Loading...
HomeMy WebLinkAbout0274 CARRIAGE ROAD - Health i 'o OSTERVILLE A = 071 019 � C CJ (60 No. Fee �v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Digoml by,5tem Construction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) El Complete System Individual Components Location Address or Lot No. `�l� />,,� lr Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Installer's Name,Address,and Tel.No. / " Designer's Name,Address and Tel.No. Type of Building:Dwelling No.of Bedrooms Jr Lot Size sq.ft. Garbage Grinder(4a Other Type of Building i e5) eAe& 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 Ge OG?eel t Type of S.A.S. Description of Soil �e_`l�4'� Ze���O� Nature of Repairs or Alterations(Answer whe pplicable) 9 ,e 7y Qc zv Q 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 b his Board of Yealth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No.4-7= Date Issued - 07D-���' No. Fee THE COMMONWEALTH OF MASSACHUSETTS Eered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Z[.1 plicatiou for Migoml *pgtem Con!5tructiou Permit / Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ( Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: �-^ Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder Other Type of Building XS lohTGL� 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 alb eel It Type of S.A.S. Description of Soil /fie-ZoG47*' ZDOD ,9�� �-Z� tg&& r Nature of Repairs or Alterations(Answer whe applicable) e,wa 1,e Cr O QG ooeui p 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 issued by this Board of Ijealth. }` Signed Date Ll��1Q9 Application Approved by Date Application Disapproved for the following reasons Permit No.; _7 Date Issued r ` THE COMMONWEALTH OF MASSACHUSETTS O 70 `©1/ BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (Upgraded( ) Abandoned( )by r e at 22 q 621'6WI W 42 5 te r411 L, een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer \ The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 4 - �0 - � Inspector- -———————————— —————— ———— - No. - r O !O D�Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi!gpodaf *pgtem Construction Perm. it - Permission is hereby granted to Construct( Repair pgrade( )Abandon( ) System located at y C�I"✓�l ll�P_ �' DES At and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio must a co pleted within three years of the date of thi a 't j Date: Approved by '! I TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE [�;-`�p� ��..c, ASSESSOR'S MAP&PARCEL ��— INSTALLER'S NAME&PHONE NO. (5-6 ') JJA�r Y� SEPTIC TANK CAPACITY ®/ ,J,� ,w LEACHING FACILITY.(type) q 506 c,, (size) d-/2 44 NO.OF BEDROOMS OWNER ln�t ��:,o�v! �!lCa.a^re PERMIT DATE: q )- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY c, V n Ca ;0 4L4 TOWN OF B TABLE LOCATION � � SEWAGE # :SS`' VILLAGE S SSOR' MAP & LO = G INSTALLER'S NAME&PHONE NO.4� Z- SEPTIC TANK CAPACITY Q LEACHING FACILITY: (type) -- (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: IL-- 1-® - 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 F f � No. �l �� Fee G 0�, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_s� L� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for bispoeal 6pstrm Const urtion VPrmit Application for a Permit to Construct( ) Repair( L�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.`_'7Y C.#)nP_1.#&E 1r/) wner's Name,Address, d Tel. o. 57 iB A .5ssessor's Map/Parce ®, 0 ( a S a I s ller's N Address,and Tel.NoS 049-9a2�'-��� Designer's Name,Address,and Tel.No��3671,617 f�Od�tT' v�z�r�, vJDGn�O/61 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(�- Other Type of Building ZKCi ',p r:n, No.of Persons Showers( ) Cafeteria(ter Other Fixtures Design Flow(min.re red) gpd Design flow provided ( gpd Plan Date Number of sheets Revision Date ij1 1al)-` Title cS Size of Septic Tank Type of S.A.S. I - (, Description of Soil Nature of Repairs or Alterations(Answer when ap licable) s 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 ace the system in operation until a Certificate of Compliance has been issued by this Board He th/ Signed Date t 2 7 ^Sih Application Approved by Y f14 V I, Date Application Disapproved by Date for the following reasons ' Permit No. ? - Date Issued h V No. �C)" `.: ,* ' Fee �V Entered in computer: t THE COMMONLWEALTH OF MASSACHUSETTS p Ye �. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS *i location for Misposai *pstem Construction Vermit Application fop a Permit to Construct( ) Repair( iJpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a.7 wner's Name,AddreM Telo. 4Assessor's Map/Parce 0'71 0 1 U yS 0 Vs ller's Nape Address,and Tel.Nos'0$- '?T-a, Designer's Name,Address,and Tel.No��de r �Urz fr- Type of Building: 10, Dwelling No.of Bedrooms .5^ Lot Size sq.ft. Garbage Grinder(�-)— Other Type of Building X No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.re 'red) ��[� gpd Design flow provided ��Q3 gpd Plan ;Date 1' 2 Number of sheets � Revision Date Title s Size of Septic Tank, AType of S.A.S. / q 1h'F f S Description of Soil } ? ,t Nature of Repairs or Alterations(Answer when applicable) IV — 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 ace the system in operation until a Certificate of Compliance has been issued by this Board He Ith/ S�i]gned ' Date 07 7 1� Application Approved by Y �t f14- G Date l (� ~` Application Disapproved by 'Date for the following reasons Permit No. �Q 1,,p L,15 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 at 7 2 � � � fhas been constructed in accordance l/ with the provisi ' tie 5 an for Disposal System Construction Permit No. O dated Installe /`-,Designer #bedrooms fr Aptiproved design flow S and The issuance of this permit shall not be construed as a guarantee that the system will ncti -as s ed. _ Date L� ` j. Inspector '�.•���- s -p ---------------------------------------------------------------------------------------------------------------------------------------- No. ot� �� v ( � - - - Fee ( 501 THE COMMONWEALTH OF MASSACHUSETTS `-PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS,. Disposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 7 / CG�:����i�G > Q ,/SY e R zV I 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:Con tructtii7on /usstt be completed within three years of the date of this permit. / Date / ( V Approved by —Yv -�l t,_ S ail " 6(,/--T- 'Pe k V":-b v-4u� __DV L tLC r ' TOWN OF BARNSTABLE LOCATION Ccq��'S5',� /� SEWAGE# L "' VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. v SEPTIC TANK CAPACITY LEACHING FACILITY.(type) tl S mac.I" (t,i.a,� s (size) NO.OF BEDROOMS OWNER Rol?�t C?�•,��^ri{1Y!�e PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY � I r P�4 ier r.4 y Haul, Town of Barnstable �VWEro�o Regulatory Services Richard V. Scali,Interim Director NAM Public Health Division ��D MAr p�0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: N IZ Zo►� Sewage Permit#2V« l�5 Assessor's Map\Parcel 71 .l C) Designer: ��� �� Installer: Address: Address: t444z,�tD 1L1"f . On t l UAW was issued a permif'to install a Y (date) (installer) septic system at 7,tll 6 -4 based on a design drawn by (address) 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. 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 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 constructed in_co Zan with the terms f the IAA appro etters (if applicable) t10F a UAVID (Installer's Signature) g MASON No.toss G-+. Desi r s Si a s'tNITAR\1`�'' ' ture ---;, ( ) (Affix Dcsi :�•.,�� 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. . QASeptic\Designer Certification Form Rev 8-14-13.doc 'L ATION SEWAGE PElRMIT N0. VILL . E URcl f , INST LLER'S ` NAME D ADDRESS 0 UILDE R OR OWA r. el' f' DATE PERMIT ISSUED J DATE COMPLIANCE ISSUED, j �VJ , y Il" E— 1000 GAL. S�PTI C T A k K t > v� L � �g eve, R� 0 L P. T 1C S.E-W A:C E P IT NO. WILL�.a E. , INSTA LL-ER'S ` NAME i ADDRESS BUILDER OR O l� ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED = i - 1000GAL SCPr1 C. T A O- < r THE FOLLOWING IS/,,ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M1-�C&-,L DAtA TOWN OF BARNSTABLE FAGELjkGE_, SEWAGE # 05 � T0 t LL-6 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. W At 7C p D0r y s a�J SEPTIC TANK CAPACITY LEACHING,FACILITY: (type) (size) NO.OF BEDROOMS_. . BUILDER OR OWNER Alk. j PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of.Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f ility) Feet Furnished by ,�`_ U��� ' `Pbo� f / a � s���' . No Fzz-A/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF........ �J� ....---..................... Appliratiun for Disposal Morks Tonstrnrtiun thrmit Application is hereby made for a Permit to Construct ( ) or Repair () an Individual Sewage Disposal System at ........ .C.A ........ .....f1 ....... S:Llca ................. I'.' l.l..._.. eL....�. ......._.... cation.Address or Lot No. .............................................................................. ... • `�D/ ¢O—wyn�er I q .-.. •.-.-.Address :......7 X t�:�.:l.Jr... ........Le..w.....-•-•-••••. .............•----•-•----- Installer Address t�� Type of Building Size Lot............................St.—feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .... No. of persons............................ Showers — Cafeteria P4 Other fixtures ........................................... d .................................................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W 'Septic Tank—Liquid capacity..tOW..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width........................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..........I.......... Diameter............0.... Depth below inlet.......&......... Total leaching area ZV!;....sq. ft. Z Other Distribution box ( Dosing tank ( ) 1­4 Percolation Test Results Performed by....... ............................................................ Date........................................ 6.4 04 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w ---........................... •---•-•-••--•--....... -................ -... .---...... -............ .--- ------ ..-...-----•-•----------•--.... ..-•••.............. 0 Description of Soil........................................................................................................................................................................ W V .......... --•------- ---------- •...................... .------- ---------- .... ---------------- -•---------------..... --------------------- --------.......... W U �110119kt­-Azi-A ture of Reairs or Alterations—Answer when applicable.. ...::`LC� "�i lE.... � 4—....ILA.... r. ...--Csl-1i7�4 ...loG�2. +c-..5 t !g:n i loco WA ............ ............. Agreement: ,., The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary ode— undersignedh p y C further agrees not to place t syst in operation until a Certificate of Compliance ha by the board of health. igned... ... ........•-•----••-•----.......----..._......_•--.....---------............ /�e ..�....------ �" Application Approved By.............. .--- -•-----••-•----- _ Date ...... Date Application Disapproved for the f ollo •ng reasons:------•-••.............................•----•----------•--.......---•----.........__......................--- ...................•---••--•--•---•-•-•---......................--•--••----•-•----•--•--..............--•--------................-----------•---•-•-•--.-.------------... ------- Date PermitNo...................................................--- Issued-.................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v;Aj.I,�.....................OF........l� i�'-• .t': : 1a�- '�z............................ Appliratiun for Disposal Works Tonstrurtiott f erutit Application is hereby made for a Permit to Construct ( ) or Repair (>() an Individual Sewage Disposal System at: calla? ( � G�_-7 ;: 't�l C2f�. .............. . L9cation Address or Lot No. ••��- ....... -•................................ ................_.....................•••.. ... Owner Address ......................... �..1.......... ..........................•--••--•••.........................._................................. Installer .Address cA Type of Building Size Lot.._.�.......___-....:....`y4.-f U Dwelling—No. of Bedrooms..............................:.............Expansion Attic ( ) Garbage Grinder ( ) `'4 Other—T e of Building ....... No. of persons............................ Showers — Cafeteria a4 Other fixtures .................................•-••-•---------._...- W Design Flow.................................. :.....gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.!..r, gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.........--........sq. ft. 3 Seepage Pit No..........I......... Diameter............5R___. Depth below inlet....._la........ Total leaching area....1-tau....sq. ft. Z Other Distribution box ( Dosing tank ( ) `" Percolation Test Results Performed by.......=n........---••-•----••----...