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HomeMy WebLinkAbout0004 VERMEER COURT - Health 4 VERMEER COURT, OSTERVILLE A= 145 087 l TOWN OF BARNSTABLE LOCATION y e zz -,,e C 0 0 R�'EWAGE # .:P,00 2' 0116 VII LAGE 0.5 feg 1 L L e ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. .T /1i1 / U,-4'1/6 eg f- SO IV SEPTIC TANK CAPACITY 0 Q? — 0 L fJ LEACHING FACILITY: (type) W C L L: (size) AI— , 13 NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facilit ° 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 L \ of Ci TO OF BARNSTABLE LOCP;TInP SEWAGE # / S 08'17 VU LAGER ASSESSO MAP & LOT 41 Jh3 NAME&PHONE NO. — SEPTIC TANK CAPACITY 100 LEACHING FACILITY: (type) 20-A5 6 (size) 1060 NO.OF BEDROOMS BUILDER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 30 LOC,.:A-TIORN "N' SEWAGE PERMIT NO. VILLAGE i INSTAL R'S NAME ADDRESS e U I L D E R OR OWNER e QA bG22al ` DATE PERMIT ISSUED © DATE COMPLIANCE ISSUED i �,` ...�,; �. . .�`�� i, �� / � ... .. �' ', �Y'''s �.,� "'2""' , i I� ��/�����-^✓ l _ No. �2 o f Fee $5 0�.0 001 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: '� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Miopooal Opotem. Construction Permit Application for a Permit to Construct( )Repair*X_�Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.4 Vermeer Court Owner's Name,Address and Tel.No. Osterville Mass. Denise Peterson Assessor's Map/Parcelr Installer's Name,Address,and Tel.No. 5 0 8-7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—8 3 3—21 7 7 J.P.Macomber & Son Inc. DBC Environmental Designs Box 66 Centerville,Mass.02632 East Sandwich,Mass.02537 Type of Building: ' Dwelling XXNo.of Bedrooms 3 Lot Size sq.ft. Garbage GrinderTo ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 140 gallons per day. Calculated daily flow --n G P D gallons. Plan Date 1 /2 9/0 2 Number of sheets Revision Date Title Size of Septic Tank Existing 1 000 Type of S.A.S.2-500 ' s 24 'X1 3 'X2 ' Description of Soil: Sandy loam to loamy sand to fine sand. Nature of Repairs or Alterations(Answer when applicable)Adding/two 500 gallon leaching chambers 24 'X13 'X2 ' 340 .4 GPD 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 nvironmental Cod and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this o f ealth. Signed ► Date 1 /31 /0 2 Application Approved by Date 2 b'2 Application Disapproved for the following reasons Permit No. 2C0 7 —6 q L Date Issued 0 -2- r � .• 20o2 1, ,, . . Fee $5050.000 Entered in com user: V ` THE COMMONWEALTH OF MASSACHUSETTS p Ye PU91LIC HEALTH DIVISION TOWN OF BARNSTABLES MASSACHUSETTS ' 0(pplicdtion for 30itpozal *potem Cototruction Permit Application for a Permit to Construct( )Repair*XxUpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or LotNo.4 Vermeer, Court Owner's Name,Address and Tel.No. Osterville Mass. Denise Peterson Assessor's Map/Parce!• Installer's Name,Address,and Tel.No. 5 0 8/—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—8 3 3—21 7 7 J.P.Macomber & Son Inc. DBC Environmental Designs Box 66 Centerville,Mass.02632 East Sandwich,Mass.02537 Type of Building: Dwelling XXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinderr(lo ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design`Flow 340 gallons per day. Calculated daily flow V 1 0 G PD gallons. Plan Date 1129102 Number of sheets Revision Date ' Title Size of Septic Tank Existing 1000 Type of S.A.S.2-500 s 24 'X1 3 'X2 ' Description of Soil Sandy loam to loamy sand to fine sand. Nature of Repairs or Alterations(Answer when applicable)Adding two 500 gallon leaching chambers.24 'X13'X2' 340.4 GPD 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 Cod and not to place the system in operation until a Certifi- cate of Compliance has been issued by this 'o -' f ealth. Signed Date 1 /31 /0 2 Application Approved by Date 'Z& U-2-- Application Disapproved for the following reasons i Permit No. 7 G q L Date Issued 2 z O Z 1 - — -------=------_--_----_----- ———— ——— ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )RepairedY((.XX)YUpgraded( ) Abandoned( -)by J.P.Macomber & Son Inc. at 