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HomeMy WebLinkAbout0113 CANTERBURY CIRCLE - Health 113 CANTERBURY CIR HYANNIS A = 249 126 i j t TOWN OF BARNSTABLE �,,� LOCATION//� ,��(,� j dG'�SEWAGE ACROIS IY VILLAGE _Qy�Oj ASSESSOR'S &PARCEIp�' INSTALLER'S INA-ME&PHONE NO. SEPTIC TANK CAPACITY , j/Gy� LEACHING FACILITY.(type)JZ hDS-,4f C 34 (size)f X NO.OF BEDROOMS j OWNER 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) J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �e V DO NO. N THE COMMONWEALTH OF MASSACHUSETTS FEES BOARD OF HEALTH = OF APPLI ATI N FOR"DIOSAL SYSTEM CONSTRUCTION RMIT C OApplication for a Permit to Construct ( ) Upgrade ( ) Abandon ( ) - ❑Complete System :�ndi,idual Components L Owner's Name = Map/Parcel# Address ^^� Lot# hone /GdfGC� Ctaller's NSA s/1 Designer's Name De �.Telephone:#' e Telephone# Type of Building: 04AM*nwwo) Lot Size Sq.feet Dwelling—No.of Bedrooms �4=11 Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. equi ed) gpd Calculated design flow� gpd Design flow provided gpd lil Plan: Date Number of sheets Revision Date Title Description of Soils) Soil Evaluator Form,No: Name of Soil Evaluator Date of Evaluation DESCRIPTION OJFREPAIRS OR ALTERATIONS The undersign d``grees to�i tall he above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu r a rees not lac the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date ns�"p�trmts q) V 1 11 11 1 VV V FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 NN DO No..'� THE CONIMONWEAL.TH OF MASSACHUSETTS FEE , v f , B OAR D 60 F HEALTH O ",O F +/ \ APPLICATION FOR DI , OSAL SYSTEM CONSTRUCTION ERMIT Application for a Permit to Construct ( epair ( ) Upgrade ( ) Abandon ( ) ';E]Complete System &Kndividual Components f _oFati Owner's Name / y +� 1 Map/Parcel# Address Lot# hone^ S�tallller's N)W4�J�•••� Designer's Name(� T Telephone# Telephone# Type of Building: 12JbI OkA4rl� Lot Size Sq.feet Dwelling—No.of Bedrooms Z5 Garbage Grinder ( ') Other—Type of Building No.of persons Showers ( ), Cafeteria Other fixtures may, Desi n Flow min. e ui ed �/O d . Calculateddesi n flow d Design flow provided x d g. ( q ) gP g gP g P . Plan: Date Number of sheets Revision Date ( Title ; ti Description of Soils) �.. Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation , DESCRIPTION OF REPAIRS OR ALTERATIONS 4 �,. 1P V I KIM I/— T ' The undersign d grees to i or above:described Individual Sewage Disposal System in accordance with.the provisions of TITLE 5 and further a rees not lace the system imoperotion until a Certificate of Compliance has been issued by the Board of.Health. ., Signed A01V A /1 Date f/ �r ! - '--Ii s`pections 0. v l� �,- � �l �/ v lf' / 1!: FORM 1.- APPLICATION FOR DSCP DE'P APPROVED FORM 5/96 No. E COMMONWE LTH OF MASSACHUSETTS FEE t7T? BOARD OF HEALTH CE TIFICATE OF COMPLIANCE Description of Work: ndividual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ,Upgraded( ),Abandoned( ) e by: C�x"f r�-CJ l km_ � at has been installed in accordanc w't��t�tt `e' provisions,of 10 CMR 15.00 (Title 5) and the approved desig p a s/as-built plans relating to application No t dated Approved Design Flow�(gPd) Installer Designer: Inspector ". .Date .. The issuance of this certificate shall not be construed as a guarantee that the system:will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 ry No. �I -I THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTR ® CTION PERMIT Permission is hereby ranted to Construct ( ) Repair ( pgrade ( ) Aband n ( ) an ' dividual sewage disposal system at /.0 4 as described in the application for Disposal System Construction Permit No. da ed Provided: Construction hall b com feted within three years of the date oft s errni eal Condit 0 svnust be met. Date ! fX!