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HomeMy WebLinkAbout0013 THIS WAY - Health 13 This Way Osterville A= 121-142 y a i i i TOWN OF BARNSTABLE z LOCATION SEWAGE# VILLAGE 0..51'�11//1/ ASSESSOR'S MAP&PARCEL a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 0 LEACHING FACILITY: (type)/G ni-C- OM17 (size) A3, `/8X //,f NO.OF BEDROOMS 3 OWNER k,�_ lW J2 1"04 /I//G�—1,r5eS J PERMIT DATE: — /9 "/2 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 ,A7-A6 M r TOWN OF BA.RNSTA-BLE BUILDING-PERMIYAPPLICATION Map [IJParcel . Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation /Hyannis Project Street Address Village_ 05 V 1I L. Owner I,M�4 f �— f / Address._ 1T JC l/z Telephone Permit Request 611 C D rr , �O 1J � I /co/ 1cA Square feet: 1 st floor: existing proposed 2nd floor: existing proposed. Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 9G10 Construction Type Lot Size n C tg-Ile t;5 Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two.Family ❑ Multi-Family(# units)- Age of Existing Structure is: AC,M Historic House:. ❑ Yes &lq-o ' On Old King' s Highway: O Yes 211l0' " Basement Type: Of Full d6rawi ❑ Walkout O Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing_ new Half: existing new, Number of Bedrooms: existing new Total Room Count(not including baths) existing �cra new First Floor Room Count Heat Type and Fuel E(Gas ❑Oil ' ❑ Electric ❑ Other .Central Air: 0 Yes VNo Fireplaces: Existing New Existing wood/coal stove: dYes ❑ No Detached garage: existing ❑ new_ size 'Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new • size Attached garage: ❑ existing Q new ,size _Shed: ❑existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑ Yes " ❑ No If yes, site plan review# Current Use Proposed Use - i i . A T1T7 Y," A ATm YwTttn/lin leet: i st tioor: existing proposeq zna poor: existing pronosea iotai new Z nmg District Flood Plain_ Groundwater Overlay_. . Project•Valuation h 1 / 00 Construction Type Lot Size ` ?_q,C /z►:� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family E Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House:' ❑Yes Cho On Old King's Highway: ❑Yes CN�Io Basement Type: C(Full dcrawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) 4 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z— new — Half: existing / new Number of Bedrooms: 3 existing;_new J Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel Ea"Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑ Yes WNo Fireplaces: Existing New - Existing wood/coal stove: Yes ❑ No Detached garage: existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ . Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review #� Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name -1/1 �r �('N l V/V& Telephone Number p � - 617M, .&�61 Address ( � ) I License# V S im i /06- + Home improvement ® p ent Contractor#. � e M o I't G`t (`cc Worker's Compensation # ALL CONSTRUCTION EBRIS RESULTING FROY THIS PROJECT WILL BE TAKEN TO r SIGNATURE DATA �/ t The Comrrion�veaLfhx of Mcissdchusefts Do artm- f of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wwlw.mass.gavldia Workers' Compensation Tnsu ance Affidavit: Builders/Contractors/El ectriciangPlumbers _A-PPlicant Information A Please Print LeeblY Name (Business/OtgmiizBiSow-individud): City/Statdzip:( 5`��/�� 11-L.�: �I Q hone.#: (�* 7 f� ( / Ara you au employer? Check the appropriate bow Type of project(required)_ L❑ I an a employer with 4- ❑ I am a general contractor,and I cmployccs(full and/or part-fin ). * have hired the 9t1-contractors 6..❑New canstrvctian 2 El am a solm proprietor or parfnd listed on thr, attacbod sheet 7. ❑Remodeling sbip andhave no =oployces Thcsc snb-contractors have g_ ❑Dcmfllition rI . zn-y capacity. employees and have workers' . addition wo for me in 9. []Btitldmg . [No workers' comp.-nann-dnrr Comp.'incTrrmnrr.$ rbqpred] 5• [] We arc a r_0rporafion and its 10.❑=Elrcttical repairs or additions 3.[ Y am a houncowntr fining all work officers.havc cxcrci.scd their 11.0 Plumbing repairs or additions myself- [No workers' camp. right of exemption per MGL 12 n Roof repairs incur once ram]t , c. 152, §1(4), and we have no cmployces: [No workers"camp. �,.m[nra nee mquirCd-I *Any applicant that chcckr bax#1 road also'fil out the section below showing their cmnpmaYafiDn policy iafaar.ticTL t HomAwocrc who eubr it this affidzvit indicafimg tbcy arc doing all wor)cand ffirsr biTr outside=b_Retars must rube it a new affiAzvjt indirafrg such tCantrachres that check ffiis bax'vnrst aliaLbcd as sdditdonal chat showing fhc narrz of tlrc subntraLtarc and matt vlhctha or not those rntitia hgvc employee -If the sub-contrAr_bxT have erMployees,they mn1 pro-vi&their w�'cmnp.p05ey mmnbcr. I am an employer that is providing workers'comperrsatiort insurance for my emproyam, .Below is the poUry and job site- • information. .. . . In iranrr_Company Naga: P olicy#or Sclf-ins.Lic.#: E7:psation Date Job Site Address: City/Stafc/Lip: Attach a copy`of the workers' compensation policy declaration page(shoving the policy number and expiration date)': " Failure to sccurc coverage as required under SCetiDn 25A of MGL c. 152 can kad to the imposition of w. al penalties of a firm up to S 1,500.0D and/or onc-yr�imprisonment, as well as civil penalties in the farm of a STOP WORK ORDER and s f[nc of Up to$250.00 a day against the violator. Bc advised that a copy of this`staf=rc t may be forAv-r d to th,Office of Inyestig�iors of tl,e WA for inrrrrmcc coycragc ymiacedon. I do hereby certify under the p • • d penallirs of perjury that the inforrnativx provided a5o�ve�yu tr/ue and correct Datm: ! — Phone# Offulal use only. Do not write in this.area,to be completed by city or fawn offtciaL City,or Towa Permit/License# Issuing Anthority'.(drele,one): 1.Board of Health 2.Building Department 3. City/Tawm Clerk 4.Electrical Inspector S.Plarabing Inspector 6. Other Phone#• - J Town of Barnstable o�THe rDts L "0 Regulatory Services Thomas F. Geiler,Director ht.tss. F� �639• ��� Building Division `orFo Mai p, Tom Perry,Building Corrtmissioner 200 Main Street; Hyannis,MA 02601 R-mY.toii,n.b arrLst2bl e.ma.us Office: 508-862-4038 Fax: 508-790-62.30 HOInIMOWNT_R LICENSE E)C nMFTrON -- Plcase Print DATE: JOB LOCATION: numlb.-erp / / J(` street ` L village „HOMEQWNER 144iJ �C.. �V 4 Fi Vl t1 l`� .- �! l- � name { home phone# work phone#. CURRENT MAILING ADDRESS: //. city/town state zip code The.curren(exemption for"homeowners"was extended to include owner.-occupied dwellinks of six units or less and to allow homeowners to'engage an individual for hire who does not possess a license;provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on'which he/she resides or intcrlds.to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such . "horneowner"shall submit to the Building Official on a form acceptable to the Building Official,:that he/she shall be responsible for all such work nerfo=ed under the building uerm3t. (Section 109.1.1) The undersigned"homeowner"asstmues responsibility for compliance with,the State Building Code and other applicable codes, bylaws,rules and regulations, " The undersigned/'bomccertifies that he/she understands the Town of Barnstable Building Department' miniatium inspecs and requireracnts'and that he/she will complywith said procedures and i Signature of Homeowner Approval of Building Official Note: Three-family.dwellings containing 35,000 cubic feet or larger,will be required to comply with the, State Building Code Section 12T.0 Construction Control. ti 'HOMEOWNER'S EXEMPTION The Code states that "Any homeowocq performing work for which a buildingpermit is required shall be exempt from the provisions of this section(Section 109.1,I-LicLnsing of construction SupdYimrs);provided that if the homeowner crgagrs a po-son(s)for hire to do such work, that such Homcowncr shall act as supcuvisor." Many homeowners who use this exemption an:unaware that they arc assuming the responsibilities of it supervisor(sec Appendix Q, Rulcs &Regulations for Licensing Construction:Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed.persons In this case,our Board cannot proceed against the unlicensed person'as it would Woth a licensed Supc-ryism The homeowner acting as Supevisor is uttimstcly responsible. To ensure that thc homeowner is fully aware of his/her respons{bilitics,many communities require,as part of the permit application, bilitics of a Supervisor. On the last page of this issue is a form currently used by Lha-t thc homeowner certify that hc/she endo-stands the rrsponsl I rl,^LJSCCz•-�- �� IL '�- '� 6 T C��• -1 � ".. 