HomeMy WebLinkAbout0100 GARRISON LANE - Health 100 Garrison Lane
A= 114-00
Osterville
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: 4� wl-r+,' c�t�. r. MAR�IVO: PARCEL NO. Q
OWNER NAME: VILLAGE: A<
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INSTALLATION DATE: 7 BY:
ADDRESS: CERT. NO. .�
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CQ`"�J' TANK INFORMATIPN_�-
LOCAT ION OF TANK:
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CAPAC I TY TYPE + AGE c!r t FUEL/CHEMICAL
• TESTING CERTIFICATION C I PASS C ] FAIL DATE
LEAK DETECTION CA CHECK IF N/A ' TYPE/BRAND
ZONE OF, CONTRIBUTION C I YES CX] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C"A YES C ] NO DATE
CONSERVATION C ] CHECK IF .N/A DATE
BOARD OF HEALTH TAG'NO. go31 71 3E 7 DATE D
PLEASE PROVIDE AKETCH SHOWING-THE TANK LOCATION. ON THE BACK OF 'THIS CARD
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TOWN OF BARNSTABLE
LOCATION 'SEWAGE#
VILLAGE � �,� �:� ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. TP' f')
SEPTIC TANK CAPACITY i (-15(> c 0. y
' � i ➢
LEACHING FACILITY:(type , �w C—a l f a 5 �te;t (size) �° X
NO.OF BEDROOMS 3
OWNER T L Q
14
PERMIT DATE: � � � COMPLIANCE DATE: d d li Ll
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility y� Feet
Private Water Supply Well and Leaching Facility(If any wells exist on p
site or within 200 feet of leaching facility) N I-) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) q/ //,A Feet
FURNISHED BY
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No. Ci`."�j l�
1 l L �: Fee o p
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
es
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplitatlon for VspoBal 6pstem Construction i3ermit
Application for a Permit to Construct) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
(?C) ' Owner's Name,Address,and Tel.No.
Location Address or Lot No. l
�v ��E A ME& �&'e e" �I rul
Assessor's Map/Parcel s�'j 1� ��
Installer's Name,Address,and Tel.No. f';L-()$30 Designer's Name,Address,and Tel.No. g*TC,,Z Py�
Seg- S ; �. ' �Ch C N
Type of Building:
Dwelling No.of Bedrooms Lot Size t'D q SCE sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
` Other Fixtures
Design Flow(min.required) gpd Design flow provided (Sj gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
-Description of Soil A- Lcal;IM-1 SA-0 -6So ,— LC-3A SANd �(� 31�: C A44VU•n-s
Nature of Repairs or Alterations(Answer when applicable) L—6 0%
Q, 5br, C.�l . c4g-/Yh AS lti hf_a_-66'
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and ena a of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmen a not WIth,system in operation until a Certificate of
Compliarice has been issued by this Board of a
Si !/� L�' Date
Application Approved by Date 3118 ao
Application Disapproved Date
for the following reasons
Permit No. Date Issued
----------------------
a
-5
�; •z u
073 Fee
THECOMMONWEALTH OF MASSACHUSETTS" Entered in computer: _
PUBLIC HEALTH DIVISION -TOWN,OF BARNSTABLE MASSACHUSETTS �
01ppfication for Misposal 6pstrm .construction Permit
Application for a Permit to Construct) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ®�s "le _ Owner's Name,Address,and Tel.No.
Assessors Map/Parcel O 0") ` ' fl MIE&
Installer's Name,Address,and Tel.No. 56 q3o--049 3p Designer's Name,Address,and Tel.No. B*sE Q
Robe c-T B.o0 r Cb .-=Pc- $Nor rk Sr
JQW f c 2 91.001 AG b N1S AA 4 CAS —
Type of Building:
Dwelling No.of Bedrooms Lot Size 10 ?5C) sq.'ft. Garbage Grinder( )
Other Type of Building - No.of Persons J Showers( ) Cafeteria( )
t Other Fixtures 1.
