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Home My WebLink About0210 CARRIAGE ROAD - Health f 210 Carriage Road ' Osterville 071 016 q - -- - - TOWN OF BARNSTABLE J� LOc ATION ACe SEWAGE #o?B04'05Z VILLAGE, 0 - IV � e . ASSESSOR'S MAP & LOT 7 INSTALLER'S NAME&PHONE NO. 02 H0-er--,11QTccr-- W L9- -9 SEPTIC TANK CAPACITY /1Q0 6191 ` c2/Co'' eld;T' '7'LEACHING FACILITY: (type) 6j06(j910H,1)rhbc-as (size) NO.OF BEDROOMS BUILDER OR O ert r WO 7 .�2- PERMITDATE: LI`13`Q 1 COMPLIANCE DATE: - 12310 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 I � � i 5 ' a � a 7t� 5 \n t No. r Caw r Fee�� THE COMMONWEALTH OF.MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Migonl *p9tem' Cougtruction Permit Application for a Permit to Construct( )Repair( : )Upgrade(Y)Abandon( ) El Complete System El Individual Components Location Address or Lot No. 21 O C/4 R W Iq IZ D Owner's Name;Address and Tel.No. OsrtE2VlL.LUI t"�S N1laRsHl9L iZEcne,rn Assessor's Map/Parcel/n �..I V C fi PriAG L' R N• iV O M• 'rR 7/ P?� li$ Egst r!o9 $t, Ni=1.v_-11UF2K� �°Y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.50 S- 3 3 4 .5LII..L i✓Ar- LflVPI rViSC-iZ /� vJlvu /V14`allt) �. 7 PArKcR MD. CQ S't-eavi L.Le- A'/4 S S Type of Building: Dwelling No.of Bedrooms L4 Lot Size 1• Ll S A Garbage Grinder(Y4-S Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 40 gallons per day. Calculated daily flow Lf Lf 4 gallons. Plan Date 3/4 M, 9 g 2.00 14 _Number of sheets I Revision Date Title P P_o PU 5 L D S€P tl e- L4 P6-rA DE Size of Septic Tank 1500 Cr/9L Type of S.A.S. 12'AS_4'L a4CH1t C-ChgmBt 2 c Description of Soil 1©"-&" L 61;1X, &-i'� Baw. Co,4�E.�1qA D 10*l R e/3 , rX`-34 SIB' Ye-L'ISH Bt2w• C4RrsE s�?�vp If_,YRS �, 31f''-- yg" •13c 13rlv 1sl�/ %IeL• 6c>A�s s�9ivl� I 0-/P_ (�� tl 9=�- 1 2«� C' L_T Y 5L'i 5�l+ ia-r/►M CP,4,-SE SW F ELv P,V s S I c7 Y(L � Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i s d b is Board Heal _ Signe , o Date y y Application Approved by 4tDate Application Disapproved for the following re Permit No. r Date Issued ? W17. .. No.AZ �v L'° ._ i � Fee t� THE COMMONWEALTH OF MASSACHUSETTS Entered in compdter: --� : Ye PUBLIC HEALTH DIVISION -TOWN.OF BARNSTABLE, MASSACHUSETTS Zfp plication for zigpogaY*Votem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade(x)Abandon( ) O Complete System D Individual Components Location Address or Lot No. Z 10 CA R 12,A G•C 14 D Owner's Name,Address and Tel.No. 0S- E2V1 t.4E It'1 f�SS I�A'(aRSN 1 L_Gn E6N�Tti Assessor's Map/Parcel y i a C A t r��'G R U. N o nn• 1'R In -7 P/(v 1►5' Easy 6,7t115t'. NEW YOUK N.Y . Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.50 8- k 2.& -8 3 4 y SUI-LIVAn- afvy(rrvC-eR1f✓y tNG . 0 S tE 2 Vt L.L C- /1'1 P S 5' Type of Building: ' Dwelling No.of Bedrooms H Lot Size 1, 4 6 Ac sev. Garbage Grinder(YL--S Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures _ Design Flow 4 40 gallons per day. Calculated daily flow 4 4 U gallons. Plan Date JP/V. 9, 2.c o 14 Number of sheets -, I Revision Date ' Title s 1?'E P t_/g[V- P Ra PO S L=D S G P 1-1 c L4 P&r,9 GCE Size of Septic Tank 150 0 Type of S.A.S. I Z'A 54'Ls4C_14fr1&ChAMBE 2 f Description of Soil;0' 019/M. G'=12" B R V. CoArs E 519AID 10 Y R 5/3 , I-Z 3 Li��B� Y L�'Is H BfZW- C419rSE SI4ND 10 YR 5 G 3,4''- 4 Fr" 13 c B r/v,I s(I �IEL• GoArsE s/4iv/7 Imo`/2 (,�L `� fr- I La" L..t Y!