HomeMy WebLinkAbout1057 MAIN STREET (OST.) - Health 1057 Main Street (Ost )� - �-
Osterville P
A 118 010
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TOWN OF BAMSTABLE
`)CATION 19 5^7 Mall? S s SEWAGE #
ILLAGE G`�ST�r v �� ASSESSOR'S MAP& LOT
INSTALLERS NAME&PHONE NO. G i�� w ��� elf'7
Y SEPTIC TANK CAPACITY..
LEACHING FACILITY: (type) (size)
t-�
NO. OF BEDROOMS
BUILDER OR OWNER S�ti
PERMTTDATE: „�G 7 G� COMPLIANCE DATE: / 2—A010 ff
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
1A.3
� � � '� C.
No. I FkEa
COMMONWEALTH OF MASSACHUSIUS
Board of Health, 11s7XUA im—MA.
APPLICATION FOR DISP®SAI. YSKM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) - ❑Complete System O Individual Components
Location Owner's Name Co t r'n
Map/Parcel# Address
Lot# Ao Telephone#
Al
Installer's Name J Designer's Name - - O IATES
42 CANTERBURY LAN
Address Address EAST FALMOUTH,MASSACHUSETTS 02636
5081540-2534
Telephone# Telephone# A
Type of Building Lot Size { _sq.ft.
�the,
-No. of Bedrooms Garbage grinder, ( )
e of Building No.of persons Showers Cafeteria
YP g p O, O
Other Fixtures
Design Flow(min.required) °� 17 gpd Calculated design flow lip Design flow provided gpd
Plan: Date Oka 'L9j� D� Number of sheets I I Revision Date
Title (7 & n
Description of Soil(s) <� a
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation 16 LnQ
DESCRIPTION OF REPAIRS ORAL�ER TIONS !jt
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agreeess_.ttoo'not to ce system in operation until a Certificate of 2Dmpliance h been issued by the Board of Health.
Sigt e�6 Date L
Inspections
�-w_- -��s�'�'��� -'� ....0 •t.w,_. ....._ .. ..s, ,��t .a:.:.. -y � £ .o
0
h ` S
No.
'COMMONWLALTH ®L`KASSAC
i�Board of Health, r/ A'(21.1% �'J41�f.�'rz-;MA.
APPLICATWN_FQR DISPOSAL YSTE91 CONST 1. N PERMIT
Application for a Permit to Construct( Repair( ) 'Upgrade( Abandon( - Cl Complete System ❑Individual:Components
Location Owner's Name w r
Map/Parcel# Address
V\can
Lot#' Telephone#
Installer's Name k �.. t I Designer's`Name 42 CANTERBURY LANE
Address v Address 508/540-2534
Telephone# sti Telephone# i
Type of Building a Lot Size' sq.ft.
Dwellil -No.of Bedrooms Garbage grinder ( )
they-Type of Building No.of persons Showers ( ),Cafeteria(
Other Fixtures .
Design Flow(min required) 3^l D gpd Calculated design flow Design flow provided �� V gpd
Plan: Date n i0`�'L.�� ' Number of sheets Revision Date
Title _ L �. � p r �~'1 ® �. �.1 r
- Description of Soil(s) '��\-e.. ��"�t�L.. �•.Z.�� t 1.I7)' r
Soil Evaluator Form No.. Name of Soil Evaluator Date of Evaluation Z 6 —/)
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned a�g+=es install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and �5
further agrees to not to a?ce th system ion until a Certificate of mpliance h been issued by the Board of Health. }}
Sign s�`� r Date V
Inspections'>`
t
NoCj -tl V /✓ \ FEE /—/
n COMMONWEALT . ®L M AC SETTS
Board of Health, t�%MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑Individual Component(s) 0 Complete System t
The undersigned hereb cer ' tha the Se age,�D'spo al S stem; Constructed ( ,Repaired ( ),Upgraded ( ),iAbandoned ( )
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and�herapproved design plans/as-built plans relating to
application No. dated Approved Design Flow (gpd)
Iy Installer, /-rs�- n /��s...-.