Design Flow(min.required) 30 gpd Design flow provided 3 gpd
' Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
t Description of Soil - L<)/AM,] SA4c� �����_ LcsAin,l �A,Nd -��JJ C� fe411)/,n -
-Nature of Repairs or Alterations(Answer when applicable) _'CN S to-1 j 1 . o o wr g..L . !A A,✓. �—B _
Date last inspected:
Agreement:
` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental ode and'not to place the system in operation until a Certificate of
Compliance has been issued by this Board of 116alth.
i Date
f� _
Si s f �/ (��' G �J
- v
Application Approved by Date
Application Disapproved Date
for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of compliance
THIS IS TO CER IFY,that the On-site Sewage•D.isposal system Constructed(x) Repaired( ) Upgraded( )
Abandoned( )by /�
at ld U 4 A?.21 S C�� [AAJI. �57(-��1(,L� has been constructed in accordance 1
with the provisions of Title 5 and the for Disposal System Construction Permit No.Z01 G/-0_�3 dated
Installer Designer /
#bedrooms _� Approved design flow C7 z J. god
The issuance of this permit shall-not a const ed a guarantee that the system 1(function as d$signed.
i
Date `'� �� ,�� Inspector ,�.,✓�(fd �',lr/�•.-'�"r`� �.�.��f 1�i/,l f ,. r�7 G -�.•✓'
2
----- --------1- — ---_
'-------------------------- _- ---_ ----- ---- - ----_--- ------ --------- ------- ----------- ----
No. "l ' ��' Fee
a1 3
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem construction Permit
Permission is hereby granted tto�Construct(�) Repair( ) Upgrade( ) Abandon( )
System located at (OC) Iq(UI ::5DN f LL
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit. _
Date_/XY A/ '-/ Approved by ~�=
l _
i
Town of Barnstable
oFTOwti Regulatory Services
Thomas F. Geiler,Director
w BMMSTABLE. i Public Health Division .
MASS.
7� ib39.
ATFp�,�s Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: �, ,-1 Sewage Permit#caCUI =� '� Assessor's Map/Parcel 1 S�
Installer &Designer Certification Form
Designer: (�A;x�' I v ) fi rJ Installer: 1`06f t"`5- d�l cc) C-.
S�` C Nr��4OoC Address:
h_� IBC)
Address: [
1
On I-I� /�t c��.k'��'a, 00 r c o . was issued a permit to install a
(date) (installer)
septic system at U1,01-Ebased on a design drawn by
(address)
G dated
(designer)-�
1/ 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 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. Stripout(if required s inspected and the soils
ere found Atisfactory. H OF Aq.9
p STEPHEN yG
ALLYN
(Installer's Signature) o MLSON -,
V No.30216 y
/STEP��\���e
esigner's Signature) (Affix 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.
q:\office forms\designercertification form.doc
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7 Publie Health I)i,> ion Dat/�4-I:,,
. . ._ _ .-,.�I.IW..-�1!:�I�z-.-.�:I��I,'�-.�1'..�1I.I.,.I..',I"�-I,-
.*,.,:,-..:�,...1,�,�-�"—j�";�',�'�-,.�!I�.,-�,:..,�,.1''�-,,.I�I�-`'�-,�,:...�,I.,-:,.."�.;�,:,.-..-�,..�1y1Ti,�--:-"%-1:II-.j.,.,��.',�`!—.-��-',.T,.'.��.,.,�1.+,.-.,�.,"..�'
'.,.-...,.�,-,.-,-..:��I.A:I�I:,.�".I.':;,::�1..I:".tzI.:i.�1�:—:..,,,.1.-,�:."1-.'��:,�'-.:[��"—.*-7,I�-��,-,.1,..,.,1 1-_..,.��_--:1I.-..I I,:7-,�,.,...7-,-I.1.",���..�L,!..,"1.,1'..,I.-�I�q
y MA.
III.
, a6�q �m 200 Main street Hy nms MA 02601
prED MPt a (" ,I.I�i.
Fi � f . D r/ .
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Date Scheduled r f. ;Tune "FeePd.
a
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Sozl Surtabzlzty�1sses,� Bent f of e Dzs .s
Pertornted b*-1 �a�uA � VYl�i�'n , Witnessed By t �/,V�
t
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c
(LOCATION.& GENERA.L INFORMATION
Ioca...n dress 1.66 di,l ,i9d` 1.. e. 0S'(eror 4i4 OwnersName �6vngy,0�(e;Ne G
W.. fF .�"c�t.-oocr .1'�0�
Address . 0L -6Am-.'l''Ak -z8Zc97
Assessor s NJnp/P�rcel N✓lcp III/ '�a��11 0P7 1;ngineer s Name 132x-cr fiS
NSW CONSTR.UCTION V REPAIR Telephonri# �a�-'?,p; .. SAZ
. )f
Land Use I^c 4 i v��4-t ct�� Slopes(%) Surface.Stones
. ,: -
-.