//,�� Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 rM FORM 1255 (REV 5/96) H&W HOBBS&WARREN PUBLISHERS- BOSTON IX Town of Barnstable 'THE Regulatory Services Thomas F. Geiler,Director Y ► Public Health Division �Ar1639.�A`` Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508'862- 644 Fax: 08-790-6304 Date: )4 U 701 Sewage Permit# Assessor's Map/Parcel2Aq �� Installer &Designer Certification Form 1 &WkmAk,Designer: AP iv6 Installer: C , ii r W� Address: ��t� !��,���, Address: On �t 6M41 was issued a permit t p o install a (date) (installer) septic system at 3 �� based on a design drawn by (address) cJf1A 0 )A r V dated (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. Stripout (if required) was inspected and the soils were found satisfactory. -- --- ----- ----I-certify-that-the-septic-system-referenced--above-was-installed--with major-changesjii.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 R '-r.ions. Plan revision or ce Tied as-built by designer to follow. Stripout (if rP- cted and the soils we 'e foun ati factory. OF M,gSs DAVID B. nstal ignature) MASON 0 ,9 No.1066 y� II Is7 / �es gnature) �,�� PLEASE RETURN TO BARNSTABLE PUBL._ OF COMPLIANCE WILL NOT BE ISSUED UN t m -qv i n 1111N FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoftice forms\designercertification fonn.doc Q ��s Town of Barnstable P it U '3 r �IVWE �pvQ Department of Regulatory Services . ,wrwsrem.e,i Public Health Division Date saes. p, 167y. 200 Main Street,Hyannis MA 02601 �'�FD MP'tp l ,�v j ) Date Scheduled 116 ✓ ) Time � + Fee Pd. Soil �V�Suitability Assessment for e Disposal /(y��_'xn Performed By: > 1�� PJ Witnessed By: , —v LOCATION&GENERRA/LynINFORMATION_ Location Address Oil n V/^ Owner's Name fin- •/ 0 � /f Address Assessor's Map/Parcel: 149 11 G„ Engineer's Name, NEW CONSTRUCTION REcP•A�, , Telephone o -1 I Land Use Slopes(%) Surface Stones Distances from: Open Water Body It Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) «l Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date_ Time Observation Hole# �l Time at 9" Depth of Perc A�... Time at 6" Start Pre-soak Time @ •�•'�I`� Time(9"-6") End Pre-soak 4� �^ V Rate MinAnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC f 11 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders. Consistent %Gravel WDI 1 . I 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) i 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.%Gravel) Flood Insurance Rate Map: Above 500 year Flood boundary No Yes! Within 500 year boundary No s Within 100 year flood boundary No Yes_ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious iripterial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth4enta lly occurring pe ious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environotectionandth th above analysis was per" ned y me consistent with the required tr�exlertiseAd experie a sc b in 310 CMR 15.01 . Signature Date 3 Q:\SEPTIC\PERCFORM.DOC r No. ' Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0ppfication for Mtzpaar 6pgtem (Cow6truction Perron Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 113 Canterbury Circle , Hyannis Pamela Bouyonas Assessor's Map/Parcel 77 5—9 0 4 6 Installer' am A s d 1. Designer's Name,Address and Tel.No. wm. '. Ro` `�i Q� ' optic Service PO Box 1089, Centerville , MA 775-8776 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 Sand. Nature of Repairs or Alterations(Answer when applicable) New D—box and 2 leach chambers . 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 is azd of He th. n Signed J1 ` 4 Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued �. Fee 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 'PU.BLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 'Application for Oigaaf *pg;tem Con.5truction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 113 Canterbury Circle; Hyannis Pamela Bouyonas Assessor's Map/Parcel 775-9046 Installer' am A rass d T 1 Designer's Name,Address and Tel.No. wm. '. to lz� ON.