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HomeMy WebLinkAbout0052 STUB TOE ROAD - Health 52 STa�5-r;: 6- ROAD, C®TUIT A=040-111 4; I' I TOWN OF BARNSTABLE LOCATION S� fTd�y�''��d SEWAGE# 4240✓e ` " VILLAGE G v T�!T ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. ceBo Cy/C— SEPTIC TANK CAPACITY F LEACHING FACILITY: (type) (size) �6 px •Z�l �� NO.OF BEDROOMS _ OWNER eta{c�a B�.d PERMIT DATE: ��- �e 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 0 Ar37 , , 37 Town of Barnstable P# Department of Regulatory Services &VANstm" St Public Health Division KAM Date 4 031 h1� 200 Main Street,Hyannis MA 02601 Date Scheduled_ 1 I /.� /d u_ o Time Fee Pd. ' ' Soil Suitability Assessment for Sewage Disposal Performed By:��YI11 d D. �g� `,,r Witnessed By: Location Address LOCATION& GENERAL INFORMATION �`'�, �4X��!� Owner's Name o`— ` Address" Assessor's Map/Parcel: Q�O � Engineer's Name jqG/v NEW CONSTRUCTION REPAIR ,,� 3 Telephone# Land Use Ver,1wl,Aq.1 Slopes(%) D Surface Stones wo pe Distances from: Open Water Body P e 1 1 ' ft Possible Wet Area t00 F . ft Drinking Water Well � ft Drainage Way 50 1 ft Property Line �6 � ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) (qiq Parent material(geologic) G Depth to Bedrock Depth to Groundwater. Standing Water in Hole: B P Weeping from Pit Face Estimated Seasonal High Groundwater Wow 13 e/i ti DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: -1M0++IeS tf r a rr p �Z Depth Observed standing in obs.hole: In. Depth to soil mottles: 6 t l h In. Depth to weeping from side of obs.hole: In, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level, Adj.factor, Adj.Groundwater level PERCOLATION TEST Wel'MN Thne a RIB Observation i Hole# Time at 9" � Depth of Perc W I h Time at 6" Start Pre-soak Time @ Time(9"-6") ` End Pre-soak 1 V 00 ^� i Rate MinJInch Q��VI I a Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- f ***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:\SEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color 'Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i tenry.%Gravell o �1�r?2iq GU �� 2It t��ke- of -3 Q Co9�► Syad �O�e 4/� R1rnci96 !�. $ 132 C IMed'OVA I D (Z s14- 4P �oss DEEP OBSERVATION HOLE LOG,, " `'Hole'#' Depth•from'E"a Soil Horizon- Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ' 'Co si ten go rave P blp 36 Lo-11A 16�P- ¢l� ►p orb o 3 `C3 Lit GD�k 5/4- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. Co i to DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling. (Structure,Stones,Boulders. Consistency. Griyg1 Flood Insurance Rate Man: Above 500 year flood-boundary No— Yes Within 500 year boundary No✓ Yes Within 100 year flood boundary No.V/ 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? �e5 _— If not,what is the depth of naturally occurring pervious material? Certification I certify that on (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 training,expertise and experience described in 310 CMR 15.017. Signature LQ #f' Date y O2, 2Q 1 b Q:\SEPTICIPERCFORM.DOC F No. GI D " q?3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for �Digpo!gar *pztem (Con0tructiou Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) El Complete System U Individual Components Location Address or Lot No. �� �J v �� �"� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building '�J' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 a gpd Design flow provided a o-'a gpd Plan Date Number of sheets I Revision Date Title / Size of Septic Tank ­'o o4- C,ZirZ Type of S.A.S. Jac . ` Description of Soil i 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 g g g P Y 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 Bo d of Health. Signed np An Date Application Approved by S Date Application Disapproved by: Date for the following reasons t1 Permit No. 9010 /a-1 '� i �"� Date Issued '" r •f fR 'V a010 - N�3 Fee Ice i No. f , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH CIVI� ION - TOWN`OF BARNSTABLE, MASSACHUSETTSYes 2pprication for �Diopaal 4pgtem Con0truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System LJ Individual Components Location Address or Lot No. ScT �/d�'T�E �O. Owner's Name,Address,and Tel.No. i COJ"Li T t%fi.