4 Vermeer Court Osterville,Mass. 1 has been constructeo in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 00 2-OBI 6 dated 2 1-1 0 7- \ Installer J.P.Macomber & Son Inc. Designer DBC Environmental Deigns The issuance of this permit shall not be construed as a guarantee that the sysl will function s d ssii,gned. Date' /h 01 Inspectors n _ nn✓ -- -- - __ -- — — — N2Gu2—�`Cb----- ----------� 50.00 Fee THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpool *pe;tem Con%truction Permit Permission is hereby granted to Construct( )Repair(X )U grade( )Abandon( ) System located at `t Vermeer Court Ostervifle,Mass. Yi 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:Co etio must ompleted within three years of the date of this permit. Date: Approved by 7 Allel-,L I r /J TOWN OF BARNSTABLE LOCATION % y e A A4 ,e e C Q u C?rEWAGE # ;2,D© 2.' O 116 VILLAGE D.S 7'eg VIZ L 2 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. A4 A C G ,4116 e9 f' SEPTIC TANK CAPACITY GG� L %�• i LEACHING FACII,ITY: (type) W e L L S(size) A 13 NO. OF BEDROOMS 3 i BUILDER OR OWNER PERMIT DATE: 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 f � � . 7 s_ . ® r ii � o� � L w E ,, (Z"or ' R c ` ► v � ? ; ems•, ti C tp ZO"ems rz c M y�,u) Zo fir. Aw /k► . Lu r v7 f 6p wr 1 oo Fr /FG UNv�/7o.J OF h0l-" CERTIFIED PLOT PLAN ROBERT I"W Coxm- UCTION ONLY s i eRucE - LOT .4 ELDRED TOP OF FOUNDATION Is-.— FEET IN ABOVE LOW POINT OF ADJACENT I TE�,�o� SAIN SIAM,, 4 MASS ROAD. do su-, L , SCALES � 'L yo ' DATE, INS '�' - I CERTIFY THAT THE Low., 170 CL� "'""""'— SHOWN ON THIS PLAN I L8 OCATED ro .INEER; 1STER REGISTER Z.�,�.: CIVIL Lip JOB-Nb1 ,r..,.�,.�, ON THE GROUND AS INDICATED AND =URY CONFORMS .TO THE ZONING LAWS OF •ARNSTASL , MASS. -,�. • r T 12 M! I S N T.R'6XT H YA N�I S, MAS;S, E'1". A E l� G. LAND SU RVEYOR O-P `BORTOLOTTI CONSTRUCTION, INC. 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508428-8926 FAX: 508428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART A C/KAT!FICATION Property Address: Date of Inspection: / Inspector's Name: is Name and Address: - CERTIFICATION STATE ENT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection:The inspection was per- formed based on my training and experience in the proper function and maintenance ofon-site sewage disposal s Otems. The System: Passes Conditionally Passe Needs Further E ati By a Local Aproving Authority ` Fails Inspector's Signature:. Date: The System Inspector shall submit a`copy of this inspection report to the Approving.authority within thir- ty(30)'days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.,,The original should be sent to the system owner, and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY x e A)SYST &I PASSES: e// I'have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced.or repaired. The system, upon comple- lion of the replacement or repair, passes:inspection. Indicate yes,nor,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 sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water,level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): 1 A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced. T Obstruction is removed 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 the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND,PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zoge I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. ; Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effuent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an'overloaded or clog- ged SAS or cesspool. 'Liquid depth iti`cesspool is less than 6"below invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT,due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART-A. CERTIFICATION (continued) 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. v E)LARGE SYSTEM FAILS: The following criteria apply to.a large system in'addition to the criteria Above: The design flow of a system is 10,000 gpd or greater(Large System)and the system'is a significant threat to public health and safety and,the environment because one or more of the following conditions exist: <; • The system is within 400 Feet of a surface drinking water supply.' The system is within 200 Feet of a tributary to a surface drinking water supply, The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone I1 of a public water supply well. "' 1 - . 