--•-•-•--------••----•-------.. Date........................................ 04 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .......... ........ ...... ... ........ ••••-••... ..... ..................... ......................... 0 Description of Soil.............................................................................................................•---•-•---------------•---.........._...................... W V ...................................••.........--••----•..... . .........••-•••-•--••----------•---..............................•--••..........-••-......--•-•...•-••••••-••-•-•-...-•-•-•.....-----•-- W .....--•----••-....•-•••••••--•--•-•-.......••••.....--•---•------•-•-------•-••......................•.........•.... .....-•-•--..................-•-•._................•-••---•••••.................. UMature of Repairs or Alterations—Answer when applicable__. [r, ...__ X_1�a `1G�a.... �-�( 7GY.� . IA....Finaf �)•E�b -.�eEA......wo-�......1C2t _ 1�� ` TAG.......�:i L�.__..i.....� U�1.. / !...1 Ct'.......................................... Agreement: The undersigned agrees to install the aforedescribed •Individual Sewage Disposal System in accordance with the provisions of T I T IL ,5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isied o y the board of health. Signed. -1 :" .....••••-•-•---••-•••-•.......................•-•---......_........... ApplicationApproved By............................. --•-----•------------------------------•-•-----••---------. ........................................ Date Application Disapproved f orw the.f ollowing reasons:..............................................................................•........••.................--- --••--•---•-------•--•------------------•----•-•----:•-•...............................-............................................................................................................ - Date PermitNo................... :_......... --------....... Issued............... •••••-•--•--•.._..._..._.......... Date THE COMMONWEALTH .OF MASSACHUSETTS BOARD OF -HEALTH ......ToWI ............OF............F�:)L Y.17"�?.�.���� z.......................... (aerttfuttte of Tuut lianu THIS IS T CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( d� b .......---. LLI..aiL....tl:!tU:a1'�....................................................................................................................... � Installer at......._ i 1?_l.L�(.� ......�-o•--•-------•-•-•--•-•-•-•...................................................................................•------•......................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod as described in the application for Disposal Works Construction Permit No :_ .d:..g^�..: ............... dated-- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT gECONSTRU D AS AG EE THAT THE SYSTEM W 1' UNCTION SATISFACTORY. DATE... /, .......__- Inspector. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF.......... C ..................... No ..yf'.�.r ..... Fzz./.;..:............_. Disposal WorkfV19onstrurtion Verutit Permission is hereby granted.---•-`!-....:=......��..-:.. _ ......... --......................_-__ to Construct'( ) or Repair ( `an Individual Scvtrage Disposal System atNo. '�"^p ��......... ---------• ............. -. *• -•-••-••--••••••••.. ........... Street as shown on the plication for Disposal Works Construction Permit No�--- Dated.......................................... Boar DATE d of Health , f ---.----•---•-------------••-------------..----••-------- ` FORM C-1255 CITY& TOWN FORMS, INC.369-9708 I f3 No. z Fee THE COM NWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Dioaal *p!5tem Construction Permit Application for a Permit to Construct( VRepair( )Upgrade( )Abandon( ) LpComplete System O Individual Components Location Address or Lot No.o7?q 0 f R1?//461C W Owner's Name,Address and Tel.No. 7 71—/P Vd Assessor's Map/Parcel .7f/ �g l� 13/A0 /�✓Q I�{DQ d!? Installer's Name,Address,and Tel.No.7 qpi f 30 5 Designer's Name,Address and Tel.No. 14A10 Type of Building: Dwelling No.of Bedrooms Lot Size • Y/ 6 AC sq.ft. Garbage Grinder(1/0) Other Type of Buildingl,&&b No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when 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 an not to place the system in operation until a Certifi- cate of Compliance has been issu Bo of Health. Signed 7 Date Application Approved b Date ,Ole Application Disapproved for the following reasons Permit No. Date Issued 4�`"`�`— No. GA —e ° Fee s { i THE COM NWEALTH OF MASSACHUSETTS Entered in computer:. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Zfpp iration for Migoe;al *p6tem Congtrurtion Permit .'Application for a Permit to Construct(VRe air rade`( )Abandon(fiA pp (p )Upg ( ) P'Complete System El Individual Components Location Address or Lot No.cZ r7 y tf y9 R1?{N 6o,C 4^-1 Owner's Name,Address and Tel.No. 7 7/ Id [lG Assessor's Map/Parcel 711 a 8/.?iN/it/6 RP1 A/ - Installer's Name,Address,and Tel.No. 0 t5 Designer's Name,Address and Tel.No. ECO _ 7067 -6/G l ffA/G .ti Type of Building: Dwelling No. of Bedrooms Lot Size y/ 6 AC sq. ft. Garbage Grinder WO) Other Type of BuildingaJO p Ab /=,C19M1F No. of Persons Showers( Cafeteria( ) Other Fixtures R 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 L Nature of Repairs or Alterations(Answer when applicable) r Date last inspected: Agreement: The undersigned agrees to ensuie the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Cbddl an not to place the system in operation until a Certifi- cate of Compliance has been issued-by-t�i Bo of Health. Signed`. s`ti Date 1" f Application Approved b _ ~' '�. Date 14:;f . Application Disapproved for the following reasons `N Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(t✓)Repaired( )Upgraded( ) Abandoned( )by \JQ:� b IC 14,M6 at 2711 ef1PR/r9L 4NE 05Tc#2 V/LC F as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - WX dated /10 Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste .avl11 fffuun..cttion as designed. Date _ ^�. 2 �'-- Inspector s eT) ` No. �f � � ----------------_----------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi progal *p.5tem Congtrurtion Permit Permission is hereby granted to Construct( ✓)Repair( )Upgrade( )Abandon( ) System located at 27tt Cd e 116 r 4/kt.E U 3ZKR V/"-C- 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. t Provided: Construction must be completed within three years of the date of thiit. Date: / / Approved PP . r f 7/28/2020 ShowAsbuilt(1700x2800) �L{ i`,k'YOWN OF B STABLE V' f' LOCATION ✓ �� SEWAGE M _.7.SS' VILLAGE 1 SBESSOR MAP&LO 0- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) CY CDC ) NO.OF BEDROOMS �--� BUILDER OR OWNER T��✓5 ���T " PERMITDATE: // -le Jtr COMPLIANCE DATE: 11-to-lJ�q 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) Fat Edge of Wetland and Leaching Facility(If any wetlands exist - within 300 feet of leaching facility) Feet Furnished by �CoL)s�- N ........... https://itsgldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=071019&sq=1 1/1 i Town of Barnstable P# oF� dp � Department of Regulatory Services . aeaxsrnarr : Public Health Division Date 200 Main Street,Hyannis MA 02601 Date Scheduled I Time Fee Pd. 6 Soil,,Sui* ]bility Assessment for Sew e Disposal Performed By�``�� 1{{�� Witnessed.By: i �� IV✓It LOCATION&G�L INFORMATION Location Address :Z� / � k� Owner'sNrr � n ` 1 ` Ott1���,5 A��//�LYFYp ��nCw ,'JF/l/nfJCtx,/,ll /V , Assessor's Map/Parcel: , Engineer's Name1 J`�V-)`1�� NEW CONSTRUCTION REPAIR V Telephone# (/ Z� • Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line' ft Other ft SKETCH:(Street name,dimensions of lot,exactions of test hAtes&p c sts, to wetlands in proximity to holes) l Parent material(geologic) Depth to Bedroc 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 ` I Hole# ,. Time at 9" Depth of Peic Time at 6" - - -� Start Pre-soak Time @ rr AA Time(9"-6") End Pre-soak `rl6 1 - Rate Minllnch f ' 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: QASEPTIC\PERCFORM.DOC " wV DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Oottling (Structure,Stones,Boulders. Consistent %Gravel IF 1 & 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) (Mansell) Mottling (Structure,Stones,Boulders. - Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate May: Above 500 year flood boundary No V Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes V Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious m teriaI exist in all areas observed throughout the area proposed for the soil a sorption system? If not,what is the depth of attually occurring pe ious material? Certification ((�� _ I certify that on �� "I (date)I have passed the soil evaluator examination approved by the Department of Envir nmen Protecti and that the above analysis was pe- ormed y me consistent with the require ining,expe i a p e e described in 310 CMR 15.017. Signature Date 1� Q:\SEPTIC\PERCFORM.DOC AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION �2 Z f ��. ? SEWAGE li VILLAGE 0�TC��S i f-�- _ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. It). 