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HomeMy WebLinkAbout0164 SANDALWOOD DRIVE - Health 164 Sandalwood Road Cotut i A= 010.- 041 TOWN OF BARNSTABLE LCd-CA;'ION I 4 .��r✓,t MAW-d SEWAGE # .2y0s-SY6 \rJ,LAGE 'k Ll_I t ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Cttft t ip.t0� y► _ S C1 �� G 2 ` SEPTIC TANK CAPACITY LEACHING FACILITY: 'I,, f (type) �'; t ����.�� (size) fU NO. OF BEDROOMS A BUILDER OR OWNER 2 i( {� � ��� yq-,-Yf: PERMITDATE: 0 ' 4 ''�5� COMPLIANCE DATE: to— 3 'vS Separation Distance Betweewthe: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /V v 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 Fumished by ` i 3-76 q r No. ©D S IU Fee �0O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes �� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for �Di000l *pgtem Con5truction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) 0 Complete System 'Individual Components Location Address or Lot No. I U4 15PtNo%Lv3c ov TM. Owner's Name,Address and Tel.No.. Assessor's Map/Parcel (26-roir, MR 7u$4141 0101,044 (SAME Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CAPIrW 1VC ENT. I LLC S N1441j FxvV 1RO,4 M&J-rA%— 5VC-5 42$-402� 533 Type of Building: Dwelling No. of Bedrooms Lot Size Z8 98-1sq.ft. Garbage Grinder()J/P) Other Type of Building hJ04C No. of Persons Showers( y) Cafeteria(✓) Other Fixtures LAJ ATbILY ��a►�T 5l nll�, LAyntMY Design Flow gallons per day. Calculated daily flow 33�. !� gallons. Plan Date 105 Number of sheets Revision Date Title C Cb� Sum l)PG('c�2 Size of Septic Tank Cxls-r 1j t5nCN 9�CiN, c- Type of S.A.S. 5 in1 Gt1,.TCL4To¢S Description of Soil i �o rcx� l a` x Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t ' d of Health. Signed Date 10-2S—I_oo)"_ Application Approved by Date Lo --9 Application Disapproved for ge following reasons Permit No. oZ U 0 Date Issued ' t /00 ^ No. Poo �M Fee THE COMMONWEALTH OF VASSACHUSETTS Entered in computer: Yes ` . PUB IC HEALTH DIVISION -TOWN OF BARNS ABLE., MASSACHUSETTS -Z[pplicatiokfor Digozaf *pgmem Con5truction Permit � fi Application for a Permit to Construct( )Repair% X Upgrade( )Abandon( ) O Complete System XIndividual Components !{ Location Address or Lot No. 4 t—,j co D 17�• Owner's Name,Address and Tel.No. Co-rU%V, M1 Assessor'sMap/Parcel 010/ 041 (5-)M0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �`.ca4rWIiDe >wNT , L.I.,C �Na� E�vVtR©n+ MACN-rAL SV1f5- 4•Za-4o2� Sag-�9(�b Type of Building: Dwellings No.of Bedrooms Lot Size Z 8 198 +sq.ft. Garbage Grinder(4 Other Type of Building Non1E No.of Persons Showers( v') Cafeteria( �) Other Fixtures L P%q ATl7R.-Y , }c ITC NA Et,1 `J{ k i t-AyNZRY Design Flow i` 3 3D gallons per day. Calculated daily flow � gallons. Plan Date 10 9,5 Q Number of sheets Revision Date Title . t T , {N �,LTQ_taTa2S Size of Septic Tank �_ N GCGQ C G� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) E ' A.0 �_-Aan 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 issue �So o ealth. Signed 1 Date Application Approved by R �Date r/� �� '� f , �. Application Disapproved for t e following reasons ' Permit No. G Date Issued b _U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired (\4.�Upgraded( ) Abandoned( )by CAA e-Q�.�- at ( V`1 10,0 0�\ w o 4 _ has been constructed in accordance with the prov sions of Title 5 and the for Disposal System Construction Permit.No. fJ�S' �y6 dated 10-26_0f' Installer Designer I '�`"�` ��• The issuance of this pcI t sthallccot be construed as a guarantee that the system ikl\funlction as ned.� Date t 1 I � ) Inspector w' No. 2 b o S= Fee 0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Oigonl *p$tem (Congtruction Permit Permission is hereby granted to Construct( )Repair(14)-Upgrade( )Abandon( ) i System located at 1 �� Sam ✓'I w o c� _ ` i1 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 of;fFi Date:_.