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HomeMy WebLinkAbout0203 PARKER ROAD - Health L KER ROAD,-OSTERVILLE 081 _ 5 } 1� #� v r� TOWN OF BARNSTABLE LOC-kf,011,o20 3 "l'e912h,Tk SEWAGE # 7'0 VILLAGE ASSESSOR'S MAP & LOT 6 d O f INSTALLER'S NAME&PHONE NO.::gw c e "R 9 SEPTIC TANK CAPACITY 1500 6'00 LEACHING FACII,TI'Y: (type) l0 � Qn l a l �F� (size) NO.OF BEDROOMS 41 BUILDER OR OWNER 4% ,(C ZV Xca PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: 0 Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ® Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fe of leachin facility) d0 ®� Feet Furnished by 2Z.�� r� -7 � 1 7A7 11 r 7-&,VX Zi1eT a DvT1cT 33 �0 X_ �G f 6 LVCAj 10N �. SEWAGE PERMIT NO. � VILLAGE` fo-q r It 1� 5 v INSTA LLER'S NAME & ADDRESS B U I,L D E R OR OWNER DATE PERMIT. ISS°UED t' DATE COMPLIANCE ISSUED /o " _ ,� M f r a o tvt�i S7t,�F TOWN OF BARNSTABLE LOCATION 03"fe.0 SEWAGE # &6- A5 -YMLAGE ASSES OR'p MAP & LOT^ INSTALLER'S NAME&PHONE NO. D r(� (ICI / .. 3 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 1'-/& NO. OF BEDROOMS BUILDER OR 0 `® C PERMITDATE: L A'� COMPLLANCE 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by LA r ,i BOX 37, /X 5 No.. D Fee . 7 . il THE COMMONWEALTH OF MASSACHUSETTS% Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pprtcatton for Mi5po!gal *V5tem Con5tructton Vermtt Application for a Permit to Construct( ) Repair( ) Upgrade(V Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.o?02 Ar ke r R L Owner's Name,Address,and Tel.No. L%Se m D fn el Assessor's Map/Parcel m //(o /I re-e-J of f l /5 Vvi'odsOr A4, ive 1l ej l , m/9 Od//If/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. _ya(?-3 3`/y 1✓( Tt7 WtT 1l owZ 1 '� liar/der AL, 0S1[°V)"/ie- n92 tad&55' Type of Building: Dwelling No.of Bedrooms t Lot Size / /0— sq. ft. Garbage Grinder (/VO Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures _Design Flow(min.required) 55d',��!^^p;; � gpd Design flow provided j7m gpd Plan Date 6—e. &.- ?% 046xumber of sheets Revision Date N 19 Title SP2/71 � S�P/Y1 c.� lk o�n3 CGT,(��" /Q�� 6,ley ✓i4p�T fJ7lc� Size of Septic Tank / 00 G,�¢�//!X Type of S.A.S. l eachj'12; GJym,7�s 5-.rolj �-!l6'ti 5 Description of Soil eV //yk/ (j -Ll „ (, o rft;"- I&tzn, J/'y 6/ d¢ -/� 44611,W jd i hP,H-010) $ca7l7� ld"-n /0�4,r 3/y Z//!, l - 7�" r--I(Y v&l fi✓te >C- � _ /� Natu a of Repa r/or Alienations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provision*Title5,00f nvironmental Cof'e and not to place the system in operation until a Certificate of Compliance has been issued b th. Signe Date ^� Application Approved by Date Application Disapproved by: ZZ Date for the following reasons Permit No. Date Issued No. _ (�,/ �. a :::� a •a - i Fee � • Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS'`�r Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS " 5 2pplication for Dlig O� p aY .9terrY CoTCsstrUCt 0n errrYit Application for a Permit to Construct( ) Repair( Up'grade Abandon( ) ❑Complete System ❑Individual.Components Location Address or Lot No. ©,3 dui rKe r`?�� Owners Name,Address and Tel.No. bsf�ry�'11c rn� r 7r.y. d',I. by r"uli7amv, Li_se i77 . 0/�N/ . Assessor's Map/Parcel © / fit/ ` ! /n R Wtlel g ` _ �5�av-yJLf-33yy Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S U llI Va,1-r enSi'i� � + OP71 "1 Pur/der A;. , 0S,*-rV0)a n-)/j odle6 ` Type of Building: ® i Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) - Other Fixtures_ , Desi n Flow min.required) p _ d Desi n flow rovided g (min. 9 ) % gP g P ��O ' gpd Plan Date Cldi�:c h��ier/07%jai 990,15umber of sheets Revision Date N t9 Title rat CJ>�7'L SySiY) Q�I7CG�.l. e�,o3 Size of Septic Tank I-600 Type of S.A.S. l eochi nti 0.,&tnhor Description of Sbil Test`. /fvic. G'4 " 0 0,'r*h i GS- /44.o 4-4 6/ da rl( kdlvw,a-�rYl-�-(R Oy' 5V?44 1 /dam lv�l 3/�y � ` a� 6a "e11c)j),A rc-.,. n»t Eafra.