4r Designer: Inspector: � l�Yl� ,>`��/ Date: d � �Y /!1� - 2 r
L" - y - r—
The issuance of this permit shall not be construed as a guarantee that the-system will.function as designed.
No.. FEE
COMMONWEALT14 OF MASSACRUSETTS
Board of Health,
DISPOSAL SYSTEM CONSTRUCTION PERMIT
f Permission is hereby granted to; Construct( 14 Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at 11'� ,� as described in the application for
Disposal System Construction Permit No. 2-UU t{-3 Iv, dated 7
Provided: Construction shall be completed within ree years of the dCohis, r � local conditionsmust be met.
Form1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date f Board of Hea
M
TOWN OF BARNSTABLE
LOCATION 5~ Mall? 5 f_- SEWAGE # �-33 .
VILLAGE S�t'/'L'%`� / ASSESSOR'S MAP& LOT `fJO
INSTALLER'S NAME&PHONE NO. _1" ?6 /,5,o
SEPTIC TANK CAPACITY �� U
.� LEACHING FACILITY: (typed (size) 0 Z,•1S
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: ,�l7 ( COMPLIANCE DATE: / 2-1Z010 f
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
d y
A ' �-y
rJ
e
Town of Barnstable
wT Of S
o Regulatory Services
Thomas F. Geiler,Director
BARMSTABLE
9 MASS.
�A i639. Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer & Designer Certification Form
p• Date:
Designer: Stephen Doyle & Assoc Installer: Wm E. Robinson Sr Septic
Service
Address: 42 Canterbury Lane Address: PO Box 108,9
f
E. Falmouth Centerville
On Wm E Robinson Sr Sep48 issued a permit to install a;
(date) (installer) service
t septic system at 1 057 Main S.t, Osterv.ille based on a design drawn by
(address)
Stephen Doyle & Assoc dated 06-28-04
(designer)
certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed,with major changes (i.e.
greater than'10 lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations.,,'Plan revision or
certified as-biult by designer to follow. 's"
OF AM$
(Instffl&s Signature) �xir;o'.,� .y
PQ`0
(Designer's Signature) (Affix Designer's Stamp Here),
4, PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
r 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:Health/Septic/Designer Certification Form
iu
...............
r
- 1
[RECEIVED
Commonwealth of Massachusetts J U N ? 4 1997
Executive Office of Environmental Affairs HEALTH G`�--.s"-T.
Department of TOWN OFBAtii ;F.'�L
Environmental Protection
Wliilam F.Weld Trudy Cox@
Governor s—dary
Argo Paul Celluccl David B.Struhs
u.(limmor ComrnbaloMr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A -
CERTIFICATION
property Address: 1057 Main St, Osterville Address of Owner.. Mary Kenney
Date of Inspection: 6—/3_,q 17 (If different)
Name of Inspector. W.E. Robinson SR
Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6
W.E. Robinson Septic Service
P.O. Box 1089 Centerville MA
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 pection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sew disposal systems. The system:
_ Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: i/ Date:
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.
INSPECTION SUMMARY:
Check A, B, C,or D:
A]r l
PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
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 Fonforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
One Winter Street is Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-SM
ice,Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1057 Main St, O s t e r v i l l e
Owner. Mary Kenney
Date of Inspection: (6 l
B]SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pipe(@)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of .
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(*). The system will pes@
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
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.
Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis for ooliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or low than 5 ppm.
8) OTHER
(revised 11/03/95) 2
L
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1057 Main St, O s t e r v i l l e
Owner. Mary Kenney
Date of Inspection:
DI SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
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 GE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 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 o r or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
req ' ments of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
P
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PropertyAddrsw 1057 Main St, Osterville
Owner. Mary Kenney
Date of Inspection:
Check if the following have been done:
jz�,mping information was requested of the owner,occupant,and Board of Health.
, one 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.
_As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
V The system does not receive non-sanitary or industrial waste flow
_LThe site was inspected for signs of breakout.
All system components,excluding the Soil Absorption System, have been located on the site.
•✓The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of bales or
tees,material of construction,dimensions,depth of liquid,depth of sludge, depth of scum.
j1nhe size and location of the Soil Absorption System on the site has been determined based on existing information or
rr approximated by non-intrusive methods.
