has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___._..___ dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE•--•-•-•••••...•••••�•••-•••••ll•-........ ..................... Inspector--•-----= .................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.......Z.2.3...i... FEE....._-.._.:!.:..... Permission is hereby granted " ' --.._..--••-• ;;t•P '" �.. ' to Construct A or Repair an Individual Sewage Disposal System at No........................................ r ........................... •------•--=�===.4�r !. ._ 1 _ -•---•-�d Street t as shown on the application for Disposal Works Construction,,,Permit No. 713______ Dated___._ . ............ Board of Health DATE................................................................................ u: FORM 1255 HOBBS & WARREN, INC., PUBLISHERS No: —�'Q 3 Fee /0 1 THE COMMONWEALTH OF MASSACHUSETTS , Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYtcatiou for lkgozar *pztem Cou5tructiou Vermtt Application for a Permit to Construct( ) Repair(V1 Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. /�/� 4 _ _l�(� d -f Owner's Name,Address,ano Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. L<;r,,:Z Designer's Name Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder (A)P Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 D gpd Design flow provided kZ2 gpd Plan Date Number of sheets Revision Date Title ` Size of Septic Tank ®�o� �c.`. Type of S.A.S. 1 I-3 q Description of Soil N. `�s 3 io A_ C.r-o' ]�c� Nature of Repairs or Alterations(Answer when applicable) n�c�`� ,�t�^� c.� oZ•S^ D 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 of Health. Signe Date n� r2Application Approved by Date `� !Application Disapproved by: Date for the following reasons Permit No. (cJ ^y 0 Date Issued No. . .p''--LJ C� �' Fee l 0 Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE; MASSACHUSETTS _a r♦ Zi pprication for �Dit po!gal .p5tem Construction Permit Application for a Perniit to Construct( Repair(/ Upgrade( ) Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. ju &,I�` u0 60 j I-� Owner's Name,Address,and Tel.No. M o. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.SCd 5� /"M 'p7e-w_ (k Designer's Name,Address and Tel.No. �1 Were tA C-.,N\'t r N,,- d aG 3 a S+r-.rer HCCi 6 e- So rve y fey 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) 3�C) gpd Design flow provided , gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1C)1(j, Cf C_ Type of S.A.S. (01 Tn Description of SoilC. ��1^• . +�, o(.:► �CY� C.�"ckJ�c� Nature of�Repairs or Alterations(Answer when applicable) A (O L (��e.`�(—��y�� c.