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HomeMy WebLinkAbout0340 GRAND ISLAND DRIVE - Health 340 GRAND ISLAND.D4WOSTERVILLE A= 052 012 D 1�1 �I p 7 a O Yo �` v n TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION v MAP NO. a PARCEL NO. ® I Z ADDRESS OF TANK:340 Gi'C�rx� �I.�@�CX_ �l/�' VILLAGE: �,��1i I Number YtrW'ot _ MAILING ADDRESS ( I F DIFFERENT FROM ABOVE) : �. OWNER NAME: 1 ' �'G� VIC, PHONE: INSTALLATION DATE: �lJ BY: INSTALLER ADDRESS: -CER .NO. OL 'P *TANK LOCATION: (ow =:�IQ7 K LOOATI ON W I TH P�QOPQCT TO �U S 1�D S NO) CAPAC I TY TYPE OF TANK AGE ` '/ YRS. FUEL/CHEM I CA1a�r TESTING CERTIFICATION [ ] PASS C ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C ] YES Cq] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES C ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BA(RNSTABLE LOCATION �Lb rC-,� � 5 61 J� SEWAGE#_v 5P VILLAGE - 1 J'0 l,� ASSESSOR'S MAP&PARCEL NAME&PHONE NO. a-Hdc ( p j u lI &/,. 8—I?7 f SEPTIC TANK CAPACITY /000 n4 /9-00 LEACHING FACILITY:(type).?Of r1 f a (size) NO.OF BEDROOMS OWNER `)ice r L PERMIT 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' ! !yf / 4'4'4r4 4 • 4 • 4 A A \ \ 4 \ 4 \ 4 \ \ 4 4 \ \ \ 4 \ \ \ L • \ 4 \.q\ \ 4 :. \ 4 \ \ \ \ ♦ \ \ / f • / ! / r r / f / f ! r / f f f f r f f f f / f / � / / ;, r / f'r f f / / f f J ! J ! / f f / J ! / f ! f f J f i / f f f \ \ 4 • 4 4 • • A. 4 \ • A • 4 • 4 \ 4 • k 4 A \ • • \ \ \ \ 4 A • • 4 • \ \ \ \ f / ! / f f f f / f f f f f l f f f / / f ! ! /./ r J f f f f \ } \ \ • \ • A • \ \ 4 \ } \ k 4 4 A } 4 A \ 4 4 \ \ \ \ \ } \ A \ • 4 A } 4 } \ \,\ A 4 \ 4 \ \ \ \ \ \ A f / ! J r ! / / f f ! / / f f I r / / / / / r k 4 4 4 L \ 4 • • • 4 \ • 4 • \ \ } \ L 4 L L 4 4 L 4 k •yQ�\ • \ 4 4��i\.��p L� L } 4 \ L \ k L 4 4 • \ k 4 4 4 4 \ f\f\/\/\/\/\/\/•rk/4/•/\/\/4 �5 �f44�J4 l \���/4fLr Lf4J4/\f\/•rLl4/•r4r 4/4r\ 4 \ \ A A 4 \ \ • 4 4 4 4 A 4 \ 4 \ \ A 4 4 • 4 • } \ \ 4 4 \ \ A \ \ A 4 4 \ \ \ \ r / / / / f f f r f • / 18 2 5 \ \ 4 } \ \ • A / r / r / r • \ • • 4 • • ! f r f r f f\/ • \ • \ \ 27 26 39 13 17 v Irv. p .` System #1 System.#2 -� � TOWN OF BARNSTABLE FtA N Lto �� � � SEWAGEE O r�� AStS�ESSOR'S MAP& LOT r INSTALLER'S NAME&PHONE NO. -�9A06Ct t SEPTIC TANK CAPACITY ( 5®® LEACHING FACILITY: (type) IP(2XA (size) -NO.OF BEDROOMS UII..D R OWNER '60�n C Ua-J? a. PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Bottomof Leaching'Maximum Adjusted Groundwater Table tor�a ttie g 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. e Mich ch f TOWN OF BARNSTABLE LOCATION 3�i0 C^A�nnZsl rtl t)��i+rt SEWAGE #`v15 P CT,o-1 I VILLAGE Os i ee 4�I ASSESSOR'S MAP&LOT q6 INSTALLER'S NAME&PHONE NO.-b -UC-e- s c-i 4@,L8l SYC 9 SEPTIC TANK CAPACITY J®DD CR/. LEACHING FACILITY: (type) j' tr�rrpo©� (size) /4000 !� NO.OF BEDROOMS BUILDER OR OWNER hk-S r-Anc:s hA-Aama0i) PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility a 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 fee f leaching facility) Feet Furnished by t• ' ' �� Gam, `3 t FEE /yy 0-$ Board of Health, S�Crl ``-e- MA. APPLICATION FOP, DISPOSAL SYSH [ CONSTRUCTION PERMIT Application for a Permit to Construct(c?fepair( ) Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components Location 3 y0 (a-RA V Owner's Name Map/Parcel# Address Lot# f ;�, Telephone# Installer's.Name Designer's Name o SUUV CLMSoc,I-A,v4S Address � Address 4/0 `'L-✓�7JuS�1/ (i2� r114�S�lUs �u Telephone# Telephone# y6\6^ C� S Type of Building / \ Lot Size sq.ft. Dwelling-No.of Bedrooms [Q���� 1 Garbage grin Other-Type of Building No.of persons Showers ( ),Cafeteria ( Other Fixtures Design Flow(min.required) o1a+® gpd Calculated design flow ata, Design flow provided 23G gpd aI Plan: Date It_ 'T I Number of sheets )I Revision Date Title Description of Soil(s) e-e jP 14A)' Soil Evaluator Form No. C �o