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. SUBSURFACE SEWAGE _ DISPOSAL SYSTEM INSPECTION FORM PART B y CHECKLIST Check if the following have been done: t. Pumping information was requested of the owner,occupant,and Board of Health. _None of the system components have been pumped for atleast 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. u; -As built plans have been obtained and examined. Note if they are not available with N/A. ��T�h facility.or dwelling was inspected for signs of sewage back-up. . system does not receive non-sanitary or industrial waste flow. i r ✓The site,-was inspected for signs of breakout. =All system components,excluding the Soil Absorption System,have been located on site. • ,,The septic.tankmanholes were uncovered,opened,and the interior of the septic tank was'in- spected for condition of baffles or tees,material of construction,dimensions,depth of liquid, / depth of sludge;depth of scum. ✓ The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- A. 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - - PART C SYSTEM INFORMATION FLOW CONDITIONS RESI1?ENTIALI ✓ Design Flow: gallons Number of Bedrooms: Number of Current Residents:_ Garbage Grinder: Laundry Connected To System:ZOL—.. Seasonal Use;,td Water Meter Readings,if v 'labie: Last Date of Occupancy: zCCG l .O MF.R AIJIND iSTRI_AL: /UU Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: / Non-Sanitary Waste Discharged To The Title V System: 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:_ If yes,Wu - ped: ions Reason for pumping: TYPE OF SYSTEM: ✓Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy'_, Shared System(if yes,attach previous inspection records, if any) Other(explain): OXEWLTE Ap§of all com nents,dale installed(if known)and source of information: Sewa a odors detect when arriving at the site: ,C)C) -4- r. F , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . . PART C GENERAL-IN FORMATION (continued) SEPTIC TANK: t/ Depth below grade: /il" Material of Construction: ✓concrete. metal 'FRP Other (explain)' Dimisions:$,6 ,r4,-,y T Sludge Depth: /p " Scum Thickness: S' Distance from top of sludge to bottom of outlet tee or baffle: 7$ Distance from bottom of scum to bottom of outlet tee or baffle: 7// Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid el i relatio to outlet invert, strucUiral integrity,evidence of leakage, etc. eZ /0 GREASE TRAP: r Depth Below Grade: Material of Construction; concrete metal FRP Other (explain) — . — Dimensions: Scum Thickness: Distance from top of scum to top of outlet lee or baffle: s y Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,deptif of liquid level in relation to outlet invert,stnrctural integrity. evidence of leakage. etc.') TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction: concrete__metal_FRP`_Other(explain) Dimensions: ., Capacity:_ _gallons Design Flow:. gallons/day Alarm Level: Comments:,(condition of inlet.tec, condition of,al run and floaLswiiches e(c:)•...,'. ...-.r DISTRIBUTION BOX:_ Depth of liquid level above outlet invert: Comments: (note if 1 el and distribution is a a1, evide a of solids carryover,evidence of leakage into 0 out of box,etc.) a PUMP CHAMBER. - R• r .,r s Ptimp is in working order: Comments:,(note condition of pump chamber,condition of pumps and appurtenances, etc.) -5- • a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type _ Leaching pits,number:1_Leaching chambers, number: Leaching galleries,number: Leaching trenches, number, length: Leaching fields,,number,dimensions: Overflow cesspool,number: Comments: (note condition of soil,signs hyd ulic fa' ure level of pondin 'condition of vepAtation, etc.) CESSPOOLS: Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow,(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C . SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. d'4, '�J UI , DEPTH TO GROUNDWATER: Depth to groundwater: Z y Feet Method of Determination or App oxi lion: ov)v �/t9 1111.51 dY T �lv t92 7_ wF 3 F ES r..... •� s v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T .......OF .....