(et p �31 LP.EG'!C z. Assessor's Map/Parcel �* �' 5jpr/ e�lT' 7,2 ©I- Installer's Name,Address:`and Tel.No Designer's Name,Address and Tel.No. `1''hi G c�e4'a�v/- 77 s'o y o� � 'Cl''t bi ,�/�/�✓o% �`r Type of Building: Dwelling No.of Bedrooms 3 t Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building *-0r4eJ' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 G gpd Design flow provided f✓O gpd Plan Date J/ -P 01-./O Number of sheets / Revision Date Title Size of Septic Tank /OOo GitG '° Type of S.A.S. J"oy- -- Description of Soil 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 Certificate of Compliance has been issued by this Boa dc�off Health. Signed riC Date Application Approved by { S Date /,2 U Application Disapproved by: Date for the following reasons Permit No. a 010 73 Date Issued -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by Njo/fYJ ,eG1`4!rOE"'�/'0r at .J 0T TOGr A. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. aO�U y 3 dated I,' -'- /v Installer .ed0`4geOte'Oie=_ Designer .G't tt�/sJ /1,J'i4✓'o�' �� #bedrooms Approved design flow 3� YO gpd The issuance�ofthis fermit shall not be construed as a guarantee that the system will tictioon as designed. D Inspector / �IA,. f No. 0-0/0 - "!� 3 _ ' . .. -- . Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS ligpogar �&p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at J'Jo'g T5.e_ Geleo . e oiU/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 of this permit. Date '/' ! Approved by r` D3C%14i2013/TUF 01 :33 FM SandwichTownOffices FAX No, 1 5C8 833 OC18 P• 001/031 Town of Barnstable Regulatory Services *- Thomas F.Gei ler,DD ector p Public.Health DIVisiou Thomas MCKeauy)Direetor 200 Main Street,4yanEnJis,MA 02,601 Office:.508-862-4644 'Fax. 508-7.90.63Q Xnstader&Dealga r Egr 'ficatiob Form Date; I )Designer: Installer:77�)k( .A�ddrm: . c'�Sb�C- � Address: 44 V41�5> *was issued a pazxcit to install a ( to (=taller) septic system a based on a deli drawn by r dated ` mac`-'ner - . I:cerfify that-the septic stam refaced above was st —�. eP SY m aped substauttally aedbrdizg,to "the denim wbieh may iz)nWe ajaz'approved'cha:nges mch as iateAl t0locaUon of the s %U&iibox and/oz septic tank . Z GQ17 ghat the septic system relffenaed above vw msta Wl' ';A pw'I:chants a,e�, gzeater0 latezal zeloeait �f#ate S or-'may.ver�io�3=re�ooiezx o�sty cvppt Of f�e.seph" e:oo,} rt ma iidan, with State& cal:tteg atians. 'Ian nevi, s xa c certified as"b�des .er t&follow. (Installer's Signature) �. -; •.i�AS�7�l •rM low Na 1a86 `s _ �ar�rawt� ' (D er s Signa#ure) . .• � •. • . - fit',s.$ta�zp�dre) _ : ..A -RE CNN I D- ate:$ s;ELT PTIRE . s + IRANK YOU. . Q:Healtb�5apficclA�signer�etcsvnam2 ''' j.. t . TOWN OF BARNSTABLE 1 LOCATION S.� ���1P_'P"de`'Ate' SEWAGE# Aa✓e VILLAGE G o T�/T ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY EX�J'T�irrr /000 LEACHING FACILITY. (type) (size) NO.OF BEDROOMS -� OWNER PERMIT DATE: �� ~� �e 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 l z 3 0 30 .010 � ' 3� TOW)LO F BARNSTABLE g .vim ( zS) SEW 'GE #CC� L=J�:4TIf'N� I,TILI,A . ` �> ASSESSOR'S MAP &LOT040 ( I 1 INSTAL::ER'S NAME&PHONE NO. �- SEPTIC TANK CAPACITY POP(025 ����L, (size) LEACHING FACII.TTY: (type) .'