C1 Name of Soil Evaluatc j r&tCe ate of Evaluation i t Jd DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree;�&= tem' operation until a Certificate of Compli ce as been issued by the Board of Health. Signed Date �� L Inspection 'l J FEE Board of Health, IJ��' S4ck-� i 'C MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(l.41'kepairO Upgrade( Abandon( - ❑Complete System ❑Individual Components .Location 3y0 6-RA1v-0 1SGAND 1DR.IVe Owner's Name Map/Parcel# Address Lot# Telephone# Installer's Name ���) � � Designer's Name St,V U CUnSUC.7'�9 N Address 1�57 7��4 i/�,Lr r Address yp 8 ��uS-� R� f'•)AP,SlbNS Jv1ILL� Telephone# �l Telephone# Type of Building 1 Lot Size sq.ft. Dwelling-No.'of Bedrooms ?I �� Garbage grin Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) aao gpd Calculated design flow daO Design flow provided oZ3G gpd Plan: Date f_a I'� 1 Number of sheets Revision Date Title S P/J�'I /P Description of Soil(s) Soil Evaluator Form No)C 60 C� Name of Soil EvaluaQ!ace, e of Evaluation '*wDESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to o to la the tem operation until a Certificate of Comp'ance has been issued by the Board of Health. Signed . Date (f Inspection �Y No.-? f � �v "" FEE Board of Health, /J /"�a-� MA. CERTIFICATE Of COMPLIANCE f Description of Work: ❑Individual Component(s) CW'omplete System The undersigned hereby cVrtify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: N E J I ���/f� ®� at 3 yd &RA.0> X�t_AiJJO -DRi ye 0,0r- t has been installed * accordance with the rovisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. %'� '��7 dated • �lJ���. Approved Design Flowo1 Go (gpd) }� Installer I�'" / tii 6i;� Designer-\ QAs,Y'e Sy/vet Cto,,SuLTRti Inspector: �i�---V ,i t�f ate: IV v V 1 The issuance of this permit shall not be construed as a guarante that the system will function as designed. No. FEE Board of Health, & ✓K S*",4 DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(L--' Repair( ) Upgrade( ) Abandon( )ari individual sewage disposal system s at J �d 6-1 A t TS 1.4 n9 -1)1'/.y(' , U SIc-f"+ I b', �arJc���lati+� F as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed n three years of the date of this ermit. All local conditions must be m Thi et, Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Dat. Board of Health % / TOWN OF BARNSTABLE Q / LOCATION SEWAGE # VILLAGE ASSESSOR'S 'MAP & LOT INSTALLER'S NAME&PHONE NO. ��a SEPTIC TANK CAPACITY ©� LEACHING FACILITY: (type) SSA, (size) ��X t NO.OF BEDROOMS a <D R OWNER �Ob �o J Z. PERMITDATE: 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 !r 7 . �ry .aO o,P)d �Et 16e ommonweafth of Massachusetts ;Executive Office of Environmental Affairs Department of 1En ironmental Protection Wllllam F.Weld Governor Trudy Coate Secretary,E EA David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 34O G6ZA,r\cTAw o e- Address of Owner: Date of Inspection: Nc)u. 63\C�QS (If different) Name of Inspector: _SoQLe Company Name, Address and Telephone Number: Sho2e�,�� �'��t• . 8 ssa� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate + and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails C' Inspector's Signature- ,n Date: �av• i.3J The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. /d2 INSPECTION SUMMARY: , ^ 4u .