- /0 6 0 Approved by Jr, �� N3 THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH � - p (� , f9w�'L............OF..... ...GCr.v�. �[d./Q i ' atinn -fur Biiipusal urkii (�unitrurtinn rrntit Applicat ere y'made for a Permit to Construct (1j or Repair ( ) an Individual Sewage Disposal fiSystem at. / /�f /� f t'.... . ......-- 4 f,�/. ?� GPI•---•---•- Location•Address / —T © �iE:00. / Tell� $'.!/1 �L!�►C�f�!°... .1 �5��®c_`�e7i`O.x..-#t��' . /. �2.1 p� V.lr�P .-•-- �( O3'er j Ad ess k4 ............a/`.....__C.-�C?r......' 1/1 ...................... ......... �`u?iS�4..............-----4.$--5---------------•---------•---------- Installer Address rr����yy Q Type�er_Type Size Lot_i�D_�...9.9.7.Sq. feet No. of Bedrooms-------------_--..---•---.:__....____Expansion A is (✓�� Garbage Grinder Q2b) a of Building ............................ No. of persons............ --------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------•---------- W Design Flow------------------A5.6?_-__--___-_-__--gallons per person per day. Total daily flow___--_----� .0-_----_.--.-..-----.gallons. WSeptic Tank—Liquid capacity`ft-Q_gallons Length________________ Width.------_-.-._.- Diameter-----.---------- Depth_-.----__.--... x Disposal Trench—No..................... Width/............... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./----_-__-__ Diameter......__._�g__ Depth below inlet__________ ______ Total leaching area-.-_-_----.--__--sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ax/0_ ;;!"C' - y G-.7-7 aPercolation Test Results Performed by-------------------------------------------------------------------------- Date------------------------------ Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water.......4�L1)-__.--.----. G14 Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground � yZ' � water_-.-.-..___-__--_-_--.-. R+ -•-•------------l ✓ - - ------------ -- = -•-------------- O Description of Soil � ...------ ------------ -------------- -- j -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- VNature 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 Article XI 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. ........ -�.._. ----�J-1 ---f`i _?7-•----•-- ete Application Approved By.......... . ---- ------ l & ---------------------- (.P- - 7--------- ---t Application Disapproved for the following reasons____________________________________________________________________________ ----------------• ---------------- ------•--•--•--------••••--•-•--••-••-----------------------•--•••-•---•••--------------••---••-•-•-••........_..-•-•----•----•--••---•--••-•----•---------••.....---------------------•-•--------------- Date PermitNo......................................................... Issued...................... ................................. Date L'-.... "S�. FEx.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARDf F HEALTH 'S .Nppfiration -for Diopooal Workii Totttitrudion Prruld is hereb 'ma for Applicationy de o a Permit to Construct (cif or Repair ( ) an Individual Sewage Disposal Sys//'ty�44e//..mqq at .n Jj/n/// / p�� //�/p/Jy� ( .q/`�/. s � //� �/nipl (/,.�+'`1 /JJe�y Z...:l.`._ ..............3... i. Jf..�'`A.. b.esar.e..t�.. '_7•.i __......_ tc:�KC �'i 9__ _:L_, _ ___.____.______'_`_'�__ �" 1..'�'t:__.P/�- ..r.. Location.Address r� o. ` �d ( tl� tli 'q;?_._ fSS�c ,_'--1•-x �� ..............tJl -------- 2� ?i �E • ff-�° ner Ad Le_p Installer Address d Type o ilding t. Size Lot_ ..j. _ __Sq. feet �" welli n No. of Bedrooms-------------- -___-______-__--- --.Expansion A tic ('111 Garbage Grinder (10) aer=Type of Building _____________________----- No. of persons------------6------------- Showers ( ) — Cafeteria ( ) dOther fi_"�fups ------------------------------------------------------------------------------------- W Design Flow................I_,�O.................gallons per person per day. Total daily flow..... _6.............................gallons. W Septic ` s Length---------------- Width------ Diameter.-- ------ Depth----- -----•---- P x Dis osal Trench Liquid capacity! capacity.......Widthn - Total Length................... ..._Total leaching area._:._____-. __-_sq. ft. Seepage Pit No-------j_---------- Diameter------- _.. Depth below inlet...........:....._. Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) d,�f_ 0#0400A4 Percolation Test Results Performed b _ " Y - ----------------------------------------------- Date ------- ,� Pst Pit No. 1________________nunutes per inch Depth of Pest Pit_._.___._:_......-__ Depth to ground water..-._ �_----------:_ f3:q Test Pit No. 2________________minutes per inch Depth of 'Pest Pit.-._-.-____--._---- Depth toaground water_-..-----__-_-..___---- ---------------- • -------- - -- . ----- --- .-• ••.... •---------------- Description of Soil ------ --- w ". . - -;�;,��,-- VNature 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 Article XI 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. t d. " Signe • --------- ate Application Approved B ---. . ' ---•-- .......2 -7- 7--------- PP PP Y GLe'l� • Date Application Disapproved for t le following reasons---------------------------- - •--------------•--•-•-----•------••----------_-_-------------------•-----------•-.----- ".ri� Date PermitNo.---- ..............................--------- ---------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH .................. 0rdifiratr of Tontpfionrr THAS IS TOERTIFYI That theIndividual Sewage Disposal System constructed ( G°+) or Repaired ( ) by......... .4 t...-• ......... -------- a .................---..................................................................................................... / ,/ �- Installer at_... ._1. !�l_ ..---•--......% ' a s a t has been installed in accordance with the provisions of :article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------------------------------------- dated------------------------------------------------ THE ISSUANCE OF THIS CER'T.I'RCATE SHALL NOT BE CONSTRUED"AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DAT � . .................................................................... Inspector......• •----•-----''W-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . t� ...... ..... ...OF.... O;�I �_ �'� �/P.................................. No....... ...... FEE �i��>a�tt . �rk,� �ono�x�tr�ion �rranit Permission is hereby granted---------- ---- ----(11Z.___ F___ -rr _. t. .._._ to Construct ( } or Repair ( ) an IndividualAe?,.age Dispo l S ssttem at No.. /P _2-••--••......c t. (ca s` �e C._� �c4 ��? <' Street as shown on the application''for Disposal Works Construction rmit No. :______. . ated__________________________________________ DATE�� 02 Board of Hea th ;• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1-7 OF 31 orsrWGwc- p /S:3 N 24 �XISrl�G ���` J � WDAT10 24 UT 3'�., �CSE2vE' P120 rip$ 42 ,t i' � f S Tt3 AC/c / 1— 4- . . /.s Si DT- &A E To l.✓ti/ 'GAF I:Q-07-0/ 77 P/- D,4 TE D / "- 4-0 ' Z>A M r-- 2 z . CEk?7"fr-Y -rA4A*r Tk/e FC)uA-, Ar/Q/%/ /S t sri of�, I'A4A r 4i4-2 GEOR E s LOW,J AS CJ- �SURv • t t i +5 .6' yw G" j. a 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, p"Q rw E •-30 AY,hereby certify that the engineered plan signed by me dated IF)1V5�,concerning the property located at t s meets all of the following criteria: • This failed system is connected to a residential dwelling only. There,are.no.commercial or business uses.associated with the:dwelling. • The.soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The.applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests.at the site without a health agent present. • There is no.increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) Z5 B) G.W. Elevation�+adjustment for high G.W. _ •7v DIFFERENCE BETWEEN A and B O SIGNED : DATE: O al S d 5 NOTICE Based upon the above information-, a repair permit will be issued for -bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. 