�the facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1057 Main St, O s t e r v i l l e
Owner. Mary Kenney
Date of Inspection: e ^ 3 -q 17
FLOW CONDITIONS
RESIDENTIAL-
Design tlow:_3_j.2_.gq1lons
Number of bedrooms: 3
Number of current residents:
Garbage grinder(yes or no):?—O
Laundry connected to system(yes or no): S
Seasonal use(yes or no):-u 5
Water meter readinge, if available: 1995 — 21 , 000 gals
1996 — 19 , 000 gals
Last date of occupancy:
COMMERCIALANDUSTRIA U
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,fl an source of information:
System pumped as part of inspection: (yes or no) _3,0
If yes,'vohune pumped: gallons
Reason for pumping:
TYPE OY-SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
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: 1�
Sewage odors detected when arriving at the site: (yes or no),gL C)
(revised 11/03/95) 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
property Address: 1057 Main St, O s t e r v i l l e
Owner. Mary Kenney
Date of Inspection: — 3 —q `%
SEPTIC TANK:_v
(locate on site plan)
Depth below grader /
Material of oonstnutiion:_lconcrste_metal_FRP_other(e plain)
%� v►
Dimensions:
Sh,dge depth:/o
Distance from top of sludge to bottom of outlet tee or baffle:'3
Scum thickness: V %g r-" I t
Distance from top of scum to top of outlet tee or baffle: !—
Distance from bottom of scum to bottom of outlet tee or balfle:_42
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, ) nod� O b d 0-,b I 7 �,
A,&i4 f / o �, r Gd
G TRAP:_
(locate on site plan)
Depth bel grade:
Material construction:_concrete_metal_FRP—Other(explain)
Dimenin
Scum
from top of scum to top of outlet tee or baffle:
from bottom of scum to bottom of outlet tee or baffle:
Commenita:
(recomm indatmn 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.)
(revised 11/03/95) 6
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1057 Main St, O s to ry i l l e
Owner. Mary Kenney
Date of Inspection: L —l 3 q,
TIG OR HOLDING TANK:_
(locate site plan)
Depth be grade:
Material o construction:_concrete_metal_FRP—other(explain) '
Dime no:
Capaci gallons
Design�flow* gallons/day
Alarm level:
Comme ts:
(ooadi' of inlet tee,condition of alarm and float switches,etc.
r
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) 6 K
PUMP C BER_
(locate o site plan)
PUMPS' working order:(yes or no)
Cowman
(note co an;
of pump chamber,condition of pumps and appurtenances,etc.)
7
(revised 11/03/95)
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C j
SYSTEM INFORMATION(oontinued)
Property Address 1057 Main St, O s t e r v i l l e
Owner. Mary Kenney
Date of Inspection
SOIL ABSORPTION SYSTEM(SAS):
-Z
(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.) 6 a
CESS LS:_
(location ite plan)
Number and afiriration:
Depth-top of to inlet invert:
Depth of so' layer.
Depth of layer:
Dimensions o cesspool:
Materials of natniction:
Indication o groundwater:
ow(cesspool must be pumped as part of inspection)
Comments: (n condition of soil,signs of hydraulic failure, level of ponding, condition'of vegetation,etc.)
PRIVY:
(locate on site Ian)
Materials of oo n: Dimensions:
Depth of solids:
Comments: (n condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95) g
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Addreew 1057 Main . St, O s t ery i l l e
Owner. Mary Kenney
Date of Inspeotion: c
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
10,6
I1 1
DEPTH TO GROUNDWATER
Depth to gmundwater:�feet
method of determination or approximation: 6 14
t ,
(revised 11/03/95) 9
i
TOWN OF BARNSTABLE �`
z LOCATION to Fc� 2 {�,�� ego ' SEWAGE #:.
VILLAGE__ <5 %J _V ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. 6-10H 4 444-,Q��
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) � -� 5���. (size) �. f
NO. OF BEDROOMS PRIVATE WELL O UBLIC WAT
BUILDER OR OWNER
DATE PERMIT ISSUED: r r C 3
DATE COMPLIANCE ISSUED: �/F� �J y 'a
VARIANCE GRANTED: Yes No �/
X'.