1. .l-.. - � ly ell, N 01 ?Q'd` E3t:Sf Aco (o'f� �.,5�1�). q'Q° Jti:rl ct�iTf fu r CY %(a c,:c:, �'SA-b;✓ems W -�y vri-►e tm7 n .6 �---- o a a, q q x68 OL AH. -WI 1 7 VI IT . ... . f f :�,C,C) f0U5 ��LFIA III I•ALL CHANGES TO THIS PLAN MUST BE APPROVED BY•THE LOCAL I I I I� WAY _ LEGEND '•"'••� - -BOMD-OF HEALTH AND THE DESIGN ENGINEER. 2 ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 20.00 PROPOSED CONTOUR, OF THE STATE ENVIRONMENTAL CODE,TIRE V,AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: - 'S68'08'22"W ® PROPOSED SPOT GRADE ' -- 310 CMR.15.405 (1) (B): - 1)A 1.67 FT.VARIANCE FROM.310CMR15.221(7) TO ALLOW LEACHING - - - --g8-- .EXISTING CONTOUR ROUTE 28 TO BE 4.87 FT(MAX) BELOW GRADE VS REO'D 3 FT. H- 96.52 EXISTING SPOT GRADE (H20/VENT PROVIDED) - - WPC 3,THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR - --W— EXISTING WATER.SERVIC SN15 TO SI INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE - - E DEGN ENGINEER. - L1� _ 4.ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING TEST PIT LOCUSn�� FROM THOSE SHOWN HEREON SHAH BE REPORTED TO THE DESIGN - - Z ENGINEER BEFORE CONSTRUCTION CONTINUES. - N ' 5.ALL ELEVATIONS BASED ON ASSUMED DATUM. 6.THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF Cn - THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF - • OY HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.. 7.WATER SUPPLY,PROVIDED BY TOWN WATER SEANCE. DO s , B.'ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED - TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.. ' 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY LOCUS MAP THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING - CONSTRUCTION. - A,1 AA I T 10. EXISTING LEACHING TO BE PUMPED,CRUSHED AND FILLED PER TITLE V. - POLE - - - LOCUS INFORMATION ION 11. 46 HOUR NOTICE FOR ENGINEER CERTIFICATION - Um 'LOT 1 - PLAN REF:'321/33 U - 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY T PARCEL ID: - TITLE REF; 2366/197 AND.IS NOT TO.BE CONSIDERED A PROPERTY LINE SURVEY ' i 121/026 - 41 - - - PARCEL ID: 366 19 PAR.-142 1S. NO PRNATE WELLS WITHIN 100 iT, OF PROPOSED LEACHING '15. ALL PIPING TO BE 4' SCH 40 0 1/8•/FT (UNLESS SPEC.OTHERWISE) W I N - LOT 3 FLOOD ZONE: "C' 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW PARCEL ID: - COMMUNITY PANEL: 250001 -001 6-D DA1'QD:07/02/92 FOR THE USE.OF A GARBAGE GRINDER /141-2 16. N 12TO WETLANDS WITHIN 100 FT, OF PROPOSED LEACHING I II. LP' - - - - t SEPTIC-, SYSTEM U) I w Ns0' 2'24"e``, REPAIR PLAN f `\1p3.27 LOCATED AT:. r I - --- 1'3 THIS WAY.. m . _ G =---- N8p22'24„ LIST ERVILLE, MA u1 = S f 9 " PREPARED FOR g 's KEMTON NICKERSON Do I I .i, #t3 W 0 O� 0 ( \ JUNE 16, 2012 DWELLING =_ _ SCALE 1" = 30' lANK CB/DISC 0 $' .\ �c� _GA�PT13Arr3�D 'OEJVM��F7c9� PARCEL ID: p- - "'y;'�� FJCIST. I,SOOG _ --a ANc O i o. 114 0 `^ 121/025 O� OP OF lAN}�G ; F_, FX-15T.LEAGYi PI 5 .. ' % O �, GARDEN ��: _ PARCEL 10: _ - �� 24'P' 121/015-4 LOT 4 PARCEL 10: i JEZKCE - � 14"0 MEYER &�. SONS, INC. 121/142. - - -- InSP polt5 AREA-28,788t S.F, 2 0 TP- 2a49' vent 3 12 0' P.O. BOX. 9811, w 16"P '12"o El EAST SAN,DWICH,, MA. 0253.7 • S68'09'16'W 200.00 59.50s9,a CB/DH 69.5 (508)362-292'2. PARCEL ID: 120/005 + . SHEET 1 OF 2 J 1434'. ' No. (/ . Fee Vne� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLation for Bisposal 6pstrm Construction permit Application for a Permit to Construct(4,t.— Repair(grade( ) Abandon ❑Complete System ❑Individual Components Location Address or Lot No.1:5 7_1VJ Oyyv✓ner's Name,Address,a d Tel.No. OSY'FrViA; kaoii�✓t0<9 iV/ck/,�o-s;oi! Assessor's Map/Parcel y Installer's Name,Address,and Tel.No.51,00—0/24^'77-fF Designer's Name Address,and Tel.No.S-6S_36Z—2 92 / led b S Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) a ac gpd Design flow provided 33 O gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1s uz/Tz /t/d S'�`o�/= •�c� ,fix new,_s;ez t,/( sv/ Gau®l,� f i� '���.r�vr- �v owch Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the.Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. e Date I Application Approved by Date / l r Application Disapproved by Date for the following reasons Permit No. / .� Date Issued a --— -------_-----_----— _ -------------- - ------------------ - - - - - I Fee Q THE�COMM,O WEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS Yes - F ftpYiration fit Misposai 6pstem (Construction Permit . x Application for a Permit to Construct(4),_ Repair(grade( ) Abandq# �)Lj "❑Complete System ❑Individual Components Location Address or Lot No. / 7-14 Owner's Name,Address,and Tel.No. Os v/ Al Assessor's Map/Parcel r � //� kr.l�pto /✓/G/C/sf'Sol�' Installer's Name,Address,and Tel.No.Slag—Z/20— 1/738 Designer's Name Address,and Tel.No. JOs�pti 1) 49-V Nr CJS 6Ys�t f-dam S6e,v S.�i 11C, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided 3 3�/O gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ;r•. Description of Soil Nature of Repairs or Alterations(Answer when applicable)�[zT, lr ,f/ jii �� �X z 2 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance.with the provisions of Title 5 of the Environmental Code and not to place the sysiem in operation until a'Certificate of 4 Compliance.has been issued by this Board of Health. Si ne Date . Application Approved by Date 6, l/9 f - Application Disapproved by ? Date for the following reasons x Permit No. C'1 Date Issued /a ------------- ---- ------ ------------ --- -- -------------------- --- -------------- - - - THE COMMONWEALTH OF MASSACHUSETTS s BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(4,)- Repaired Upgraded( ) Abandoned( )by,/0 at -! 1' ! /� has been constructed in accordance with the provisions of Titl 5 and the for Disposal System Construction Permit No�/� dated Installer , />ft/Q� - ���/aS Designer NC #bedrooms_� Approved design ow is - G gpd The issuance of to his pecmiV shall not he construed as a guarantee that the system witt/�i // on as designed. Date Inspector j v, Y J) / - c / 9 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct Repair K--r Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. c'4 Provided:Construction must be completed within three years of the date of thi permit. Date Approved THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M AC DATA Darren Meyer, R. S. 17815850293 P. 1 'own of Barnstable VE Regulatory Services Thomas F.Geiler, Director -`.�artsree�. V9� `6 ,�' Public Health Division D.. bfThomas McKean,Director 200 Main Street, Hyannis. MA 02601 1403-790-6304 Installer Designer Cert: caticn Form Dace:`; Sewa-e Permit# :assessor's Nlap\Parcel Resigner �. _ ,r _, ,4 .... . ,L�l b _ - •3 Installer: (c�/4�,1-e Address: r Address. Or. _ was issued a permit to ins-'all a (dare) (installer) 1. septic system at ' `t ?' t•� =t�- based on a desi-n drawn by (address] dared (designer) Le J ° l'[ Certify that the s;.pt:c system ref4 erenced above way installed substantially according to tine design,. which may include minor approved changes such as [iiera[ relccat:ua 0.1"Po. distribution box andfor septic tank. [ certify that the septic system referenced above was installer' with major changes (i.e. any than 10' lateral relocation of the SAS or an vertical relocation o`any corrpo.em of the septic system) 'Dut in accordance with State & Local Regulations. Plan revision or certified as-built by designer to foi[ow. of o DAtREN•,M. t's (I -call er's Si„nature l'40 r ' f ST I "-�(Desi`ner's S:Jnature)/, (_affix Designer's Stamp here) PLEASE RETURN I B INSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE B,• RNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, Q: FicalthiSeptic%Designer Certification Form 3-26-ck dec r Town of Ba' nnstable. P# Department of Regulatory Services tar,g� = Public Health Div ision � Date e ,a y tee$ 200 Main Street,Hyannis MA 02601 l / 1 Fee Pd. /C Date Scheduled [i'�✓ I Time ,Foil Suitability Assessment"fog--,Se Disposal - Performed Byp0"V-1,t41\ � eA Witnessed By: A01 i LOCATION & GENERAL IT&ORMATION Location Address . 