=L'fs14 9rnNC1�rsEsIA4 i-Ew TINE is - Nature of Repairs or Alterations(Answer when applicable) I - ,I , 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 TV y this Board Health Signed �r /)n v _ Date , Application Approved by1 it: d ' � ,{ ( K.;� i'Y� Date Application Disapproved for the following reasons \ Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER that the On-siy�e Sewage Disposal System-Constructed( )Repaired( )Upgraded(X) Abandoned( )by �l 1 A C I _/K at 2-1 0 �' r! W G- - D 1--):5-tewl L.LE /Y1p6,S has begn constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N . W". atedInstaller Designe1UL, =/1�G fNEER ffv //V The issuance of this permit hall not be construed as a guarantee that the systt'te wil funct as esiened. Date t l)�. Inspector I r� . . I ---- _--�� — ----------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS =- PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS '=iZpogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade�(')Abandon( ) System located at 2-1 V Ci4rr//QG-E= (2,ro/41) 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 m st be c niple ed within three years of the date of this pe t. Date: 12 1/ Approved by '1 / a Town of Barnstable Regulatory Services Thomas F. Geiler,Director �srAA= ' KASLPublic Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: /llAy 1 2, o N Designer: +me Installer: �c& Ilacalls7cL Address: —r PA R w w R R.p Address: ,;�lc,,o 57, dsI"G-'2V1 ..c.e ./j'1/�SS QS✓e��,/ 1_ On ��3 6 Y , , cP,&C2�//,`r l2 was issued a permit to install a (dato installer septic system at Z.1 o CprrY46- ► 2D. 0st51ZV1W s based on a design drawn by (address) Af,45s SuLL�✓/�N G/►��/NE�R,Iwy NL dated ZN/_qT O y (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF SULIINAM ( r taller's Signature) (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLLANCE WILL NOT BE ISSUED UNTIL BOTH THIS FQIUM AND AS- A BUILT CARD ARE RECEIVED BY THE BARNST_ABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF BARNSTABLE rc LOCATION 410 C9r 1 Air SEWAGE #o700LI'015Z VILLAGE -ASSESSOR'S MAP & LOT INSTALLER'S NAME&'PHONE NO, SEPTIC. TANK CAPACITY /�QD G�/. -: Q0. 6; 1aO LEACHING FACILITY: (type) �OO6,st IfAohiLV-S (size) NO.OF BEDROOMS BUILDER OR O er7� �� -7��• PERMITDATE: /�3_O COMPLIANCE DATE: Separation Distance Between thi Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet P Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I N h � LOT I Town of Barnstable P# D FTHErp� o Department of Regulatory Services a �a� Public Health Division Dat � e4 / U L/ 94i MASS.. �e� 200 Main Street;Hyannis MA 02601 Date Scheduled 2-4 2 b Time 0.i�d"1 Fee Pd. V Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: LOCATION f GENERAL INFORMATION Location Address ( o Owner's Name 1 y7R,Sh t/ nl" « 'T✓' Ir�a�1R 111 )/D ea-,r i� - /Vo�"' r/ 1,J ff Address //S Z:LUf Dodl Assessor's Map/Parcel: / J / Engineer's Name 0 7! - 0 r IO S u"I d�q fv -C/YGNEW CONSTRUCTION REPAIR Telephone# 50e- 11,�f- 33 Land Use 12 F_S t Dt'/t/bqC_ Slopes(%) Surface Stones Distances from: Open Water Body '2-7 5-- ft Possible Wet Area It Drinking Water Well ft Drainage Way ft Property Line 7 S ft Other — ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) PNNASANT PA rN . ft ' L45 A C. .� s ' 33 - h Parent material(geologic)QclTlt 15i$#P/ k} l- Depth to Bedrock Depth to Groundwater: Standing Water in Hole: N/A Weeping from Pit Face Estimated Seasonal High Groundwater LESS 14,41v `rCl.13, &'WA"fiCR 114J4'P� DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: NJA: Depth Observed standing in obs.hole: in. Depth to soil mottles: 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 1 t o i Time t O A/►'j Observation Hole# T11 Time at 9" Depth of Perc q I& I A/C�l t=JC, e Time at 6" Start Pre-soak Time Qu Time(9"-6") (,V `7 I'vt t N End Pre-soak - t Rate Min./Inch Site Suitability Assessment: Site Passed L/ 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:HEALTH/W P/PERCFORM 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) s� i Z" 3 y" G'aArSF 34" of, Be SAND tin YR &A — y� i i S.