TOWN OF BARNSTABLE
J y�2-IS
CATION ��R�-2 6\ i � SEWAGE #: q�
VILLAGE_ ASSESSOR'S MAP & LOT
t"INSTALLER'S NAME & PHONE NO.
+EPTIC TANK CAPACITY /Z)r'� g
LEACHING FACILITY:(type) Pa-e (size)
NO. OF BEDROOMS_ PRIVATE WELL O UBLIC WATE cam- ',
BUILDER OR OWNER
DATE PERMIT ISSUED: ( '3
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �/
s
av
See C r6,,
1
I io u
1 �
�I �
No.. ,...' :_....... FE$.....� :.. �
THE COMMONWEALTH OF MASSACHUSETTS �►Jry1"""
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Allp iration for Uhipnsa1 Works Tonotrnrtion irmit
Application is hereby made for a Permit to Construct ( ) or Repair (clan Individual Sewage Disposal
System at:
Location ddress or Lot No.
;. IVY"
,✓
-• Yt- ................................•----------_... .............
� Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...3...................................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ---------------- --------------•-•-•-------------
W Design Flow____..__S-`_;:5...................... gallons per person ver day. Total daily flow___77 �_0......_..................gallons.
WSeptic Tank J—Liquid capacit}I&•_gallons Length__l'-_'-___.___. Width._-_.___ Diameter________________ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.------/------------ Diameter._10---------- Depth below inlet._. ��_____________ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................
P4 •-•-•••--•-------------------------••---.._..--------------•-•-....--•------••--.........--•--------.........................................................
0 Description of Soil.................................................................................-----------------------------------------------------------•-•••----•--•----------•--
x
V
--------------------------------------------------------------------------------------------------------------------------------------
---------- --JrV
- ---- --•--f
U Nature of Repairs or Alterations—Answer e� a plicable___. -6�— �{��__._.__( ._.S'� ...........................
-----------{a.- _---(K-------� � T - �...._�r��=- ------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been eued boar4 of health.
Signed - .........
Dace
Application Approved By -- --:..-r-o--- -- - --------------------- --------------------------------- --------------------------------------_--- ......
2
Dace
Application Disapproved for the following reasons- ------ - ---------------------------------- ------------------------------------------------------------------------------------
--------------------------- - -- ------------------ ---------------------------------- ----------------- -- ------------------------------------------------------------------------------ ---------------------------------------
PermitNo. -----G� .............. ................... Issued -------/-------- .......................
Date
No.. .' ....... � r� F�s.......�... ....
t
THE COMMONWEALTH.OF MASSACHUSETTS
-BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for llispuual Works Tumuuriiun Prutit
Application is hereby made for a Permit to Construct ( ) or Repair ( fan Individual Sewage Disposal
System at:................ ��•-- 7 A d..l.... 5 T' ..............� 5...v v..1.
.13.=`5•-•----•-----.•...--•-------..........-----..
Location- ddress or Lot No.
..i 1VV� u�� `/ r -lf ----•...........................
.......................... .......... ............... ............'......-.-.........
Owlr
ner-- Address
--- -----------------
P
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms___--.. ..................... .__..Ex Expansion Attic a g— -.------- p ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures •---•-----------•-----------•----••-----•--------•--------•--•------------------------- ---•--....... .--......---•--••.....-----•--.............
W Design Flow......... .........................gallons per person per day. Total daily flow..._'- �..........................gallons.
WSeptic Tank Liquid capacity/y .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..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0-4
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ----------•-----------------••-•--•---•---•--•----------•------•-------......--------.........------.........................................................
0 Description of Soil........................................................................................................................................................................
W
U .._.....•-•.............................•--•-----•------------------•-----.__....-----------....-•-••----•----•----•-----•••••--•----------•------------................................................
W
x ---------------------- ------------------------------------------------------------ ------------------------------------------------ = -----------------------------------
••---------------• --
U Nature of Repairs or Alterations—Answer w en applicable_____:. .., 5���(___.1_ ...5 ..i............
