HomeMy WebLinkAbout0041 WESTBURY WAY - Health 41 Westbury Way, Cotuit
A, = 027 048
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS.YOUR NAME in town (which you
must do by M.G.L. -it does-not give you permission to operate.) You must first obtain the necessary signatures on this form at 2.00 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1st Fl., 367 Main St., Hyannis, MA 02601 (Town H'all) and get the Business Certificate that is
.required by law. .
DATE: r-/ �✓2 7 \�1�,�/ Fill in please:
APPLICANT'S YOUR NAME/S;
BUSINESS YOUR HOME ADDRESS: 1 we `b�� �1
[ !• :�hi�!"k:`.;7(4¢[' 4 i d!'din r r r
L1 e.•vr. �-/ .2 O Q
'9 I�-`�%�ys�•:r TELEPHONE # Home Telephone Number
vi`1il"``y:� OR EIN #: y2 —AI �� E-MAIL: 1 5 GL :-O5v 1 cloujQ�-c7�
af;t,ltt: ;;i:ct,[, & h 11
NAME OF CORPORATION: 50YX 011'5'Fru F 16 r
NAME OF-NEW BUSINESS 1 G ✓1 Y i i2? TYPE OF BUSINESS C�t7►1 �/�c{
IS THIS A HOME OCCUPATION? _ YES' NO pp
ADDRESS OF BUSINESS: . ► LJe' ' v� l.U�� t v� rM MAP/PARCEL NUMBER (Assessing)
When starting-a new business there are several things you must do in order to be incompliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth '
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally oWgStrM0tYrWffAV6F%1MCUPATION
RULES AND-REGULATIONS. FAILURE TO
1. BUILDING COMMISSIONER OFFICE I�COMPLY MAY E$UL.T INFINES,This individual has bee i of ajp . r requirements that pertain to this type of business.
Authorized Signature**
COMMENTS: 44
2. BOARD OF HEALTH
This individual h b en i formed oft e ermit requirements that pertain to this type of business.
thorized 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:
TOWN OF BARNSTABLE
LOCATION 7`/ f! �'T��� 4e-,1,YSEWAGE# 3
VILLAGE C®�v�% ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. ��� �/� ®aQ„
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) �,si� � (size) J- X aZ
NO. OF BEDROOMS
OWNER
PERMIT DATE: �� " COMPLIANCE DATE:
Separation Distance Between the: ' //�� Oc'�
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �o� 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 -
i o
WeS 'rvl Wr`y
flee Ir
No. 1 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes
RppliLation for Mispo8al .pBtem Construction 3orrmit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No.��l✓�`�J ��� A%j Owr is Name,Address,and Tel.No.
Assessor's Map/Parcel �p� —' � S"p�3d6f 9/03
stalker's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
tRJ
7 s� a
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building4'4!0� No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) c� 3® gpd Design flow provided � gpd
Plan Date 1� �—/ � Number of sheets '� Revision Date
Title
Size of Septic Tank L�X✓cl�j/�'�' o 00 f(ype of S.A.S. ! 4T�C/Y 44.'� 47` P
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 E vironmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of ea f �a
Signe Date
Application Approved by Date /) `�-
Application Disapproved by Date
for the following reasons
Permit No. 4)4 j 6 , Date Issued
No.
3 Cs- .. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered incomputei:
`
` PUBLIC HEALTH DIVISION ='TOWf� OF BARNSTABLE, MASSACHUSETTS 'Yes
Zipplicatlon for Vsposal *- pstrm Construction Permit
Application for a Permit to Construct( ) Repair(G)Upgrade( ) Abandon( ) ❑Complete System Andividual Components
Location Address or Lot No.�// /E`✓'P�'v4't,'/ O, s Name,Address,and Tel.No.
Assessor's Map/Parcel -0 C; 1;:;-00 36!✓
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.'Oelp
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Buildings e-/ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 O gpd Design flow provided IS 1-0�9 gpd
Plan Date �` e7�—/5, Number of sheets Revision Date..----
Title
Size of Septic Tank .eX--JT//"6� I o 00�r(11ype of S.A.S. G �%✓G/l caT��/{�A�J��g1°�
n r -
Description of Soil d! Grp �''�1 J 6/O G: -
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 E vironmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of ea _'T e
Signed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons w
Permit No. a G 1 G (n 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 GG��O Cy� •�`� //GLp
at 5;�/ /i�/�✓T, !/�,��sV has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No,)L-/:-3 S& dated
Installer �J�'J .���v.�`�/,�t— Designer -4,0ytn2 F/��J'0"W• Oc'�
#bedrooms Approved des' flflov4 1 � gpd
The issuance o this ermit shall not be construed as a guarantee that the system wRI fun3tio �as designed.
Date 1 Inspector �>/, J
---------- --------- ----- -------------------- ------ ---
� -- -- -------
No. Fee �Q
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSET 1. TS
Disposal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( )
System located at e �oai�✓'/!cs6/GL�' G.4114 y
ol
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must ber completed within three years of the date of t�pH ermit.