5t�� as3 4q gASepec\percexemp.doc G R.' r Town of Barnstable Regulatory Services Thomas F. Geiler, Director 1639. ,0�' Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Designer: Shay Environmental Services,Inc. Installer: �m Gr—% . L—LC Address: P.O. Box 627 Address: _4403 _East Falmouth MA 02536 CQ-f1 On S 0t ' w.as�issued a permit to install a ate) C (installer) septic system at o C��i based on a design drawn b (address) g y Shay Environmental Services, Inc. dated r1s (designer) \/" " I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. y(Y1 OF MAS_ S CARMEN �N (Ins ller's Sign e-) o E. SHAY No. '1181 GIs T F_ SgNI TAR\ esigner's Signature) (Affix De i tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form ,. Town of Barnstable oFt"E r°w Regulatory Services ti g Y Thomas F. Geiler, Director • BARNSTABLE. 9 MASS: Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: /G7-2 7-S L%Lruj Designer: A Ive(Al Installer: -Ze /,;91V6 Address: .36Z (r-�-6Z.d . rat Address: o�:�ft7 a On - <70,F -6/6/ � /� ®� � was issued a permit to mstallia (date) (installer) :�, septic system at �9• OIJ -rk!Aw�, based on a design drawn by _- (address) J m //{,r{ dated �+\�q & #d 4_ /I/0 (designer) - I er€y that the septic system referenced above was installed substantially according-Up the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I 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. P(H OF ( st 1. Si ature) O TIMOTHY M. I p SANTOS n No.4Go78 CiV!L (Designer's Signature) (Affix Desi ' amp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF :COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form FF ao4li mvo claIMf uvl� � k 1S. Hb _ J r)t is qoi(i , . b2 w wdrkf� � Ina►',As 00 - f �UPvf efV0 r✓h*rid-I✓� } °FINE T Town of Barnstable Board of Health saxivsrnsLE, 200 Main Street 9� 039; ��� Hyannis, MA 02601 Arf Office: 508-862-4644 Wayne Miller, M.D. Fax: 508-790-6304 Paul J. Canniff, D.M.D. Adopted September 5, 2006 Vehicle Washing Policy Vehicle washing with the use of cleaning solvents, including but not limited to; chemicals, soaps, degreasers and detergents, is expressly prohibited at any and all automotive repair shops, bus companies, automobile sales businesses, vehicle rental businesses, vehicle detailing businesses, municipal owned repair garages, and any other businesses or government agencies where an approved car wash system is not provided which meets all the Department of Environmental Protection Regulations; 310 CMR, the Division of Water Pollution Control; 314 CMR and the Town of Barnstable Code; Chapter 108: Hazardous Materials. The spraying or rinsing of an engine or under-body of a vehicle is also considered "vehicle washing". Exemption: Water from a spray nozzle or pressure sprayer The use of water from a spray nozzle, pressure sprayer or garden hose to spray potable water only (without soap) to rinse dust and debris from vehicles is not considered "vehicle washing" for the purpose of this policy. However, the washing or rinsing of an engine or under-body of a vehicle by any manner is not exempt, regardless of whether or not a spray nozzle, pressure sprayer or garden hose is used for these activities. Penalties Failure to comply with the Town of Barnstable Code, Chapter 108: Hazardous Materials may result in a non-criminal ticket citation of$100.00. Each day's failure to comply with the Code shall constitute as a separate violation. PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Paul J. Canniff, D.M.D. Q:\Hazmat\060906-Vehic1e Washing Policy.doc 1 YOU WISH TO OPEN A BUSINESS? ^F„ For Your Information: Business certificates [cost$40.00 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: " �O// / Fill in please: APPLICANT'S YOUR NAME/S: < l� 1 ary§Sr F V lyt t 4 �'qs' B 51`N YOUR HOME A DRESS: OA fV/ESS TELEPH. NE # Home Telephone Number c� 1 NAME OF CORPORATION: ,� TYPE OF BUSINESS NAME OF NEW BUSINESS v_S' IS THIS A HOME OCCUPATIO ? Y S NO ,�5' l ADDRESS OF BUSINESS to `lW� MAP/PARCEL NUMBER 010_w (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 COM sIo ER's OFFno�ff MUST COMPLY WITH HOME OCCUPATION This individu I h s n �o my rmit requirements that pertain to this type of business. RULES AhlC7 