2�- —r(;rf, �y Owner's Name N(CjMfs . �J I�✓l � I� � � Address Assessor's Map/P4rcel.• I Engineer's Name ®A rrt✓h kA_e/LQ_' 1�� .� ® ~- 33( 1. NEW CONSIRUtON REPAIR JL Telephone#S6% n � .&?ie2 Land Use 5 �.dL1 'Slopes(�.') Surface Stones Distances from: Open Water Body >� ft Possible Wee Area ft Drinking Water Well ft i Drainage Way yI tsD ft Property Line 7/ ft Other ft SKETC$:(Street name,dimensiods'of lot,exact locations of test holes&perc tests,locate wetlands in proxitnity to holes) I tic,y; .0� /"v - ��B�O,. :�1 �f '� err.«+• 3•E, 105.00 �ayy ...... .yy V P e•- .... - D 4..� -...:._.._ .. .._.. �OJ �• % 6• ' JV F130-00 t N16'36'24•E Parent material(geologic) GIQ� �U71�d`� 1 Depth'to Bedrock Depth to Groundwatdr. Standing Water in Role:* q- i Weeping from Pit FAee N Estimated Seasonal lHigh Groundwater AA i DtTERMINATION FOR SEASONAL]UGH WATER TAtLE Method Used: ! In. Depth Gbperved standing in obs.hole: In. Depth tq sgll mottles: Depth toiweeping from side of obs.hole: I in, oroundwater AdJusttnent tt. Index Well# Reading Date Index Well level ' Adj.Actor� Adj.0roundwuterLeVol,,e P�ERCOLATi N TEST . Date �f�'x1 �__ Observation ' Time At 9" Hole# i k 2�. Time at 6"' .-.... Depth of Pere _ - ��O} Time(9"-6")' Start Pre-soak Time.@ i End Pre-soak Rate MinJlnch ! X Additional Testing Needed(Y/N)•. Site Suitability Assessment SitePassed Site Failed; Original:.Publicx,edtth Division Observation Hole Data To B e Completed on Back-- t is.to be conducted within 100' of wetland,you must first notify the ***If percolafiibn tes week prior to beginning. Barnstable Conservation Division at least one (1) t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel I1. n tl 1wfYl / YK 0 S � DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 1 Consistent %Gravel) �rl- Ztl' r Ug wt (O I 4 i DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil.Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel t i } — ; , ; D EP OBSERVATION HOLE LOG Hole# Depth from Soil on Soil Texture Soil Color Soil Other Surface(in.) ; (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra I i j Flood Insurance Rate Map:. Above 500 year flood boundary No— Yes _____ Within 500 year boundary No ✓ Yes,,,,,,.o,r Within I00 year flood boundary No_ Yes Depth of Natur'allyy Occurring!Pervious Material Does at least four feet of naturally occurring pervious material exist.in all,areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per sous material? Certification ' I certifythat on 1 date I have passed the soil evaluator examination approved by the (date) Department of Environ ntal Protection and that the above analysis was performed by me consistent with the required in expertis and experience described in 3,10 CMR 15.017. Signature Date Q:\.SEPTICIPERCFORM.DOC Town of Barnstable Geographic Information System s $ March 29, 2012 121055a Pig #257ny� u. 1210)5006 . �,/d ..� P'`121092, 1 { #,250 e #319 {{ NW 121141001 121004 12 #251 1033 xy kk s sz f #189 1 21 01 5004 � \ `°r ` `\ { � . � 121015005 `•�` #242 41 t 4 'f d141002 12103 'y �� f°6 * '#15 S: #201t 121003 law ":#236 p � a3•tY yY7�.ri,P�¢ { r .�yj, : . wT+2,F 121031. K 2 121026 J.a:.:;�?s: F - "#226 - h(ri 5 1 002 "N�=,� s'` <,, r `'� _ f' � /• ' - '� 21 a / z�A#225 { i• y i' t; _ ���r�¢fym� `��� Iw9�• G. 121030g� < 121044 b; 121142 `r ` r " #13 #223IbY` \ #63M,. 121001 p L1 is i 1.21043 erg : #215 t "" rs. �i�f ,� #216tt ': rry m^'i: ' � ^w��� .Yi � ��r r: �� \• �� �, t,^ rp�*12102� e r y 4�M1 y r ,..,,,;,,.a^"�."y '� s 5 ..y ''� #214Y¢it f�� t ��r• `v t:�C(>tw�, cxm�r .•" 0-0 120005 of s fF ✓tom a `: r P �klir #182 °� 121042 121045 121029 it 4.lz0004? { 1210273 #201 .., #208 E f �{'yr� � o �P' #239i7s r" 12 051002 p f f, P r s9? #140 ` 120012, 120013 1 4:8 e� 03001 r 13 f�� t. 4 i 120062 i, 9193 t 1� " �' #249 vs. 1. #250 #39 DISCLAIMERS:This map is for planning.purposes only. It is not adequate for legal Map:121 Parcel:142 _ boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected PBrCBI V=100'may not meet established map accuracy standards. The parcel lines on this map Owner;NICKERSON,MEL80URNE& Total Assessed Value:$337000 are only graphic representations of Assessor's tax parcels. They are not true.property Co-Owner: Acreage:0.66 acres Abutters 4k`'-'a `r'.E boundaries and do not represent accurate relationships to physical features on the map such as building locations. Location:13 THIS WAY Buffer - i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(� I DATA TOWN OF BARNSTABLE LOCATION_ C% SEWAGE# � ASSESSOR'S_MAP & LOT INSTALLER'S NAME &PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ?- /:off . i (size) NO. OF BEDROOMS f j BUILDER OR OWNER PERMITDATE: `'- i�<<- ✓ � i. COMPLIANCE DATE: �— i 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 byf i s C5. Imo/ r ' , TOWN OF STABLE BY: jv TO GER COMM ONWEALTH AL TH OF MASSA CRUSE TTS County of Barnstable,ss: , On this 31 day of i 2008 before met the undersigned L.i rsn�+egned table'public,personally appeared the Awn Manager for the Town of Barnstable,proved to me through satisfactory evidence of identification,which were � ����.�®� _ the preceding or attached document and acknowledged to be that he/she"Dwbil I to be she person igned it voluntarily or the is s signed on purposes. _ stated Notary Pub * Printed: r I� My Commission Expires: OffICAL SEAL a SHIRLEE MAY OAKC COMMOK NOM Y P(IBIIC LTHQFM AS _ My C SgCHUS �Expires 3/28/Z008 S _ 5 i r I - NOTE: MAGNETIC TAPE TO REPLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT THE PROPOSED - i 1 FINISH GRADE SHALL NOT BE < EL:54.33 FOR A DISTANCE OF 15' AROUND-THE _ SEPTIC TAN PROPOSED D-BOX PROPOSED S.A S PERIMETER OF THE S.A.S.- ' T.O.F. EL.=59.00. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER 14' OUTLET AND SET TO 6" OF.FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3' OF F.G. INSTALLED F.G..EL.-58.0t F.G. EL:=57.5/59.0 F.C. EL:59.0t =YWOINSPECT1ON MAX.) LENGTH. 4 � OF .&4J, 9"' ry aVENTDARL I (MI B'MIN COVERT I L e 83 MO 5�1%(MIN.) J6"MA%COVER L 1S'(MAX1- ORTS (MIN.) :12.J7' - 0. 1140 4"SCH40 PVC O S-IX (MIN.) O S�1% (MINK) 4'SCH40 PVC - 4"SCH40 PVC 1p ®INV.-'55.28 a ®INV.= 55.03 0.38';;'INSTALL 48'LDUID INV.= 56.7 INVE `�/HITAPII'� INV.- 57.0 LEVEL INV.- 53.87 CO P IR TAI GAS BAFFLE PROPOSED - - D j" D-BOX 4 ROWS OF 4 UNITS 0 5'/UNIT+ 3 COUPLERS O 1.18'/UNIT 23.48'/ROW _ INV.m54.20 DB-5(H-201 INV.=54.02 501L ABSORPTION SYSTEM (PROFILE) (2) EXISTING 1,500 GALLON SEPTIC TANKS EXISTING OUTLET- - - "RESTORE VEGETATIVE.COVER , - - BACKFILL WITH CLEAN PERC SAND - NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING - TO TOP OF CHAMBERS,- 60, - PIPE ANVERTS PRIOR TO CONSTRUCTION _ 2) D-BOX SHALL BE SET LEVEL AND TO BREAKOUT=TOP ELEV.a54.33 , GRADE ON A MECHANICALLY COMPACTED SIX .INV. ELEV,e. 53.87 INCH CRUSHED STONE,BASE, AS SPECIFIED IN BOTTOM ELEV.- 53.00. _ 310 CMR 15.221(2) EXISTING SUITABLE - 3) REPLACE EXISTING 1,500 CALLON SEPTIC TANKS' 2.66' 'MATERIAL• TEEM WITH 1500 GALLON SEPTIC TANK.IF FAILED, 5' MIN. ABOVE-BOTTOM G.W.DAMAGED, OR UNDERSIZED. - T.P. EXCAVATION OR . EFFECTIVE• 4)•INSTALL INLET & OUTLET TEES W/ •. BOTTOM OF MOW PRE IDE48.00 T USE 4 ROWS OF 4-ADS ARC 36HC - GAS BAFFLE AS REQUIRED (H20) UNITS - IJO STONE W/ 3 COUPLERS _ . sj PLACE'TEE IN D-BOX: IN EACH SYSTEM PROFILE . TYPICAL SECTION N.T.S.' . SOIL LOG P#: 13652 DESIGN CRITERIA DATE: kAY 23,:2012 NUMBER OF BEDROOMS: 3 BR DWELLING SOIL EVALUATOR:, 'ARREN M. MEYER, R.S., CSE. (/1614 SECTION 1D.Js" WITNESS: INVERT - SOIL TEXTURAL CLASS: CLASS I - DON DESMARAIS, BARNSTABLE BOH HE/GHr END CAP DESIGN PERCOLATION RATE: <2 MINAN Me, TP-1 Depth EIe TP-2 Deph ADS ARC 36HC HAMBFR DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. 59.0 0/A/E. a*:) 59.20 0/A/E 0` 0 LOAD). GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) MODEL ARC 36HC IAAIAY su+o- i LOAMY sAND LENGTH SEPTIC TANK:330 gpd x 200% o 660 gpd RE-USE BOTH EXIST. 