+ Check A, B, C, or D: A) SYSTEM PASSES: NOV 1 .l 1995 have not found any information which indicates that the system violates any of the failure criten`as definenp R 15.3 Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 h i, Primed on Recycled Paper SUBSURFACE SEWAGE DISPO SA LAYSTEM INSPECTION FORM CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B)SYSTEM CONDITIONALLY PASSES (continued) royal the ution x is due to Sewage backup or brea kout or high static water level observed in the dembw o ill passi inspection broken t ct bstru h approval obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system Board of Health): _ broken pipe(s) are replaced _ obstruction is removed distribution box is levelled or replaced The system will pass The system required pumping more than four times a year due to broken or obstructed pipe(s). inspection if(with approval of the Board of Health): _ broken pipe(s) are replaced obstruction is removed • Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: L : Health in order to determine if the system is failing to protect the _ Conditions exist which require further evaluation by the public health, safety and the environment. �) SYSTEM WILL PASS UNLESS BOARD'OF HEALTH DETERMINES THAT THE SYSTEM IS THE ENVIRONMENT NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AN Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.IF APPROPRIATE) DETERMINES THAT LIC WATER SUPPLIER, 2) SYSTEM WILL FAIL UNLESS THE BOA►Rv1DANONEREALTH (AND.THAT PROTECT THEPUBLIC HEALTH AND SAFETY AND THE THE SYSTEM IS FUNCTIONING IN ENVIRONMENT: ur UiLutcry lu o f The wstern nas a septic tanK and soli absorption system and is within 100 feel to a surface Water supply well. public surface water supply• private water supply well. The systeni ha, a septic tank and soil absorption system and is within a Zone of I o a ri private water _ 7he•system has a septic tank and soil absorption system and s less than0100tfeetbut 50 feet or more from a p The system-has a septic tang _ 11 t' t ammonia nitrogen and nitrate nitrogen is equal to or less than 5 welt, unless a well water analysis for coliform bao aria and volatile organic compounds indicates that the we is ! supply presence free from.4pollution from that facility and the p M. D] SYSTEM FAILS: s stem violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis I have determined that the y ' tion is identified below. The Board of Health should be contacted to determine what will be necessary to correct for this determina the failure. cloggedor SAS or cesspool. _ Backup of sewage into facility or system component due to an overloaded waters to an overloaded or clogged SAS or _ Discharge or ponding of effluent to the surface of the ground or surface Ovate cesspool. 2 (revised 8/15/95) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D) SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of,a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. • (revised 8/15/95) 3 r Y u „ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: t'(ArAC'-cL Date of Inspection: SRS Check if the following have been done: Zumping information was requested of the owner, occupant, and Board of Health. Zone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ZAs built plans have been obtained and examined. Note if they are not available with N/A. ZThe facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. �II system components, excluding the Soil Absorption System, have been located on the site. Z—The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility ov,nei (and occupants, if different from owner) were provided with information on the proper maintenance of Sub Surface Disposal System. ` �"T'qt�Q �� c Ccs��GC� ir. -ti�.� • (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C `` SYSTEM INFORMATION Property Address: 3y0 Owner: ��QStAnc.