Date / / Approve by-
-
NOV/05/2015/THU 04:09 PM FAX No. P. 001
Town of Barnstable
Regulatory Services
4 Richard V.Scali,Interim Director
« naaxsrABLE.
MASS. Public Health Division
Pa ". Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer&Desiff�er Certification Form
Date: /, Sewage Permit#c oi`J" ';�6 Assessor's MaplParcel
Designer: 1 Installer: a3rr
Address: XL Address: 14q 4 1
On was issued a permit to install a
( ) (installer}
septic system at based on a design drawn by
addres )
dated �D
(designer)
I certifythat the septics stem referenced above was installed substantiallyaccording to
the desin, which ay include Minor approved changes such as lateral relcation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
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
r certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was construe liance with the terms
of the RA approval letters if applicable)
a� pAVil)
av>�tsor�
sta er s Signatur No_
�V s r>:�`�
s'9NI rnV�F�'
(Design 's Signature} (Affix Desi�'gW Stamp 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. ---
QASepticTesigner Certification Form Rev 8-14-I3.doe
Town of Barnstable P
Department of Regulatory Services
Public Health Division
Date
1'639• 200 Main Street,Hyannis MA 02601 '
Date Scheduled 4 J �A�,,�
Time�- Fee Pd. ,
:Z!:
Soil Suitability ALesSmjentfo r sew e Disposal
Performcd•By:. i Witnessed By. fn✓ �/< ^ Q f
Location Address
LOCATION& GENERAL INFORMAT ON
�/
/ •���+��G7 �. Owner's Name
q GG�uIT Address /C
Assessor's Map/Parcel: ��,r��-.
Engineer's Na
NEW CONSTRUCTION �!l� p`..�.P`
REPAIR . OV_ Telephone#
' lT
Land Use Slopes(96)
Surface Stones .
Distances from: Open Water Body ft Posslblc Wet-Area
ft Drinking Water Well . ft
Drainage Way ft Property Line _R Other
ft
SIKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
Parent material(geologic) Depth to Bedrock
Depth to Groundwater. Standing Water In Hole: Weeping 11'otn Pit Pnee
Estimated Seasonal High Groundwater
DETERAGNATION FOR SEASONAL,HIGH WATER TABLE
Used:
Depth Observed standing 1n obs.hole: In. Depth Id sell LnUttlee:
Dellth to weeping from side of obs.hole: ln, Groundwater mottl Adjustment
(t,
Index Well#: Reading Date: Index Well leYol
--. _ Adj.fhctor__ Adj.Groundwater Level
Observation PERCOLATION TEST bate„��, Iritna
Hole#
---b�-• Time at 9"
Depth of Pere I Time at 6"
Start Pre-soak Time Q Time(9"-6")
End Pro-soak
Rate MIh./luch
Site Suitability Assessment: Site Passed 'Sits:Failed- Additional Testing Needed(Y/N)
Original: Public Healib Division' Observtition Hole Data To Be Completed on Back-------�
***If percolation test is to be conducted within 100 of Wetland,
must first notify the �
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:ISEPTICIPERCFORM.DOC / /,
. f ,, lV/ J
DEEP.OBSERVATION HOLE LOG Bole#
Depth from Soil Horizon Soil Texture Shcl Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
r s� latency,%'oravel)
TT
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders,
C n ten
y
IF, Insurance Rate Maps
Above 500 year flood boundary No_ Yes
Within 500.year boundary No,
, q '
Within 100 year flood boundary No., Yes _
Death of Naturally Oceurina Pervious Material
Does at least four feet of naturally occurring pery ous mti erial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of it rally occurring pe lous material? .�.
Certification
I certify that on lot • (date)I have passed the soil evaluator examination approved by the
Department of Enviro men Protection and that the above analysis was performed by me consistent with .
the re ui fining,ex rtise a ex err c described in 10 CIv1It 15.017
Signatur Date D
Q:\9EPrlKAPERCFORM.DOC
COMMONWEALTH OF MASSACHUSETTS
COPY
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS -
DKPARTIR ENT OF ENVIRONMENTAL PIW'fECTION
:!
ONE WLI,�TER STRUT, BOSTOA M-A 02108 (617) 29?.-550()
TRUDY CO?t-:
Secretary
ARGEO PAU], CELLUCCI DAVID B. STRUHS
Cocttrrussioner
Governer
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address:
!WAY Nsrrae of Owrxa.
(�oTii r 7 Address of Ovvner:�JL
Date of lnspecton: -9C1
lgwre of Inspector: (Please Print,_?E I D C E t_L I C
I am n DEP approved system insPecYos Pvrsuarn to Section 15.340 of Trtle 5(310 CMR 1 5.000)
conlwy Name: --
Maidng Addreris: -`pl I & .i €-- —�(-�&P49 T H PORT MA
Telephone Number:
CE -11FICATION STATE_IAONT
1 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:
' Passes
Conditionally Passes
Needs Fu her Evaluation By the Local Approving Authority
— Fails
Inspactcx's Signature:
Date:
The System Inspector shall sut,mit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty 1301 days of
completino this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer, if npplicoble, and the approving authority.