1,500 GALLON SEPTIC TANKS - 58.67 B IOYR 3/I 4"; 58.87 B tDttt 3/t 4" - 63" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT - EFFECTIVE LENGTH ' 60` - TO CHANCE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (330)/0.74 n 445.94 S.F, LOAMY SAND LOAMY SAND DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.IOYR 8/8 IOYR 6/8 SIDE WALL HEIGHT 10.38" ' DISTRIBUTION BOX: 5 OUTLETS (MINIMUM)(H20 LOADING) 56.33 C 32 56.37 C 34' OVERALL HEIGHT 16 PRIMARY S.A.S MEDIUM SAND OVERALL WIDTH 34.5" 4640 TRUEMAN BLW USE 4 ROWS Of '4 - ADS ARCHG t616 H 0 UNITS NO STONE zsY 7p MEDIUM SAND 10.7 CF e HILL/ARO, OH/O 4J026 AND FXT ND D 1.16' W/ COUPLFRS IN BFTWFFN FACH UNIT. ^ 2.5Y 7 J CAPACITY -PERC a 34.75- / (80.0 GAL) Aw 03 O"NAgE SYSTEMS,INC. BOTTOM AREA; .(GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) PROPOSED SEPTIC SYSTEM SITE PLAN (CHAMBERS: 4/ROW)16 UNITS x 5.0 LF x 4.80 SF/LF ce 384.00 SF 132' (COUPLER: 3/ROW) 12 UNITS x 1.16 LF x 4.80 SF/LF = 66.82 SF, 48.0 48.20 1J2 13 THIS WAY, OSTERVILLE; MA TOTAL AREA - 450.8 SSF PERC RATE <2 MIN/IN. (-C2" HORIZON)DESIGN FLOW PROVIDED: 0.74GPD/SF(450.82SF) 333.60 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Prepared for; Nickerson Engineering by: Surveyln9 by: SCALE HCHECKED •1,Damn N.M,y,q R.S.;CSE,h,nby eeNfy that I am curunlly oPproved b MADEP MEYER 6 SONS,INC. AM.Doul�Sums Y Punuont to]IO'CMR Is.on J• NTS . - to conduct Boll,voluallon,and thot the above onaly,le he,lbeen performed by me oon,10,nt elth N, PO BOX931 (508) 419-1086 nepulrsmenle of 310 CMR 15,017, 1 further a tlly Uel I ha„Poeeed the Sall Eval.Exam In October, 1999, EAST$ANDW/CH,AU 92577 DATE: EET NO. 6oeae2.29u 06/16/12 OF 2 I `I 1 , _ , . a ^ SSAC NWEALTH SETTS THEIn O COMMO F MA STABLES�SSACHUSETTS BA Of �011CYIPLYCLE -Upgraded (�ETtLf1tA�� Repaired(�Y. Upg CERTIFY;that the On-site, Sewage Disposal system Constructed TH1S IS TO f has been constructed in accordance by dated. doned( ) itN o�� Construction Perm d the for Disposal System 6 gPd Designer ! Q. the provisions of Titl 5 an Approved design flow lller stem w. un tion as esi ed. drooms e c�ristrued as a guarantee that,the system - i shall notinspector ___ issuance of this pe - - - .- -- -- - ie - _ --- ` : r Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: �'os7i4[ 42F ,-70ieW-rl, BUSINESS LOCATION: 1. ? !:T S way 0 C Cre vjL1_-;' MAILINGADDRESS: 13 Th/(S 14/4S4 . a uic« Mail To: Board of Health TELEPHONE NUMBER: `�d� yz�- �a'z� Town of Barnstable CONTACT PERSON: K P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: ryE- yoo Hyannis, MA 02601 TYPEOFBUSINESS: (��'vnak2i�✓C� i2. s�a2oiT�d,1� Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO 1-� This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes _ Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants ` . Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other,chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers Metal polishes hydrochloric acid, other acids) - Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 'o . - --. _ _ 6 : r� �.7 € ly` IArJ 4 t 0 P&J ,F . -- ---- 5y y Town of Barnstable Health Inspector oFZHe t Office Hours yP� ti� Regulatory Services 8:30—9:30 x . Thomas F.Geiler,Director 1:00—2:00 x x x BARNSTABLE. MASS. s Public Health Division �* 16;q. �0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT - SEPTIC QUESTIONNAIRE 1. General Information: Size of Property:_ Address: ' ' 60 U " 0 Map Parcel ! �- Name: ! Phone#: ' .2a. How many bedrooms exist at your property now?-"3 2b. Are you planning to add any bedrooms? lf\-�O If yes, how many? 2c. How many bedrooms total are proposed at this property (including the amnesty unit)?--� 2d. Please include a copy of the floor plans for the entire property showing the existing rooms in the home plus the proposed amnesty apartment and/or addition Please label each room clearly on the plans..ux-� ® o^ 3. Is the dwelling connected to public sewer? YES or NO . j If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is NSIDEPor OUTSIDE a Zone of C�bution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC E'? 6. Is a disposal works construction permit on file? < YES for NO C!). 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES`9or ENO S. Is there an engineered septic system plan on file at the Health Division? YES or NO .9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedro s at this property. Special Conditions: I(cam sw� Sub 00, ac, Signed: Date: Q;/health/wpfiles/amnestyapp ♦ qr I. TOWN OF BARNSTABLE LOCATION I3 7h/.� SEWAGE # ZOO -/4 .S VILLAGE 07fr5 "t//l1r / S ASSESSOR' MAP & LOT /2/- 192, ,T / INSTALLER'S NAME& PHONE `- 3 SEPTIC TANK CAPACITY ,LEACHING FACILITY: (type): R -1000 ��s�'� .:F (size) NO. OF BEDROOMS BUILDER OR OWNER A<r-ollDJ'oh A�icklliydlo PERMrTDATE: 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)4, Feet Edge of Wetland and'Leaching Facility (If any wetlands exist within 300 feet of leaching facciti Feet Furnished by ___ _ �", P �: 4_�„ � � 4 h r .� �� _ �� .. S � ' � v� a -� r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for �Dizpaal 6potem Conotruction Permit Application for a Permit to Construct( ' epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �%S (, �/ Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. s- 718 Designer's Name,Address an Tel.No. 5".09" 4I23'-- d �' ✓®$,C��/ �-t � <"i'�C�� �Ii't!".k`'ap / AS f ' �p Type of Building: �g az � 3l�dl 1 f� 1 l r r e r,,,�Z#��-R% Dwelling No.of Bedrooms l L t�Jiz sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer whyn applicable) !�Qv 1 rJ4 /I-OrO i�al X46!'r2e_ 54e4i1L' Lax Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oard ot Health. Signed Date Application Approved by Date h Application Disapproved for the Following reasons Permit No. U - J Date Issued q1 Id =10 � V � l �S f Fee ': ''• THE--COMMONWEALTH-OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTHI DIVISI;O'N VTOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Mf4pogar *p5tem Construction Permit Application for a Permit to Construct(4,)`2tepair(m )Upgrade( )Abandon( ) El Complete System ❑Individual Components ,m - . Location Address or Lot No. ✓j 7"Lj js (,!//4!' Owner's Name,Address and Tel.No. Assessor's Map/Parcel1 OS V `r/�F 2 hj%j;k/ Installer's Name,Address,and Tel.No. sU g- �/2 — q'7 3 rS Designer's Name,Address and Tel.No. S-O$" 92$- Type of Building: G a« � 3 �I �N o�fr Pr pTr p P Dwelling, No.of Bedrooms / Lot 'iz 1 1 sq.ft. Garbage Grinder( ) Other Type of Building" No. of Persons Showers( ) Cafeteria( Other Fixtures { Design Flow " gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title r Size of Septic Tank Type of S.A.S. ..iDescription of Soil Nature of Repairs or Alterations(Answer wh:n applicable) 2yl3 /� /xdo 6AW , .C-,,40'06 Fk-eo e- ��A►X f t3f2�J G/ rn X 1, A76,1'J /!JOo ©,d1 L/=.� '�'/.I mo• /���l'� f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of theOEnvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Poard of Health. Signed ! Date Application Approved by / , Kj . Date 4'10 Application Disapproved for the Yoll6wing reasons Permit No. a U tl 3- Date Issued d ——————————————————————————————————————— THE COMMONWEALTH OF MASSACHUSETTS �1 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed (e--)-ltepaired ( )Upgraded Abandoned( )by ��-i�!� �. / !� /.► /iS t - at -coy" f�S�"/.�'t/!/'%�= has been constructed 'n accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.a(k=Z.- 14'Z- dated -I / o? Installer J!,f lu-0 z. Designer Iloge U 5 The issuance of this ermit s 111 not be construed as a guarantee that the syste t ,Ja Date �� _e Inspector .�i/ ► r I � '-------- No. ()0 3 ' Fee J d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogar *pztem Conwtruction permit Permission is hereby granted to Construct(4.,�"R p r( )Upgrade( )Abandon( ) System located at f 12 7"4 Lzzl4 6 5f-x e1/,z I: and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of t ' perm t. / Date:_ Lily (1 Approved by Ii TOWN OF BARNSTABLE �l/ LOCATION, �� h1." ! SEWAGE # 1Do'3 -/G. VU LAGE ASSESSOR'S MAP & LOT /2/- INSTALLER'S NAME&PHONE NO. 4'-P, SEPTIC TANK CAPACITY /5�� / LEACHING FACILITY: (type) 2 - /DOb 6"1 r9 (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE:_`z', /S� 03. 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 faccili�) Feet Furnished by i I i s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTEfM�OlY d REDE�VED APR 15 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 13 This Way _- - Osterville Ma.02665 _ MAP 2' Owner's Name: Melbourne Nickerson PARCEL Owner's Address: SAME Date of Inspection: April 7,2003 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: (508)428-1779 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Si nature: c� ---- Date: Inspector's g — The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments System in good condition. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Puge 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 13 This Way,Osterville Owner: Melbourne Nickerson Date of Inspection: April 7,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D. A. System Passes: _X_ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated be ow. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s):The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: i Page 3 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM_ INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 13 This Way,Osterville Owner: Melbourne Nickerson Date of Inspection: April 7,2003 C. Further 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 public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform 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 less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: f Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 13 This Way,Osterville Owner: Melbourne Nickerson Date of Inspection: April 7,2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform 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 less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large.systems in addition to the criteria above) yes no 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 I1 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered if yes„ in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. A Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 13 This Way,Osterville Owner: Melbourne Nickerson Date of Inspection: April 7,2003 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X_ _ Pumping information was provided by the owner,occupant, or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ — Has the system received normal flows in the previous two week period'? _ _X_ Have large volumes.of water been introduced to the system recently or as part of this inspection _X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS,located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example;a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 13 This Way,Osterville Owner: Melbourne Nickerson Date of Inspection: April 7,2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):330 Number of current residents:2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no):No [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2001—82,000 gal 2002—78,000 gal=219 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgtl,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Pumped every two years. Source of information: Homeowner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:___gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: Tank,D-box and first leaching pit 25 years old.Compliance date for expansion pit 7/14/89. Were sewage odors detected when arriving at the site(yes or no): No I Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 13 This Way,Osterville Owner: Melbourne Nickerson Date of Inspection: April 7,2003 BUILDING SEWER: X (locate on site plan) Depth below grade: 6" Materials of construction:_cast iron _X_40 PVC other(explain): Distance from private water supply well or suction line: 30' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 6" Material of construction:—X—concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8' long x 5.2'wide—1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 2611 Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tank in good condition baffles intact. GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffler Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): r Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . Property Address: 13 This Way,Osterville Owner: Melbourne Nickerson Date of Inspection: April 7,2003 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Box set level flow equal at both outlet pipes. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 13 This Way,Osterville . Owner: Melbourne Nickerson Date of Inspection: April 7,2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: T pe leaching pits,number: 2 (6x6) 1000 gal pits leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, et .): First pit has V standing water and a high stain 8"above water level.Second pit has 3'standing water. CE SSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: D pth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: M Fiterials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) M terials of construction: Dimensions: D pth of solids: C mments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 13 This Way,Ostervilie Owner: Melbourne Nickerson Date of Inspection:April 7,2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. V� d Qt t 17- ® Z p 40 3� � sZ 'U n 'Page l 1 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 13 This Way,Osterville Owner: Melbourne Nickerson Date of Inspection: April 7,2003 SITE EXAM Slope None Surface water None . Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150.feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater map shows water below el.20 property at or above el.50. Health Complaints 06-Aug-99 Time: 10:33:02 AM Date: 8/6/99 Complaint Number: 2007 Referred To: GLEN HARRINGTON Taken By: LS Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: Street: OSTE RVI LLE-W.BARN STAB Village: MARSTONS MILLS Assessors Map-Parcel: Complaint Description: HE HAS BEEN PUTTING UP WITH DOG ODOR FOR 3 YEARS. HIS NEIGHBOR, BOB SOUZA BEHIND HIM PILES THE DOG FECES ON PROPERTY THAT BACKS UP TO HIS. HE HAS TOLD HIM ABOUT IT, BUT THE LYE IS NOT WORKING PROPERLY. THEY CANNOT GO OUT INTO THE YARD OR OPEN THEIR WINDOWS WITHOUT GETTING ILL. THE HOUSE IS BEFORE BUSCH GARDENS. HE DIDN'T KNOW THE NUMBER. YOU CAN TALK TO THE COMPLAINANT ABOUT IT. THERE IS ALSO A HOSE DRAINING ONTO HIS PROPERTY FREQUENTLY FROM THE NEIGHBORS AND HE DOESN'T KNOW WHAT THE LIQUID IS. Actions Taken/Results: Investigation Date: Investigation Time: 44 c f3 TOWN OF BARNSTABLE LOCATION . _ �! SEWAGE # VILLAGE Oxttit& ASSESSOR'S MAP S& LOTZg i 7l y;:� -INSTALLER'S NAME & PHONE NO. /� `SEPTIC TANK CAPACITY f00� LEACHING FACILITY:(type) L , / (size) 0 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER f W k DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE•GRANTED: Yes Now/ �,r ...�� ` � _ �� e O �� �� No. � Fps M THE COMMONWEALTH OF MASSACHUSETT BOARD-OF HEf,&-Vr.T ....... .........................1-1��X� : .. Appliration for Disposal Works Toostrurtioo Prrmit Application is hereby made for a Permit to Construct ( ) or Repair " an Individual Sewage Disposal System at: '` ............... ......................................................... .................... ............. ._._.. ......t. ....t No-....--••--•--......--...... .. Location_Address Owner `, Addres Installer � Address UType of Building Size Lot............................Sq. feet Dwelling.—No. of Bedrooms_______:____.......................Expansion Attic ( ) Garbage Grinder ( ) �`4 Other—Type T e of Building _______________ No. of ersons......_._...._.__..___._._._ Showers YP g ------------- P ( ) — Cafeteria.(...__). dOther fixtures --------------------------------•--------..._..-----•-........_....-••----•-----•------- ------------...-••---•-•-•- 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......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........... -__________-. f3i Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ t� Descriptionof Soil........... - .. ... --1 ----------------------------••-----------------------•------------------------------------------------.....----------- U --------------------------••-----•---•-••...----------..._. ._,_..._•--•----_ -----••-------•-•-....---------------------------••------------•------•---•------•---•-----------•-..... W ------------- ----------------------------------------------------------------------------•------------•--•--..------------ 1 - - U Nature of Repairs or Alterations— w r when appl le------------ 5t __:_ .