�NJ) y2 1,/y Few Frwt� 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) I 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) S 'I Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes 6/ Within 500 year boundary No z Yes Within 100 year flood boundary No Ll 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? — _-- If not,what is the depth of naturally occurring pervious material? Certification � I certify that,on P 1Z I L.. i 99 r(date)I have passed the soil evaluator examination approved by the Department of Enviro ntal Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Date Signature ! Q:HEALTH/WP/PERCFORM TOWN OF BARNSTABLE l� LQ-6-ATION Gl� �,1A AAAC SEWAGE # VILLAGE j ,� (d l // ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. umlaqs 4/019,56 � SEPTIC TANK CAPACITY /600 -A LEACHING FACILITY:(type) (size) ` (. .NO. OF BEDROOMS , PRIVATE WELL OR PUBLIC WAVER BUILDER OR OWNER �10,Z%YL .� DATE PERMIT ISSUED: r/ AJi 6 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No a .. r �� ,� �� `� �/`� �/ i ��, � ,' it / - 0/4 THE COMMONWEALTH OF MASSACHUSETTSA� DROVED BOAR® Off` H SALT TOWN OF BARNSTABLE rlb Appliratiun for Uiupuua1 Vorku Tunu#rnrtiun rrrm t Application is hereby made for a Permit to Construct ( ) or Repair (1)0an Individual Sewage Disposal System at: 05-r�,�,'/ ---- ation-Addres Lot No • ` - ..................................................... � ........................., .....,r...�" Owner Addr / W ,1e ............................ Installer Address d ype of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other 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. 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................minutes per inch Depth of Test Pit.................... Depth to ground water........................ tz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --••-•------•--•••--••••-•-----•-•••••-••-•--••--•--•••----•-•---••---------------------------------......................................................... 0 Description of Soil........................................................................................................................................................................ x V W ----------------------•--------• -------------••-••-------•------•--------------•--• - ••-•-••----------------d.-.--____-----------d----�--------------------•-•-•�----�---•-----•-..---:---------ma----y--�------�-.•-..-.- x •---•••.....................••-•-••-•-•-•--••--•---••--•-•-•----••••--••--•-•--------••-----••••----------_-_-_t-�----•-• :__._._..-.-.-_-_•_j•-�--- ._._ 7 �_.......-=--- ---- V Nate of Reairs or Alterations T nsw� n applicable ______.�. � _._._._.__� /_4._-!1._______ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e has been issued by the board of health. Signed .- u vrt ,v C �� .�.......... --------------------- �.:... ----------------.------- Approved By .......................... ---------�......... --------------------------------------- Application Dare ' Application Disapproved for the following reasons- ---------------------------------------- ------------------...............------------------- ------------.--- ------------ . ............ ........................... ................................................... ......... ... ..................................................................... ........ ................ ... Permit No. .. ...........................�JG..�--------- Issued /.. � Date No. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE .��r lirtt Uan fur Disposal Works Tonsumaian fermi Application is hereby made for a Permit to Construct ( ) or Repair (�f an Individual Sewage Disposal System at: - y y tion-Address ^ r px 1-� _ _yam - - ---------------_-__.-__-- .� _-(-'---- ---- --- Owner �Ad - -� - ------------------------------- � -�f --� rz` L installer Address V ype of Building Size Lot-_— Sq_ feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder .( ) aOther—Type of Building ____________________________ No. of persons--------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------------------------------------------------------------------------------------ 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 z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results ' Performed by------------------------------------------------------------------------- Date_--______--- a Test Pit No. 1________________minutes per inch Depth of Test Pit___________________ Depth to ground water-------------_-_______ 44 Test Pit No. 2----------------minutes per inch Depth of Test Pit__.________________ Depth to ground water-----_____—________ a ----------------------------------------------------------------------------------- -_ ------- ----- - _- 0 Description of Soil------------------------------------------------------------------------------- V ------------------------------------------------------------------------------------------------------------------------------------------------------ -- ---— ---- x ------------------------------------------------------------------------------------------------------------ - - -.t - U Nature of R airs or Alterations—An when applicable___ _ - 1,59_________ _1� -�eA_�1_C___F1_N��__ ------------ ---- 1�C�r� �� ------------------------ - - -- �----- --------------------------- --- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal`System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e has been issued sued by the board of health- ' Signed-- -_ A lication Approved B ---- ---- - -- Application Disapproved for the following reasons- ------------------------ Daw - - - ----------------------------------- =->-------------------------------------------------------------------------------------------------------------------------------------- ------ - Dam - Permit No %G'" ----- Issued ` � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4 TOWN OF BARNSTABLE (9jerTifirak of aloutpliance THIS IS TO CERM That the Individual Sewage Disposal System constructed ( ) or Repaired ( �) by — ----- ----- _ �/ ,�` 1/�-D Q-- 5 at / ti-�G� �V -�-----------��-------- _o ff�-�-� 1 ------------------------------------------- has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. _ ___�o__v�_ 5__ /____-___- dated --_� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / DATE---------------�f 1-------- --CJ' --/�- ---------------------------------------------- Inspector -------------------- -------------------- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � ^g TOWN OF BARNSTABLE No. ---------------- i Disposal arks Ton,loftu on jrrmit Permission s hereby granted------------- - t ----- ------ ---------------- to Construct ( ) or Repair (�,'an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit 1%a�.__2_<_ wed_____ DATE----- �--��=��------------- -------- ------ FORM 36508 HOBBS h WARREN,INC.