NOTES AND CONINIENTS
mop - Oki ?
�.. 9 10
. • RED YEO
- Y° 3 1999
o` TOWN OF 9AAN5TABlE
NMAI DEFT. ,%,
revised 9/2/98 Page I of11 Sao
%J Pr,nttd on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0RP44
PART A
�/
CERTIFICATION (continued)
Proper dr ty Adess:41 WesT6wi WTiA 1 QJ-v.T)mra
owner: C1/j>�1� tJoV c�eAu
Date of Inspection: . ]
L4—lq-9t! �
INSPECTION SUMMARY: Checli( A,) B, C, or D;
A. SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR415.303 exist. Any failure
criteria not evaluated are indicated below.
COfNf1AE%TS: _ /f B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the—Conditional ess" section need to be replaced or repaired. The system, upon
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determi ation in all instances. If "not determined", explain why not.
The septic tank is metal, unless the owner or operator hi s provided the system inspector with a copy of a-Certificate of
Compliance (attached) indicating that the tank was instal ed within twenty (20) years prior to the date of the inspection: or
the septic tank, whether or not metal, is cracked, StTUCtL rally 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 complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level ob erved in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distrihution box. Tie 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 replaces
The system required pumping more than four times a yei r 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
SUBSURFACE SEWAGE DISPOSAL SYS-11 VA3. SPECTION FORA6'.':
PART A
CERTIFICATION (contirwed)
Property Addres ssC H Wi STIN V) w1a� x
`l /w 1
Dale of Inspection:'L
`T_).
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALT }
Conditions exist which require further evaluation by the.Board f Health in ordar'to determine if the"system is failing to protect the
Public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMIN IN ACCORDANCE WITH 310 CZAR 15.303 01(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT E PUBLIC HEAL-1-H AND SAFETY AND THE EIVVIRONMENT:
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering ve etated wetland or a salt marsh. 1.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(A PUBLIC'WATER SUPPLIER, IF ANY) DETERMINES THAT TI1E SYSTEM 15
FUNCTIONING IN A MANNER THAT PROTECTS THETUB IC HEALTH AND SAFE-T-[ AND THE DWIIRONMENT:
The system has a septic tank and soil-absorption system(SAS)and the SAS is within 100 feet of aaurface water supply or
tributary to a surface water supply. `
The system has a septic tank and soil absorption system and the SAS is within a Zone I oCa public water supply well.
_
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply wel;,•
The system has a septic tank and soil absorption system and the SAS is lass than 100 feet but 50 feet or more from a
r private water supply well, unless a well water an lysis for coliform bacteria and volatile organic compounds•indicates that the
well is free from pollution from that facility and t ti presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance _(approximation not Valid) x
3) OTHER
r n to
xr
t
reVlsEed 9/2/98 Page 3or11 fib. '41 `
r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICAT)ON (cofibnued)
Property Address:
Owner:
1
Dateofinspecuw1: rl
D. SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
_ I have determined that one or more of the following failure co itions exist as described in 31O Ctv1R 15.303. The basis for this
determination is identified below. The Board of Health should a contacted to determine what will be necussary to correct the failure.
Yes No
Backup of sewage into facility or systern cornponent ue 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 clogged SAS or
cesspool
Static liquid level in the distribution box above outlet .vert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6 below invert r available volume is less than 1/2 day flow
Required pumping more than 4 times in the last year 'OT due to clogged or obstructed pip als)
Number of times pumped
Any portion of the Soil Absorption System, cesspool c r privy is below the high groundwater elevation
Any portion of a cesspool or privy Is within 100 feet c f a surface water supply or tributary to a surface water Supply.
Any portion of a cesspool or privy is within a Zono I o 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 fe t but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has bee analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, amrnon nitrogen and nitrate nitrogen.
I
E. LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following: .
The following criteria apply to large systems in addition t the criteria above:
The system serves a facility with a design flow.of,10,00 gpd or greater (Large S�Wem) and this system is a significant threat to public
health and safety and the environment because one or m re of the following conditions exist:
Yes No
the systeni Is within 400 feet of s surface drink ng 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 are (Interim Wellhead Protection Area IWPA) or 6 mapped Zonell of a public
water supply well)
The owner or operator of any such system shall upgrade the syste in accordance with 310 CMR 15.304(2), Please consult the local regional
offic:, of the Department for further information.
S'cViS2G 9/2/98 Page,tofII
l '
Y r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM,
PART B
CHECKLIST
Address I WeSI
Owrwr: &\Uvow-
Doia of Inspacbon:
Check if the following have been done! You must indicate either "Yes" or "No" as to each of the following:
Yes No r
Pumping information was provided by the owner, occupant, or Board of Health. a
!V None of the system components have been pumped for at least two weeks,iinctthe system has been receiving rroTmnl flow.