& s4?,L4 5xr U/!o Al,cl - 7�l" L' l alde t el •>Ze�'hahi zali.,L a•S• r 1'/� -IZ3'' /i've Im Nature o RepaI�'/r A/01Yations(Answer when applicable) a 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 o the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issuAby-,-th!isr of Hea th. _Sig / ,' /) r-, DateApplication Approved by ��%� / rn ��l Date Application Disapproved by: Date for the following reasons f Permit No,.. Date Issued --------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance �. THIS IS TO CERTIFY,that the On-si a Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( X) Abandoned( )by /'Jf +fit ao 3 /OCL rKp r A , OS�✓!/�� has ee c -struct d in cord ance ^ with the provisio f Title j and he f r Disposal System Construction Permit No. / dated Installer d � I Designer -1 os #bedrooms- ` Approved design-flow a " gPd The issuance of this permit shall not bd rconstrued as a guarantee that the system will fun tc io as designed. Date P Ins ector T / G ---- V ----------------------- ...._--, No. Fee/ F MASSACHUSETTS THE COMMONWEALTH HUSETTS O S C PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS iqu;al 6p.4tem ConsAruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( x Abandon ( ) System located at AW , OS k r t//11? and as described in the above Application for Disposal System Construction Permit.The pp icant recognizes his/her duty to comply with Title S and the following local provisions or special conditio . Provided: Construction st be com et within three years of the d e of thi pe /-- Date f ' Approv by �', 1. �•3 Town of Barnstable Regulatory Services : wNer,►xs.MASIL - �� Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601, Office: 508-862-4644 l Fax: 509-790-6304 Installer& Designer Certification\Form Date: N 2-9 oL Sewage Permit# Ma0arcel ►I to/o& 1 Designer: SULLIVAN Et4wtA s ER.1 Wb 1 N e Installer: Address: OS'1"ERVIL.LIE /19Ass Address: ✓�' � �5 zy On /L$�ld� ®`�G10 / �OG1�5 was issued a permit to install a (date) (installer) septic system at 2.03 PA RKGIX Q.D, o sTErtvww,NA based on a design drawn by S u L vA�✓ (address) E.N('rl Ne g RI rva i N e-. dated Dee. 2q, 2 gos-. (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as. lateral relocation of the distribution box and/or septic tank. -j'Hls CtrLT1Fy5 CaMPLIQN" w i rH TITLltr V oNLy 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. 07 qk (Installers gna ) UIVSi 1 i ture , • i U0.29733 o 1 VIL C� -� (Designer's Signature) (Affix.Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICA OF COMPLIANCE WILL NOT BE ISSUED UNTIL.BOTH THIS FORM AND AS-BUIL CARD fi�tE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc 9 10 1 commonwealth of Massachusetts 1 Executive Office of Environmental Affairs 1b ,P ra Department of tioP p m o Environmental Protections l°tio s s` 4°�999y f�n� William F.Weld e� v Guarnor r9e eF , . N Trudy Coxe >1 Secretary,EOFA Davld B.Struhs 6 �' Commtssloner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION i")W2.e.Sb�Ce Property Address: ac)3 ?Vl -( ``t Address of Owner: Date of Inspection: d CC k O t l gcq"T (If different) Name of Inspector: —Zr-o OAa.e.c�_1t;&Ter Company Name, Address andeTelephone Number: COAX, 8"t^ Ssa-q CERTIFICATION STATEMENT 6S 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 sewagedisposal systems. The system. Y Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 0C%- /S/9 9`/ report to the.Approving Authority within thirty (30)days.of completing this r shall submit a co of this inspection ep PP The System Inspecto PY rand the system owner shall submit inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inmpecto Y the report to the appropriate ional office of the Department of Environmental Protection. regional The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARYi a Check A, B, C, or D: AJ SYSTEM PASSES: 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 cr iteria 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, i 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. i (revised 8115195) 1 • Telephone 617 292-5500 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 P Recycled Papa ~ Primed on 1• DISPOSAL SYSTEM INSPECTION FORM / SUBSURFACE SEWAGE D PART A 10 CERTIFICATION (continued) Property Address: a Owner: I �'1AQi e'Se�ce Date of Inspection: O3a. to)tq�� B) SYSTEM CONDITIONALLY PASSES (continued) inspection )f(with approval t the level observed in the distribution box is due to broken or obstructed Sewage backup or breakout or high static waterstem will pas Pe pipe(s) or due to a broken, settled or uneven distribution box. The system Board of Health): _ broken pipe(,) are replaced _ obstruction is removed distribution box is levelled or replacedThe system will pass more than four times a year due to broken or obstructed pipe(,). The system required pumping of the Board of Health): inspection if(with approval_ broken pipe(s) are replaced obstruction is removed Cl FURTHER.EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Board of Health in order to determine if the system is failing to protect the • Conditions exist which require further evaluation by the Boa public health, safety and the environment. 1) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER SYSTEM WILL PASS UNLESS BOARD OF HEALTH WHICH WILL PROTECT THE PUBLIC HEALTH AND SA FEN AND THE ENVIRONMENT _ Cesspool or privy is within So feet of a surface water elated well or a salt marsh. _ Cesspool or privy is within So feet of a bordering g If 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (A L7H' p SAFETY IAND DETERMINES THAT ND PUBLIC WATER SUPPLIER THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC i l' GI 1lilruiary 10 a ENVIRONMENT et lu a surface water supp r 0 feet _ The �vstem nas a septic tanK ano so►i absorption system and is within 10 supply well. surface water supply. I well. system and is within SO feet e a private et or supply a from a private water Th e ,v,tem ha` a septic tank and sail absorption system and is within a Zone I of a publifeet �ater The system has a septic tank and soil absorpt►o Y '£ for col)form bacteria and volatile organic compounds n Is equal totohless than S ?he systen►has a septic tank and soil a,sorption system and is less than 100 feet bs — supply well, unless a well water analysis resence of ammonia nitrogen and n free from pollution from that facility and the p ppm• D) SYSTEM FAILS: 15.303. The basis the system violates one or more of the following failure criterieO a s efinedetwhat will be necessary to correct I have determined thatY for this determination is identified below. The Board of Health should be contact the failure. clogged SAS or cesspool. _ Backup of sewage into facility or system component due to an overloaded °r du to an overloaded or clogged SAS or _ Discharge or pond ing of effluent to the surface of the ground or surface waters cesspool. 2 ' (revised 6/1$/95) r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 0.3 ?",1,w Owner: /y142;c 3o 7 cc Date of Inspection: 007_ /j- - 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 safeh 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. i (revised 8/15/95) 3 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: cP0_3 ArJel Owner: M142i'e 707ce Date of Inspection: 0CT. Check if the following have been done: _1�,'Fumping information was requested of the owner, occupant, and Board of Health. None 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. N�d As built plans have been obtained and examined. Note if they are not available with N/A. Z_The facility or dwelling was inspected for signs of sewage back-up. �he system does not receive non-sanitary or industrial waste flow v' I The site was inspected for signs of breakout. IZ'*AII system components, excluding the Soil Absorption System, have been located on the site. A,:�'T_he 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. Z'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. Z�The facility u,,1"i: wnd occupants,.if different iron' owner► were provided with information on the proper maintenance of 5ub. Surface Disposal System. • 4 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C // SYSTEM INFORMATION Property Address: a03 �J,/a/- OS/PrP�i��o Owner: N1.q2l4�1 S0r Date of Inspection: OC7. /S/Pf'7 FLOW CONDITIONS RESIDENTIAL: Design flow:_gallons Number of bedrooms: Number of current residents: Garbage grinder (yes or no):,&-Q Laundry connected to system (yes or no):=-5 Seasonal use (yes or no): A10 Water meter readings, if available: Last date of occupancy:,Q/1ry��Cr COMM ERCIAUINDUSTRIAL: vv 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: System pumped as part of inspection: (yes or no) O If yes, volume pumped gallons Reason for pumping: TYPE OF SYSTEM 1-�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: 976 Sewage odors detected when arriving at the site: (yes or no)A�o S • (revised 6/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C- SYSTEM INFORMATION (continued) Property Address: �2c� Owner: Date of Inspection: OCx-, SEPTIC TANK:_ (locate on site plan) i O• Depth below grade: �8 Material of construction: L_concrete _metal _FRP _other(explain) Dimensions: O X 6 X el Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:—af� Scum thickness: iir ncst2/`a/c.*r only I Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle:10 i4 Comments: level in relation to outlet invert, structural (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid integrity, evidence of leakage, etc.) GREASE TRAP:_, (locate on site plan) a Depth below grade: Material of construction: _,concrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to toti of outlet tee or baffle: Distance from bottom in bottom of outlet tee or baffle: Comments: tlet tees or baffles, depth of liquid level in relation to outlet invert, structural ='.trecommendation for pumping, condition of inlet and ou integrity, evidence of leakage. etc.) 6 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION (continued) Property Address: 09,03 0—S er- *JI e Owner: Date of Inspection: OCT ll�� lS,Q7 TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete,_metal _FRP_other(explain) Dimensions: Capacity: gallons Design flow: aallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Yl$U9/� Depth of liquid level above outlet invert: lrym Comments: (note if level and distribution is equal, evidence of solids cart)-over, evidence of leakage into or out of box, etc.) F. PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) 7 (revised 6/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 07 03 ds/erv,Il Owner: M,921 t Tor c e Date of Inspection: OC T' /off 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: 6 i leaching pits, number:�- leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: '.. 1J,� Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) - rovr2Pa wo o c F CESSPOOLS: _ (locate on site plan) `[ _ _ _ .. Number and configuration: O(lC'27'l0W CCSSpOd/ Tyco 1-7o DjsT B°X / b r Depth-top of liquid to inlet invert: �/of ATT►iM e✓ 01 tr srcCl«n Depth of solids layer: I Depth of scum layer: Dimensions of cesspool: _ Materials of construction: — i (boo C0'q0d'V'1 Me` Covr.2 rs' o Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: _ (locate on site plan) Dimensions: Materials of construction: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 8 (revised 6/15/95) 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' ,► 0 : ag 3 6 /?-r ' Tt'unT Yoof •—• <—�g2ttE22� DEPTH TO GROUNDWATER ©d Depth to groundwater. o� feet method of determination'-or approximation: (revised 8/15/95) 9 r � No.......--LIDS y FR$.. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration -fur Mgpuiitt1 Workii Cnoma-riirtiou Ppruift Application is hereby made for a Permit to Construct ( ) or Repair (J.-<an Individual Sewage Disposal S stem at: N ......... -----------•---•--•--•--•---••--•-••-------•----------•---••.-••--------•-•-•.--•..........-•-... �-q Location-Address or Lot No. W z Owner Address Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............... No. of person5_5__---_____-_---------- Showers ( '— Cafeteria ( ) QOther fixtures ------------------------------------------------------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Ligflid capacity------------gallons Length---------------- Width................ Diameter................ Depth---------------- xDisposal 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. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water_.--_-------.--_--_... (4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Ix ---------------------- --------------------------- ---------••----- - O Description of Soil.... ` � ��-G.�r�- ---------------------------- -------------------------------------------------------- c� - ------------ W x - ----- V Nature of Repairs or Alterations—Answer when applicable."_W..Py�._i_il..._...rLp.pQ__�� _. ----- I. . --------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary 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. ' ---------------------- /C Date Application Approved By---- -- ...... ---(-----------------•--------------------------------------------------------....--- ----------------------- ---------------- Date Application Disapproved for the following reasons:-------•---•-------------•------•-------------••-------•----------.....--•--•-•-•-----------....----•-----...... ...........................................................-----------...-•---•-----....-------------•--•--•-------••----..........................-----------•--------•-••--•----------------•--.----- Date.......... --•-- Permit No...... �J�� Issued J ' Date No.......... /S....... Fu$........`..... .��...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .. .. .L-... _... ._.. ... ..................OF......... ............1T��.� Applirttfion -fur Ui.spuiittl Workii Tomitrurtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( 4,Y"'a'n Individual Sewage Disposal System at: Location-Address or Lot No. `f ---------••-•••••-••--•-••--------•----....-••--•---••----•--••--•--•----•---••-•----••----••-••-. Owner r Address ......•....._... .......................•.. -.-.. ....... ••................•... •--....---••-------...----•-•---••-•--------•---•-----•-•••......................................• � Installer Address d Type of Building Size Lot____________________________Sq. feet U Dwelling—No. of Bedrooms-3_______________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............... No. of ersons... Showers — Cafeteria Q' Other fixtures ------------------------------------------------------------------------------------------------------------------------------------------------ d W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity_-_-----_--gallons Length---------------- Width...... Diameter................ Depth._..-_--_--.-._ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area-----.------------sq. ft. Z Other Distribution box ( . ) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date--------------------------------------- a Test Pit No. 1................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-..__.--_-_--_-.--.--__. 9 ------------------------ --------------------------------------------- O Description of Soil....\A)c,--�i... ° ------- 4.t --- --------------------------------------------------------------------------------- x V -------------•••---•-•--------------------------•--• .........._.......•--------------....•--•-------•---------------••------.................--•--------------------------- --•-•---. ---•------------ W UNature of Repairs or Alterations—Answer when applicable._ -______�_�?_�_��__vc!--:__._----'------.Y•.l_u.�_���. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in Signed -._-_ he board of health. operation untila Certificate o Compliance has�� issued by>:�\��`n rl c/� a� • � ySL J Date Application Approved By-----�:.__:_.�� Date Application Disapproved for lze f ollowing reasons:----••.....................................•---..........----•----....--------------•-------•--•-•._...---•--•-- ..................................---••-•-------•-----------.