� C`\Ac�vr�mA2A Date of Inspection: ,\ FLOW CONDITIONS RESIDENTIAL: Design flow: _ 3O gallons Number of bedrooms: '3 Number of current residents: I Garbage grinder (yes or no):__1A_tS Laundry connected to system (yes or no):yO--S Seasonal use (yes or no): No Water meter readings, if available: Last date of occupancy: COMMERCIAUINDUSTRIAL' Type of establishment: Design flow:___gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)— Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: m( System pumped as pan of inspection: (yes or no) If yes, volume pumped a®o gallons / Reason for pumping: TYPE OF SYSTEM �5eptic tank/distribution box/soil absorption system _Single cesspool— SySTcr1.73y- Z-�N� Overflow cesspool Privy ' Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed(if known) and source of information: ST=�- 11f�2c rt q4 Sewage odors detected when arriving at the site: (yes or no)No 5 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 340 GL`Ana�s\ar�o�Z�u� - 0'% er- Akc Owner: �\qzs, !t��nc hfacn��m A2C` Date of Inspection: Nov _�,�lciciS� SEPTIC TANK:_ (locate on site plan) Depth below grade:/02 Material of construction: 4�ncrete _metal _FRP _oiher(explain) Dimensions: X 6 7� Sludge depth: = " Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_/v � Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) S7s/en'J//! �'xC'c' C///C'O/t9� /d•�/ GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of cum te, bottom of outlet tee or baffle-.- comments. condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural (recommendation for pumping, integrity, evidence of leakage, etc.l • 6 (revised 8/15/95) r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of inspection: N� f3�lciSS TIGHT OR HOLDING TANK:,_ (locate on site plan) Depth below grade: Material of construction: _concrete ,_metal _FRP —other(explain) Dimensions: Capacity; gallons Design flow:______ Qallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Ev eA Comments: / f (note if level and di stribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) �O %i'uf�/�i►'i t' �'o�a�., PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: appurtenances, etc.) (note condition of pump chamber, condition of pumps and (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3`(O C�+��=' �� C. Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching.chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) o i 9 CESSPOOLS: (locate on site plan) / and configuration: ✓ f.2r ooc/z Number a g 1E'T Depth top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: O Dimensions of cesspool:-- x Materials of construction: QbXt2eT& Indication of groundwater: 1110tlt F n inflow (cesspool must be pumped as part of inspection) �t'SS Coo Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) cc 'C //C/l,J oi;, PRIVY:_ (locate on site plan) Materials of construction: Dimensions: j Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) B SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' ❑ �ts�,�ak � 1QNX 4� FQ nN I 13 Lw 6b _V,;T -3 G A I 3 C-e. ec1 S S el Est b x� �-- A � Liz' coSSpo�� if( , . DEPTH TO GROUNDWATER / CrsSpoc, Depth to groundwater:_,.C�feet method of determination or approximation: U��.C°S, " Cu /�; ��-�2�ai)r Uc% S` • (revised 8/15/95) 9 R ASSESSORS MAP N0: 4 - PPRCEL NO: Flcs..36)........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE A - %'_� -. 'ILZ"*� jgliv a i� usat Works Tomitrurtion" Vamit Application is hereby made for a Permit to Construct ( ) or Repair (,�-T an Individual Sewage Disposal System at: ....:3 4f0 �r ................i fn•�2. ............................. Location-Address or Lot No. ►�1R: J°��_..... � !?!11t2 -------------------------•----- •---------------------------- ......... Owner Address W G o 2.. .. �.. �.;z...-..........C?a -- Installer Address Type of Buildin Size Lot............................Sq. feet U Dwelling 7No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons.......................... Showers Other—Type g --------•------•----------•• P -- ( ) — Cafeteria ( ) Otherfixtures ---•--------------------------------------------------•-•••-•••--•--••-----••-•---•---•-••............••--------•------• ----------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.4—a°..