-` Distances froim Open W@ter Body ft Possible Wet Area ft Drliiking Water Well ft ,
..
g , y
Drains e_t�JA ft Property Liiie f# Othef ' tt
-
,:SKETCH (Street name;dunensloits of lot exact locations of test holes&perc tests locate Wetlands iii proximity to holes)
\plGei:SG V G r +'v G�LC-6� � C+�--k:.
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Parent Material(geologic) 4�21 ~n• csl. Depth to Bedrock
Depth to Groundwater. Standing Water in Hole; ft0ll�li>a\�U�Q V4. Weepmg.,front Pit Pace
Estimated Seasonal High Grorndwater Cr
1
t ,
..
D TERMINATION 0A SEASONAL HIGH WATER TABLE
Method,Used n � 0 , 1�
Depth`Ob'served standing in obs hole:: "in Depth to soil mottles in
Depth to weeping from side of obs hole in Groundwater Adjustment R
hid ex Well# Reading Date c Index Well level Add.factor -J Groundwater Level
. PERCOLATION TEST D.te (l Time �0 { W�
Obsavatiori
. Hole# — _ '; `Time at 9 .
. . r( _��r
Depth ofPerca' ` �I.0 T Time at. .�-.-,{ .
1 1
> .
StartPresphkTrnte n pt1Z I� 3 Time(9'6 )
Eitd Pre-s-onk �o;z9 ,(Oily ` k �� z :S�,�S`
Rate Mut/Inch 4?ttir ;e, �. �'1 ' t _
slte Suitability Assessment Site Passed I Site Tiled Additional TestmgNeeded(Y/N)
Ongmal.PubllalleTlth Division OUservatign Hole Data ToABe Completed on Back ----- .
. � -
**If percolation test is to be conducted'v►rthn 100'.of wetland,you must first otify.the
. .
Barnstable Conservation Division at least one (1)Week prior to beginning. a
v,' Q;I IEALTH/WP/RCRCFORM
t .- .
. % # 207`1- a/ZIJZ
" I . . . . . ... ... �. I . . . I . , .., � , —� . I �. �
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1. . - . I .
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...,.—�I�.::::?`.*":I.,.��.��..":,.�:*1—I-.,.-1...,��:,,..,�,.-;,:*.,'..*::..:.,:�.w",,-.,,.:.-:I.,*,*,—.*...;.-I.-.�,�-I..,.,_�.,-..,.-:;.��I,.�:,.;-,..�..�:...��,.�;".�,:..'..,-..,..�...,.:-,.,*�:_�*.:.:..`�,.,,�-.I."..,:*.`-...�I.1:I.I1%�...',�.:.,,..�.III.��.1;.�...�:I�..,..:.II:;'II.—..-:,.-...I.i.�i.:-....1.�I-.,�:�.1.—.".I.-,.,.1....:�.-�:,,..'..,I.I"m-.,.I,,:�,�..I.,:—�...�-..,.
DEEP OBSERVATION HOLE LOG ]Kole# _
I " Depth Fro Soil Honzon :�. =.Sort Texture "Soil Color ' Soil '; Other
Surface'(' ) - USDA) "' (Mansell) Mottling . ($tructbre,Stones,Boulders
Coisise c °° a e .
r (� a
�:. 0.��t�NtL rS �' 9�= `.c0 ll SC ^�(.6}✓�LlG
1,`?d�V�
l OPsv�
2
b`
;�
l. . .:..
`DEEP OBSERVATION HOLE LOG .Hole #; 2
Depth tom Soil Horizon Sort Texture : Soil Color Soil Other r
.I-,7I-V�'II.—I�'r 4—.I*,1.%.--_I..-.��_.�.,��,,v-1..�..,,�q.:.�I,w.I�*.,—�,,�i...-7A'��.:
Surface(in) (USDA) (Munsell) Mottling (Structure;Stones,Boidders
... - c %Gravel
Consisteii
x 1 0 ,o !2�s . ore lb
G
Vvta t o. R b` n
j
,
.