/t D rates during that period. Large volumes of water have not been introduced into the system recently or as part.of this
I inspection.
1 As built plans have been obtained and examined. Note if they are nct,av Vable with NIA
The facility or dwelling was inspected for signs of sewage back-up, .t
The system does not receive non-sanitary or industrial waste.flow.
`1U The site was inspected for signs of breakout..
All system components;tar lulling the Soil Absorption System, have'been located on the site.
The septic tank manholes were uncovered, opened, and the.interior of the,supticatank was inspected for condition of baffles
or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.,
1 The size and location of the Soil Absorption System on the site has been'determined based on:
Existing information. For example,'Plan at B.O.H. °
Datermined in the field (if any of the failure criteria to
lated to Part C is at issue approximation of distahce is:unpcceptahlr -
f 115.302(3)(b)1
The facility owner (and occupants,if differeri2 from owner) were provided with information on.the proper maintenance�if
SubSurface Disposal Systems.
`e
a
Y'evl.SeCl .9/,1,�98 Page5of11 ,;
SUBSURFACE SEWAGE DISPOSAL SYST11ki INSPECTION FORM
e PART C
'1 SYSTEM-INFORMATION
royp"Address: i I WQ j�(� W��)U tr Wa fTNA '
Owner:
Date of Inspection:
�l FLOW CONDITIONS
RESIOENTIAL:
Design fiow: g.p.d./badroom.
Number of bedrooms.(design):, 3 Number of bedrooms (actual):
Total DESIGN flow. 3
Number of current rescdents:__��—
Garbage grinder (yes or no):
Laundry (separate system) (yes or nok 61 If yos, separate inspec°.ion required
Laundry system inspected (yes or no)
Seasonal use (yes or no):, -"
Water meter readings, if available (last two year's usage(gpd):
Sump Pump (yes or no):- /4fa
Last date of occupancy:_�yaxlete�
COMMERCLALANDUSTRIAL:
1 ype of estzbGshmenC
Design flow:. Apd ( Based on 15:203) /At'/
14
Basis of design flow _ — —
Grease trap present: (yes or no)_ -- - — — —
Industrial Waste Holding Tank present: (yes or no)—
Non•sankary waste discharged to the Title 5 systum: (yes or no),
Water meter readings, if available: —
Last date of occupancy:—_
OTHER: (Describe) ----
Last date of occupancy:
GENERAL RAJ
WIMPING
RECORDS and source of information
Systum pumped as pan of inspection: (yas or no),
1' yes, volume pumped:—gallons
Reason for pumping:
TYPE OF SYSTEM
Xj Septic tank/distribution box/soil absorption system
Single cesspool
Overtiow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed(if known) and source of information: OKA _ Is
t
Sewage odors detected when arriving at the site: (yes or no)ZI/v /
revised 9/2/98 Page 6of11
r
f
SUBSURFACE SEWAGr DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
(k)' p, y Address: , CoTt,uV m .
orotx r: C,j a -t CtlA-U.
Date of Imp-ecoon: V 1 y_Ct C,
BUILDING SEWER:
(Locate on situ plan) I
Depth below grade:
MateriAl of construe •on: cast iron �40 PVC other (explain)
Distance from privnte water supply well or suction line
Diameter �
Comments (condition of join( vg�r ling, evidence of loekzge,Vte,l f n
Iv- -"�� �"
SEPTIC TANK:
(locate on site pl n) r J �1
Depth below grade: N
Material of construction: concrete metal Fiberglass Polyethylene other(explain)
If tank is metal, list age _ Is.ace confirmed by Certificate of Compliance_ (Yes/No)
Dimensions:
Sludge depth: /
Distance from top of sludge to bottom of outlet toe or haffle: v.
Scum thickness: 0 Yl J
Distance from top of scum to top of outlet tee or baffle:—�L/- vl
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined:,
omments: �
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of le kale, a c.lt4
i
GREASE TRAP:
;locate on site plan)
Depth below grade:^__—
Material of construction: concrete metal Fiberglass Polyethylene other(explain)
Dimensions:,_ _ __ --
Scum thickness:__
Distance from :op of scum to top of outlet tee or baffle:_,—_
Distance from bottom of scum to bottom of outlet toe or baffle
Date of last pumping' _!
Comments:
irecommendation for purnping, condition of inlet anti outlet tees or bat les, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.') --
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE_DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSIEVA INFORMAI ION (continued)
®,.gin ; ;�......�,:: �1 v�257bv�{ w��,CoY>�T�lmt�•
Data o1 lRzpmction:
TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of inspection)
(locate on site Dlan)
Depth below grade:_
Maierial of construction: _concrete -metal -Fiberglass Polyethylene. c ther(explain)
—.�.