----------------------•--•-•-----•-•--•---------•---•--------------------------------------------•--------•-•--•---------------------•---- Date Permit No......��5•-.l•-------•••--•••------•-•---•--•--.. Issued. -'�- -------�--••••............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r OF.. �... �-......... ........ i� ...... ............................... wrrtif irate of Womplitturr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( �() ..................................................... --------------------•-------- .............................................................. Installer at3.............•--------•........_..---------••----••-•--....... .............- has been installed in accordance with the provisions of :Article XI of The State Sanitary Code as described in the � /,/ application for Disposal Works Construction Permit No__________________S_._�.._........... dated-..-----_- ...._... -�'................ THE ISSUANCE OF THIS CERTIFIFATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Inspector........ DATE THE COMMONWEALTH OF MASSACHUSETTS /i /Z 4 e, ;r) j BOARD hOF HEALTH ...............�I./`..l!:............OF........ ./.�lt '.............. No....... FEE---- lJ RsVv ial ork!i Qlamitrurtion Vermit Permission is hereby granted----------�_)z??_zz"zz.......Z./--- .�j------------------------------------------------------------------------------------- to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at No.......... ?.�`jl�f .-...........�Q W G••TEtU/Gc ................... ---------------•---------------------•---------------.....------......--•---••--••--- Street r —� 7— 7 as shown on the application for Disposal Works Construction Permit No.-.�,�_a____--- Dated___._...........1.....7 ........... --------------------------------------------- =f - _ t�/ 7 % $o d o Health DATE.................--------------------------------- --------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f ' • -'°'� e LEGEND EXISTING WOOD FRAME CONSTRUCTION NEW CONCRETE FOUNDATION WALL f ® NEW 2X4 WOOD FRAME CONSTRUCTION SMOKE DETECTOR _ NOTES . - A. t IOVIDE�TEY CASLBERSN IMMEDNTE VICINITY ALL DOOM I .. I PI ALL BEDROOMS ______ _______ -- -_-__-_ I IN EACN STORY INCLUDING THE BASEMENT ______________________________ 1 PER 1,2009E OF FLOOR AfiEl1 ALIGN i . ® . : J ' v .I to I _.__._ ......... 1 . I I - El : •!:1 I _ " I I I - - I 1 •I i i NOIG ROO °;i I � >Sv.F' 1T Q I TOSS `i !�i i�i `;1• I 1 F''r�-,,f,+_ 'r'�7 ............._ ''.,.y'i 1. . l . ; i I - - 1 i i 1: ` 111 ----- - - 1' I I 6) �i / ':_J. 1�:i` - •-'T—\ \e j II I I I I 11.` - ilE 1 itc!= _,,•J� L.I. I I ILL:.-i..i..i ' 7.0 . T 1 I I _ CFiAWLSPAGE I I .:..:..:_:.:._:_:. ii. __ : I I I ROOM �l/TLRr ROgN ! I 1 � I ;':; i! i 108 � .._.-- C�::a°1 005 ' I 11 I - - I rl I ; :I!!� i i j.• i �- - S i ' 11 1 -_-----�-s-...-,I-:\.-'.-.�-.:-./.�..i-:�_.'-�_�•e-`,1__xJ-T8_iII I iI 1 I/r.TI_-IIi.I II 1I-iI.Ii I jII-_-i iI a�t•'o .."' _527-p�._.O AN 1I1III;I i1I II 1 I :11II II I;II lIl-.::i'._'`�T i.�'"_I oj_iD_..-fiI._A.I.';.l�li.:if i..7_i_._.�,i__.�.i i_.:I i i t!. •T�'!l-i"li:.i�i'.i: �®'__-_-1t_-�A--A Y.BlIYNfDi0 00_FF_-___ DARLtY Nik:'Et LL� 't K`a y-C O.•F T24' I4. 28'- • 0• CRAWLSPACE F(§P II1 I1I T2.O9.M. . FOYEPO4H! 101 R 00 IFLr1 il:i! 1 HIM U AI 1L_-__ -_____ i 104 I I �. Dffie IOsovisaFlcrese1M. 9v3iiJlu l"AeAeLrvd4H'aVlrmR A•lo .luu 102 .de. ST vOAGE MUDflOOM 8 a ) t PANTRY RESIDENC efa E ST002 2G 0 ____--____ U I 1a3P RucdJ Af—d 02 1 L __------_ ......._..... REED A.MORRIS O N 026Z SOB429- V 8 79 FLOOR PLA N S Date: Scale: T 2,21/08 1/4'_1-0• BASEMENT/FOUNDATION PLAN FIRST FLOOR PLAN 0 1 2 4 8 F7 _t ' LEGEND EXISTING WOOD FRAME CONSTRUCTION .. ® NEW 2X4 WOOD FRAME CONSTRUCTION . O SMOKE DETECTOR .NOTES E= - - A PROVIDE SMOKE DETECTORSASREOUIIED. - . -- - INIMMEI YK:NITY OFALL BEDROOMS I W ALL BEDROOMS - IWEACHSTOAYINCLUDWG THE BASEMEM I PER 1,20(1 SF OF FLOOR AREA i E'• _ .. ----------- ' :1 li I liHIM 1111 Ill BEDROOM 07 1 L• ili BEDROOMf j. HALL II BEDROOM3 1 Lo 0 0 � � I I i � 41'-6' I I : 179H:. 