. ...
DEEP OBSERVATION HOLE LOG Bole #-_
Depth from Soil Horizon Soil Texture SA Color Soil''. Other
Surface(ur) '`(USDA) (Murisell) Mottling `(Structure;Stones,Boulders.
Con ' io el
i _ ^
o t1C i bw oo t21 41
.I.�.'..,!.9�.*q;;:.1--.,��.j.�1".F9.I�"1.d�'-.,-1I—."�,%..-IVj'.�I.�9.:.�,I�1;,",:I,..r�.j�V..r-�9..I1 w,rW-..,.:—�,p�9 z,.�".9,.V..'1,1,:12,.�,.,.,.;—�r���:Idw a,I:I.�I'��V.�.,,,I,'.
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. _ .
.r : _
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..7
..
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DEEP OBSERVATION HOLE LOG Hole# L/
Depth from SoiLHonzon Soil Texture Soil Color Sorl Other
Surface(m) (USDA); (Mansell) Mottling (Structure,Stones,Dould.. .
Consistent °°Orav I.
J
O l
0
.r I� r �
� .I," 2,-i k I
.,
'
b L m �,� rb o , k 'b � t b-ac, .
R
..
:, Flood lnsurnnce Rate Map , , F'
Above 500 Year hood boundary `No Yes
_ t
Wrahin 500 year boundary No Yes "
y .
Within IOOyearfloodbou -r":y'r Yes - ,
Detith of Naturally Occurring..eryiou-Mnterial
Does at least four feet of naturally occurring pei vious material exist in all areas observed throughout the
area proposed for the sort absorr .. system? _ �Z
the de th of iiaturall"occurring er.ions material? , .
' If not;what> p „ y
r' ;_ F
Certification • .
I certify that on v\ 2OD� (date)I have passed the soil evaluator examination approved b.the
Department:of vino nelital Protection and that the above analysis.was performed by me consistent,wtt
-, tile,required tin nisi , expertise and experie.ce descl 9,:r it%310 CMR i5 017
11 t, e,/
Signature 9`^- Date r°�-�.
�arE� TriiW►'Ji' ncroRM. ; r. C'�Zoi bit 02
}}
�GT x221
F�
x 22.1
i �O x226 .
UP 1179/1 \ EXISTING
x 22.1' x 22 5 LEACHING PIT
DIST BOX
l r
23.2
22*5
TP
23.3
22.e # c�
22.7 UNIT
JP .#3. 5i 23 ' 10G X 23
22;9 ELEC. A
23 1 : 1NG
TP 1 METER % ID
N
0
60
x 23:2 ice' GApGE 1 1 YGUESS ` 24. . . BLUEST( .!,.
GA5
METER TH��'nO�a ' STEF
34'
G
G 2171 �P
-23 79 �C 23.23:8 .37 _
2 LIGHT
x 22:8 t / 23.5 \ COBBLE
G )GRAVEL STONE
N DRIVEWAY EDGED
o RETAINING `' WALK
WALL 23
I. IGHT
Loca�zohr,...3
TOWN OF BARNSTABLE
vivo ,
LOC'AT10 SEWAGE #
VILLAGE nk!`01 11E ASSESSOR'S MAP & LOT
INSTALLER'S NAME S& PHONE NO�WO1®9�`
SEPTIC TANK CAPACITY �DDU Qh
LEACHING FACILITY:(type) / v1S Cod (size)
NO. OF BEDROOMS PRIVATE WELL O LIC WATER
BUILDER Oi--()WNER� AV CL__
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: <,� �' •' �
VARIANCE GRANTED: Yes
A� A
`^ �u 12,
.41
THE COMMONWEALTH OF MASSACHUSETTS
BOARD �QF HEALTH
..........OF....A)"902/. __n�................................
Aplifiration for Mipmal Works Tonwurtion Vrruat
Application is herebymade fo ermit to Cotruct A or Repair an Individual Sewage Disposal
System lit: V
----------
7----------------------------------------------------
cat n d. ..............
. ........ ...... _1. ..........................................
Own Address
........... ............................................................
Installer Address
rn� ------------ --------------------------------------
Type of Buildiney - Size Lot.74,!?&_'_Sq. feet
U Dwelling o. of Bedrooms___..__.._..................................