REC,LILATI®IDS: FAILURE TO Au •ze i e \ ail N1 Y I WLT IN PINES. F2. EN S: RD OF HEALTH This individual has been rm d of the permit requirements that pertain to this type of business. MUST COMPLY WITH ALL 'HAZARDOUS MATERIALS REGULATIONS Authorized Signature* COMMENTS: 3.. CONSUMER AFFAIRS (LICENSING AUTHORITY) ` This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: • Date: / TOWN OF BARNSTABLE q/ Z, TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: _ s/IkAl BUSINESS LOCATION. INVENTORY MAILING ADDRESS: l TOTAL AMOUNT- TELEPHONE NUMBER: 0177 CONTACT PERSON: '( EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: Z=4 1A,6y INFORMATION/RECOMMENDATIONS: Fire 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 material 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) Miscellaneous 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 Miscellaneous 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 Miscellaneous 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 (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) (( Jy, Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 7rican' nature Staff's Initials LOtCATION SEWAG PERMIT NO. VILIL Ad E INSTA LLER'S NAME & ADDRESS 73 o&r' B URDE R OR OWNER //-��ter✓ o. ���Gu tv� DATE PERMIT ISSUED DATE COMPLIANCE ISS/U/ED i3 A .J t �� ' S� e /TOWN OF BARNSTABLE LOCATION' (!! mot'��� C�.(`�®�. SEWAGE # VILLAGE �� ASSESSOR'S MAP & LOT' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Y LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER yu-\r 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 I N for 3 24 E ONDAno 24 r 3z i I 49't SS 42L07- 't ' P,2onoc 2 i4. SG 1 7 a� No............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1..0W!7..............OF....... PI"� .L.. / ./C" ............................................. Appliration for 31isp o ii al Works Tutuitrnr#inn Permit Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal /System at: D ' ��/ - ./.--- - �1 � A.t� .....................n 1. C.tL�.C�Gtx.7�.....�r.�.L1. e.......... �<?_�k No � Location-Addres .--- t No. r� rr.`-!'�cna_�P......Assx r --�- c------- -------�,0.6......&.73.--------�� v1:�lP. /�.oss..... or ® ess Pq Installer Address UTyp 'lding Size Lot..�_.mR..� 1..Sq. feet Dw ling No. of Bedrooms............................_.........Expansion At�,yc (/�J Garbage Grinder 40) r—T e of Building (� a yp g ............................ No. of persons..........__....._..._____.. Showers ( ) — Cafeteria ( ) d Other fixtures . ......••------ W Design Flow......................VQ.............gallons per person per day. Total daily flow.................................._.._._____.gallons. WSeptic Tank—Liquid*capacity/QA4✓__gallons Length................. Width................ Diameter---------------- Depth..._............ x Disposal Trench—No. .................... Width............ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------f_-_-__-____- Diameter. ....... Depth below inlet........ ... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank aPercolation Test Results Performed by......................................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2-_-.--•_---___minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1.______...P___ Descriprioi� f Soil -` �...-� -- x ----••--•-•--------------•---•••------••---------•--•--------------•-•---------••---•--•--•-•-•••------------•••---------•------••-•---•-•-----•----••-••--••-•------•-•-•----•----•-••-•...------•-•--- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•--------------------------•--•------...-------•----------------------------••-------•--------.....:------.....--------------------•-•--------•-------•------------• .................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of IITLE 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. (Sg � .�Z1 ?2•--- ate = � 2APPlication Approved BY _ ! --- --- ----- D ate Application Disapproved for the following reasons:-------•-------•------------------•---------------------------•------------•---- Date Permit • No.