-PUBUSHERS r PAM - Fee-- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVe[r CongtructionPermit Application is hereby made for a permit to Construct (- ), Alter ( ), or Repair ( )an individual Well at: -0/0 _C sr U r----k^ -- u vv Location — Address Assessors Map and Parcel ---------!,o yll -----—----— —--------- —_ —__— — >j0 —cG f/r Ct�--r —��. O S r�n s_vj / Owner / /� Address q -AA--�cQNcue_(1--�e_l -- -�'r' (�_�'_ _ _ ,�1• /J®c.J/jor.. �c� `^_O±Q /bo �Ltor AAA, Installer — Driller —— Address Type of Building Dwelling--------------------------------------------------------------- Other - Type of Building---------------------------------- No. of Persons------------------------------ Type of Well-9=,- --------- Purpose of Well - - - --— — --tl"f_!_ 7�to�,,,----------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed -,— ------- ----------- ��J--- date f Application Approved By date Application Disapproved for the following reasons:-------------------------------------------------------------------------- ----------—-- ---- --- --- — __---- - --- - - --- - -- - -- ----- date Permit No. - - - — ----— -- Issued --- — ------------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well /C�opst cted 01), Altered ( ), or Repaired ( ) bY------------------8-A--56- ` - --- -- --------------------------------- Instal at------- v - Cv_<�iG -L --�`'T'r1s2c l L_'----------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit `W =- ;!Dated '- � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------— -- — — - -- Inspector------------------------------------------ - - - ----------- ^„�.l�i+�s±..c✓�"'SY�+'f""'�"">�'n'i`vrr.�� !'!E-+. � � �.M�'xt`C�Yvrrj�i`'Ai't�'�'@+.+7yk,..r �.r,r"+�++'�'v'.s:- - No.� ." � Fee-- •BOARD OF HEALTH TOWN, OF BARNSTABLE 01ppCicat ion for Ve(C Co0truct ion Permit Application is hereby made for a permit to Construct (- ), Alter'( ), oc Repair ( ')an individual Well at: - OST�lv1��n - --- --------------------------------------------- Location — Address Assessors Map and Parcel �— —N O—v - --------------------- ,�d ��—G 1/r U F .v • .O S !'>/�, l!n —--— — —— — — —---—— —--- ------------ / Owner / / Address q / 3/_ /Jo��Qor.. Rd �oa 960 /1.to� 4��cR _ -'Q�---- ---------------- - --- - — -------------- Installer Driller } Address Type of Building Dwelling-----.------------------------------------------------------ Other - Type of Building---—----------------r------------- No. of Persons----------------------------------— --- Type of Well—4• ---------- - ----—-- - Capacity----------------- — Purpose of Well -- 1 Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed --'---- - -- ------------ IQ_& l S f----- date Application Approved By -- � '� °�------ zo�z date Application Disapproved for the following reasons:---------------------------------------------------------------------------- ----------—------ -- —-- - — ---------------------- - -- _—_-_—------ ss�� date Permit Issued —- No. "'_ ��c 7 — --- --- - r ------------------- - -- --- date BOARD OF HEALTH 1' TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual/W/Well /C�on77, cted ( 41), Altered ( ) or RepairedbY- lC i-L1--,Scu n�w r �/ L ) t (( —�J/i -` ------------- - -—- - - —-- --- —-- ------------ ------------ -------------- Installe L osr�l�, / at- 1 _ Lg! �� -�--`�=— =-----------------------------—-------------- ---------- -- --- --- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit A . --- - -Dd ate ------, -- -�' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- --——-- — ----- Inspector------------------------------------------ --— BOARD OF HEALTH TOWN OF BARNSTABLE 1"err Con5truct ion Permit Fee---- Permission is hereby granted to Construct (�), Alter ( ), or Repair ( ) an Individual Well at: No. - - -------------------------------------------------- street as shown on the ap 'gation for a.Well Construction Permit No. -- -s� " -----— - —-- Dated-— -i — ---- — -- DATE Board of Health —��'_—��°'' � ---------- Y� ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich,MA 02563 (508)888-6460 . 