Expansion Attic Garbage Grinder iC6
04 Other—Type of Building ---------------------------- No. of persons............................ Showers Cafeteria
Other fixtures
Design Flow...................3__ --------g'a"I'I'o"ns...per...person---,-i----per day....'......Total-------....daily-' -'...flow_______.._._.------------------7,7,-------7.....*6--------------*g"a"I'I'o---ns".
04 Septic Tank—Liquid capacit�'�' ___,gallons Length................ Width..............._ Diameter..._.._......... Depths..............
Disposal Trench—No..................... Width.: Total Length.._.... .. ....... Total leaching area..__...._._ sq ft.
.1.-----------
Seepage Pit No..._'_9------------ Diameter-----I.... ......... DV
h below inlet_...._ r......... Total leaching area...`
e q. ft.
z Other Distribution box Dosing t
�_A Percolation Test Results Performed by........ --- Date........................................
0.4 -e
Test Pit No. I....Results
per inch Depth of Test Pit-"J.-V ---Depth p__-t-h----to ground water...jac).....
Test Pit No. 2................minutes per inch Depth of Test Pit............_._._... Depth to ground water....._.............._...
.......... ..................... ................................I.............0 mw. -V.............
............... ....... ------------ ...... ------------Description of Soil...... ..
----------------------------------------------------------------------- ------------*--------------------------------------------------------------------------------*-------*------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_
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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complianc as Peen
I —i s s bAe board of health.
Signed....... --------
-----D,...
Application Approved By ------------- . ....... .... . .. 3=..................
Application Disapproved for the following reasons: ---------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------.............................................-------------------------------------------- ........................................
Date
Permit No. -------- --------------------_------ Issued .....//�../.?..'?r
Date
G ! . -
• / �t
No.. :.C g F�s_......� ..a....._
THE COMMONWEALTH OF MASSACHUSETTS
/.._ BOARD OF
HEALTH
Appliraiion for BWVoii al Works Tomtrurfiott Prrutit
Application is hereby made for a Permit to Construct(/) or Repair ( ) an Individual Sewage Disposal
System at• /
.... ?...... ......................................1 ..('..�.. .t �- ----- .................................•----...
location- dd ess or Lot.No:—
................ 3i � f� roc l .
Owner" � Address
c
Installer Address 1
dType of Build" g �'j Size Lot.�..�.j.E.._✓,b—.-Sq. feet
Dwelling -No. of Bedrooms.............................................Expansion Attic :P51— Garbage Grinder f(.JW)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
PaOther fixtures........................................................................................................................................................
W Design Flow....................:................_gallons per person per day. Total daily flow..............7... 6............gallons.
WSeptic Tank—Liquid capacity?nff2.gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.,...I............ Total Length....... ._l.._..... Total leaching area....................sq. ft.
Seepage Pit No.....�_.......... Diameter....."..._-----_- Depth below inlet........:.......... Total leaching area.... .:!. sq. ft.
z Other Distribution box (�^')� Dosing tankKi
aPercolation Test Results> L Performed by........ _)f✓Sf!=!/ ...I-. �--- ................ Date........................................
,..a Test Pit No. 1-----/_-----__mmutesper inch Depth of Test Pit.......�.f p'=_. Depth to ground water_._Gt•?-'�.-.--�s/
fit Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----------
+....:. ---------------
Description of Soil......._.... "....�.......... . ...................'
x
W
---'-•----------------------'--------'-------------...---------------•--'-'•---'-------•-••.-----'-----'-----'••-----------------'•--------•-------•-----•-•------....................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed..................................- --- --- -- -------........................-------------------- ......----. ......------- --------
Date
ApplicationApproved BY ---- ---- . ... ----------"r`-�-------------------------------------------------------------------------------- �1...."Date a y
Application Disapproved for the following reasons- ---- ----------------------------_._................. ...............------. -- -- .....------- --- .-----
---- --- ---------------------------------- - ----------- -- ----- ---- . ----..........----........-----------.......................................................... ........................................
Permit No. .........� ------------------------- Issued ..--G/--.:..-1.�.-':�Y
Date
THE COMMONWEALTH OF MASSACHUSETTS
�•—`� BOARD OF HEALTH
..........
---. f.Jl t� ..... OF ...
/%/i �U >/- l L.............................................