---------•--•-----• •- - Issued-------------•----------•-•--••-•--•--....._--•---•---- �_---.,-_ 1 Date rY I No FRz THE COMMONWEALTH OF MASSACHUSETTS .BOARD OF HEALTH 4�sat s.. .....� .........OF. ,t' L... .........................Xti ✓ y VVltrttftun for Dispvii al Works Toustrurtton Vamith. Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage. Disposal- SV.Stem atfj• d�. .....1... - !1. + c ...------•---t. c t r ---..Ui.�_ j..: .f'............. .. � Location Addre� ./�i.,. t No .../�- - . --••--, .....: .......Al .....12 K: s' Installer Address ­11 T �iny - Size Lot.-� ____.. Z::.._._Sq. feet 0-�4Dwelhallo. of Bedrooms......................_...____..__..._Expansion At�;nc (/ jGarbage Grinder ) 'PL4� er-Te of Buildii` No. of ersons........................... Showers — .4 P g P ( ) Cafeteria ( ) Q' Otller fixtur 11...... W Design Flow_._.. " '_ 'gallons per person-per day. Total daily flow....._. gall ons. lons. WSeptic Tank—Liquid capacitylfE?.......gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench-No..._........•...•._.. Wid .................... Total Length.................... Total leaching area....................sq. ft. Seepage�P.it No_`--___--__. _-__:, Diameter- .. Depth below inlet '... Total leaching area.__.........._....sq. ft. Other Distribution box DosiA'� tank '~ Percolation Test Results Performed by -------------------- -------......................--•---••--••••• Date.................................. 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,.ao;,ground water........................ ....... O Descripti �f Soil•-- .. 4 / Wes; - -- . x -------------- W U Nature of Repairs,or Alterations—Answer when applicable ... ` .. :_ .............. _.___ ....._........... ................... ............................... Agreement:: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of thef State Sanitary Code— The undersigned urtl:er agrees not to place the system in operation until a Certificate of Compliance,has been issued by the board of Health. ig -• . . ----- ---::: � Dat Application Approved By_-..._. .._.. . ........ / e 7 •... .: Date - Application Disapproved for the following reasons:- ._.:_r.:. ......... ......... ................................. ......... . ................... .........-•-•----•--•--•--........--•---......--••-•------------------------------------------------------•-•-••----••---••--••-••••-••••-••••-••••-_:.................................................. Date Permit No.........................................................` Issued...aTC .............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH Tnrttf aratr of Toutpli anrr THIS. t TO CE TIFY,,,T t the xi4iv' ual_S age Disposal System constructed ( ►) or Repaired ( ) by 9. bt G1K� /\�""a �C fJ I ..t Y r6t at ... 3 ---- ..-- --------------------------------------------------- has been installed in accordance with the provisions of.T ` fi he State Sanitary C e a de abed in the fs • application for Disposal Works Construction Permit No. __ _ __.7.d-__ ............. dated-.------- .................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM- WILL FUNCTION SATISFACTORY. DATE........•-• -` Inspector.:'--......�(�,� v �!-,�e�r -- a,.=...... ........................ THE COMMONWEALTH OF MASSACHUSETTS� BOARD F HEA TH t ,,. � ti _ • �t��ro,�at1 -�_k. �. n� Uart •� Permission is hereby granted------. '••• •... •.............. ................ to Construct ( or epa ( ) a .. ndivld al ewage Disposaoyooeni Sr Street / as shown on the application for Disposal Works Construction Per ' No.__. Dated•-/2 �...............:. ----------------- DATE .. Board of alth� s -----------------------------------•--------•-----..............•••••......... �.: FORM 1255 HOBBS 4 WARREN, INC., PUBLISHERS -/ I, L CATION . SEWAGE PERMIT NO. VILLAGE INS TA LLER'S NAME ADDRESS B "E R OR OWNER DATE PERMIT ISSUED 9 /i 7 DAT E C 0 M P L I A I E N C E S SU D 7 2 _ _ _ �, -� i .