1-800-339-6460 FAX(508)888-6446 CLIENT: Mr. Hoyt LOCATION: 210 Carriage Lane Osterville, MA SAMPLE DATE: 11-27-95 COLLECTED BY: D.A. Scannell DATE RECEIVED: 11-28-95 TIME: 12:OON LAB I.D. #: E11-357 JOB TYPE: Nev well.- irrigation SAMPLE I.D. #: E11-357 WELL SPECS.: 37' RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 5.68 Conductance umhos/cm 500 121 Sodium mg/L 28.0 14.3 Nitrate-N mg/L 10.0 0.16 Iron mg/L 0.3 0.10 Manganese mg/L 0.05 0.176 COMMENTS: Low pH indicates high corrosive. characteristics. Manganese level is not a health hazard, but may cause aesthetic problems. Yes No WATER IS SUITABLE FOR DRINKING PURPOSES PARAMETERS TESTED. xxx Date r Rohald J. S ari Laboratory irector IT = Less Than / Sly a R R. AGE GOAD / ve n r Oo CA ster32 koc rc f o US Allfit �. \ i LOT E.t.61a AC, SE •LAWN / etiT ARC—'/ LOCUS PLAN Scale : 1 "= 2000' r ; Assessors Map 71 Parcel 16 Groundwater Overlay District AP F.G. 26.5 j Vent AReA O�I� n n � 2y F.G.25.0 \ qy --� I25.0 22.3 \ w 24.0 23.75 e Top El. 23.3 x Bot El. 20.3 Is O'K 22.96 22.79 Rlrnov� Iaxls'r• 2 Compartment,1500` ^ Bedding as Bottom TH Elev.14.5 L t-: .a-I PI'� Gallon Septic Tank Per Title 5 No Groundwater 5.1STIL FOR MAS*Efft� \ ��0 0 5E�,-,C, TANK- x DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM t3U1T�( I-r3'oDii00M) �� CpNNaCT&%1ST• Not to Scale TO S`EPTtC"TANK I� c ade NOTES DESIGN DATA , \A 7� �— I.Water Supply ForThis Lot is Municipal Water Single Family-4 Bedroom m M Fab -_—_Compuaea Fill 2 Locution of'Utilities Shown on This Plan Are Approx. With a Garbage Grinder Daily F low:110 x 4= 440 gpd At Least 72H ours Priorto Any Excavat ion For This SepticTank:440gpdx200%=880gpd X N I/e=vz^ Project The ContractorShalI Make The Required / Poo Sane Notification to Dig Safe(I-880--344-7233) See Note No. 8. � r —26 �xI e.,., S �EORco►.rI / �� 3. The Contractor is Required to Secure Appropriate LEACHING AREA ,//i" DWti.LLIN6 R6_PIPE EXIBTINSr PIPINCr v I " perm to moil Town Agencics roi-r cils,,ructioli Tel Id6aM1 ✓Y5'�E'•t'1 �-._� Chamber f 3/4"-I I/2°Double .. o - N I washed Defined byThis Plan. 440 gpd/0.74=595 s.f.+50/o=893s.f.Required p_ • Sidewall= 2(12'+54')2= 264s.f. _ _n x i_ 2'-0' I 4 Install Risers as Required to Within 12'of Bottom Area=12'x 54'= 648 s.f. Iz'-o" Finished Grade. 912s.f.Total Provided 5.All Structures Buried Four Feel or More or Subject LEACHING CHAMBER DESIGN CROSS SECTION OF CHAMBER to Vehicular Traffic lobe H-20 Lauding. / NOT To$CALE 6. Septic System to be Installed in Accordance With All Piping to be Schedule 40 PVC.Use 6- x 310 CMR 15'.00 Latest Revision And The Town of 500Gallon Leaching Chambers in a g l CBarnstablef Board of Fleath Reulations' 12 x 54 Washed Stone Field as Shown. BRIE-K j 7. All Piping to be Sch.40 VC. pp.-rlo / B.Seplic Tank Shall be a 1500 Gal., 2 Cornpurtmenis. \ The First Compartment Shal I Have a Volume;of Not Less Than 660 Gal.And The Second of Not Less Than330 Gul. I TH ELEV, 24 $ � pX1ST.LeAcl-) P1'rs O TO BE PUMPEDd- LOAM, ORGANIC F1\LED WITW Ct_EAtI / �. 0 LAWN E IMN COARSE. SAND t O YR 5/3 1 $AND Fl OV R S6R6E - 34, LAWN A(ZEA 13C S3RN'\SN Y>=1�. COARSE SAND 1 O Y R 6/4, .. •✓ '{8 C LT YlgI.ISN t3RN COARSE •✓ �../ 120' SANr) mew PINeS 10YRU/y 140 GROUNDWA-rr-R CLAS5 \ MATERIAL IT1GR'G.No. P 10i GS'8 DEPTH .41a INCNE S LMSS TI-1,0.W "-MIN /1NCW BY'. SLJLL_IVAN ENGINEERING'INC. W1TNL_SI3S D. S-rA1.IT0NJ T.04'.. B.O•FI• psz�. Fra, 12, 'Zvoy IR v Top SITE PLAN PROPOSED SEPTIC UPGRADE PLAN VIEW AT Scale I"- 20' 210 CARRIAGE ROAD OSTERVILLE, MASS. FOR HENRY H. HOYT SCALE, AS SHOWN DATE' JAN.912004 SULLIVAN ENGINEERING INC. OYSTERVILLE,MASS.