-. ........ --
Exrttfiraxte of C�oznpliancP
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,! ) or Repaired ( )
by ^..`-....-.-...P...�........�fi l�r'f 'tom J .... — stal ......-...` ./............. -
atf.�. .................................................... 1............................................... ---- ---------------------------......--------------------------- .-------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ........94.'W--------- -6.V... dated ........ -- cfC .........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. ....................................................... .. ................. Inspector ----------------------------------------------...................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.N. .........OF........
:..J /L� / L�
N0.......y-.�r....�U FEE...10.0.........
Dispoal Workii Tunofrudinn '"motif
Permission is hereby granted..........f e'-"•-•-----••---•---•---'-'-• .............................................................
to Construct (� ),or Repair ( ) an Individual Sewage Disposal System
at No........--"---'' .........%rc 1-71- 6/1..•-t/)I)P_ — 5 /;"�/'//�' I�
•' ----------"-•----•......•-•-"......•---_._ ...••-"'------••--'..................
Street 9y / K
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
'-'-----•--------------••'--.....'---'-'----..............----••.._
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
{� TOWN OF BARNST
_va ABLE ,
LOCATIONI o r� L,�r,a
SEWAGE #
VILLAGE �ew,'/1E
ASSESSOR'S MAP & LOT /14.=d
INSTALLER'S NAME & PHONE NOr}��py `
SEPTIC TANK.CAPACITY �6�j
-
LEACHING FACILITY:(type) ma` s
NO. OF BEDROOMS
�/ / PRIVATE WELL O LIC WATER
BUILDERQWNEIt,-)
DATE PERMIT ISSUED: 9
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes
i
(!� J 7
` r
r
83 -
A3 -CO - V7
F
----------
7
BAXTER �NYEI. :-
z
ENGINEERING &
SURVEYING
C-4
Registered Professional Engineers
and Land Surveyors
(0
78 North Street - 3rd Floor
C14
Hyannis, Massachusetts 02601 , W
z
z
Phone - (508) 771-7502
a-
-7622
www.boxter-nye.,cm z
0
STAMP STAMP
z
OF
OF
;�`LOCUSrWp,
V = 2OW
Scale. IST
AL
0
0
1 010
CB/DH D 2.6 .
0
PREPARED FOR :
2.1
H. Hance Jr.
ames
Bevedy'S. Hance
NOTES:
lb GENERAL
b,
424 Eastover,Road
MAP 114
LOT 1581 1.) TW NW OF IMS PLAN 6 TO MX OMM'Sff MWONS AT LM
Charlotte, NC 28207
L.C.' PLAN �,2664-92
LOCM AM IS COMPRM OF.
x 21.8
"JAMES H. HANCE JR.. &
BEVERLY S. HANCE 1) ASSESSOn WIP114
LIMIT OF WOW
PARCEL 007
CERTMTE C130M
x 22.1
LANO COW 2W4-IV
x 22.1
22.6
AC UNIT. ELECTRIIC 0 O*fk'4WB IL HAMM 4K Bromy wam
EASPM RW
METER AND EXIS"ING LEACH PIT
UNDERGROUND -BOX TO BE CW&OTT& N.C. 2MI
UP 1179/1 EXISTING,
AND D
ELECTRIC SERVICE TO
'PUMPED DRY. AND
X 22.1 , BE RELOCATED. 22.5 EACHING 22.0
ic-RIEMOVIED 3.) PWff MOWRK- AS WN ON 7M NTH Emme. sw
COORDINATE TANK TO BEPUMPED
DRY. FILM VAN
U71UTY COMPANY
PROPOSED LEACH 9�% SAND AND
FIELD WITH 2-500 DIST. BOX
ABANDONED IN
GALLON PRECAST
PLACE. 2ONW AS I RIC I RF-I
�OH FND
CONCRETE LEACHING .2 CLIRRENT WMAI ZONIM REMOAM
CHAMBERS WL LOT ARFA 43,5W SF
PROPOSED' 23.5
TP #4
TION ;A WL Uff FRWAGE - 20 FT
AM
x 22.8
A/C 125 Fr
WL LOT MM
TP,#2 1000 GALLON
UNIT 6M: CB/DH FND Mw ym - V ff Sw & KM YM - 15 ff 15 ff
22.8 SEPTIC TANK
22
S HELD
23. 0.
poo (APPROXIMATE
23.3\ ELEV-20.98 (NGVD) MERLAY MMM AP, S.EP.