-- � �1 ,�� [�� I _ �g'��, YS+s '^KY';vE9+•s.. .,s 7�. �; ��?�;:,, Ss_ -s:., .*.. - _ ! 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'7- U/ST,2i.8UT/ON 80h' F'O; S ovr Er�s) An�D 4E.AGNiAIOG ra/r ' �' - _ , � _ �TO BE OF .i�aE/�/F•0�2�ED'`•CQ.VG.2ET� { COwCC% E rE s'TreE:VGT -JODO ems/ M/N r� 7 €L 20000 ti. w� -10 'LOAD/NG•• YF �t�40re CO RONAO D2/.-VE:'WAY ti/pT TQ B� LOC�tT�Z� Y.a T' p Zf � �c? '� ' # o,Vae y5 r€M uAv_ E Ti' ^� �.., :. r _ a s+ 1 � � � � rY.•. � ,fit � s�` • •8 ���� �� � - _ t ,a� a, bA'7'E' E.4L774 Q :?Aeot/i�4 � � -'y,� ,: a ++G�y.t r{ �.W + ..• �� ' l��. b�+���' _ i �.', .ti -�•n ..may ;�_ r_� J _ 9 y � � °i}'i 4y,�xe f.� z• ,:'vF. '.�- � ,:',.,_- L'• _ �,..,k l•,,, .t N •'.s�M1'�5' h }._r Y. r• ,a-' �r'� - y Ny:. `•.�. �,.. +`+r •�. •i+ _ 4 � zm•. as�"1'?z'^S'�: f{ y .;� !'.�. - ?�,:...- ,+.��-t. - "' _ - - ,::� �'. - �,,''•" 4 ik- � f".. ':'!;` _ { '- �' �#!' .T Ar'4 ..L.Y.-r ,: i , tir r,r:*Sti, S?.�4a 1 •i y.. b - g n �' " :'�, + -n fy f _ ' " k•'At."1,-• `t..uu+*`--,`:�i�. _ A•s.:d;�,r,.`^.rrr0-.�`�'Z r ....`B,F-. `-z�i".f�R';'�. .w:: '�f`;-;:�"`s -- '.. . Y.a3i r.. _. FA k .s:. � . :C•�- :'�`�''��r'' .. .. - _ t �~ - y';, a�wr>tiv`ravAcu *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE (O Least 24 inches tall SECTION A -A ALL OUTLET PIPES FROM THE 10' min. from Schedule PVC w/Chorcoal Odor Filter DISTRIBUTION Box SHALL BE Existing Foundation [house to septic tank PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET t�FOR AT LEAST z FT. 12' CONCRETE COVER TOP OF FOUNDATION = ELEV. 100.00 (Assumed) Septic tank covers must be D-BOX Govan must be within 6 in. of finished grade within 6 in. of finished grade a 3 - 5'OUTLET e 2 • Grade over Septic Tank -98.50 Grade over D-Box- 98.75 I i�de over SAS - 98.7s 3` of 1r8' - 1/2'..Washed Peost .- /' \. KNod000T5 f�. 3/4" to i 1/2 " Washed Crushed Stone j I ` ` 55' OUTLET "� l tY *LET t, `"` to';��',.. S Q02 4" PVC(CAPPED)WSPECTION PORT TO BE oX 3' Maximum cover 8' H" 15' EXIST. S=0.01 or Greater 3 HOLE 0 8'OF \_ // Top of System- Elev. �94.75 WSTALL6l AND TD BE WATHIN GRADE "- -{'+.` y- .'f} lyse• 1�.SSr1�lf7Mee�N EXIST. PIPE - to 1,000 GAL s= . tss' to CV 30 O.Ot' per foot 0"Effective Depth 1.75' }` pp FROM EXIST.FOUNDATION rn SEPTIC TANK O IXI ' ef,t,sor to M PLAN SECTION CROSS-SECTION n oa sr+. rn o 5' cohimm FULL FOLnaa4n it H-10 n ' M 0.83' (10 inches) 5 Units 2 b 25' 30' � v - - a, 0 3' 3' S -� m t o n w. ti tF" SYSTEM PROFILE 6 In.of 3/4--i 1/2- 6 ' �31.2s' 3 HOLE H-10 DISTRIBUTION BOX M Not to Scole a compacted stone c rn NOT TO SCALE ®s3>r'aavfatepey6ea.nanysziTisrtnrtEa ti / 37,25snu+t 'c 5 3.5' 3.5' A Effective Length i 1 3, m SOIL ABSORPTION SYSTEM (SAS) 61n.of 3/4'-1 1/2* o ,o �, GENERAL , NOTES compacted stone Qo Effective vldth INFILTATR❑R',HIGH CAPACITY (H-20 L❑ADING)/ GE❑RGE ❑'BRIEN NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 0 1. Contractor is responsible for Digsafe notification, Verification of Utilities o m (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. w Bottom of Test Hole 1 Elev.=67.50 NOTE: OVERALL HEIGHT Of INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 10" 2. The septic tank and distribution box shall be set Groundwater Observed - NONE OBSERVED lever on 6" of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. Design Calculations 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) 5. The contractor shall install this system in accordance Garbage Grinder. No with Title V of the Massachusetts state code, the approved plan Leaching Capacity Proposed: 330 Gol./Day Minimum (Min. Per Title V) and Local Regulations. Septic .Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. 