1' T.O.FIN I I BATH - - I 205 :li O D FULHAM ® BA20' i RESIDENCE WASTER BEDROOM 1 :Ij2041 I 1 i� CLOSET ' :: I I03ParbRaot _. I __—..:-:.-:_ii.•:�_i 1_Lil. ----_----- I osrm ue.26 e.•l mus I------------------L------------- REED A.MORRI SON 5ce',m 79 FLOOR PLANS Scale: 114'=T-0' OSECOND FLOOR PLAN D 1 2 4 6 cc - _ — .w_a sma,,.a.v�,..� .,.u`4awb..n...r....:..�.-3...�..._y.,,:umr�...�. �.. ,y..aka...n,a�s.�.a.�u'- ,...`.zz,...•--+�. i — — ---___—___ — ------ \ _I / a Lr j Dm I ' M _ � `. I I I I I i I 1 --- I ❑ ❑ I RESIDENCE -i------- -- I I - I I I I 1 I 1 1 I I` i 1 ------------------- gEMD A.MORRISON t ---------------------- �, p �I ---- I `I _ - ]13Pad3re = , FLOOR.PLANS- EXISTIIN (VIOL T:ON bNDITION / Date: Scale: - 1M'=1'-0 221AS 9 .. 0 1 2 4 © A3 SECOND FL OOR PLAN 2 { FIRST FLOOR PLAN �: ❑ ` .. - S �- � MM>I :y �: � T' 1 i'7..'� } Y & y f���t..74 k'a .. S_- ."c4 k , 1t a� W 4 ti 4 _.....,....,. :. :. .. ..: .. ....,... ,. :n: ...n , .... r.. .. .,..:,.a'; ask ...... ... .. .,: a. x .. .., ... _ ..., 1.... ,., ._- :. ..... .. F.... ... ._,.. ... t .S. ... a l...e ,... x ..... ax - �ru� n:....«. .... ... .. ,... ,.....,v«.. w �., ....... ......:.:,.. 7- r.. .. F w......w..&. -r kK ...�{... .. .r'k. .. \., ..,_.,.�.w�.......�:�:a.w,�,�,:v,r.,..�.�,<.,.s,,k:.,,:.�.��.,_..,,_..�._.—",�;�.....>.�,....,._._`3�.;., r_.�,�..�ti.,.a_. .:�.r......k�.,. ,..��._��... ,yylk YA � ���~c �� Yv �•. IFcvm 54 .12 I 1 i'`�• + 4 ---------------------------------------------- At :`i `ice•-.'$�� 3._ 1 I 1 - I 1 I t t s: II u I I I I I I I I I------------------------------------------ - ., Date: 2M„M OBASEMENT PLAN - 24•-(r r - 7-0• 2019' 2•-0• LEGEND . • NEW CONCRETE FOUNDATION WALL - NEW US WOOD FRAME CONSTRUCTION _______—.@L___ -________- __—_, ® NEW 2%4 WOOD FRAME CONSTRUCTION 30•e• I O SMOKE DETECTOR - T.O.FIN. NOTES _ i I A. PROVIDESMMEDETECTORSASREOJRED- D I I IN LLBEDNEOOICI VICINITY OF ALL BEDROOMS N EACH STORY NCLUDNG THE BASEMENT 1 - 1 PER 1,200 SF OF FLOOR AREA - 1 44 O d1'-0' 1 I ot lb 1 I _ CLOSET 2 2DO CL T 1 1 I 204 202 ^E.. s. '• � i BATH 1 2C0 1 •+r r ``` �e - I I j�•' -. L----------------- I ',•- ram `" "�:4�\ . SECOND FLOOR PLANio 28 r 2&r 2G-r 1 21-T 1 r-m - r------------------------------------------------� I I f30 r--------------------------------------i i I T.0.w FULHAM TTT _ ® 1 111 r''10.10 a' i RESIDENCE L_ I I I I 104 ---- I 1 I / .02655 4.00NCRETE SLAB - I ON GRADE I I I GARAGE \ I GARAGE 101 101 \ 5 PEEDA.MORRISON - I I 130•-4.1 I / - 30'-0' a0.4- / so'-0. ` 1 .n Amh— eu 7.0.FN.� i 7.O.FlN. `1 i 1 -b GRADE I T.O.FN. / T.O.FIN. `1 _ / .I. —_ �_______ I I / SLOPE \\ 1 I I I 11 \` SLOPE \ 1 - O.urrvuk02655m 1. L_ I1 102 I I 101 \'1 I 5094298479 l- ---------------------------------_---------� .. L------------------------------------------ :.f`... FLOOR PLANS - GARAGE Date: Scale: - 4 2 241P 4 412' 24'-0 222r06 1/4'-1'-0• OFOUNDATION PLAN O FIRST FLOOR PLAN _ 4 Fit 2 a o AG1 �7 f moor ASSESSORS REF.: - Map ` 116, Parcel 81 • ° ' \ Benchmark: e �� Top of SB fnd '•r�, NIF E1.=30.74 NGVD'29 SB ? '°• •• Audrey A Hinkley fnd ° r. ,. : ° °• ••'•• 's�:;:' 3dx3 ° ` OVERLAY DISTRICT. ' •58'15 E 3ox5 AP - Aquif r Protection District •^a x a ;�: N80 ��• �,,,,,,� OC ° good Fence f As Shown n Plan Entitled , e5 175.46� _ "Revised Gr undwater Protection -Qa •� arker Neale 6. 176.86 Cedor Trees ` Overlay Districts - April, 1993 PStad ig r{y a Tim ! \ b•• f bar' e � ifLandscO Q ,00 t `�➢ J e•,C �' t CHICIG� 42.9' LOT AREA l oo Cfi4^M c�RAtt j7 670-S.F 101� Y 2N,.. �.�. o,� a Le end LOCATION MAP: 31 1 Lawn I o Scale: 1 = 2000 ± x to po m C le Rhododendrons Gas as a 6 Deciduous Tree C�f+&5 Me er 6 a ° Z FLOOD ZONE: Coniferous Tree a co 3 203 , ' ` p 'c: o \ 31x1 Zone C 2 Story W/F Dwelling I v r t b I Na-rI.- F� / g ` ?� \\ � �: cn � Light Post / o Community Pane! No. Rt > `� s2.s ( � -O Guy #250001 0016 D ff3z.o'(ms1 ' I -0- Utility Pole 0 l ! �pOn -ohw-Overhead Wires July 2, 1992 El CB/dh (Concrete Bound/Drill Hole) a,, o \ i ` fi tnu�Cio I c� pEtOP" to-2 a Lawn Pasc" .