` ______________ �'._______. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of THTI1E 5 of the State Sanitar Code—The undersigned further g es not to place the system in operation until a Certificate of Compliance has iss by the bo rWofhjh, Isk _ inr -S Signed---•--_� ----- .. ._•_�1 7 ! b............... ............ Date Application Approved By.... ! ....... 't ----•----------------------------------- Date Application Disapproved for the following reasons_ ____________________________________________________•__----------------------------_.__..._.._____--.-.-__-_. -------------------------------------------------------- ---------------------------------------•------- . � Date � Permit No.. ,. .... Issued. - � Date No.!_� ..._..: Flzs....:........................ THE COMMONWEALTH OF MASSACHUSETTS ...........................................OF................- ---------------..................... Appfiration for Disposal Works Tonstrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: .... ........_ eI ................_..... .......Location-Address 14 ...,/-n .� 9 o Lot No... .. 1 .. ... S Owner � �'�� YA Addrejs� l � a .......:......... •... -- -----=r----._.::..._..__.....':... ....................... Installer Address fd Type of Building Size Lot...........................Sq. feet U Dwelling—No. of Bedrooms.....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ...................................................... 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 ( ) Percolation Test Results Performed by.......................................................................... bate........................................ 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........................ ----- ------ -- ----------•-•--------•----•.....................••-•-----------------......................................................... Descriptionof Soil............��'�'�' !►` `3----------------------••----------------------------------------------..----------------------------------.----..------ U --•------------•----•--••--------------•-•-•---....-----------------------............---------------------...------------------------------.................................................... ------------------•--- --------•-.------ - ------------------------------------------------------------------------•---- UNature of R, air or Alter tions—AMwer when apple )le......._ `� �.. .r.. ............... ..:. ......... ---............................................................ - --k 10_ .... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT LE 5 of the State Sanitar Code—The undersli gned further r9tees.not to place the system in operation until a Certificate of Compliance has e issued by the boa?d of health. j r ," v f' li , Signed ...................\ /1 't.-- ..............................................' ,.,, '� Date Application Approved BY 1 .................''C ' ;r • � Z....f �l:!i ------------------------------------ // , ..-�---•..................................... ..............•-•---Date ............. Application Disapproved for the following reasons:Cf....................... . -•--•---------- -------------------? +` — _ L4 Date Permit No. ............. �.._. .'r;-•-----_-..--_--. Issued-----------•------- ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS A BOARD_ OF HEALT v-:N ..........................................o F...... ._.e'...:r..3`..................................................... Trrtifirtttr of Tomplianrr THI,�-:JS TO CERTIFY, That the In vidual Sev��age Disposal S-stem constructed ( ) or Repaired ) C�.........................'--•--�---'-�------.`i--- Z'...----------.. f Installer _� at... ` �� ..._ tom._ . t�---.--...t- -..--- .................................................. .....-----•-----..... -••................................•----•---..... ----. " , has been installed in accordance with the prov ions of T"!TJ 5 of The �tate Sanitary Code as described in the application for Disposal Works Construction Permit No._�. ___�_ _j::.�..... da.ted_............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIOAI S TISFACTORY. DATE.... •---- .............................................................. Inspector........................ I ......................................... THE COMMONWEALTH OF MASSACHUSETTS __.._ BQARD OF HEALTH No .............c: .ry FEEC» a .I .t� .................... %Va 4gi Works Tnnstru �i at . ramit Permission is hereby granted..." �-`" '"- V F � .........................----------------------------------.._...-=-------------------- .............................. to Construct ( f Repair (1.) an-',Individual Sewage Disposal System atNo............................ •--..... ............-.--•--- a. ......_.._........... .. ---------- Str et _ rJ as shown on the application for Disposal Works Construction P �t Nod'_!..____: iDated•--__ ---- _�` ..^_-�. ..... if r t i s . l / 7sJI - ---- '''] �/ Board of Health DATE...t..�-- /T - ........................: t FORM 1255 HOBBS & WARREN, INC., PUBLISHERS No.. u a Flza......, THE COMMONWEALTH OF MASSACHUSETTS BOARD9a . HE T l.-._.........OF........ , !............ Appliratiun -for Disposal Works Tomitrurtion Vmnit Application is hereby made for a Permit to Construct (k_� or Repair ( } an Individual Sewage Disposal System at: Q .? - esTERviu r' ........................... ......---------�t� We--Il1�14rs!TIl�lf. ...••-••-•-------•--•-•---•••••••••-••---••--•-•--•--•••--••-••••••••......•-•-••......-•--•-.... y Location-Address or Lot No. .............. .......... Owner Address ?3- .-10...... -----------------------------•-••--••----- -----••------------------------------- Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling i;?No. of Bedrooms-------............ 3----------------------Expansion Attic ( ) Garbage Grinder (4,a) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- -- W Design Flow______________ _�.................... tllons er erson er day. Total daily flow____._._.__ �__--_____--._ gallons. gg P P P Y Y -3-- --- ---g WSeptic Tank i Liquid capacity./Ogg gallons Length................ Width................ Diameter_-.--. -..---__ Depth.-_----_------- x Disposal Trench—No--------------------- Width------------__ . Total Length_.-____-_-___--_--- Total leaching area....................sq. ft. Seepage Pit No....../------------ Diameter.....fe �?_. epth belo inlet____________ ______ Total leaching area...._._...._.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Q;- Jr /—A0 7e e Percolation Test Results Performed bY------- --------------- .................................................. Date.........--------.......------------.... Test Pit No. 1----------------minutes per inch Depth of "lest Pit-------------------- Depth to ground water__..--------..-.-_..__.. (� Test Pit No. 2----------------minutes per inch Depth of Test Pit................. Depth to ground water-_.--.----_-_--._--..__. ----------- -------------••-••-.... •-�� ---••------••• ----- O Descriptio of Soil. ~. • ••.•Y '�o �� .. . w ,/ ------------ ---------------------- ----------------------------- --------------------------------------------...------------------------------------------------------.._.._..._..._.......----- U Nature of Repairs or Alterations—Answer when applicable.-.----......................................................................................... ----------------------------------- ---------------------------------------------------------•---------------------------------------------------------------------------------------------- --------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witli the provisions of Article \I 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. Signe ......•... - - ----- .- . + . •- ------------- Date Application Approved B Date Application Disapproved for the following reasons--------------- •••• ..------------------- •------------•-••-----....•-------------•--...----••-•-•-------•- -------------------•--- .Date PermitNo......................................................... Issued........................................................ Date No........-. Fps......... ............ THE COMMONWEALTH OF MASSACHUSETTS --- BOARD OF HEA L TH 0--t- .. ..........OF.