Dimensions: --
Capacily _- ---— gallons
Des-cn flow:-----_--_ gaflons:Cjay
Aia:m preseni
Alarm level: `_.Alarm in working order: Yes - No
Gate of previous pumping: ,
Comments:
(condition of inlet ice, condition of alarm and float switches, etc.)
rr
DISTRIBUTION BUX:
Notate on site piar.)
Depth of liquid level above outlet invert:
omments:I Vim,"�"' WAS /7eu
(note if level and d`tstrlibution is equal, evidence of solids carryover, evidence lea a into or out of box, etc,.)
PUMP CHAMBER:___
;locate on site plan)
Pumas in working or6er {(es or No)
Alarms in working order (Yes or No)--_-_,_
Comments.
fnote condition cf pump chamber, cordition of pumps and appurtenances, etc.)
revised 9/2/98 Page 3rr11
L— -
t
SLfRSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION I:ORM
PART C
SYSTEM INFORMATION (continued)
z z 'roperry Address:L4) W?l� v"A l) CoiutT,ly)H
Date of Inspection: H") rr Q
SOIL ABSORPTION SYSTUM (SAS):
(locate on site plan, if possible; excavation not required,.location may be approximated by non intrusive methods)
If not located, explain:
tasn.rann pits rul nlf.l P.r'.
leachino.cha,nbWs,nurnber:,_,__.;:,
feb; hsng,gall{ties, numbtar
fa�ching trerrrl,es, nutnbe len�ib.fe:._ i
leaching�fields., riumb'cr, dinner sicns
overflow.cesspiol, nistnber: :'
Name of Te,T.Iogy:
Comm:ent�:
(note co fdi on of oil, signs of hvdr.iulic failures vel c4�onding arrp mil, coi ditio f veg tation,�t�� —
�,
_.. _
/tin Ea — y �tl v lZ �a �r i --' - — - _- ----
CESSPOOLS: �__ ----_..—._.._ -------- -----_-- yt
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer: ;
Jepth of scum layer. e
Dimensions of cesspool' ___-___
Materials of construction: —_
Indication of groundwater.
,,,n,,,., I:Accnnni mi,r5r t,n numnnrf ns nart of insoactionl ----
Comments:
,note condition of soil. signs of hydraulic failure, level of ponding, condition of vegetation, etc.
PRIVY:
(locate on site plan)
Materials of construction: Girnensions:
Depth of solids:
�;onurnents:
-I 'i ,.� ti,,,J..,.1;,. t-.;h, 1.. of of n�n.lin ndi inn of vanmatinn atr.,)
iI,J Ic: l,'Ji�ui u, ivir, ......,. ... r.,. ..�, -. -
1. y
--revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
• PART C
SYSTEM INFORMATION(continued)
Address:q 1 weSTbwrL� U)",Co "T,MA
o.arr,er: C�cjle, i3ofeau�
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
�f
vs ^
,
t
revised 9/2/98 Page 10of11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
/) W�sTb�'ropevtY Address:4 ( WA I
Date of Inspection:-1
NRCS Report:narige _
Soul
.... ...................::::. _
7Ypldal defatfi iu grrxind.wat�r ,
IICr$ fate wehcitp vinitwi
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Cher_k Collar
Shallow wells
Estimated Depth to Groundw--4�3qeet
Please indicate all the methods used to determine High Groundwater Elevation;
Obtained from Design Plans on record
Observed Site(Abutting property, observation hole, basement sump etc.) "
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps i
Checked pumping records
Checked local excavators. installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
I X/z ,
y
revised 9/2/98 Page11of11
TOWN OF BARNSTABLE
41 WESTBURY WAY
LOCATION SEWAGE #
VILLAGE C 0 T U I T ASSESSOR'S MAP & LOT
INSTALLER'S NAME Sz PHONE NO.ELLIS BROTHER CONST . CO . 362-ilf
SEPTIC TANK CAPACITY / m
LEACHING FACILITY:(type) ) Q'- .(size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER UhGG�
I
BUILDER OR OWNE� &AYL6 13OUA(Z�'�l/ � t1C- KCsKcc—
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No 1
o
LJq
a
qq i
I
y~2 gAPPROVED
No........ TH
Barnstable Conservati Depe Faa INQTVWEALTH OF MASSACHUSETTS
ened RD OF HEALTH
TOWN OF BARNSTABLE
Appliratinn for Diri.pniiul Works Tontitrn'inn Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( )"an Individual Sewage Disposal
System at:
--
� r Lot No.
0%.ner /f. Add ss
• ........-- • . ;
Installer Address
Q Type of Building Size Lot------------ .............Sq. feet
Dwelling—No. of Bedrooms----------a-----------------------_----Expansion Attic ( ) Garbage Grinder ( )XV
Pk Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ---------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
AG Septic Tank—Liquid capacity------------gallons Length--.............. Width---------------- Diameter................. Depth................
Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
0.4 Percolation Test Results Performed by.......................................................................... Date........................................
04 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Ltt Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a .............. -------------•...---••-•-------------•------•--....-•-----••---..............._.•-•---..................----•-•-•--•--•---••--••--------....--
0 Description of Soil---------- ---•---•---------•--•---•-•-•----•-----------•---•-•-••--------•-------------....----------•-------------•---•----...---•--------..._...._--•-----------•---.
x
U .......................................................-------------•------------------•.....-•••--------••-•--------------•-------------•-••------------------•--•----••-.----------------------...--•-
x •-- --•------------------------------------•------------------.....-•----........-------•---------------------------
U Nature of Repairs or Alterations— whe a licable- i .X
-� °"`�"- .
-- --•---
.......__
'`..'�.. --2r� ----• � d��=�. .------•------------- --••-----------------........----------------------•------. .
Agreement:--
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental de—The undersigned further agrees not to place the
system in operation until a Certificate of Co been issue2� _04
e brd of health.
Signed .... .. ........ .... .....
ApplicationApproved . ..�A f...... ..... . ....... .................... .................................................... / oat
Application Disapproved for the following reasons: .................................................. ................. . ......................................................
........................... ... ................. �..`/f..q...... .......... ..........................................
G� Date
Permit No. .... ............................................. Issued
. .... ................ ...................I)We......
Date
J
i
c�y'- 2 9
No............. = (� � ,f`S`� Fxs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Apphration for Diripmial War1w Tomitrurttnrt Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (/an Individual Sewage Disposal
System at
/Loc ation btldress .....................................................
O�rner
`�__ — — �L=e��! =! �rf.-Csc y�7�17I
• .............. �a /f
Installer "' d a._......y_... .
Address J /
UType of Building Size Lot.............. !..-.........Sq. feet /
Dwelling—No. of Bedrooms.-.-.---_-�----------------------------Expansion Attic ( ) Garbage Grinder
Other—T e of Building ................ .._. No. of ersons............................ Showers —
a YP g ----•--- ----_.persons- ( ) Cafeteria ( )
QOther fixtures ----- ------------------------••-•-•---•-- •-•------------------......----- ---.------------------•------•------••---•-••------...._----•-
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity-----.-----gallons Length---------------- Width---------------- Diameter................ Depth................
x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
�-' Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................nunutes per inch Depth of Test Pit.................... Depth to ground water........................
GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 De •-•-•-----••----------------•------•-•--••-•--•---•-----------•....------........---......--•---•---•-...............-•-•-•------•-•••-"......-•-------...•
scriptionof Soil---------------•-.....-•---••--•-•-•------------------------........-•-------------•-----
K�.._._.... ------ --------------------•--- --- -----................... --------
U Nature of Repairs or Alterations—Answer when applicable.. %?:�.._..,�sJ ___ / I c��- �--
a
......................C.— ...._...... _.`...._____...._. ____._. ._'�.... _.___.._........._....____._._._..._..____...._..._._..._.._...__...__.__.__._................._..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental —The undersigned further agrees not to place the
system in operation until a Certificate of Compliance •as een issued by�the board of health.
Signed ..:........:::...:--.:. ....... /f ... ............:......... -- r �� r'..
Application Approved By- :..--lx�±l_ ./ "� ..................................................................... .....eL� �� �f..
Application Disapproved for the following reafons: ... ....................................................... . ....................................................
.................................................. .-- ..... .. .................... -- .. -- -- --............ .. -- ........................... ........................................
LL,, Dare
Permit No. --- ----- -C. .............. Issued
............
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
. V�E�i�i.CM�E II� V-II1tt��t�IritP
'THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ........ :.1..... �a�g - �.. - - ...._ _.Gcv...!..5.. ......._............
Installer
✓� -
at --------..._ ........!/r/ .. -- --- ------------ *....
. ..........................................--------
has been installed in accordance with the provisio�n�f TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Term it No. (r.L f...-._?.. �f_............ dated ._..._...� �/s�..._..._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..........::............... r
....... X........ ......... ------- Inspecto
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE ,
No._._...... FEE............... --_.....
�i��.u�tt1 ur1a� �utt��r�r#Uan �rruttt
Permission is hereby granted--- -----_------_------ -----------------------------------------------------------------------------------•--•------••----------.-•---
to Construct ( ) or Repair v<,an Individual Sewage Disposal Systreemm
at No.....•.........j r / s-�✓J% _._ /! .� -- = ... ./.•---------•----------------•--•-•--••---..............
� Street
as shown on the application for Disposal Works Construc'�tion Permit No.��� �-�-_ Dated._���f��Y....___......._........
c-�
..!_ ��----�.----e- —.-. ...........-------
/! .__.... -•----......• Board of Health
DATE e�/--• ---
FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS
No....�r`'��"z..... FEs..... ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
OF........... Y
Appliration for Disposal 18orks Tonstrurfion,, Prrinit
Application is hereby made for a Permit to Construct ( or ) an Individual Sewage Disposal
System
obdd. ._ ...._...-• 2z-_. ._.