TP 13 0 X 1\0CATION)
X 22.6 22.9 4ALLON
SEPTIC TAW 1 M
TP #1§1 ,*
5.) A ME Zk" WS NOT BEEN PSM0 MR IM ME F DETERWO
ID
D-BOX 400 TO K NETESM. A TITLE SEARCH SWL BE PBWORMED BY OThM to
/2 STOR �T kAOUSE
A 0 to
A 6UES CU
GAS X 23.2 G 6.) THE PROPOW LW *MMTW SPWN IS SW ON MW MME RECM ,
METER = C C,4
STEP
WMIATION CONSRW OF PLANS AND DEEI)S. CC a
0
.4 Uj
7W OMM FUMO MW fEREON KE "M AN ON TW MW FM
U) 10 CLEANOYT SILIRVEY PWOFM BY MXTER K ENWAMW SLWVDW IN FMKM 2014.
X 22.4 23. Ok
;7
W
23.79 7.) COIUAW PANEL MMOM 2MI :0016 0
OE' CD
23. THE FLOW MMMANM RATE UW WKS TW AM IS ZW &
9
�23.7
X 22.7 LIGHT
23.8 23.7
ENIMSM& ffMiGON MN GIS MMMk
'X -Uj
23.5 COBBLE
x 22.8 GRAVEL4
0
P 240/8 STONE
U
SITE 6 Nor WM AN A.C.EC. (ARFA OF CRffrA ENWRONWAL CONCM�
EDGED
ING WALK.
CL
CB/DH FND RETAIN S17E 6 NOr WITINI AN ARFA OF ESWTED WRTAT OF RAW WILMH PER
WALL
NWSP K* OCTOW 1. 2D10 IESTWTED WHIAIS OF,RW WLDLFr
U
MR WE SM M NA KRA" PROTECTKIN ACT MUMS (310 CUR 10).
GHT
22'5 X 24.0 SITE DOES NOT CONIAIN A'CERWO WRNAL POOL PER MIESP MAP OCTM 1.
2 2010 WIF VERK
X 23.0'
MAP 1 lPER NNW MAP OC70M 1. "to ,
SffE 6 NOT WrM A PRIORITY IWAT�
LOT 261 x 23 6 �'o
x 22.5 %WW MWATS OF WA SPECIES' FOR SPECIES (NCIER THE NASSCHIMM
LC. PLAN 2664-127 "x 23.2 MAP' 114 PARCEL 007
TBM: CORNER OF EN0QW0 SPECIES ACT. FWUMNS (321 CMR10).
CL
IOT AREA='61,750 SF TOTAL
9 LOT 261
SITE IS NOT WMIN A swE APPRovED zow i aun vxTER'REC1i*W
LIGHT
YY -127�
(47,492 SF UPLAND) ELEV L.C. PLAN . 2664 PROTEM AREA
=23.79 (NGVD)
JAMES H. HANCE JR. & ATWER ESTIM (MMSBRE
SITE 6 WITIN A ZONE OF,CONTR8M VA
23.8 ,, , BEVERLY S. ANCE
B.O.K RM
Uj
x 24.2
23.5
x 23.0 9.) um" WMA" S�m
AIL, SET
X 24.4
TBM: MAG N
IN PAVEMENT 7W CONTRAC= SIVU CONIACT'AV SAff (AT 14*-M-SNO AM UlLff�CO&PANIES TO LOCATE
ELEV=23.42 (NGVD) ,
\\x'2 3.5; ALL 061M UW= AT LEAST 72 HM PRIW 70 THE START OF CM7RUC71OK TW LOCATION OF
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BAXTER NYE W
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TYPICAL SYSTEM PROFILE ENGINEERING &
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nm v 000STAu MM IMMIIIEM SURVEYING
1. ALL SYSTEM COMPONENTS SIIALL BE NVSTNIED N ACCORDANCE MM
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iHNR01UGN THE DATE OF TM � ANY LOCAL. RULES � REGULATIONS � -
PLAN. Registered egistered Professional Engineers
and Land Surveyors
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2 ANY CHNNGE TO 1HS PLAN MIST BE APPROVED IN NAWTIrG BY 1HE
ENGINEER• ELEVATION INFORMATION MUST NOT
FI�SFIED MADE 23.6+J BE CHANGED wRFIOUf WRITTEN
PRIOR APPROVAL BY THE ENGNfDt. 78 North Street 3rd `Floor
SET MANHIOLE FRAMES & COVERS To I
• SET COMER TO r ARM FM GRADE t
WITHIN 6 of FINISH GRADE. RISERS Hyannis, IUaSSaChUS@ttS 02601
ac GONERS SWILL BE WATERTIGHTRISER O COVER SNALL BE IMTERII(,Hi 3. Will CONSTRUCTION IS COMPLETED. PRIOR TO BACKFN.M NOTIFY THE
OWN OF HEALTH AGENT'AND ENGINEER FOR INSPECTION.