• %Ptic Service PO Box 1089. Centerville, MA , 775-8776 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. PlantDate Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand. %Ci 9 Nature of Repairs or Alterations(Answer when applicable) New D-box and. 2 leach chambers.- 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 is Board of He th. s�� Signed% L4 a. Date Application Approved by /A.'� Date is Application Disapproved for the following reasons Permit No. Date Issued U ———————————————————————————— • — —� ..—————— - THE COMMONWEALTH OF MASSACHUSETTS ,. Bouyonas BARNSTABLE, MASSACHUSETTS t� Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by Wm. E . Robinson Septic Service at 3 Canterbury 1re e,,, �y nnis rJVIA a en constructed in accordance with the provisions of Title 5 and the for Disposal Sy fern`oristruction Permit No. dated ^' Ittstaller inlm. F . Rob ins o#�[``� 1. ( Designer__ r r The issuance of this permit shall not be cons ru d as a guarantee that the syst' Alw ,function as desiggnedf Date /�l � C7 p ` 1 tr '�/� �� �'i 1 'Im V ��Ins ector �j � / /! /� i s% r t et No. ! "'�--�-------------------------Fee $50 — THE COMMONWEALTH OF MASSACHUSETTS � PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Bouyyonas Mi5po!5af 6potem Construction Permit Permission is hereby r ed o C struct(( air(X U ra e( ) ba n( ) System located at antler gt�ry) t,ire le), y nnis�', 1�i and as described in the above Application for Disposal System Construction Permit.The applicant recogni es his/he duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructio. must bb/c�ompleted within three years of the date of is`eretnu't ©' o Date: (/!L Approved by �( � L�✓, f i TOWN OF BARNSTABLE LOCATION� C'Atj t 2 h, ay Grze I - SEWAGE # - vn.LAGE t�Q ASSESSOR'S MAP& LOT f INSTALLER'S NAME&PHONE NO. 4 AM F 26gd,,Jc;CV0 .Soh"r -775-9"7 7L SEPTIC TANK CAPACITY 1, 600, LEACHING FACILITY: (type) q S (size) NO.OF BEDROOMS ;t - 3 BUILDER OR OWNER PERMTTDATE: 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 I Furnished by � S r� 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) -' I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated e7 concerning the property located at 113 Canterbury Circle, Hyannis, MA meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)To of Ground Elevation(according to the Engineering Division G.I.S. ma 4 p ( g t� g p) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNEDL/ DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). `� r Y i 1 `�` i� Q 1\ TOWN OF BARNSTABLE LOCAThN i iAE a. C SEWAGE# -D.F r flit VEU.AGE N t S ASSESSOR'S MAP & LOTaIfy INSTALLER'S NAME&PHONE NO. (,As►'1 � R®�e tiD Sc��� S���11 '7 -T 7L SEPTIC TANK CAPACITY I, Cafe LEACHING FACILITY: (type) (�k--((; (size) X 1 V ?t- oZs NO.OF BEDROOMS a = 3 BUILDER OR OWNER PERMUDATE: COMPLIANCE DATE: L bi In —T 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 cry r c� 0 A / c i G � o 1 i f b O O � b o -� LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAIVE & ADDRESS r+ / � ass .0" c, BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED , .,�� /__ �_ _\ � �• .. ; � � �� _� �� , "rr .� ', I - i - THE COMMONWEALTH OF MASSACHUSETTS �— BOARD OF HEALTH . ......... ...............:................OF...........................------.......----.--•---...---------.......................... Appliratiun for Diupuual Works Tatuitrnrtiun nutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal I JS•=�st..e.m�aft '�rP_/. i!`. o• ........................... / or---L--g-.