�C Addre or Lot No.
j sx,
---...... 17Z r Address
•......•. ....--•---•--•----------------•-----••••-•-ler Address
d Type of Buildin Size Lot... 7-. � __Sq. feet
U
Dwelling�No. of Bedrooms..n------.f-----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________•.__-_•- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P4 Other fixture
W Desi n Flow................ __. .-,.-gallons per person per day. Total daily flow....._..... t�--YJ
g -J ------------- --g P P P Y• Y x�--• ---- - --------------gallons.
WSeptic Tank-L Liquid capacity -gallons Length---------------- Width...... ..._..... Diameter_............__. Depth-------------.-.
x Disposal Trench—No..................... Width .........p otal �e�ng�th ...._. _. Total leaching area....._..............sq. ft.
Seepage Pit No.../............... Diameter. ?--- ept o0finlet,..._.____._.__..... Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tankI-A ( ) C . /0cI
a Percolation Test Results Performed bY-------- ................................................................ Date-------------------------------------
Test Pit No. 1................minutesp er mch Depth of Test Pit.................... Depth to ground water......_-..._.---..------
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
tion of Soil._...-.--_-____. a-_ f
P - f
O Description cs'+
x
U
w
UNature of Repairs or Alterations—Answer when applicable.................----------------------------------------------------.--------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed I vidual Sewage Dis System in accordance with
the provisions of Article XI of the State Sanitary Code T undersigned furthe agr es not to place the system in
operation until a Certificate of Compliance has Fen is the board of h
Signed : ------ -•-•-••-•--- •. •-•--•-- ---------- ---- - -- � 113,
ApplicationApproved BY---------- r— . ............... ----- •----.. -- . F........... - ----------------- -------------------
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------------
-•--------------------------------------------------------------------------------•----------------------_-_____------•-•----_----------------------_-__•-------___--_-_-......-_---___......---_-------
Date
Permit No......................................................... Issued---�- ----�
---------------------
Date
`-' — --------------- --- — - --
No....... Fx»............ .. ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEAL .
T k-j
........, ......... .. ...................OF..................................... --
I
Apphratiott for Rovoottl Works•-Tottutrurtiott Prrutit;
AP li tion is hereby made for a Permit to Con truct ( or` air ) an Indi dual S vage` •i al
y?4rdf
.. ..... 7t on Addr
-..... ----- ------ -----------•---- --•---. -------- -- ---------------- •.� -____--- ---------
'ner _ Address p
s s
-- ------------ ..................................................... ..........
:................................ ......... d 5 ._......
f
-=' - ••.
Installers Address t"
UType of Buildit -�� Size Lot............................Sq. feet
Dwelling—No. of Bedrooms__ _______________________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Byuilding ____________________________ No. of persons............................ Showers( Cafeteria
3 Other fi u -. . - "------•_---------•-•------•.
W Design Flow.............................._ __gallons per person per day. Total daily flow---------------------------------------------gallons.
]x Septic Tank—Liquid capacity------------gallons Length---------------- Width___-____--- _._ Diameter---------------- Depth-----------_--
Disposal Trench No.................... Width.................... Total Length -_ Total leaching area....................sq. ft.
..,. Seepage -----• Diameter___ - _ ) i� ;leailg area sq. ft.
See a e Pit No _ _:___.__ � __
Z_' Other Distribution box ( ) Dosing tank ( )' .
�]
Percolation Test Results Performed by--------------------------- --------------------------------------------- Date----------------------------------------
;- Test Pit No. 1................minutes
.per inch Depth of Test Pit.................... Depth to ground water-------------------------
�Tq Test Pit No. 2----------_.....mmutes , inch ]�epth of
w .9est Pit..:__._. D nth to ground water-------------------
�/ f -1-+' JJ .,.' "` x.:'l•�............. - #,
...._._ _..�___ .__ _____ ........................................................ ...
DDescription of Soil..........................................................................................=----------------------------------------------------------------------------
x
-----------------------"------------ --------•----•...--------- ---------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable._______________"---___-_"--__"________________"___--_-------------------------------------
---------------------------------------------------------------------------------------------- ....
X Agreement: 4
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 A dersigned further a not to place the system in
operation until a Certificate of Compliance has be , •ebyr, e board of health.
:;�4V
_2V---
ApplicationApproved By--------------------------------......................-...-........ ........................
.._..Date
Application Disapproved for the following reasons:.................................................................................=..............................
S •-----••-••--•--------------------•--• ------------------- ------ --...••--•------------=••------•----•....•----•-•-•---•---------------•-------------•--•••--------------....._..------_•-----•-•••-•--
Date
PermitNo......................................................... Issued--=- - ......................
Date
.....� pum.;aa;.aTµ'"�•.'"1.}"#YF'.&''s''lre."'�� -A+"S4d't:-°"'+ew,�.^+^•.� � - -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 4� f
, ............oF:.:. ............................