---..0I ---- - .................................... Appliratiun for Uiupuuttl Works Tunitrurtiun Prrutit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at �" .................................r.: ...................... • •-----•-----••-••-._._...--••-_.0._S.J- -••--•••-•....--•.....--•................. Lo ion_Add res or Lot No. _................... . % ._ o /1 (/j� Address ................................................ fjZ Att�.( :..._. 1.:.�.5�.!✓Y/ ................................... .... Installer Address Type of Building Size Lot MO.J 3 S?..____Sq. feet U Dwelling—No. of Bedrooms.............. ..........................Expansion Attic ( ✓Garbage Grinder � 6 aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _________________________________ _ W Design Flow___________________________________________gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacit�_ �.tallons Length................ Width-.............. Diameter................ Depth................ x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________ _______ D meter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution -pox ( Dosing tank ( ) Percolation Test Resul s Performed b ........................ Date_____ . �.2. 04 Test Pit No. i.... " minutes per inch Depth of Test Pit_.__._ ` Depth to ground water-----.-.�eU��_ (i, Test Pit No. 2......_. minutes per inch Depth of Test Pit ____________ Depth to ground water______//_.vv______.__.__.- P+ •-•------------------••-------------------•-----•----•..._...__...........I......_......•--••_-••-•-..............<......................................... 0 Description of Soil..................................................................... -'-� pr- ---- x t_ u -------------------- ---------•---.._..--------........----------._....._......................----�-•-----f- --=------------�-ter �.A,........�,�n ------------ W ------•------------- .................................................................................................. .........................................................-....................... UNature of Repairs or Alterations—Answer when applicable............................................................................................... •---------------------------•--..._•--•----•-••-•-•------------•---•------..--••---...........----------.......----------------------------------------•---------_--•--••-•-•---•--•...--•-•-•--•••----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIThE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu the board of he t . Signed---------- .... -_---• to ,/ ApplicationApproved By.................................................................................................. Date Application Disapp=oved for the following reasons:_______•___________________________________________________________________________________________________•___. --------------•-----------••-------------•---•--.....----•-•-•--••--------•------•-------......._......-------••----•-••---••-•-....-----••--•--.....-•---------...------------------........__...--•--- Date PermitNo........................................................ Issued....................................................... Date No.. ..'�.4 .� FEB.... ........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF H EA T .......... ........0F...........�//�d....... .... .. ----------------. ----------- --•---- Appliration for Diipo,ittl Works Tow3trurtion Vrrntit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: r»- - ........••............................ . .........._...........7.....=`--------.co . ......._..................-.._.0...5.1............................................. Lo ion-Address ....... or Lot No. ......................- _ll,.., r1 !''G1... S?If s ' •4 �`" -�o............................