•----. ..................... ...... o�yy .. .a.. AdresOw ............ s r. ..............................:...... - ........... O(/f? Installer Address •Hype of Building\ Size Lot-----------------------------Sq. feet U Dwelling—No. of Bedrooms ..... .. .....Expansion Attic Garbage Grinder (/F43 Other—Type of Buildin �" ..1 5�.n'�,No. of ersons............................ Showers Cafeteria a yP P ( ) ( ) d Other fixtures .. ---------- ------------------------------------------------------•------------••••--------------. ---------------- -- W Design. Flow.............. ..: ... ..gallons per person per day. Total daily flow.......... . ..................gallons. R; Septic Tank—Liquid capacity/E.'vT>.gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.... sq. ft. Seepage Pit-No......✓............ Diameter.......6.XZ. Depth below inlet.......4.......... Total leaching area..................s . ft. Z Other Distribution box (� Dosin tZ ) �' •r Percolation Test Results Performed by.-. 17-1 ?' ..:.............................. Date... Y/ ._..._..... a Test Pit No. 1................minutes per inch Depth of Test .................... Depth to ground water..--.................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' -------------------- e.............. - ------ O Description of Soil..............0--......C�.............-- ,�f --/� � -Y��a�=- �-----------------------•-------•-•-----•---•-----•-•--........------------- .............................................LZ=/l/------------..°J. �Jf.. .:166- :S --•-------------------....-----------•--•--•--....._......---•--•.......____... U 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 TI ITI L,;. 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 li h. g -- ------------------•----•-•----••--- •....-• --D--- .... ... ApplicationApproved By...... .14-------------------------------------------------------------------------- ............/Z-... Date Application Disapproved for the following reasons:-----•--------------------------------------------------------•---------------------------------...---•--------• ---------•-----------------------------------------------•--..............--------------........-•-•-----...------......----------------------------------------------------------------------- ••...... PermitNo...........V. -...•.. Issued_.-•----................................................Date Date r THE COMMONWEALTH OF MASSACHUSETTS ^ [/ BOARD OF HEALTH OF.................................. ... { T , .Vvlirauvn for Disposal Works..T wtrurtinn Vomit �.+A, Application is hereby made fora Permit to Construct ( �') or Repair."( ) an Individual Sewage tD sposal �system at* kA... .........6ck......... . ..... AAA,� . ►!� _... tioijAres ,CQr -o - - Own 61 r `---- 0-11 v� d il i"�� Installer Address !` :d Type of Building_ Size Lot Sq f �. Dwelling 'No. of Bedrooms._ i _____Expansion Attic ey Garbage Grinder ( a ` ' Other—Type. of Buildin I' �. ..►°RNo, of persons______________ ___________ Showers ( ) — Cafeteria ( ) Other fixtures .._ ................. ............................... WDesign,.Flow._..._ •. ; gallons per person per day Total daily flow_..___._ 3........................gallons. W. Septic' Tank—Liquid capacity./ gallons Length .._ _.._.. Width.................1,,Diameter................ Depth ___._._._... x Disposal Trench s No..................... Width............ v T otal,Length_____.._____.......: Total leaching area...... _ �'_.tsq. ft. �. Seepage Pit No....... "_....__ Diameter.__._._�. DeptlfRAow inlet___.____ Total leaching area.................. ft ._....... s . . Z Other Distribution box ( '' Dosm a ( ) '-' Percolation Test,Results Performed by.. .