�� cv-S~ P _S2 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 rovisions of Title 5 of the Environmental Code and not to lace the system in operation until aCertificate of P P Y P Compliance has been issued by this Board of Health. _ p� Signefl Date Application Approved by ( Date `y J Application Disapproved by: Date 'for the following reasons Permit No. Q=no Ln ^L16) 3 Date Issued Y' , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance i THIS IS TO CERTIFY,that the On--site Sewage Disposal System Constructed ( ) Repaired (V) Upgraded ( ) Abandoned( )by 5C6 SA at �1 SC SCN�d 1� '4 is ac�c� �b )` has been constructed in accordance { with the provisions of Title 5 and the for Disposal System Construction Permit No. -X0(0 dated Installer SCy k\ M 17e'c� Designer ez�q I _ i #bedrooms ,�� Approved design flow _ -- 0 gpd The issuance of this permit sh 11 not b construed as a guarantee that the system will function as, s gn ed: ,.. Date c�' ��) Inspector ___________________rf No. ��6 i % o l Fee /©Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Misposal *_ p!5tem Construction Permit Permission is hereby granted to Construct ( ) Repair y/) Upgrade ( ) Abandon ( ) System located at l cfc� S q A d to Lo�U d 6+.)r (o- j\t and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction) must be completed within three years of the date f this permit. Date ! Approved by Town of]Barnstable Regulatory Services Thomas F. Geiler,Director A Public Health Division Thomas McKean,Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790>b304 4 Installer& Desi er Certification Form ' Date: a Sewage Permit# gb66-- JA3 Assessor's MapWarce 10/Y_Z Designer: 14,4v" pC � Installer: SGO,�\ -C-C"VC Address: Address: VAVWg&W:,4 fir-, dr. . vxG.7 j'`e M" On q /Ea °G SLU M ti , was issued a permit to install a (date) (installer) fl septic system at / $ SAPb*_ 4,>vb b*f.4 vC based on a design drawn by (address) POE dated (designer) , 1 certify that the septic system referenced above was installed substantially wdoording to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. T certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. zz AM (Installer's Signature) No.35401 r At t ' .0 `�V( f � < er's Signature) (Affix esig,a is Stamp Here) EL EASE RETURN TO BAIaNWABLE PUBLIC TTVAT qrU DIVISION. %rTgpY%Tv%_C nn OF COMPLIANCE WILL NOT 1BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT—CARD ARE RECI';IVED I3X THIJ I3ARNSTABLE PUBLIC ULALT�M 1lVIS10N. TH&NK YOU. Q:4St0cl1)esi9ner CertihWion Form Revised.doc ' 4 ►�} T HOLE A/. 19 tri L E h C I I Tr I - �6 - 77 H I T \IN •fi klQL O T lI�Jt. i�lURF:>1`f ;I EJ E-' T;�(( .d �pf6�r Box -,I b 57. Ir_LEV /7. 