6. If, during installation the contractor encounters any SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch soil conditions or site conditions that are.different Bottom Area: 0.74 gal/sq. ft. x 372.5 sq. ft. = 275.65 gallons I from those shown on the soil log or in our design Sidewall Area: 0.74 gal./sq. ft. x 78.72 sq. ft. 58.25 gallons installation must halt Sc immediate notification be Providing: = 333.90 gallons LOT #31 I made to Carmen E. Shay - Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, septic system unless noted as H-20 septic components. TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE g 8. Install Tuf=rite gas baffles or equals on all outlet tee ends. ON THE ENDS. NO STONE UNDER. I I 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. i I I 1 10. All solid piping, tees & fittings shall be 4" diameter 1 ' Schedule 40 NSF PVC pipes with water tight joints. 214.56' 11. Municipal Water is Connected to ALL OF The Residence and Abutting Properties Within 150 Feet. I I i I i I THE PROPERTY LINES ARE APPROXIMATE AND 98., __ _ ____ ' I COMPILED FROM THE SURVEY PLAN GENERATED BY _ _ - t I�i UJ GEORGE LOW,. RLS OF YARMOUTH, MA ----- --- r,\- ---------- - --- i 7 ENTITLED "CERTIFIED PLOT PLAN OF LOT 32 SANDALWOOD DRIVE, COTUIT,MA ----------------_ EXIST. 1000 GALL 1 DATED JUNE 22, 1977, & PLAN BK 284 PG 42 SEPTIC TANK I `. EXIST. I I 81 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 17 __-1 1 '1" DRIVEWAY 1 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN L_O OI I -rt---- --71, THE SEPTIC SYSTEM INSTALLATION. TEST HOLE #1 1 i i \ 99 ELEV.= 98.50 D-Box ; ��h;- I I )14. EXISTING LEACH PIT TO BE PUMPED OUT & FILLED IN PLACE. Failed 3 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 17 Leach Pit-0 :-r _ L,i \� I I I U. FROM THE EXISTING LEACH PIT TO BE DISPOSED O f 20' 10 OF AS PER BOARD OF HEALTH SPECIFICATIONS. _-..___ :. • it -- --,HERE-ARE-iw-WETLANDS-ARE-- 2 Y PRESENT_WITHIN- 00' JF T HE PROPERT EXISTING \\ _. ISTIIYG____ ='• i' r. K' 3 BEDROOM 37. 5 = HOUSE I I I ASSESSORS MAP 010 PARCEL 041 LEGEND #164 1 v u� I I lam' ►vt+.miciperl-"N`"-tine-•-�•-- - t• --1 DENOTES PROPOSED 104X 1 + 1 SPOT GRADE ' I i ' TEST HOLE #2 07,,\ , i I I DENOTES EXISTING EL-EV.= 98.75 4" �� I I X 104.46 SPOT GRADE Vent I 1 I 1 PROJECT BENCH MARK r PL PROPERTY LINE TOP OF FOUNDATION , OT #32 I 11 28,987 Square Feet II 9-6-P- PROPOSED CONTOURELEV. 100.00 (Assumed) , - - - - - -97 EXISTING CONTOUR 277.00' i ' 1 ' ' DEEP TEST HOLE & 1 i i PERCOLATION TEST LOCATION 1 LOT #33 i i i 6 FOOT STOCKADE FENCE 2-18' DIAM. ACCESS MANHOLES 1 i I i I I _ PERCOLATION TEST try ' ' I Date of Percolation Test: OCTOBER 24, 2005 1 P LOT P LAN Test-� Performed By. CARMEN E. SHAY, R.S., C.S.E.Results Witnessed By. WAIVER (Per Barnstable B.O.H.) 0 F PROPOSED SEPTIC SYSTEM UPGRADE WtET � T EXCAVATOR: Shay Env. Svcs.,� j '�- -- Percolation Rate: Less Than 2 MPI ® 52" T ACCESS COVERS FOR THE SEPTIC TANK. -------------- I PREPARED FOR IE (. DISTRIBUTION BOX AND LEACHING COMPONENT --_ 1 SET DEEPER THAN 6 INCHES BELOW FINISHED Test Hole Test Hole ; I M R . R I C HAR D J S U LLIUAN ;. - : j + • ti GRADE SHALL BE RAISED TO WITHIN 6" OF I NO. 1 STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. NO. 2 1 AT DEPTH SOILS ELEV. .50 DEPTH SOILS ELEV.8.75 ' # 164 SANDALWOOD DRIVE PLAN VIEW INSTALL TUF-1TTE GAS BAFFLES OR EQUALS _ I 0 98.50 0 98.75 1 3-24' REMOVABLE COVERS Sandy Loam Sandy Loam I C 0 T U I T, M A I �. 10 YR 3/2 10 YR 3/2 r 3" mM•clearance 4 0"-9' Ae 97.75 0'-6- Ae 98.251 9u.Er a" ln.F12' min. k,tet to outlet a-ma. ,s INLET Sandy sandy I 0 PREPARED BY: Uqu level _ OUTLET Loam S9C 1 10 YR 5/8 10 YR 5A N l Y M N E. A�H Y. 5 r k �« :'S -r ► HA �' ENVIRONMENTAL SERVICES, INC. E o * 4'-0" min. 9"- 24" 8s 96.50 6"- 24" Bs 96.75 by o.waw. Liquid depth SILT SILT AM AM 8/6 2 o a/6 Perc I N �o P.O. BOX 627 2.5OY �F - `f #1 GIs EAST FALMOUTH, MA 02536 .. 24 50" C, 24"- 52 C, i Depth to Perc: 52" to 70" I r1 _ AP edium/Caa aa NITAR+ edium/C Perc Rate= 2 MPI TEL/FAX 508-539-7966 CROSS SECTION END-SECTION sand sand I Groundwater Not observed ze r 7/4 25 Y 7/4 No Observed ESHWT SCALE: 1"=20' DRAWN BY: CES ATE: OCTOBER 25, 2005 TYPICAL 1000 GALLON SEPTIC TANK 50N- 1321 C, 87.50 52"- ,32 s7.75 ADJUSTED H2O Elegy. None NOT TO SCALE PROJECT#SD819 FILENAME: SD819PP.DWG SHEET 1 OF 1