FIMSH GRADE 23.4 -
• 4. ALL SAMrNtY DISPOSAL SYSTEM PIPING TO BE 4 SCHEDULE 40 PVrr•
Phone r508 771 7502
4 SCH 40 PVCFLASH GRADE N 22.8t SET MANHOLE FRAME 1Lt COMER TO WITHIN 6 ,�r� .,
PROPOSED L=10'. s=2.00% of FM�ISH cNtADE i ERs dt oaVERs sHWl UNLESS OTHERWISE NOTED HEREIN. Fax - 508 771-7622 _'"'�I C,�+
CRAWL SPACE
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r � 2' BE WANED PEASTONE 9 min Cover STAMP STAMP
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SHOREY Sn5OO OR EQUAL SHOREY 00-3 OR EQUAL NDEPOIDENRY VERFI D BY THE OWNER OR ITS REPRESafTA1NE. THE
TO BE INSTALLED ON A LEVEL STABLE BASE CONTRACTOR AGREES TO BE FULLY RESPONSN3LE FOR ANY AND ALL DAMAGE'S CONSULTANT
TO BE INSTALLED ON A LEVEL STABLE BASE ABSOMM SYW MI HIM LEACHN MMI ff MAU
SEPTIC TAN( TO BE IISPECiED d: CLEANED MMiIILLY 2 OIiiLE1S REQUIRED His N4�NCH MIGHT BE OCCASIONED BY lif CONTRACTOR'S FALURE TO LOCATE THE
UTILITIES EXACTLY• F ELEVATION IPORM A71ON DIFFERS FROM PLAN
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110N1.
LIQUID DEPTH N SEPTIC TANG DEPTH OF OUILET TEE BELOW FLOW LINE POSSIBLE RL�ESHGN• AT UTILITY VERIFY N HELD THE LOCATION CROSSINGS.
OF TEIFPMONE & DAT COW AND R1IOCATE N'
4 FEET 14100
INVERTS ELECTRIC► GAS.
5 FEET 19000
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168 (ELEV 8.9) � ) � ) �
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SEPTIC 'TANK REQUIRED.- 330 x 20OX 660 GALLONS
QUI
SHEET TITLE
USE 1,500 GALLON SEPTIC;TANK
WA OBSERVED NO WATER OBSERVED NO .WATER OBSERVED NO WATER OBSERVED
NO TER
TO ELEVATION 8.8 TO ELEVATION 8.5
4
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N
EXAMINATION� I CERTiFY THAT IN JULY 2007 I HAVE PASSED THE SOIL EVALUATOR EXAM
Q
APPROVED BY THE DEPARTMENT OF ENVIRONMENTAL PROTECTION AND THAT THE ABOVE SEWER INVERT INTO DISTRIBUTION BOX - 20.7
e
SiSTENT WITH THE REQUIRED TRAINING EXPERTISE 1 ,
o ANALYSIS WAS PERFORMED BY ME CON SEWER INVERT OU'T OF OiSTRIBUTION BOX 20 5
` IN 310 CMR 15.017.
AND EXPERIENCE DESCRIBED SEWER INVERT INTO SAS 20.4
S.A.S.
D A T E . 03 12 2014
BOTTOM OF 18.4
3
NO GROUNDWATER AT ELEVATION 8.5 20 0 20 40
_ 1
SIGNATURE DATE
s
SCALE IN FEET
S C A L E 1 20
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DRAWN/DESIGN BY: CHECKED BY:- SOM SAN
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JOB NO 2014-012 CAbO FILE: 2014-012-SIP
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