__._._ __. Date Test Pit No 1 :...........minutes per inch Depth.of Test P .................... Depth to ground water........................ (z, Test Pit N6.j`2.._... `_.____.minutes per inch Depth of Test Pit ........ Depth to ground water________________________ O Descri tion of Sol.___... ...__ '�• ..... �t!!'L._ 1 P _ f ____________________________ r•__ — __ __•.,N .__ ___..._.____ ,f *, :' a r''cr� U Nature of Repairs o. Alterations—Answer•when applicable'^.____. ............................-•••••------- - ---------- - -- Agreement. The undersignedxagree's to install the aforedescribed� Individual Sewage Disposal System in accordance withx the provisions of TITLE + j`of the State Sanitary°Code—„The undersigned further agr es not to placetthe system in Op until Certificate�of Compliance has been issued b t B ,,.o�a�rd of hea Signed ��l .i .................. -- �I 4 F. I TJ ..AD A Application Approved Bap -------------------v--•----••••...._...........••••_•---- _y Date Application Disapproved for the following reasons: •-•--------------------------------------- =----- .._._....--------••••- - ----------------•-•-- ------•--------•----•----•-------...•• •••--••--•-•••_•- y °.' Date Permit No....... ... '......... Issued-_ ......................................... -_...- Date „' ," THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. :.......oF...... ...,�* b�c ... ....................................... ' .,� � �f�rrfifirtt#r of f�nnt�rli�nrr ' ' • THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed'-( or Repaired ( ) by ..• .......- -------------------------------------------------------------------------------------------------------------------------------------------•--------•--- --------•- I taller 'at ----_--••• °`-- ---- .. -•- �i. _ iG j � .k C//le L 14�has*been installed in accordance with the provisions TImLF r of The State Sanitary Code as de bed in the y application for-Disposal Works Construction Permit To ________________ dated / :_ ................................ THE ISSUANCE-OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. /� . .--••_....- •-•---••--•-•-_--•. Inspector.• DATE..... J !y_ THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF ;:,H,EAL -y ._..... .............................................. g No........: .......... FEE....e �'— Dispn1lat, nrkn Tnnntr inv anti : .... Permission is hereby granted.......... •- ----------------••••---_--•-- -...•--------..._----.......----......... ............. to Construct (A) or Repair ( ) an Individualewage Disposal System at No................. ?�==:' --------...... t,.k cllle G e .....••..... Street s as shown on the application for,Disposal Work Construction Pe`r ii`t.,No.:___ 1 ___ Dated..... ✓...� �7. 7 = i Al�, ��,t� 'ak. Board of Health DATE------------------------••---------_--•• ------ =- 1 FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 1',A r t A. t 1 N rgr ; ; t," i ?,` EX; ANS/oA/ Le rch. # fir � r�ra , s F ��� y �� � �► I ka P/ST,' .SEP rtC i ask d! Y -- f` It 7 T Zvk - .r ����'"a f •ro rk 2i 70 s 'u Ir � ij i t} t WW N � w nl T� r. v 2 y C C L: ; 3 t £p ' ♦s x N of Mgss c' r 1 b� ROBERT,' �G P. BUNIKIS v, No.22162 O �n s w, k• p IST FSSlON.4V E:: IS,T1. '4 �OT4,EL-�i /V,ATi ,y n 0.__ � r_� � - ' �RTIFIFn,_ p�-Cr ni �,A k -v A ��♦ •s r.i:ey;F? .k:k k - -.,-_ -' "' , k if`yA'��1--,.,�. ` FI,Na,SHE ;: SP0T EL,EVA:T:10N, L-.CT 21. C�4W7-Erl `8U2Y C re FI Vll . ED CONTOUR; I0.-0� y11+/tV/fl/s . �> Ate 0 V E D BOARD OF H EALTH' ' I Nelf 1r a ASS =AGENT SCALE .. / _ 30 r DATE !o f k t QMRED6E ENGINEERING CO. /NC`IC L i E TBr�s1 Ny I CERTIFY THAT THE -' PROPOSED r EGI,5TENE REGISTl:RE01 JOB NO. 7,_,o �.. BUILDING SHOWN ON - THIS --PLAN '=r p CIVIL LAB::) vFNEER� S ! CONFjO,RM.S TO THE , ZON!NG LAWS j SURVE OR- DR. 9Y -- OF BARNST-ABL E , 1�A S . d ---f 3 1"�NC MAIN ST E 7!