60t 11.5°-� ✓51% 5&_?'r c C. 5f_VV SEPTIC TANK CAPACITY ;-a ao V LEACHING FACILITY: (type) (size) NO.OF BEDROOMS4 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f tlity) Feet Furnished byp 4Uz VOOt- 1 / . I v I 1 f http://issgl2/intranet/propdata/prebuilt.aspx?mappar=071019&seq=2 2/14/2018 i ASSESSORS MAP: 7 TEST HOLE LOGS PARCEL: )1 !'ire installatibtt Shall coirri�f +vith"l'itle van l �w'l"ou ul' luard of � � j G� FLOOD ZONE. �� j, �) - Ilealtlt Regulalions. SOIL EVALUATOR: --� S`--- — WITNESS: ;})I Yi-b _ 2) "1'lie installer shall verify the location of utilities, sewer inverts and septic REFERENCE: Cam" �� Zp DATE: .' �1 - components prior to installation and setting base eleva(ions. PERCOLAT ,ON RATE: 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per toot. The first -._ __.-- --- — -- - r ; two li;et out of the d-box to the icaching shall be level / -- _ . _.. f� C�_.__ TH-t TN-2 4) !'his plan is not to be utilized for property line deterniination nor any other p / p purpose other than the proposed system installation. 5) All septic components must meet'Title V specifications. 6) Parking shall not be constructed over I-I 10 septic components. ` 1 � 6 P i 7) The property is bounded by property corners and property lines. 8) `I'lie property owner shall review design considerations to approve of total LOCATION MAP design flow and number of bedrooms to be considered for design. Receipt rVD15L of payment for the plan and installation based on the plan shall be deerued %`� approval of the design flow by (lie owner. --- `"-- _ (} I � r` C I Z� 9) Che existing leaching or cesspools shall be pumped and Filled with material per l'itle V abandonment procedures. Those within [lie proposed SAS shall j r/ ►i j be removed along with contaminated soil and replaced with clean sand per Title V specs. 3, ( to 10)System components to be 10 teet troin water line. Sewer lines crossing the ; Ali' �L water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if �`Z applicable. The proposed SAS is being installed below the water service line..'flie line is to be sleeved as aforementioned and maintained in place. Z S E P 1 I C SYSTEM DESIGN t l) u a garbage grinder exists it is to be renioved and is the responsibility of(he owner to eiisure such. FLOW -ESTIMATE 12)The installer is to take caution in excavation around the gas line if such exists. 0 0 0 0 �5'b w .BEDROOMS AT ,� GAL/DAY/BEDROOM - GAL%DAY 13)Tire installer shall.verify the location, quantity and elevation of the sewer lines exitinu the dwelling prior to the installation. �C 14)This plan is representative only that a system can fit on a property rneetin SEPTIC TANK Y Y P P Y g `Title V requirements. .M1 l �} 5�_ GAUDAY x 2 DAYS • . GAL t5)_- 1,� -.�t +A.«I G✓ LUIC.Iv� J `� 01�-� , l:4 ZDOd ALL N SEPTIC TANK� I -.��_--- 'J� - _.. F\1� R-- _ tM - D- SO 1 1. ABsotP fON. SYSTEM� , id f.7 - i L SIDE AREA: 2Z�-fi l2, �r XZ� LDi 1 ��' 4 UnVI[s 4 5� \ .r.Y BOTTOM AREA: , r °i I. s11+ASPI ;� t _ "� r :, tt 5(0 yp, \t�S i ���crv-I �l ► , SEPTIC SYSTEM SECTION a �� q ,�✓ RAd 44 NZ U ' ,� 9 Q+ti_Y Ll L' r1L4�ilCi t t►,� ---.� .,� _ 1 r "GAL. i k 11✓ - /� [-_- r, � � . � ob SEPP C NK r p ► ��r_ fit — ` . m ._ -__ SITE AND SEWAGE PLAN All i-----. LOCATION : ?/? � L�-��16T . i Ali 1 '� p / -�, •� 1 PREPARED FOR : �UW..- � b tic, o SCALE: ; / DAV I D B . MASON � DATE: DBC ENVIRONMENTAL DESIGNS EAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833- 2 1 77 u I N o; r Iv --- ,' Ito a Cec��u �;A 2• ' r 22'l/ 4 4 ry ti Azo�• N fv 1-1 Art 1 ti A awe, for f TG Aoot H ��1 -1 2 G C-Q Ij Ji Z2 ZI .O C Z X1Z �L�`/ S. C.• ,Kfz�S Y•/�r�i Poo- �-" �._ f. �'' 1� �O �c� 1ZT Ivt k,1 U P- i E RM I ql.�4&h,� I L 74 TC—:k Q q P- 9 ft. tow 0 � � G ► ST E'L'�U 1..,L��J U �''JF�,,��''�/f>� :, 4 a' R``c� LEV-4T1v ►ems &5 Gb c�►..! ►�,��l.D.. = ca . ca - i T��ui L-L-C �,A4�- -.� �