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 ( ) aPercolation Test Results Performed by...........................................................................Date........................................ Test Pit No. I................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........................ 1:4 •-•-•-•••-•-••-•-••-••••-••-••-••••-•--•---•--................................................................................................ •---------- -••- ODescription of Soil...............................................................................x V •--•--•-•--------------------------••-•-----------------------------------------.....--•------•--•-------------•---------------•---- --••-•......•--.•• f U Nature of Repairs or Alterations—Answer when applicable.___-__-_-- fT9�l..------ spf �7 Al jx-------------- ------------------ -----------------------------------------------------•----•-------------........---------------------...------------------ ...................... 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 Compliapce has been issued the board of health Signed - 4�1 Application Approved By ------ ------------- -:-- -A........ .... 9 Application Disapproved for the following reasons --------- ------------------ -----= -------- -------.................................................. --------- -------- ------------------------------------ -- ----- ----------- --------------...----------- --- -- .....------------------------------ ----------........................ Dare .....q4t----_---- Permit No. - Issued ---------_ No.. Fss..�. �-./............. THE COMMONWEALTH OF MASSACIUS'ETTS '. i BOARD OF HEALTH TOWN OF BARNSTABLE .�J�Ivlirattoui for Diupuua l Works Tpustrurfiurt Prratit Application is hereby made for a Permit to Construct ( ) or Repair (vj-an Individual Sewage Disposal System at: ....:3.y�.... � •�......... .. :� 2 v.... . .............................. ....................................................- o....-•---•------.......................... Location-Address or Lot No. --- --------.......................................... OwnerAddress........... ..................... w ............................., �•,���� - oce�l CP�P.�1.... ----------- -------------- -- 5 Installer Address Type of Buildings Size Lot............................Sq. feet U Dwelling 4 No. of Bedrooms...3....................................Ex ansion Attic a , gp ( ) Garbage Grinder ( ) P., Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.Io9_°_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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 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........................................................................................................................................................................ x U -•••••••••-••••--••--•••..............•--•..........------•------••----•----......-•----......•••••--••--•••••-••••--•.....•---•---•-•••-•-------•-•••-•-••-----•--•----•-••---••-•--•-----....._..••-- w ............--------- U Nature of Repairs or Alterations—Answer when applicable.______-__;Z2i7 ��..._.....�Ud.p�'Qf-T��/ ..... .•-•••-._. -•------•------------------------------•---------------------- --------------------.....----------•----•-••-----------------------------...... a s�/_... �/------------...... 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 ce has been;�l he board of health. Signed 4�1 - - �' F ........ Sf.Z 1/ P D.,Application Approved By - ° ...... !I� -- 4(ly Application Disapproved for the following reasons- .............................................. --------.................. -----.....------...--------..: ........ ......................................---------- ' Dace Permit No. ....... ----- --------- Issued THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (Q.1rdtfi a e of Q-14untplian e THI54S TO CE T That the jndiv' al Sewage Disposal System constructed ( ) or Re . ----_-..