.. _>_.
............ - «..._.._ ._/_��r-7..... ..:57.. .--•-•------••-•--------••-•......................•--------
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 y-_the boar of health.
Signed .... - - ------------.... ---- ------------------------- ------/. h��+�
<� �i �u' � Date
Application Approved By ......-- .. �r. - ----------------------------------------- ----
Date
Application Disapproved for the foll6wing reasons- ........................ ----------- t ................................................... ------
..............................................................................................................................................
Permit No. `T
------�...............................................D` .... Issued ----- '� ..F
j Date
THE COMMONWEALTH OF MASSACHUSETTS
i BOARD OF HEALTH
TOWN OF BARNSTABLE
('Iertifira#e of Tompltttrcre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by............ ........ ....►.A-��..... �:..�......�'f...�?7 ...----. ----------....------------...--------...---- -------...
-----------
Installer `
at ��� �^ . .!!t--:_. -�7-........._��,.L�....l..z'�'C� ` -
-----------
has been installed in accordance with the provisions of TITLEA of The St e Environmental Code as desc ibed i
the application for Disposal Works Construction Permit No. � '�f� ...------ dated -Zo-- �--�."'
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................... ....... 1 -----------....................... Inspector ... ., `-'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Gjj TOWN OF BARNSTABLE
No.. .'.- /f
FEE........................
Disposal Vorks T-Ronotruditit ramit
Permission is hereby granted...............G-y--&� G__''o �.,) 5`r /f C
...._ ..
to Construct ( ) or Repair ( ) an Individual Sewa!e�Di§posal System
at No...................
� .j......... .tom z°
Street
as shown on the application for Disposal Works Construction Permit '_� �Dated_.__ t3............................
///�► / � Board of Health if
DATE..... .......................
FORM 38308 HOBBS 6 WARREN,INC..PUBLISHERS
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DISTRIBUTION BOX
]Fire LOCUS
58
-TRENCH
PROPOSED LEA Off
tior,
1500 CALLON SEMC TANK H20 LOADING , Number of D-enobes I
bamber 8
Number of C s
El, 245
PROPOSED LEACH TRENCH END OFF X TS OsterTille
PRECAST REINFORCED CONCRETE DISTRIBUTION BOX 0
H20 LOADING
1500 GALLON REINFORCED' CONCRETE SEPTIC TANK Install 'on a level base A dj. High Ground Water IEL 1�' - IYETLAND
Minimum Construction Materials Per 310CMR 15.226(2) Minimum � wall thickness = 2
Tees shall be constructed of Schedule 40 PVC, and shall extend a Minimum inside dimension = 12 z,C:) c, Ens� ZVXA,
minimum -,of 6"r above the flow line Of- the se on Outlet 'inverts sball be equal to each other and at 2" minimum
ptic tank and be
the centerline, of the septic tank located directly under the below inlet invert
clean-out ,manbole. The distribution, lines. from the distribution box, sball all have
The inlet pipe elevation shall be no less than 2"' nor more than 3 equal inverts as determined ,by flooding the distribution box to
the height of the distribution -line invertafter all lines bare
above the' invert elevation of the outlet ,'pipe.
:Septic, tank shall. be installed le vel an d true to, grade on a le vel, been sealed in place. '
stable base that I has I been mechanically compacted' and on which Invert adjustments shall be made b7 filling, odth dura ble and
"6 of
crushed stone, has been' placed , to ensure stability and nondeformable material permanently fastened to the line ,or
to prevent, settling. reconstructing, the lines until all inverts are of equal ele va tion. ASSESSORS MAP 118 PARCEL 10
Septic tank,shall have. a minimum cover of. 9 .
'Three eO manholes nfth readily removable impermeable ' covers ZONNG DISTRICT RC
of�durable material sball -be provided ,_M*th access ports
being.placed at the center and over the inlet and outlet tees.