� ('�'�(� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 3 COMPLIANCE DATE: 9� Separation Distance Between the. Maximum Adjusted Groundwater Table and 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 t1� V r ._ _.. ® 1/ O t 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS Zippricatton for Mi-qpogar *p!tetn Construction Vermtt Application for a Permit to Construct( )Repair(grade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. Owner's Name Add ss an el. Ilk- o Assessor's Map/Parcel n r���e>Ad d Tel. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_ 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when a liable) 4- W 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 ' sued is Bo Healt Signed Date div� Application Approved by Date ? •_� Application Disapproved for the following reasons Permit No. Date Issued i .�T�O, F BARNSTABLE LOCATION C V'+ 1 VJ ly � SEWAGE # P VII.LA C ��� SSESSOR'S MAP &LOTUS INSTALLER'S NAME&PHONE NO pNh SEPTIC TANK CAPACITY ktb 0 _ t LEACHING FAciLrrY: `'�Y t'`n Et VLU (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 9 _ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet ---qFTR Private Water Supply Well and Leaching Facility_(If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by t � • r ��. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Migogaf *pztem Con!6tructfon Permit Application for a Permit to Construct( )Repair(u')Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. Owner's Name Add ass an el. o. W �\J ti. Assessor's Map/Parcel ' •o.., t n \ er's N e,Ad d Tel.N _ Designer's Name,Address and Tel.No. 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 galfs per day. Calculated daily flow gallons. Plan Date N! mb�er of,-sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when ap lifcable) 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 ' sued y�isBojEealt . Signed Date9/10 A A Application Approved by Date 9 .3�S°�f Application Disapproved for the following reasons Permit No. 1 - �_o 13 Y Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )by rr'. at S__ �5 1"_ OJ 7` (� - has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. _ dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will funs,' m as designed. Date Inspector \\ \ l No. Fee, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mizponl 6potem Construction Permtt Permission is hereby granted to Construct( )Repair(�e-)Upgrade( )Abandon( ) System located at 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 this permit. Date: Approved by t +a i 2�F�f } 3 I I• A r. 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT WITHOUT ENGINEERED PLANS) O �kCD 1, ri y certify that the application for disposal works construction permit signed by me dated concerning the property located at �J� meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility • There are no private wells within 150 feet of the proposed septic system t • There is no increase in flow and/or change in use proposed i r ' • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. � q/3- Please complete the following: �- A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) (D I B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder cert r l l. ,C 4 ION S E AGE PERMIT NO. Lot Lf 3 1�(J� TOE ' VILL lE ` c©f ?3- aD I N S T A LLER'S NAME i ADDRESS s ��-® The fe1-41 S y0 o� B U I L D E R OR OWNER 8' DATE PERMIT ISSUED �c 9C 3 DAT E COMPLIANCE ISSUED I/ Q� O � 01,19 cr)b rem S � � " � No..61 Fs$..... - .........:. ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town..........OF........Barns.table ............ Appliration for Uiipufial orki Tnnitrnrtiun rumit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage' Disposal System at: Lot 43 Stub Toe Road Cotuit, Ma. ................_................................................................................ --•-•............._..•-••.................-••••--•...••-•--••-•-••...................•--.......--- Location-Address or Lot No. .....apann iS_--atar...c?nstzuC t off].-_C t............. .......2 4.... x G 1_t._2 Qjad...p ime......EQ..._.X����i1Q 1h, Ma. W � Own ..•.. .Address Ins-Q1e Address Type of Building Size Lot.2 0.,-2 U..._..___.Sq. feet U Dwelling—No. of Bedrooms......3....................................Expansion Attic ( ) Garbage Grinder (Aid) '04 4 Other—T e of Building ............... No. of persons-_........._............_. Showers — Cafeteria a' Other fixtures --------------------------------....................................................... w Design Flow..............5 ....... per person per day. Total daily flow...........3 3 0 7 __ gallons. WSeptic Tank—Liquid capacity.._10 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...Robert__.E..•_Raymond�•--P_.•E._____ Date...__11/10•-8 2 a 2 P p 12 ' P ground no water 1.4 Test Pit No. 1................minutes er inch Depth of Test Pit-.----i.........._ Depth to ound water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•••----•--•-••---------•---•----••-•••--•-••--•-•----•-------------------------- ---------------------------------••••••••--.....••••-----------•------.... 0 Description of SOU........0"-36" subsoil_1__36"_-144_"_. sand & gravel x 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 iITi . 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ued by e and of ealth. Application Approved BY ............... .� ----------.... Date Application Disapproved for the following reasons------------------------------------------------------------------------------ ...........................•-•--.....---...... ---------------............----•---•.........••. Date PermitNo......................................................... Issued....................................................... Date ✓r No...4�..�1:�� .. FEE .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................Tow21.---......OF......... ................................................ Appliratiou for Disposal Marks Tonstrnrtinn Prrmit Application is hereby made for a Permit to Construct ( X� or Repair ( ) an Individual Sewage Disposal System at: ................_...._.......................................................................... ...........................t.................................................................... Location-Address or Lot No. ......Ae,n!s._&._ax_..Ccu.%txLc-tion--C-- --------- ------- ram P4a4i4-•Lr-1:v4&,....Sc..--Y-a owth Ma. aOwn � - -..•-.- •------•--..•-•Address.............................. ..._.... 1 .!................ ---•- ..... Installe Address UType of Building Size Lot_. .,�&I.........Sq. feet Dwelling—No. of Bedrooms......3....................................Expansion Attic ( ) Garbage Grinder 40) '4 Other—Type e of Building ............. No. of ersons............_............... Showers — Cafeteria a YP g --------------- P ( ) ( ) 04 Other fixtures --------•-•-•--•--•---••-•-••-•. . .... .. Q .............................. •----------........------------- .------------------ w Design Flow............... .9....._......._._........gallons per person per day. Total daily flow-----------3.3-0..........._._.._..•....gallons. WSeptic Tank—Liquid capacity....1JUMIlons 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 L'.4...E.... f...P..-E...... Date...... a.s7/_. 2............ Test Pit No. I-----2........minutes per inch Depth of Test Pit___-_.2.2......._. Depth to ground watenno.._w.&ta: (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ............•••--------•----•••-•......................••-••-•--•--•---•.........---•••-•......•-••-••-••---•--•--•-••••---•-•----••-•---.....----••....••-- O Description of Soil..