� ° N ,i,ti T CH. ! Y R , P. 6 - a 7 S0 YAR' OUTf MAS:. HYAN�N! MA` 1 / t/ E T _1, O F r; R.E G } D � ., - �R SURWEYOR - zr ft, -do P17 -7 ''CA00 V, IV YNO, S)v wJA1 '0AI I S/,,D 91zz SIXINns ilU 'd 7-911 kv 2"9 838 �.x 0-7 o 2 Y w -9 M.1 V G7 7 7 W-L Q ;SU V.V A(0/4,L V 70 D 3V_;� 0-7 7. ,f7j/-, C, S_L7r17S_9Y :z -7 H(7/,q _L r:7-4 7/OS 0 .31.VC .-7t W4AII.Lgq 76�'ICI 710S S_ 0 'C7 a-:F�L 1,9;M1 77M9 - 007 7/09 SWOOYC_-79 YO YgV.4V,?IV Z/ V Ncl-C NgI.-V to AIOIJ-tp'7/79V-L —7-A-5- W A�g 7W�90cl-91C _-79telkfff�9 -77/V/ --yo 1VC)1_L.:7Rsl .979DIL W.9,_LVA4 CAVOOYD 4'4 r�7 9/V/C77//79 LV X99"All -7.7 j_Y.7,tl/Yj A 1176�7 &0 Z g!9 t z g v A I& C i... ri , --- Y:,Ulv-lit I-V C) _7cf/e HGaf/ g --------s Cci 4 L /f - /7617 jf� 7zWA97 r7l D c7 IV-V-.5 /V V-7 7 -woo: 'A be,'K-7A a V/ C 7=7 S-/7 _-7 6 7-7 A/08// -L 5 WO AA V_-74Le 1HI*170&61 _-79, 7 7 WIYS' /y/kv -r_-7e7 Va/­ 0/-Z 3_4 ON ASSESSORS NOTES: � LOGS TEST HOLE PARCEL: i-, l . .. . . • " pr SO I L EVALUATOil: I �1v�✓ C ) F LOOU ZONE: I 'l'l,e installation shall comply w,tl, title V and 1 own o 47W Board c �1�.-- �-�Pc�IC�}� llealtl, Iteg;ulations. IIEF ErtENCE: WITNESS j�'�(" (� 2) 'I'l,e installer shall verily the location of ulilities, sewer inverts and septic `}�J.— _. _ DATE: �. Components prior to installation and setting; base elevations. - l 1 Z_I Ij PEftCOLA r I UN RATE:E: -�- 'Z 1 1 1 , 1 l , '`� 3) All gravity septic piping; to be 4 inch Sch 40 PVC at 1/8" per loot. '1"1►e First �� �_ 1�, 1 1G two feel out or the d-box to the leaching;shall be level. 11I- I �, 11-1-2 4) "l'l►is plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. ��,1A, tvv (p t l I 5) All septic components must meet'l'itle V specifications. la �� 0 �b t G) Parking shall not be constructed over I110 septic components. Lo 10 7) 'I'lie property is bounded by property corners and properly lines. LOCATION MAP lj 10� 00' 8) The properly owner shall review design considerations to approve of total ` 4Jv design flow and number of bedrooms to be considered for design. Receipt /^ p� of payment for the plan and installation based on the plan shall be deemed n "✓ n CIA approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material 1 per'Fille V abandonment procedures. 'I'hose within the proposed SAS shall be removed along wilh contaminated soil and replaced with clean sand per yap'1` y�l�1` Title V specs. �- l lee li m water line. crossing (lie �� � �lt,,1 � 10)System components to be 10 t o , . Sewer Imes c,oss, g, water line shall be sleeved with 4 inch SCI 140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as alorementioned and maintained in place. ?� � � ,� S E 1 I C w S Y S T EM DESIGN ( 11) If a garbage grinder exists it is to be removed and is the responsibility of the 'C __7 owner to ensure such. t FLOW, EST I MATE 12)'fhe installer is to take caution in excavation around the gas line if such ' exists. BEDROOMS AT I� GAL/UAY/hEUROUia - GAL/DAY 13)exi installer shall,verify the location, quantity and elevation of the sewer lines exiting the dwellinflirior to the installation. SEPTIC TANK 14)'I'his plan is representative only that a system can lit on a property meeting ��J GAL 'fide V requirements.�GAL/DAY x 2 DAYS ��;; USE In GALLON SEPTIC TANIt�� 5r,, r\) SOIL ABSORPTION SYSTEM I w... U`d _1?Ql1J,1- 2 W < �fl Aab Zj�o U�fT� - t °F M b V40 c���Yi 4, 1 , (10I UJ Gooft-05 o��J DAVID syi yl M f o a Gov P t✓ 5 x L,�X Zo I _ _ _ .._ i x 0.7 SEf' T1C SYSTEWSECI' ION LfNiv �►/ — — _ ,� IOU 1nO GAL ;J/,✓ W SZS SEPTIC TAIJI( �x�l, 06100 SITE AND SEWAGE PLAN - LOCATI Q14 : � I �Z. C2,wi—C, 11 P R L"P AR E D FOR M SCALE : a ()AV I U [3 . MAS01i fk'2 DATE: � ly DBC E14V I R014ME1�'1 AL DES I GIJS 5 f:AST SANDWICH . MA DATE IIEAL1H AGE14 f ( 508 ) 833- 2177 Z