---.- at 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. .... .'".-.. --.- dated ................................................ 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 TOWN OF BARNSTABLE No..... ............ FEE... ................. �tu�ru� 1 1 �u��j/u, �utt��ruaa)t �pruti� Permission is herebyrantedi•••.•_ .. / .-�1,/..V )�a=' `� -------------------....................................... to ConstruetJ((), or Repair\ ( an I, ivi�lual�.ew ge Dis,o aI System. l /Y at No..••••- ....... T�. 1 � 1�....� � c+� t street q 9 ^ as shown on the application for Disposal Works Construction Per i o._q��.........- D��'d.........�._./.. -../.-.v._..,. --........_.I; ::. •--- ---�.._..-------•----.. ............../ - � Board of Health �. DATE.............. .1 ........................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS f�#4 #320 x i u / Wetland Limit x " ;s '° ,oF •s C F ,�T l as Flaggedi byxl ENSR °"" l 44 30/SEP/99 Existing f w I�#3 ry Pool O `w— ct µ 1 } 4nR Sk w ''� �• p/ o Laf err NIyyilson w-1 a � 4� Fi / i k jornesqj 2 271 t p mJ: k yGi.' Chain Link Fence t & Rail Fence h: x Ql i 329 Poe 13 I O. 41.9' tstal peaa ,. •^ rts M t geese 171 co Location Map Proposed o TBM E1=12.9'NGVD 1"=2000't Pool Equipment Total Lot Area top of Mag—Nail W/F Shed :I 49,567±SF II ASSESSORS REF.: 10t7' Map 052, Parcel 012 / --------- - ; w n / r- Cl) i { Apron ' .k,,,••,. l� 7 6 - ZONE ' 6 . RF 1 � Area. (min.) 87,120 SF (RPOD) r`"''•` w o Frontage (min) 20' �- Width min) 125' Setbacks: 42f' ��- _1 1 1 Lots eyed..._ Side 1 /2 Sty Unre9.. 0 \, a t Rear 15' \ \ 0. 1 Approx Septic W/f F Lo r A •� i 1 as per TOB V� ' SS-. � �„ ,• � Inspection � Dwelling card S1� OVERLAY DISTRICT: \p i AP — Aquifer Protection District 0 Ci FF 5' Paved Drive one C With ii FZOOD&ZONE: i I stone Covering ,' o Community Panel No. x i ------�' o o #250001 0018D Proposed Poo/& --- July 2, 1992 Fence Enclosure o ❑ ❑A- Unit \ I N ��Of YA on c ' pnonooppo9oaoo I y` Proposed Fence Enclosure \ I a RD R 10-` - o RICNA LEGEND: 5' High Block chain mesh `�o- 45.0' \- j " 114EUREUX w/gates as per Town of o ,�' r r Ced I Z. .op No. 343122 �o a Electric Meter Barnstable reguirementS oM is oCB/DHt C't �^2F �/ 146.20 I I *. Light Post � Guy . �9 s j/ / 5,13"W p I � Utility Pole S��iG6 'Post & Rail Fence . . S77•o - -OHW— Overhead Wires —25—— Elevation Contour e ❑w Water shutoff / FCH J CB/D" 0 15 30 45 60 FEET CBID Fnd - / Sheet # Title: Prepared or: Notes Revisions: Scale: Plan Showing Proposed Pool CapeSury 1"=30' Peter Friedensohn 1.) The property line information shown was compiled from iavailable record information. Date' of 1 1 340 Grand Island Drive. In 7 Parker Rood 398 Atherton Street 2) me topographic information was obtained from on on the 18/OCT/11 IJV Osterville MA 02655 ground survey performed on or between 25/MAY111 and Barnstable (Oyster H(7rbors) MaSS (508)420-3994 (508)420-3995 fox Milton MA 02186 26 MAY 11.3.) The datum used is NGVD '29, a fixed mean sea level datum. U.W copesurv@copecod.net C338_4g 1 1 t 4 • a' O� t, NORTH / BA Y :.• / BRIDGE / TREET LOT 13 G, WEST BA Y LOCUS �o �• 1 N77 05 _ " COTUIT 329.03 (fed) U BAY YSTER HARBORS' LOCUS MAP \ SHEDS { . WELL I ASSESSORS MAP 52 FLOOD ZONE.• "C» 3 - - - cA o. '.n:_RES. ZONE. "RF=1",r . r -___-_ -_ � \ o I (� PLAN 'REF• SEXIST, o o g.0' .32817 . SrSTEM _ - - - - - = 5.g• • I L C. 15354-77 l HEAD ASSESSORS LOT 12 G� XIST. _ _ ====-=_ 1 I . . AREA=49,572 SQ. FT. - - - - _- - - -- - _— �. _.- -= u HSE.�340 " ti a- - - - - SEPTIC PLAN LINE OF REGISTRATION PLAN 32817 . 1-1sT�_14,g' - _ -__ - _ CVs LC PLAN 15354-77 PROJEC T L OCA TION A o� FLAC =___— _:HIM. - - - - - -� - - - - cT 9 00 STONE �— — _ - - _ _ —L I to VE �_ 9 �, .