BUILDING SETBACKS-
Th e outlet tee' shall be equipped Tdth gas baffle. FRONT -
SIDE.&' REAR 10'
0 VERLA Y DISTRICM
WP, & RPOD
Design Do to:
Tbree Bedroom 3 X 110 gpd 330 gpd Required Flow FEA fA Data: Zone "C"
FIRM Panel 250001 0016 D BM: T?p e
No Calrbage Disposal Ele v ffl.
Panel Rev JuI7 2, 1992
Datum:
C X
Use. bomber Trench 31.61 x �V'W � 2',Effl.Oep th
[31.6' + 31.6' + 9' 4 9 7 x 2.0, 162
GENERAL CONSTRUCTION NOTES 31.6' 9' = 284 31
1. All 'the workmanship and materials shall conform to REP Title 5 446 0. 74 330 GTD Total Design Flow IZI 32
and the Town of Barnstable rules and regulations for the subsurface .0cektior, N) .
disposal of 'sewage. service fellce W I
2. At least one access port over nk tees shall be accessible .,pterl A
ta
rdt,�Jh 6" of'finlsh grade, � vdth any -remaining -access ports brought 30 13'
proPose 121.07
to Pdtbin 12" of finish grade. 9
3. All components of the Isanitary system , shall be capable of
Tilthstanding H-10 loading unless . they a ' un-dler or Tdtbin 10 ft 27
f
Of drives or parking. H-20 loading shall be used under or Tdthin 125' TO WETL4ND 2 W, 00 16 1
10 ft of drives or parking unless noted, Plastic equals may be
00 J
used, in lieu of all precast units. -,78
4, The exca va' tor1con tractor shall' verify, the loca tion of all site
23 13 3' Prop+ed T,
utilities priop 'to any excavation, and shall be responsiMle for V � \
1500
0 128.40
all matters relating ,to electric, easements.
Gall"Yhnk
5 Se wer 4" Schedule 40 PVC -0
pipes shall,-be, laid a t .02 slope.
6. Any masonr use bring co vers to grade shall be 10
y. units d to 'A
mortared in, place. 4)
7 Finish gi-ade shell ha ve a minim um slope of 0 02 ft per foot. 0 0 1
Existing
Fire Destroyed;co
01 BVW FLAG 7 Dwelling
I i Remove ,
19 0 Me 'lel
1000 Gallon
Se t0e��y
p t ic To nk
Exis
20 Destroyed
BVW FLAG 6 Deck ce
31 10'
1,99,
.......... ___33
560 Ekistin
TB El. 32. 0' Leach
34
0) Al 0 40
A SL I Oyr 312 BVW FLAG 5 BVW C 3 oe
PARCEL 10
0
B LS 107.r 616 BVX FLAG 4 SOIL P111T 7,481__�_sq.ft. 24
301-P 31 Grade Plan
Sep tic Up
29 30
Prepared For.
1127 28
EUSTING WETLAND Proposed PPork Limit
AfED to T
TO FLAGS BY "ENSR" 68-30 JI and Silt Fence 0A,"AAA 1057 MATIV STH-E-C
S MA
A "AC3,,
E Pump and Fill
FIN 0 23
Existing:Leach Pit
SAND SOIL PIT I V Osterillle, Massa ch use t ts
with Clean Course ,Sand S��EP�Ac 1�r- 0,
2. 5y 616 1
Scale: 1" 20' Date: June R8, 2004
BVW,FLAG 2 Prepared Br.
Stephen J Doyle and Associates
El. 22. 0, GRAPHIC SCALE (0 -10 42 Canterbury Lane, E Falmouth, AfA 02536
No Water -Encountered Telephone.- 5081,540-2534
10 0 5 10 20 40
A .!sr <=> X-:1L <=>
V�3
Soil ,Log F, -It"A OF4
Performed B
S. Do7le
EREW
Date: June 26, 2004 BVW FLAG I ' I H Y CER7YFY THAT THE STRUCYMES IN,FEET
<2 AfthlInch I inch 10 ft
Pere Re te. ARE,�SHOWN ON THE PLAN AS THEY EATST
ON THE GROUND. NO.23971
o
DA TE PROFFESIONAL LA MAL
NO. DA DESCRIPTION
::3
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5 ILijNP
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