7 Ih IQ' MAN ' SePrfc -� ��^^;; - TANK 16' t� J - 3b L0H M L.IJ l j ��KfST AA)b SUBSOIL 1 FOUND 4 7a' ,° 50 1 ' N1N ,� � 3 9- !44 P1 E b!uM WELL TO PIT 58 SAAID A'ND a-PX EL 10 v NO LJhTEEZ ENCO�tfTER�D a u/LD/nrG S E7rL3.4C�;� U/;�E�•w/�it,/7� .. • 401 �, SEP T/� 5 y5 7 a^4 CoJV3 T2/✓C T•!6Ai - S/-!A L.L G fJJ�lF02M T4 MA S . r $/s NJ ArL O bt/ COD4 7"1 7'L f- I - RE:.V/w�b �� ! •� w � � 4 E'er �� &.4'TE0�- P' ' ' ;Y '�#0'ob M. c +9Pfa-c y C33NAA47-,/ 1+Z�CZ;JZ.4 T/OA4� "<200& 4.E�C1-/ y4 'APWC.ITy oc Pisa sr , ON 5 / AN Cov c=R7b C- E 7-p inlZE T /iv 1' O.F F/A/ 5-oY 'G1zAZ7 : F2aJ•.� /A/F/� 7�A T/A/C, z4"�ov /o • sroE Jv I COVE.2 2a'N. O F 4"C4sr --- -"- Bax I Z/"N/iD o sQabe 2G� _ L�!'%►�JJ/�t ••} $.r D14. � _ t C _ M>//TGN -F4Ow i�1tE '�' �g 4� Dld, /O LL-gC1,/ u Y4 j�FOOT /O MiN A wf/iv /-`>irci ' P/r a i "DiA. / 4 /Poor r a �'� - �2 - - A MJAJ NI". / acr S HEO v + ' GA G.L 4 / 3T0 n./E. /NVf_.2T G.4 , , 'N✓E'Q7- Q) ALL F>AG/TY 7'it A/ A l2 0Un/0 { /N /T ./ ( , VE er egg- r i s C� LOCATip/l/ . 3 1t ` TAAi�e�. >Sr'r2/BVTiO�v 80K A Ole. ,��. ^ .4 r E¢CJ 7 7`S� AN}a L E.4C .�/7- • � ••r 7'� O�F'.�?E A/F42CED GO C;�ETE ;, „,. v 03�VE TE ST.2�.VG7}/ 3000 F5/ T L L " 20000 LOA D/n/6� r • / .,/ . - - r • ---= � -'� ,c?,�f-V�wQy !vor ro BE [,.oCAT�D �, -�'"•�%�' ��7"���.�7`, .'+�t.�� Rr�� > , 4VE� SySTEi✓J Cun/L;�ss .H- 2a - ' r' ;Ko i G L O<►D .vG /S USED. .. ♦ v icy, 2. RT-J41R UIS N Y 'fl.4 TE <! PP�'O✓.4z— . } g ae:._.+.1-_.:-yf-..a a-iu.1-..i.;-1 4....c. J .. _..,_• _,_ Y._.k..r;}"'4 ' .. .' e' .. ..r :E, -.„ - + WINDOW AND EXTERIOR DOOR SCHEDULE INTERIOR DOOR SRIEDULE KEY MANUFACTURER ITEM NUMBER QTY STYLE ROUGH OPENING MATERIAL KEY MANUFACTURER SIZE, QTY STYLE ROUGH OPENING MATERIAL • A BROSCO 9 LT DOOR LH 3'-2 3/&x G'-I I° EMBOSSED METAL I BP05CO 2'-6°x 6'-& RH 6 PANEL 32'x 03' 5.C.M ITE B ANDERSEN PLUG 5061 I R S'5UDER 5'-O x 6'-I.t• WOOD/WHITE ALUM.CLAD 2 BP05CO 5'•a x 6'-& BIPOLD 6 PANEL 62'x 03° S.C.M0.50NffE ��L CI ANDERSEN 2442 NARROUNE DH 2--6 I/&x 4'-S I/4° WHITE ALUMINUM CLAD 3 BRO"-SOD 2'-O'x 6'-0' LH G P-6 PANEL 50'x 03' 5.C.MASON ME MNOVPMO_M 1��7 I C2 ANDERSEN TW2442 TILT-WA5h DH 2'-6 1/&x 4'-5 1/4' WHITE ALUMINUM CLAD 4 5R05C0 2'-6'x 6'-& LH 6 PANEL 32°x 03' S.C.MASONRE r D BR0500 9 LT DOOR RH 3'-2 3/4Y x 0-I I° ENID055ED METAL E RAYNOR O.H.GARAGE DR 9'-0'x T-0' EMBOSSED METAL P 5RO5C0 GAR.OR.TRAN50M 9'-2'. P-2° WOOD)PAINT I G BR05C0 INSUL.FIRE OR 2'-10 3/&x 6'-I I' EMBOSSED METAL f H ANDERSEN -431 O TILT-WASH DH 2'•6 I/0°x 4'-1 I/4° WHITE ALUMINUM CLAD ( r r i 24--a � o I 5'-4' 5'd 6'dL 2'-I 4 2'-10q 2 qm 1 I D 4 NVAN INEXST.SLIDER LOCATION71 4 CI w - I `I 2 X 10 PLO NO N J015T3 p I6°oG. 4N O BATH/IAUN. W ry a O NEW NEE�•I�xISDOOR MUDT wAu KITCHEN� FAMILY OO O M Y�31j/_`, ROM . s I 3 CL. g_ Tr=: A c I In FIRST FLOOR 7F" .. § 2'-9F EXISTING v LINE O LUAU LIVI NG ROOM EXISTING C I DINING FC 3'-9RCME O ` E O PO5T5D IN RNE� DATE: 11/08/02 6'6 I I'-0• 6'6' ' gEVL9ION3 I 90d.I. apr.rw 16'-Z7'.,. as�ww 24'd 12'd 1. _ NEW CONSTRUCTION FIR5T FLOOR PLAN DgpwING NO. SCALE 1/4"— P-0' I__J EXISTING i I Al OF 4 } I j �mill ARCHMEC URAL MOVATIONS F4 I . a F 24'-0° �! Q - Q 432. �'2 2 3'-9' 3'-9' S'-I• •PWMBING 3 5" -ALL __ EXIST(TO BE ING BALCONY Q Q� co} y. EXISTING REMOVED) CT'� N I a WINDOW C2 NEW _ JLK WINDOW V CLOS m 2 3 W/D TO R[PIAL[ . CLOSET T 5 EXISTING —M Y I SLIDER O I EXISTING EXISTING J '% I/ I I I- I N -m� BATHROOM CLOSET Q 4'I I " 2'-4 ❑ EXISTING V t LINEN ETUCYY/PLAYROOM w) A4 ¢ CZ 2 • O I 4'-.4� 777711 ry NEW MASTER BEDROOM. a'oWA5TING Buow — _ T1Tt.E: i I ' en RPMOv[ EXISTING _ SECOND WALL § I FLOOR a I I EXISTING onsrlNG ROOF BEDROOM BEDROOM S' 3'-51I` 3-54 I W_I O• 5'4 �.,. DATE: 11/08/02 24'o RLTMONS _ NEW CONSTRUCTION SECOND FLOOR PLAN 0 EXISTING SCALE 1/411= P-0' DRAWMG NO. A2 OF 4 - � I ... p.. .. ....,x � .. .. y ,.. CM., a. A. •. ._ n -'-xr .. -. '., :„. . ., c.. .. ::,,y ,.. •(a�'r.,,:.. f t. .u9 ACCESS COVERS MUST BE WITHIN INSPECTION 9' MINIMUM. INVERT ELEVATIONS : DES/ GN CR I TER / A :6' OF FINISH GRAD GENERAL NOTES PORT 3' MAXIMUM COVER INVERT OUT SEPTIC TANK: 99.4 DESIGN FLOW:FIRST 2' TO BE LEVEL MIN 2' OF PEASTONE INVERT IN D/ST. BOX: 98.27 3 BEDROOMS AT Il0 G.P.D. PER ! . THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION _ INVERT OUT D I ST. BOX: 98. 1 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. I AM P/ 3/4' - I I/2' DIA. INVERT IN LEACH CHAMBER: 98.0 2 99.4 /0' DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 97. 17 NO GARBAGE GRINDER 2. VERTICAL DATUM /S ASSUMED. FOR BENCH MARKS ~ 98.27 ADJUSTED GROUND WATER. N/A SET. SEE SI TE PLAN. 6 HIGH CAPACITY INFILTRATOR OBSERVED GROUND WATER: N/A SEPTIC TANK REQUIRED: EXISTING 3 OUTLET 330 G.P.D. X 200% - 660 GAL. 3. ALL CONSTRUCTION METHODS AND MATERIALS AND D-BOX CHAMBERS W/2.5'= STONE AROUND BOTTOM OF TEST HOLE ♦l : 90.6 J000 GAL 8'r x 50'I x /0"d SEPTIC TANK PROVIDED: 1000 GAL . EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL SEPTIC TANK 6" CRUSHED STONE OR CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL COMPACTED BASE SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEAL TH REGULAT IONS. \ DESIGN PERC RATE ! 5 M/N/I NCH PROF I L E : NOT TO SCALE _ �� \` / * SOIL TEXTURAL CLASS - / 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER j_ %jorllew, EFFLUENT LOADING RATE - 0. 74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPD / 0. 