-- II`3 i� 13 ."2:a. . ...a:4°° .'a, A _s�... ►�i. . 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 TIT...1" 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..............................•----•---....------•-•-----•-•-•--••....---••--••••-•... ................................ ate Application Approved BY----------••----- �*. .... , ---•---•----------•------- •••'gI I _ .............. Date Application Disapproved for the following reasons:------••------------------------------------------------------------------------•-----------•--•••---••••..._... -•------•-----•--------------------------••-•-----••---.....-•------...---•--------------.....------....._....._..........------....------•-----•------------------------------------------•-•••--•---•. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH ................`�'.ow-11.............OF...........I✓.. X:lt . 611<.......................................... Tntifiratr of TompliFanrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................. .---•-------------------------------------------•-------......---------•---•-----•---•-•-•----------------......---.....-•--•-......------------. 2.1 Installer has been.instilled in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.,.73�094P;F............ dated_.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ZCONSTEAS A GUARANTEE THAT THE SYSTEId 1A91L � TION SATISFACTORY. DATE.. .��......®_..__...... Inspector. ----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH } i'oc�n..............OF..............Bar slabl� � Ndl.....: ... ........................... FEE..-•.,fQ............. Disposal satl Works Tnntrnrtuan rrntit Permission is hereby granted) nllis Star Construction •CG_.-.-- --........................................................ to Construct (Y ) or Repair ( ) an Individual Sewage Disposal System at No.......Lot•43 Stub Toc Roads_ Cotuit„ ila. ... ....... .............. ......-•-•--•---•----•••••----•--............---••---•••----•-••-----•-•---•--•••--•-•............... *si Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... �r # :::.�-• `''--------------------------------------------------------•..._....._ DATE. pi ✓ „ „ Board of Health •----........ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS .,' 1� ALL E : E'v ,► OWJ 0 Ak f� "L A6-1 SE•, L(c dt ALL L /- V 1 5 U�:><:3 1 C_.. "k 4-c .�d E` A M i v i►-•'1�,� ofz ►/6 - ; _ I r p lk►t_t r' . p7�aeti tsE 'SPicG,FIED rn ♦A)D r.d THE too IE_W, r�►.�� cll' SC�leDv 4iD p�/ , ,I O Y i' C:`, ALL. 'S E P'K. TAXA IL I �r 1 r ft,6J T rc,, +Fyjy A..t. w - �, N 2A .i.'.tEEL__ ..,,.t. .JG�S :.'t�E.._1 .Jr- , i.�t'r►► t_EA.CN,.IE, P� SA �� r� j _ I I._. �" - -- - - --- �-- ttEwti,JE Au_ _�.1� ta2�+rE MAC t21A.1_ �F_.JE_.),riI ! O C C; ��/ r4 ,��/EQT EL-EvxrrO.JS OF L.E<.c+4I_k=j VI'll. k<'c L-aa IL I/ '�=•' _ �'� �' I -L y,, -=-- - — J 0 A eaa�s c,F �,. /wc� �cr��L� -►, �.s.y c�t� Ica r F _ i rn PT ) I i, rife r-+CSTIF, WHEJ..� T•+c S`i`_.rE.M +S r�E_AR_ IC' - -- JI rl , I JI � O O � J ^ (1J �,/ (r".1►1 ETIh.J .ti.�0 PP I?L.._ �.�2 i r $E .�`,t P..-.t C� r►J TYP►C4L DIST21Cs11T10►.i fox ! t ( � (� ` r1 �.►c� j y ? U OT TO Sc A L E { �C.�.L._� 4_J �"./,i [K.._. YC X- 11 T UtrTE D.�TQ6WT.n,! acrx a.aa nano c�yv_. 1 i sty"+G l>.�.L $EY"fK, t-^.IK ,� �.A. L� > AS► �!sir_ P ET 2041 VA7/0A/ P 75 S*R ,C SY A•+1E.C.CA.►J �'cF�-n`,T ►joT S�.oLE MoT Tc yi►- E �^--. - �7 Ut E Gi U/►.! Iu��e'E.: T.w K S RF ru Fcxt.E D T.►t►t+,,G�a t' ArxCOGA r/0A/ O-ATr = G //�l n %..qG�J �.✓rr►+ F�� rK.0 wE.Dt o yr ¢E w r T>+ r o r �) .�A\ u 11,: r!,(� 2-A `It fs M 8E t10 E D S't"L. je,*L^ ..1 AI O T G"Ac.0_E 99 nr A g,-,- w�C. V•9 o�s��v.�riows sy: ANT it` s i 80,4 l O o� fAe,4 L T H Co ti c c-r T/►• 9 6aT*oM. ws' I-. �c�oo 1•S.I Rs�T � *s.