%AT
utdifirate of Toutpfiuua
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( , �Repaired ( )
bY-----------------_-- �- ° x--4------------------------
r ;.A Installer �..
------------------------------------------------------------
has been installed in accordance with the provistons of Arti4e' XI of The State Sanitary Code as,described in the
application for Disposal Works Construction Permit No...,A-_ J ...... . ............ dated"_- �' ��
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. ��
DATE S - ------------------------ Inspect ,�- �- •-,� ._.+•---------
e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.... x .............
No....
Ropooal Morkii TWntitrurtion rrutit
Permission is hereby granted--------- - --•-
to Construct (, �r-crt''Repair ( )' an,,fgvidual Sewage Disposal System
at No..... t == ---.. i .__.. -. � �r" l. 'a t.s s is , m't r ° ��tteet x / .
as shown on the application for Disposal Works Corstruction Permit No _A :__..._ Dated___ .?_>.�' --W,
;.� r �*
+ � �' Board of Iiea5tl�
,a L(
DATE = } ---•--------•-•------••----
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
ASSESSORS MAP : �� _.
µ� --------------__ - _-__ 1 E S i {-{0 L E L 0 G S
PARCEL: � ��
_ .... 1) 'I he installa(ion 511,111 comiA willt 'I'itle V arr-1 Tom) of, )omd of
. -_... ... .
FLOOD ZOIIE:. _.._ �/ �CJ9►� SOIL EVALUA•i OR : I 1 Gt I lealth Regulalions.
—_-- _ . _ WITNESS •.M 2) 'I he installer shall verily the location of utilities, sewer inverts and septic
11EFERENCE: -+ '
DATE:—.CY components prior to installation and sclihi g Lase elevr ('
PERCOLATION ItA�CE: L 3) All gravity septic piping to be 4 inch Sch 40 PVC at I/8" per lout. 'flee lust
two feet out or(lie d-box to the leaching shall be level.
�� 2 Z�7 � _ _ --- 4) 'this plan is not to be utilized for property line deterutinalion nor ally other
_-- ---__------- TH- I TH-2
purpose outer than the proposed systems installation.
5) All septic components must meet'1'itle V specifications.
6) Parking shall not be constructed over II 10 septic ens g 1 t cc mpon s.
mama 7) 'the property is bounded by property corners and property lines.
tUlto, y ►' to 8) The property owner shall review design considerations to a > )rove or total
LOCATION MAP 'tv '�J V7 design flow and number of bedrooms to be considered for desiReceipt
n._ g
W, of payment for the plan and installation based on the plan shall be deemed
approval of the design flow by the owner.
0,1 G� 9) '1•he existing leaching or cesspools shall be pumped and filled with material
t ��
per Title V abandomtemt procedures. Those within (lie
proposed SAS shall
be removed along with contaminated soil and replaced with cleats sand per
�� I 'title V specs.
4140j �WV K 0 �j 10)System components to be 10 feet from wafer line. Sewer lines crossing the
water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if
—! �/ lJ - applicable. 'Ilse proposed SAS is being installed below the water service
Z-7. Z 7 line. The lime is to be sleeved as a('orementionecl and main(aimed in place.
SEPT I C SYSTEM DES I GN 11) If a garbage grinder exists it is to be removed and is the responsibility or the
\ owner to ensure such.
FLOW ESTIMATE 12)'I he installer is to take caution in excavation around the gas line irsuch
exists.
3 BEDROOMS AT //0 GAL/DAY/BEDROOM - 5�, AL/DAY 13)The installer shall verily the location, quanlily and elevation of the sewer
—' lines exitimp the dwelling prior to file installation.
SEPTIC TANK 14)T his plan is representative only that a system can fit oil a property meeting
Title V requirements.
���GAL/UAY x 2 DAYS ��3L GAL �� ��;;
' G US L IO�D GALLON SEPTIC TANK(D� L,,,..1 'r
f
SOIL ABSORPTION SYSTEM
r
C�
C�CI G '� 1�S i�-I 1� ►�,` a�,t,
1 � \
DAVID
f
v S 1 DE AREA: ?���
+' ti IVIASON
BOTTOM AREA: .
M o SEPT I C SYSTEM SECT I ON -�" y 'y•
- - 03 —�—
l �lrrt
lop (OW000(
i J
h� .ga lu �. sirs ---
Z' loe
GAL ,' 1�Alm , =�= O
�-• � SEPTIC TAIJKPEP
11T
3 SITE AND SWAGE PLAN
LOCATION : L w
lr
00
PREPARED FOR : .j 1jp
HV �,4 11,2
SCALE:
Ne W
DAY I D. B . MASON(RS DALE: IDIZ112DI5
o
DBC ENVIRONMENTAL DESIGNS
a EAST SANDWICH . MA
DATE HEALTH AGENT ( 508 ) 833- 2 177
-