� PA TIO CAR. 34 0 GRAND IS A DRI —I OSTER VILLE, MA. 4 . O — - — Eli',q y o APPLICANT. P. �N \ PRO1 ADDITION-9�, — - — ►'_ 1 ROBERT GLOVER T-1190 CAR SLAB BENCHMARK y c9- :/'_30.0 — �i TOP OF SLAB I EL=100.0(ASSUMED) � � cv ' YANKEE SUR IIEY CONSUL TAN TS o % �' P. O. BOX 265 I o UNIT 1, 40B INDUSTRY ROAD I w MARSTONS MILLS, MA. 026 o� a p� ,9� , I PH.(508)428—0055 — FAX(508)420-5553 PAU y� �` ' BRME C� \ (fnd) — — — (f d) , I I SCA L E.• 1 "=30' DA TE. 11129199 A. G. I Sc MERITTHEW vW %as _ \ , N77 05137E {° 146.20' Nm / REV. IREv• p mpg ,{• 7 ° �CC;s i�® d1 `�, �i L f • - \ \ `fir `. I �`®�aa la�Os R3" • eA��P 96-\ - I JOB NO. 52176 SHEET 1 OF 2 EL. =_100.0' TOP OF FOUNDATION 20' MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC 2"LA YER OF MIN. 'PITCH 118 PER FT. 1/8"-1/2" 1 _ CONCRETE COVER WASHED STONE � � ii . � .. . . . . � iEL EL=98.0 4" CAST IRON PIPE ' (OR EQUAL MINIMUM 11 rj CLEAN SAND 9„ PI7rH 114 PER FT. MIN. PIPE PI7rH 1118" PER FT.= O.005 MIN. FLOW LINE 5' - 5' INVERT ' 1 10 EL= 96.1 " — 97.0 MIN. 14" OVER DIC " EL.----,-- INVERT LEVE 0 0 0 0 0 0 0 o p o n 0. 0 0 0 0 0 0 ° oo° ° CAS - 96.5' �6 SUM LEVEL 0 00°0 0 00 0 0 0 0 6 0 Q0 0 0 0 0 0 °0 0 0 INVERT BAFFLE EL._ INVERT INVERT 0 ° °o° ° ° �- o o Go `ti ° 8 ° o o L.=95.I 96. 75' --- EL.= 96.1 _ EL.= 95.8_5_ - -- (M BE PLACED ON FIRV BASE) DISTRIBUTION INVERT MECHANICALLY COMPACTED OR B" OF s7nNE —9 BOX EL.= 95.6 --— N __1500__GALLONS FIELD FORMATION �T► TO BE WATER TESTED SEPl IC TANK, IF MORE,THAN ONE OUTLET ' . FIE ATI w PLACE ON s" STONE . 314" TO 1-1/2" SOIL ,ABSORPTION - .. . 'PROFILE OF DOUBLE WASHED STOA E YSTEM SAS) 111IW-29s / . , SEWAGE DISPOSAL SYSTEM, . ` = DJ=z 4' BOTTOM OF TEST HOLE OR IlSGS PROBABLE WATER TABLE ELEV. __90_.4' ' NOT' TO SC ALE- f 1 9�199 OBSERVED WATER TABLE (11122199) ELEV. =_ 88'_ OBSERVATION HOLE I ELEV PERCOLATION RATE MIN./INCH AT 48 INCHES,; DEPTH' ORIZ a Y TEXTURE COLOR MOTT OTHER= _ :j-3„ O ORGANIC 3"_14'" _ A •SANDY LOAM.t . IOYR 5, 1 4»=42" B LOAMY SAND IOYR 5-8 GENERAL NO TES .. Cl MED. SAND IO YR 6-4 PERC 2 -126 WATER ENCOU ERED ELEV.= 8 ( 14 inches) _ r , r 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E:P. TITLE 5 AND THE TOWN OF _ R_lVSL4fl_LE____ RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO �,` $ SOIL -TEST WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" PATE OF SOIL TEST 11122199 S OIL TEST DONE BY BRUCE„_G. v MURPHY, R.S. 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN WITNESSED BY: DONNA MIORANDI PROPOSED ,2—BEDROOM-' 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL "BE P,#9609 DESIGN CALCULATIONS.' USED UNDER OR-WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS . 2 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL GARBAGE DISPOSAL . . . NO BE MORTERED IN PLACE. TOTAL ESTIMATED FLOW 5) DEEDED OR NO I ZONING REGNATION HAS ULATIONS EEN D O WNER/APPLICANTE AS TO CIS TO H ( 110__GAL/BR./DAY x ?__ BR.) 220 GAL/DA Y OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. INSTALL LEACH FIELD REQUIRED SEPTIC TANK CAPACITY 1500 GAL 6 UTILITIES SHO WN ARE 'APPROXIMA TE ONL Y, EXCA VA TION CONTRA CTOR 20' X 16' X 6" FIVE FOOT OVERDID SOIL CLASSIFICA TION . . . . . . . . I IS TO CALL "DIG— SAFE" AT' 1-800-322-4844 AT LEAST 72 HOURS ` TO APPROx 42", TO _ DESIGN PERCOLATION RATE < - 2 MIN./IN. PRIOR TO COMMENCING WORK -ON SITE. . 74 7) CONTRACTOR IS TO VERIFY, GRADES AND ELEVATIONS AS WELL AS . . MED. SAND HORIZON EFFLUENT LOADING RATE . GAL/DA Y/S.F. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. CLEAN M7,DIUM SAND LEACHING CAPACITY (AREA X RATE) 236 GAL/DA Y 8) PARCEL IS IN FLOOD ZONE_ _""C TO BE USED, AS FILL RESERVE LEACHING CAPACITY . . . 236 GAL/DA Y .- 9) LOT IS SHOWN ON ASSESSORS MAP _52_ AS PARCEL _12_—_. : (20x16x. 74). ;.. ,. JOB SHEET 2 OF 2 NUMBER _ 52176 ------