•-...-.......... r Address W ---......--•-•---••--•--•---- eue.t. �r�/�. Sr!.>•�............................... Installer Address 7 7TV � Type of Building Size Lot___..�.f__________________Sq. feet ., Dwelling—-No. of Bedrooms..............?._._._.._.___.__.._.__..._Expansion Attic (kb Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ................................................................................................................................................----- W Design Flow............................................gallons per person per day. Total daily flow.................................__._.._....gallons. WSeptic Tank—Liquid capacity(.tv-.!..tallons 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 (,/r Dosing tank ( ) a Percolation Test Results Performed by...........................6.e cl,�j_(� ..... Date........�ll?If . ......... Test Pit No_ 1_... -Y minutes per inch Depth of Test Pit - _ Depth to ground water.......,.,y;y GL, Test Pit No. 2______ __ _minutes per inch Depth of Test Pit___-_. ______...: Dep:h to ground water........................ -------------------------------•----------------....----------......_._..,-•----------•-=--•-------..............-.......................................... DDescription of So_l.................................................................... ..................i..a !?. ... . .---......... � --•--------------••-•-••••---•-•••-....._._..._..._..------------•-•----------•••-•--- ,, - -- 5 Uw --------------------------------------------------------------------------------------------------------•-----------------------------•------------•-------•----•------- -•.....----------...•---_..... Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------••--•-•-..............•----••-•-...---••-••-••-•-•--•---------•----........---•....---•--•-------------••-----------•-•••-------•--•••••••••••----------------•---------_-•--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'2ITLE 5 of the State Sanitary Code—The undersigned further agrees not to place.the system in operation until a Certificate of Compliance has been issueed_by the board of liegltth Signed............... :,'� .2 G --- ...... � �- to ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons:........................................_...................................................................... _ ---------•••---•----•----•-----•-•----------•------•----------------------•-••------------...-------...----------------•-----•-•....---•...----•------•--•--•---•------------•-•--------••---------_._.. Date PermitNo........................•------...-----••---------------- Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..y..... ...............OF................./..�.4 Gr.5..�ee.�4.le.............. Trr#ifiratr of Tontpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( ) by .............. , ............... ----•-••----•---------------------•-•------•--•-----........---------•-- // ---'Install er at.......................... 4..• •. ...._... ---- ---I-------• _••. --•-•f fib �_ has been installed in accordance with the provisions of TIME 5 of The State Sanitary Code s de, ibed in the application for Disposal Works Construction Permit No.__ _ i......... eated_.'� �� 3 d A;,,,.. THE ISSU NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WIK FU CTION SATISFACTORY. DATE'.. ...... -------------- Inspector.... - , :-.-.... 1¢„Pr. j'— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH dt,.r. OF............. ..w. ,,, ............:.... .. i. a..l.. fr.. .. ......... No<<....3 .� o FEE........................ Uispwial Works Tonstrur#ion Prrntit Permission i hereby granted... �"�}-"_ -- to Construct ( or Repair ( ) an Individual Sewage:Disposal System ---� at No. L�............... Street as shown on the application for Disposal Works Construction Permit No..................... Dated...............J-.................. •----------------•--••-------•--------------------------------------------...--------••-- Board of Health DATE................ ��--�= - ------••----._......