[ FsvILT vo Ir -, ,.,�,.e'Z. v./ c ti F i c f �r.t 1 y N 6•y •a ,� TOr' Ffx,r1 rs�'row� Q,YZ =, 7 H ' E r t r S., 4 Q,. JE F 'U I ,+ tt.eA D! G'a X ��I►�1SN CiCi►DE <o°��Q- �tV[F Tr N K =j ca-Cit-jbca. "s r I EAk c r+.►,C. • K 1 ' 7ja�� 7J6 rz - - c - %r 0 (o°�1_ ---. - _, r•Li_---- - --=r_ _1__ � pew 5 t o..1 e • 4 ^ O ® OCD V"^04E D ti1c1L ? �2 ee,NFocu� cr�.�c ptS� '?s`'X =- V •- •• O 0 O m ;EV Q S� m G A O m p® V t=C ✓l Crr C'j �l SEPTIC TA1�)YG EvFv 7­7 ��• TY P!C,e.L T t ,$ NET Tr, -CA,L AGNINS-, 1 Le-0 T_341 Aj(�A PIT \ NNO d5 L, / 4 A N V� AIYO Z` c 3 ZG 1_---- � _ -- r i s r C'ory gout C'� 11EsiGN C,e�TEI-'� /��tno�y�r PROPOSED D�[/GL5 I ►�IC� LOCAT ► ON ---— 7 G_ _ �f�k0 Cdt/TdIJL RO$ERT f � POE EWA E SL 0 SG DISPOA 5Y_5 EM A/vM I E,e - pF dEO ec�M s _ Eri'lT �GLT E� PR O g RAYMOND b p� 6�LL GW S Ase Te j_1 V oEP,0 4 Y _ SS � PEQCIX�II�� 7�' No 19875 b �,. ,.•- �E.*�.�//N6 A �CIS T t .�` CJA �:�T�QJ�-- (C07J 1 T) M A S S ,.. Ae" DNA L L r b.PGLIC_AAIT ' E►.1GIU�L�Q L Lrj>_.1ST, L-� J Ioo9'• EXPA►.1ylo f' 2d GQEAT �► ►C ��'►✓E 3� S`TQ P>f12 �,.L= 1 , yA,l ti Kxi rl I M A . i C— FA4_MU OJT P, J�ICEjr');_;T SeWs 2 OESeG 1•.1 * - ROGER. k SCALE DATE SHEET C?T' " " r_s`+ �"� 1.4�2C 1 . �5G oU + RAYMQfVG ►.!i_��E j; 15 j9_ ,A ho.2)Sxi 0 0/S'TE''y�P DRAWN BY CHKD BY APPD BY PLAN NO ASSESSORS MAP : _ TEST HOLE LOGS NOTES: PARCEL: � � � I - --- ----- -- '(b SO I L EVALUATOR : )il( 'D� ' )wk C�6 FLOOD ZONE: U-�o-TIGw (, --_ _ _ _ __ WITNESS :, lA�f l I �� y 1) The installation shall comply with Title V and Town of Yarmouth Board of REFERENCE: i� -(_ - -_ __ .___ _ DATE: '7 Health Regulations. The installer shall verifythe location of utilities, sewer inverts and septic �� Z7 ���j PERCOLATION RAVE:-� Z Wl� � ��-- � � 2) components prior to installation and setting base elevations. 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first ,z TH- I TH-2 two feet out of the d-box to the leaching shall be level. Old " f7 bllz(aVll(, 0I I(� 4) This plan is not to be utilized for property line determination nor any other y►�„i� ' 10 purpose other than the proposed system installation. lb� 77 5) All septic components must meet Title V specifications. qo40 I '� �l� 6) Parking shall not be constructed over H10 septic components. LO Jo (p�?' 7) The property is bounded by property corners and property lines. LOCATION MAP / 8) The property owner shall review design considerations to approve of total v0 �/)P � J" � b design flow and number of bedrooms to be considered for design. Receipt ,t of payment for the plan and installation based on the plan shall be deemed . �p �I � �b�(y(� approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material JO-4r,"rg, per Title V abandonment procedures. Those within the proposed SAS shall Z — - — be removed along with contaminated soil and replaced with clean sand per Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if 1 SEPTIC SYSTEM DESIGN applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the FLOW ESTIMATE owner to ensure such. - ' r4►w \ ;j 12)The installer is to take caution in excavation around the gas line if such ^� BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY exists. 13)The installer shall verify the location quantity and elevation of the sewer SEPTIC TANK lines exiting the dwelling prior to the installation. ` � 1 �GAI/DAY x 2 DAYS - k::0 GAL ( 1 ' USE IUxD GALLON SEPTIC TANK SOIL ABSORPTION SYSTEM OFF ofS P� 5,D L,r,'x Lf_-- �13Z s, qN 10 SEPTIC SYSTEM SECTION 0 i jm D-BOX -- M O GAL SEPTIC TANK -- C) SITE AND SEWAGE PLAN LOCATION : �Z �u� _foC T)DnT PREPARED FOR : �"�� �.��a�v�' C P .w M / SCALE: I- ` -� DAV I D B . MASON I�5 DATE: I I jallo� z DBC ENVIRONMEN AL DESIGNS EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833- 2 1 77 Z o /D l � � 3