74 GPD/SF - 445 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- ` STANDING H-20 WHEEL LOADS. `,',4 �`-� �, `� ��• PROVIDED: 6 HIGH CAPACITY INFILTRATOR CHAMBERS W/2.5's STONE AROUND, A-496 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR 496 S.F. x 0. 74 - 367 GPD APPROVED EQUAL. `a•.p,�����j �-QCUS 6. SEPTIC TANK AND 0-BOX SHALL BE RE/NFORCED SOIL TEST P I T DA TA ��pdS.+E� PRECAST CONCRETE AND WATERTIGHT. D-BOX SHALL INDICATES I ND l CA TES BE WATER TESTED TO CHECK FOR LEVEL WHEN THERE PERCOLATION OBSERVED /S MORE THAN ONE OUTLET. �r ! TEST - GROUNDWATER \ 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE'. f TP s/ P•! !382 TP •2 / 1-688-DIG-SAFE AND THE LOCAL WATER DEPT. / HORIZON TEXTURE COLOR HOR/ZON TEXTURE COLOR 101 .3 FOR LOCATION OF UNDERGROUND UTILITIES.L OAMY I OYR LOAMY /OYR Q A 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE SAND 2/2 SAND 2/2 L 0 C U S MAP DES 1 GN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION 8' .. .. .... _..... ......_ 100.E !4' ... .. _. _ _ .. 100. I R SCHEDUL I NG OF THE SANDY IOYR p SANDY IOYR OF THE SYSTEM TO ALLOW FO LOAM 5/6 LOAM 5/6 CONSTRUCTION INSPECTIONS. 36' ................. .......... ..... 98. 3 40"- _. 98. 0 COARSE I OYR C / COARSE I OYR 9• EXISTING LEACH PIT TO BE PUMPED DRY AND a l2'RED MAPLE �� g0•� �� _ SAND 6/6 SAND 6/6 BACKFILLED. � 9•r t . _- -.--. SS• F TR GRAVEL TR GRAVEL ALL LE l0 ENCOUNTEREDBBELOWTTHEAINVERT OFH�HEZLEASCHING S4" 60" FACILITY TO BE REMOVED FOR A DISTANCE OF 5' TWIN /0'MAPL O fe AROUND AND REPLACED W/ TH SAND IN ACCORDANCE TPoI WITH TITLE 5. !28' NO WATER 90.6 /20 NO WATER 91 . 3 8' \�l1 PAYED DR/VENAY �p� l2'HORNSEAY I DATE: AUGUST 2. 2006 TEST BY: STEPHEN HAAS WITNESSED BY: DONALD DESMARAI S ` PERC RATE: f 2 M/NI I NCH O 1 A1' -, 6 HIGH CAPACITY �• � V Gam'- m INFILTRATOR CHAMBERS , G m X ~ w/2.5't STONE AROUND w a 5 IV �- Z TP12 "` r a O EXISTINO R1 SEPTIC LANK �' l i BM. C04WR BULKHEAD � EL-103:67 ''0 r` x a LEACH PIT SEAT / C S \KS7 L� � S / G/V i y10 / 4 8 S.4 /VO,q L W000 OR / VE . M.4 P / O . P,4 R CEL 42 ,. 25. 657+ \S, F. /�1 2 Ah �► &A R /VS rA 6L. E . ( CO TU / T ) "A . 6.5 xr. '� ,� PREP�1 REO FOR LEGEND ■ CB CONCRETE BOUND T000 STAC WAR � E � � - -W WATER LINE SOAL E : / - 20 A UOUS T 2 / 2006 V HYDRANT GAS-� OVER EAGLE SURVEY I NG i NC eM. ca rcH BASIN � - - OHW- OVER HEAD WIRES � . . RIM - 97.86 # LIGHT POST 923 Rou t a 6A -E- UNDERGROUND ELECTRIC LINE �' _ Y a r mo u t h p o r t MA 02675 T- UNDERGROUND TELEPHONE LINE %% I /►/\�� 508 � 3 6 2-8 1 3 2 -CTV- UNDERGROUND CABLEVIS/ON LINE �1 / ( 5 0 8 � 4 3 2-5 3 3 3 + 40.4 SPOT ELEVATION -40 EXISTING CONTOUR {�I PROPOSED CONTOUR 0 10 20 40 JOB NO: 06-085 F!EL D:CFW/EEK CAL C: SAH CHECK: CFW DRN: SAH ,i , �,s€ser a4.r ,.3itr- I�rewp .�Ar. asa .t�z