\ I SB (Stone Bound) ZC 7- � / N 0 d t7;Cox ZO�tA C �`` \ Nd z; ` p p ` 1 cBJ(d 1 I ZONE: NI cwn 'i'- fnd' RF-1 Area (min.) 87,120 SF (RPOD) e am 16.5' - Frontage (min) 20' g R N ; U.P. ohw -ttiAi P �s5'+O T W/Conduit , r pAR i, J g _ e 6 _� -- - 176.55' Width (min) 125 Hed9 _ _1 29x7 I91 Setbacks: 2sx2 4 n Fron t 30 NL30'S8'15'E Ave Side 15' _ I F:irst e Rear 15' r dldn _ / ' -� - 2&xE N/F (35' Wid ) 2�! Da vid w Sampson . � >rxt81". b;:>�bx d t_�ACt-1 t�ir.SE2`�`sYs / C3� PUMPED ANSJ (� t�hOVt?, DESIGN DATA mLle-v. aq.0 Single Family-4 Bedroom-Existing \..A\ev►a Garage-I Bedroom-Proposed [9. d FILL_ Fradh Dail Flow 110 e x 5 ' 550 d y„ ot2GANlc� _ Grad* No Garbage Grinder - 0 Bi t7A.fX.K YELis" emty SANDY 6t G-S21t.°>`1%L\::15H SRN .5ANDy _ Y gP gP 22' UC.>^.M IoYR -3/'i LOAM \o vR 3/51 : Septic Tank 550gpd x 200%=IIOOgpd 7 � Filter VP_L1 ISN Rzz M".b C.eOARss- YGaL'%5W t3r2N SANDY ~"---Compacted FillUse a 1500 Gallon Septic Tank(Existing) Id' , gZ SAND 5-YR. •1J4 g2 LOAM .toyRS/& a, Fabric �a 0%_I\zM yet_, l=INGL , O tvs esmrst V=tNSL N lie"lie• LEACHING AREA Tw,, C I LOAMY SAND a.SY L/� c{ t_OAMY .SAtV i7 a:5Y s/� Pea stone 550 gpd/0.74 = 744 s.f. Required 0 - FRoM 5t PTrc. C ot.:tvrs ymt.. t Af-=I> a� ��1 vim`, t�teo Sidewalk 2 x 116,=23?s.f. , Z' SANfJ 2 ,5 Y G G SAIV 2',5 y �/L Leaching Bottom Area: 12 x 46 =552 s.f. ai4"-11/2"ooubl. 784 s.f.Total Provided. I ANk 123 NO GRoL istr>w :,r;Lm oftSmri,,;r_% a Chamber J Washed Nb G1�OVNDwArEtt ot3St3RVEP G1_P5 S t MA'1 c-Rt At_ .3 P6RC. Na. It t93. PE=Rc. a0 64 J D_emr% pAT6 �� ` -q'2"QS 1.._E£is ` V4AN 2MlN/INCH I I- 4-10' l LEACHING CHAMBER DESIGN Gt-Aas I MA'TERIAI- lz'-o" All Piping to be Schedule 40 PVC.Uses 500 Gal Ion Leaching Chambers(H-20) �e3s -r1IAN 2t.n,N/trteat CROSS SECTION OF CHAMBER in a Washed Stone Field as Shown. BY: St►1-i-\VAN �NGtNra�R\NG ING. ,raS: b,C7E.SMAf{A15,T.b.C3... .Q,H. MOTES ..NOT TO SCALE cd 1. Water Supply For This Lot is Municipal Water. Remove 8k Replace All 2.Location of Utilities Shown on This Plan Are Approx. Risers-See Note 4 Unsuitable Soils Within 5 At Least 72 Hours Prior to Any Excavation For This V y, of The Outer Perimeter of Project The Contractor Shall Make The Required ,pF aL=cS '+, f G.30.0 F.G. 29.8 The System. Notification to DIG SAFE-1-888-344-7233. �tX" ,a•' � � PETER 3.The Contractor is Required to Secure Appropriate • °. u� t •-.,-__, Permits From Town Agencies For Construction r�, •�,�� ,, 26.5 Defined by This Plan. rV fr, (( t+,// w Er, •■//�� �� C.! I.tl Jl:v.4A �/It�rL [G' st.1500 r Top El.27.5 4.Instal l Risers as Required to Within 12 of Finished i134312 lon Septic 27.1 Grade. 112 k. :�`�::'>; Bot.El. 24.5 _ 26.9 26.7 5.All Structures Buried Four Feet(4) or More or Subject ioVehiculartobeH-20 Loading. �� Install PVC Tees in Exist. Bedding as Bottom T.H.-I EI.19.5 5 6.Septic System to be Installed in Accordance With ' - �$• ° PARTIAL PLAN Septic Tank.See Note 8. Per Title 5 Bottom T.H.-2 El.19.5 310 CMR 15.00 Latest Revision And The Town of „ , Barnstable Board of Health Regulations. Scale I = 10 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 7. All Piping tote Sch.40 PVC. Not to Scale Ravi sl oN f q(o( MOVp_o GAR AC e.4-At> Mut7R00t.A Title: PREPARED BY. PREPARED FOR: Notes/Revision: Sullivan Engineering, Inc. CapeSury Timothy W. Fulham1.) The property line information shown wasSEPTIC SYSTEM UPGRADE compiled from available record information. PO Box 659 7 Parker Road Llse M. Olney 203 PARKER ROAD Osterville, MA 02655 Osterville MA 02655 2.) The topographic information was obtained OSTERVI L L E-, MASS. 9 5 Windsor Rood (508)428-3344 (508)428-3115 fax (508)420-3994 (508)420-3995 fax Well esl ey MA 02481 from o o the ground survey performed on 241FO Draft: M J D Field: MDH/WHK 20 0 10 20 40 80 3.) The datum used is NGVD '29, a fixed mean sea level datum. Date: December 29 , 2005 As Shown Scale: Review: PS Comp/Draft: RRL Prof. # 2-1-1 o o I-{' Drawing # C 435 4 g 1