-- - . f4r7t�.e.�.. ..Cd ;r�._:.............. Appliration -for M.gpoottl Vorks Totw4rurtiott Perotit Application is herebymade for a Permit to Construct (�� or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ................ .......A c xt// to c'yC.fo r✓ Owner Address .........................e4- 111---•----••---•-------••-•---•-----•-•--••--•••-----••-••-• ............... .................................................................................. Installer Address UType of Buildings� Size Lot............................Sq. feet .-� Dwelling--No. of Bedrooms____________________q---------------.-----Expansion Attic ( ) Garbage Grinder Other—Type of Building ---------------------------- No. of persons--------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ _ _ W Design Flow________________ ___V._._.._________._..gallons per person per day. Total daily flow-------------?_ ®-----___--.-.-_-.gallons. WSeptic Tank Liquid capacity--/..q�9gallons Lenoth---------------- Width................ Diameter---------------- Depth.-..------.--_. x Disposal Trench—No. .................... Width------------___- . Total Length.................... Total leaching area...............-----sq. ft. Seepage Pit No......./----------- Diameter------/ O fl---'Depth below//inlet_____________// Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0, _ ; 70t.-- /" /0- 76' . a Percolation Test Results Performed bY----------------------•--------------------------------------------------- Date.................................... Test Pit No. 1--------------__minutes per inch Depth of Test Pit-------------------- Depth to ground water..-.-.---.-.---.-....-.. . �14 Test Pit No. 2................minutes per inch Depth of `lest Pit.................... Depth to ground water__..--______--_.___.... W .._..... -•------------ -----------`fi-Z�......................................... -•---•-•-•----•-•••-------- ---- -•• • ...... .. -- - ---- -.-_•••-.G Description of Soil-. ZZ &­ -----i ma x ...... `,_.... .- G.` _.. _.. ... A4 Frl ----------------------------------------------------------------------------------------------------------------------------------------------------_------------------------------------------------- .. J Nature of Repairs or Alterations—Answer when applica.ble------------------------------___.-.______-______-.-__-___.--.-.--.-------..--..---_----._-----.. ---= 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 lru�w,, �� /V � f l Date Application Approved B �........:---------;ZL;----- ._-. /1.E=f ----------.•.--- ---- r 7-1---------- PP PP Y-----�----=--=- %� � t � Date Application Disapproved for the following reasons:--------------------------- ----------------------------------------------------------------•-----------•-------------------------------------------•----•---------••---••-----•-------------------.__-------------•---------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f �..... ...............O F........ �� .� .. ......'....... (1rrtifirat��e^^ of f�outpliaure �,�-- THIS IS TO CERTIF 'That the In dividua`l�'Sewage Disposal System constructed ( ) or Repaired ( ) by------=• ------------==••••--------............------ - •-•---•--•----•-••••-•-• ••----•-- ------- -----•-•---- f at___'_ '__ .�._.____j_. ___7r sealer, } �4:_. � �__....._..___ ^� 1 ---- -- - ��a ........................ has been installed in accordance with the provisions of : ttcle XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No� _�' _ �:�..__'-:_....__ dated..--._7-`.�r'.---� >''...__.___. THE ISSUANCE OF THIS CERT4FICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_-------•--/..............62-�------------•- .- ................ Inspector----- ------- -------- -- .. - ..`.-'•-r..--------.....----------- THE COMMONWEALTH OF MASSACHUSETTS J BOARD �QF HEA4LT�. � No._ G?"7J.••.• FEE_ / i��o�ttl ork�`-��n�trttrtiott �erratit Permission is� by granted f.✓1_---`-� ---- --------�---�-/- to Construct ( or Repair ) an Individual/§e--) Disposal System f� at No.__U f v C. '� r - /-.f�------ ._. --- - - f Street / as shown on the application for Disposal Works Construction Permit No.--____-_���--,Dafed - '- ��✓ - - - --------------- Board of Heaith 7 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Pam. i,.cg o8 i o f � 411G e ' + - E 2D �92 33 i NR /ID op I i I Scale 1" 40t CERTIFIED rLUT PLAN Being lot �#3 as ahown on a plan dated 4-9-1976 by King & Reekie Assoc. , of Scituate . Mass. . Recorded in Barnstable Re istry of deeds in book I, hereby certify that 30 page 2. the existing foundation -location is correct as July 12th, 1976 shown and does conform '' cF with the building setback Owner builder: or �s requirements of the Town Kempton Nickerson ThomesA. �,`� of Barnstable. Hyannis, .Mass. 1 0 JACKSON i No.9937 H ' �9A la's TEVt <% l . "° Signed N 08 4 o ' ��� •�ih 3(� T WAY" o � fit /69, 8s o 30.00 � a v _ 10 20' a . . o �0TJ-�(IOATIDb1 �\ )•1 t. . I,maa-c�cE-l�Rlk - - i 0 p (3 1 L-oT. 3 0 } i 1 taa� 200.00 Scale 1" 401 CERTIFIED rLUT PLAN Being lot #3 as ahown on a plan dated 4-9-1976 by King . & Reekie Assoc. , of Scituate Mass. . Recorded in Barnstable Reggistry of deeds in book I, hereby certify that 306 page 2. the existing foundation location is correct as . July 12th, 1976 `��& OF shown and does conform j ors with the building setback ► Owner builder: recuirements of the Town Kempton .Nickerson. n►om89A. of Barnstable. Hyannis, Mass. i a JACMN `> No.8937 O QSTE 6 �tioSU%tV A . Signed r - LOC&.TION : 5EWAC�E 'PERMIT UO. - - VILLAGE It�ISTALI..ER�'S- 1J�_ME � ADDRESS 13U.ILDER5 IJL MF— ADDRESS DATE PERMIT ISSUED '- -n — — s DATE CONAPLI WACE ISSUED : — — _ ry a� ✓4/E �`./ r � O �' ,, �� ! '�� � � �� \ '� �. I • GENERAL NOTES: OSTERVILLE I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL THIS W A Y f - LEGEND !J BOARD OF HEALTH AND THE DESIGN ENGINEER. PROPOSED CONTOUR 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 20.00 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE PROPOSED SPOT GRADE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: S68'08'22"W - 310 CMR 15.405 (1) (B): —— 98 —— EXISTING CONTOUR ROUTE 28 1) A'1.67 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE 4.67 FT (MAX) BELOW GRADE VS REQ'D.3.FT.• + 96.52 EXISTING SPOT.GRADE P� (H20/VENT PROVIDED) I •0*15 w I F, 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR W— EXISTING WATER SERVICE TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE TEST PIT 0 LOCUS DESIGN ENGINEER. 2 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING Z FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE'CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED-DATUM. - Uj �0 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. Op 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED I TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. - LOCUS MAP. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY - THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING k CONSTRUCTION. LOCUS INFORMATION 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. PLAN REF: 321/33 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PARCEL LOT 1 TITLE REF: 2366/197 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY T- PARCEL ID: -� 121/026 PARCEL ID: MAP 121 PAR. 142 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY i 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 4i FLOOD ZONE: "C" 14. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPEC. OTHERWISE) W (n LOT 3 COMMUNITY PANEL: 250001=0016-1) DATED:07/02/92 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW I PARCEL ID: FOR THE USE OF A GARBAGE GRINDER 121/141-2 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING SEPTIC SYSTEM N80. 224 `,, 1 REPAIR PLAN N E LOCATED AT: 1p3.27 ------ 13 THIS WAY LA ` OSTERVILLE, MA. 1 I = °\� ------ N8 '_ __ G 22 24.,E PREPARED FOR �P s� 9,9.18 KEMTON NICKERSON c0 I i W G JUNE 16, 2012 00 ! -= D1 EILLING -__ O - �.%; SCALE 1 ' = 30 G W 'TANK _ =_ _= -__ 0_F O '�Ass9c CB/DISC _-- . -```�•� Oar -GARAG3A=_ �14 P_� D R E G , :TOF.g5.56= -- 12 P" O �11CF0 PARCEL ID: O �`` ;' EXIST. j 121/025 p ���;;%Y SEPTIC TANKS � ph' Op'O 8 Oa I�G151 NI TAR�aa V v� I -5 1 EXIST. LEACH PITS �\ O �;, + %, 59 PARCEL ID: NOTE IO `. GARDEN ( 24 P ,w 121/015-4 w c� I O •`� LOT 4 _ -' MEYER & SONS, INC. ,r Q) ----- PARCEL ID: i'•.