_ FORM 1255 A. M. SULKIN, INC.. BOSTON r , Q. �+o �90 L 6,S N,n'� it (� SEnvC 7nNk' •.. , Ub �U-r- g • o s D3ox/d� C A 7 3 v sir ti �29.7a.5 �n �dN�, / ' \Cp ®✓ J 2 4 o � Z/G 2, v u k3) 1=7:) 2G N o OF Mqr /hlN. hS,�uQ o`er A yG ! wi D rH /oo p,. A. M ^' fur Y/aiYn 20 .o MORSE cn No.10951�O /STEP �FSS/ONALEa�\ LEGEND CERTIFIED PLOT PLAN) EXISTING SPOT ELEVATION . OxO .. , EXISTING CONTOUR --- p — �r} n :. GoT V r�M�! ; -T FINISHED SPOT ELEVATION / tr � .. Z. LF FINISHED CONTOUR 0 k�I ELUr-t-[lj--r j. 1 N APPROVED = BOARD OF HEALTH !s '8// 183 DATE AGENT SCALE= / DATE = 6,1 EL R OGE ENGINEERING CO. IN CLIENT I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED 40B NO. L2.2 � �' BUILDING SHOWN- ON THIS PLAN CIVIL LAND DR. � • � .M, CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR OF BARNSTABLE, MASS. �J TZ.C—. 712 MAIN STREET CH. BY, % HYANNIS, MASS. z � ?z S3 , P - SHEET'—L OF — A E REG. LAND SURVEYOR NO-re = /F ErITNLR TA/.E S,PT1C TAN/< OR •, ?O AT ~AOr- _EACH/rvG P/T ARE M0.4E T/�A:•/ /2"BELOK/ /O i•l M/N ;AA01F, 4 24"O/•!METER Co,-ICRETE COYER.� pi.— SWALL 9F BROUGNT TO 4)TAOE. �,-�,v t�T'eA y I CO/VCJwArr& 4 Pi�C o/P.e fy E.4 Y y CAST /.P O/Y C J✓E.4 SH.4 L 3 c £/S E.� i Altiv. TFr AC !F//V DR/✓E yt/A y 64AD CO do - .terms 2�L 4YER I-� _ s �_ . . o - . • c� '/8. _-'/e' i MJJV:PlTrJ D/ ` ••� t ► • • • • • • • • • •�a RYA SHFO 57LNEAll g Orr. i ®OX • t ® • • • • • t •� •• -c- • • • • • DEPTI+I. • • • • . WAS1NED STONE 7 Fr w a,o 7.9 • a • • e •. e • • t • PRECAST,SEEPAGE 1NYPRT �LEYAT/�l� f'1T C /�R crTY S 48 <A�./!)j°?' �.• • • • • • s • • s••a R/7 OR 5V411V. a Ec. 3Z. /XYERT AT Orlr"IMS FV F I 3 4,g /d Ff C&EC TABVLAT OA.1) C hVtgT .%EPra TA/Vlr O/A1�9 D�ITL T q,6P?IC TAAIPC 3 '♦ /lVtF1''D13TRl8�TOON 3' F '' .SIQCT/D�i! G/ GROIJNO Nr�iTACR Til�E ONyZ,�T110377�/Bl�IOAlB°� 3�_�..�. J '; .. .. .,.". ._- - NtEr LEACAMIG Pr7*= �,s %w Ae 1�G l W O1tS~AL SKS71 UM E .� r L CNYMS P/T Ti�QuL�tTto/� :; SSAFt1� '•.s =0~ D/MEN-TIOAl A 3 DES/6X G4iTEJ[♦.4 _ . - .- , -y� . _ - - - OJpltw$/o IV 8—�FT NtJMBFR OF®EDut00IlS v 3 DIMEJWSlOI�I �s'—�FT.. n�' / t:AaeA�.F vrsPos.4�u/rr�r �o 54/1- LOCH 330 SD/lL TES T TOTAL E1TUy6TEp FLAr/ ./A T NUM8ER QF LEACRIAW PITS �SLE✓. 4 o z ELRY, 5io.3 OF SOIL 4 .S/DE Ll•AC�/A/O A►EJ4 R/T /�� ,S1Q� AT. - Gt4T� TEST RESULTS JV/TA/ESSED BY ✓RE `1'*c"3 � PERCOLAT/OM AArar,*/ Lcss Iy/A,S/I/VCM Sd35ot . -r.rP rr 'z-b TOTAL LEAC/�1/NG AREA SQ. FT. PON COLA T'/DN RATE 02 Jy/�L�/JVCH R FSERVE GE.4C'.•t1N6 AREA► z. `'6 SQ. FT: �-U 2 - tz � • /p=r L Y i'`� G SEcc r o r 4 Te—sr L_ + F r TArc�u 63'[ Ct,n IL6i/!SE 8 rS' S3 - &L P. . - '�= ORSE �o,��t aN r 5 g3 EL OKEDGE ENGINEER/NG CO /NC Li . No'10951 Q C L ! l .v/S. :1.f 4 S1. 7/2 , A 11V S T- , Ayr YAN iST No G�OVNO kYi4reM 1�NCOUIV7. '.CEO GzeE•. .: ® CL/ENT. DRTE c/ONA�EN [I GROCINO 1wATER AT EL—�i/ JOB No: S/aEET_of i ASSESSORS MAP : TEST TEST HOLE LOGS :/ Zit 7a//�/ . -fiv f/ •.5 /�G.� / C v w� �, c .� G1 PARCEL : �= `, � ! � •,/ 0., c �R/p /� / lit S0IL EVALUATOR : ��tv t� - r -r .� %; U U- �_�YY.+�1S 7 FLOOD ZONE : � i� h WITNESS : /vo p -2 co, t L r REFERENCE : l� ���( /Q3S� �y-.�//J DATE : f��+ �) PERCOLATION RATE :� , ' / , iu��s 0.•.c.� 0 k ( Luc' 2> =h S�`'c /x r �' -- -� T H- 1 T H-2 .� /e�c.� T/v n S c a VL . Tf 3 oc,u,y ����, �� /� f l in� �v C' '� /he�� Sc. '9 pUc LOCATION MAP 8� —9 v k e i(f C/4e SEPTIC SYSTEM DESIGN /e CA A f�r V p •,�, �� cS�,� -r� f w`. /vt ,S .r'G..� (/...x. "'"'`/UGC.. - FLOW ESTIMATE j B OOMS AT ` ib GAL/DAY/BEDROOM - J/ GAL/DAY 7Z<<' Cv �G v� .� EDR _ f�-..' - CAE, 1L J1c C ',S SEPTIC 2EPT I C TANK 53O GAL/DAY x 2 DAYS - �' GAL USE Ib)D GALLON SEPTIC TANK (ffqaju - iZ?�;LUG r`.f uT ►�+.(,o u y SOIL ABSORPTION SYSTEM 1 �` r- x S I DE AREA: G- '� { 7` BOTTOM AREA: x 1, x I - z-30 3' -- /c" '�'` SEP ► I C SYSTEM SECTION ,TlKlk�, 37.`� 1 7 n z nF ✓g nc�� 4A5ATC>(lp Tl�-J�o � � GAL *16 SEPTIC TANK �-' � �,.���J?� � �, - �� �vy5j, SITE AND SEWAGE PLAN LOCATION � ?*� r 4 PREPARED FOR . 0 SCALE : DAV I D B . MASON , RS DATE : j 0 DBC ENVIRONMENTAL DESIGNS r EAST SANDWICH . MA W : DATE HEALTH AGENT ( j08 ) 833- 2 1 77 W 2