�_CE ---� � - �, 14�0 121/142 1 C m5p ports P.O. B O X 981 AREA=28,788f S.F. TP_ 2.148' � 12"0 o vent 16 P EAST SANDWICH MA. 02537 12"0 El S68'09'16"W 200.00 59.5 0 59.4 R . cB/DH (508)362- 2922 PARCEL ID: 120/005 SHEET 1 OF 2 J 1434 NOTE: TO PREVENT BREAKOUT, THE PROPOSED NO TE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL•54.33 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK _PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=59.00 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER 14" OUTLET AND SET .TO, 6 OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. I LENGTHD •• �F.G. EL.=58.Ot F.G. EL.=57.5/59.0f F.G. EL:59.0t F.G. EL: 59.00(MAX.) OF MA`S'T9 / 9.45" � DAM VENTF� W 9" MIN COVER/ y L 10't 36" MAX COVER L 83' P L = 15'(MAX) INSTALL Two INSPECTION PORTS (MIN.), 12.37" 1140 ® S®196 (MIN.) O S=1X (MIO 5=1� (MINK.) 4"SCH40 PVC 4"SCH40 PV4"SCH40 PVC 10" 14 INV.= 55. 10.38" TO Sq )p� ® INV.= 55.28 �.uowo INV.= 56 INVERT NITAR ® INV.= 57.0 LEVEL INV.= 53.87 COUPLER DETAIL GAS BAFFLE W 4 ROWS OF 4 UNITS ® 5'/UNIT +.3 COUPLERS ® 1.16'/UNIT = 23.48'/ROW INV.=54.20 ) INV.=54.02 SOIL ABSORPTION SYSTEM (PROFILE r (2) EXISTING 1.500 GALLON SEPTIC TANKS EXISTING OUTLET RESTORE VEGETATIVE COVER 1 BACKFILL WITH CLEAN PERC SAND 60" TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV:=54.33 GRADE ON A MECHANICALLY COMPACTED SIX INV. ELEV.= 53.87 INCH'CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 53.00 310 CMR 15.221(2) EXISTING SUITABLE 3) REPLACE EXISTING 1,500 GALLON SEPTIC TANKS 5' MIN. ABOVE BOTTOM OF 2.88' MATERIAL ' WITH 1500 GALLON SEPTIC TANK IF FAILED, T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.88' = 11.52 DAMAGED, OR UNDERSIZED. (5.00' PROVIDED) USE 4 ROWS OF '4-ADS ARC 36HC 4)_ INSTALL INLET & OUTLET TEES-W/ BOTTOM OF TESTHOLE EL.=48.00 - (H20) UNITS - NO STONE W/ 3 COUPLERS GAS BAFFLE AS REQUIRED IN EACH ROW 5) PLACE TEE IN D-BOX. SEPTIC SYSTEM PROFILE - TYPICAL SECTION N.T.S. wrs. 16" SOIL LOG P#: 13652 DESIGN CRITERIA DATE: MAY 23, 2012 SECTION fo.as- NUMBER OF BEDROOMS: 3 BR DWELLING SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 INVERr SOIL TEXTURAL CLASS: CLASS I WITNESS: DON DESMARAIS, BARNSTABLE BOH HEIGHT END CAP DESIGN PERCOLATION RATE: <2 MIN/IN 'Elegy. TP-1 Depth EloV• TP-2 . Depth ADS - ARC 36HC CHAMBER (H20 LOAD) 59.0 0" 59.20 0" DAILY FLOW:- 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. 0/A/E 0/A/E MODEL ARC 36HC GARBAGE GRINDER: NO NOT DESIGNED FOR GARBAGE GRINDER LOAMY SAND LOAMY SAND ( ) 10YR 3/1 1OYR 3/1 LENGTH 63" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SEPTIC TANK: 330 gpd x 200% = 660 gpd RE-USE BOTH EXIST. 1,500 GALLON SEPTIC TANKS' 58.67 B 4" 58.87 B 4" EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. L1°Y SAND L10 MY �D SIDE WALL HEIGHT 10.38" DISTRIBUTION BOX: 5 OUTLETS (MINIMUM)(H20 LOADING) 56.33 C 6/8 32" 56.37 C 34" - OVERALL HEIGHT 16" OVERALL WIDTH 34.5" 4640 TRUEMAN BLVD PRIMARY S.A.S. MEDIUM SAND 2.5Y 7/3 10.7 CF HILLIARD, OHIO 43026 • USE 4 ROWS OF 4 - ADS ARCHC 3616 H2O UNITS-NO STONE - MEDIUM SAND CAPACITY 80.0 GAL AND EXTENDED 1,16' W/ COUPLERS IN BETWEEN EACH UNIT PERC O 54.75 2.5Y 7/3 ( ) ADVANCED oRaNAGE stisTEMs. INC. r BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) PROPOSED SEPTIC SYSTEM SITE PLAN (CHAMBERS: 4/ROW)16 UNITS x 5.0 LF x 4.80 SF/LF = 384.00 SF 48.0 132" 48.20 132" 3 THIS WAY, (COUPLER: 3/ROW) 12 UNITS x 1.16 LF x 4.80 SF/LF = 66.82 SF . OSTERVILLE, MA TOTAL AREA = 450.82 SF PERC RATE <2 MIN/IN. ("C2" HORIZON) Prepared for: Nickerson DESIGN FLOW PROVIDED: 0.74GPD/SF(450.82SF) = 333.60 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED , Engineering* b SCALE DRAWN 9 g . Y Surveying by: MEYER&SONS,INC. AfAcDouesff Survey NTS D.M.M. • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pOB0X961 (508) 419-1086 DATE: to conduct *oil evaluations and that the above analysis has been performed by me consletent with the EASTS4NDWICH,MA02537 CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil EvaL Exam in October, 1999. 5o83622922 06/16/12 D.M.M. 2 OF 2 ON %r u j 'L srv�n sGY� 6'oz v i ar- LL } { I -7 Ln Ln I. �., {z SiT 10IJ A I � P{ � __ E�/ 2L11 Op I70P.M W-cSYnkb( r1 q, i---------- 00100 vw =o I�—(//� � _ __ � A� � ��-✓1 O F I i '1QXI��i,�16"6Z -��>'. -_ \9 1 - L I,,A0G, t711JIUGi/ I�I'Gi#F. - y W lo'x�Z ,- _ -- .. < v, 2g 6g ' lea ecy b ` jkU ANC NGf kN act +� sr"ac�pvo E ... � ,. '• �1dz2 ol. Sa�F'�ITN OF MPSS�4Jy 4L :. ... I I i I 1 It� it Ir.r � 1'�` 3 I , 1 �i i u r•i I ;I r _ I ICI a LA ,3,a,T IV HT N flVs�4 ILI � � I 9 ! y I I� N� 1� i i `li ! I I ! �. ' i �; I � jl •; •III — � oil �eNo. Ito MASS. orJy OSTER V WA Y ILLE' RouTE ze GENERAL NOTES: THIS " 20. 00 1) SEPTIC LOCATION S68 08 22"'W PER TIE CARD fr SEWAGE 189-346 1,000 GAL SEPTIC TANK AND (2) 1,000 GAL LEACH PITS t` INSTALLED 7114189 2) SEPTIC INSPECION REPORT oGa� GUNSTpCK PATRICK M. O CONNEL p LOCUS ROAD ARRIL 7, 2003 d o y 3) EXISTING (3) BEDROOMS HOUSE RENO VA TED TO (2) BEDROOMS WITHIN HO USE AND (1) BEDROOM WITHIN GARAGE PROPOSED. 4) SPOT ELEVATIONS BASED ON SURVEY AND 'sd ROglj MATCHED TO C.I.S. DATUM LOT 1 r� A.M 121/26 �j w of LOCUS MAP RUCE� G PLAN REF 321133 G. � MURPHY y ASSESSORS MAP 121 _ No.749 ZONING: "RC" rp i Ngp��, LOT 3 sfCISTER� GROUNDWATER PROTECTION A.M. 121/141-2 qN�T ARP 0 VERLA Y DISTRICT. "WP" 58.6 103 Z', � rs W x J PLOT PLAN OF LAND W ,2z 2¢'� LOCA TED A T z5.9 EXISTING 3THIS WA Y 0 56 g 2-BEDROOM�- OSTER VILLE, MA. hrousE ,.��ED� i PREPARED FOR: EILEV° 61.0 24.3 ;' � LUSTING °x KEMPTON NICKERSON \\ �► 8'5 ti GARAGE y 5 BB ARRIL 14, 2003 \ �'► (1) BEDROOM60 , 1 r rri,,� PROPOSED X O QQ `����`���OF,,ygs OO r \ 59X97 o c�4' '��PAu ���9�'s L A. '•=y �� ��. A.M. I21/25 Q�• \\ 0 60 ti _�= MERm IE1N m SCALE: 1"=30' ass i� y............ --- FENCE s94 -----� A.M. 121/15-4 YANKEE SURVEY CONSULTANTS LOT 4 �6 UNIT 1, 40 INDUSTRY ROAD A.M. 1211142 60 E S.F. 6 P. 0. BOX ,265 AREA=zB,788 MARSTONS MILLS, MASS. 02648 E` TEL. 428-0055 FAX 420-5553 A.M. 120/5 S68 09'16"W 200. 00' J# 53351 C GM i 20' MIN. CONCRETE COVERS 2"LA YER OF LEVEL WAS 7i�NE EL=60.0' GROUND EL._TOP OF _ 60.0 MD S ' `t GARAGE SLAB 4" CAST IRON i . i i , ELEV.=58. 7 OR SCHEDULE 40 6IN. 6�lIN. / i / / i 6t�lIN. 61fm Z. P. V.C. PIPE 4" SCHEDULE 40 P. V.C. ADD 1 4" PER FOOT PIPE — MIN. RISER RISER = 57.4' FLOW LINE DIST. BOX 1/8" PER FOOT PRECAST INVERT 1 10" 19" 1/8" PER FOOT PRECAST MIN. s" MIN. ACHING EL.= 58 0-- cas INVERT MIN. CRUSHED ,o I W ° PIT eaa - 57.55 SANE " o8S8o8a8o8 BINVERT p J c INVERT EL.-_-- EL. _ 56.6 c INVER ° 6 F ° 3/4" TO 1-1/2" INVER _ 56 4 0° �W c ASHED STONE 1500 GALLONS 0 - EL.__5_6.B EL.-___-_ ° SEPTIC TANK DISTRIBUTION BOX ° �' c' 50.4' NEW NEW 2'I�I,E'AC� PIT _ I z, PROFILE OF 12'DIAM. SEWAGE DISPOSAL SYSTEM NOT TO SCALE TOP OF CATCH BASINS ON GUNSTOCK ROAD EL ALL ELEVATIONS ARE ASSIGNED GENERAL NOTES 1. THIS PLAN IS FOR INSTALLATION OF NEW SEWERAGE DISPOSAL SYSTEM FOR GARAGE. 2. PLAN REFERENCE BOOK 321 PACE 33. 3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM DESIGN DATA:AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.R TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS ONE- GARAGE FOR THE SUBSURFACE DISPOSAL OF SEWAGE. NUMBER OF BEDROOMS 5. ALL COVER TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN NONE 6" OF FINISHED GRADE. GARBAGE DISPOSAL 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE TOTAL ESTIMATED FLOW 110 GPD SAME, UNLESS NOTED BY FINAL CONTOURS. 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE ( 110--GAL/BR./DAY x 1_- BR..) OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER 1500 OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING SEPTIC TANK CAPACITY Y' SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING. EXISTING LEACH PIT REQUIREMENTS UNLESS NOTED. 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL LEACHING CAPACITY (BOTTOM & SIDEWALL) 549 GAL E. BE MORTARED IN PLACE. 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE W[TH (3.14 X 6 X 10 X 2.5) + (3.14 X 52 X 1.0) DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 10. THE EXCA VATOR\CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. 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