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HomeMy WebLinkAbout0141 WIANNO AVENUE UNIT #A - Health 1411. 'WIANNO AVENUE"�- l' A= 140 056 I r YZ.,....... FEiz No....... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF.�_?1:�e�-_—;17?�',�__" ...................................................................................... Appliration -for Dispotial Works Tomitrurtion Prrutit �_ Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: /J- y/ A W-/ , QW.. .. -- ------------ --------__----------- ............ .......... ......a.................................. .............................. cation-Address or Lot No. ........................ .................................................................................................. ........... 0 ne Address .. .... ----- ..... �4 ........... . . . .... ... ....... ................................................................................. aller Pq Address Q Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder ( ) a, Other—Type of Building ---_----------------------- No. of persons..--------.-----.-.----.---. Showers Cafeteria ( ) PL4Other fixtures ----------------------------------------------...................................................................................................... Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. Septic Tank—,El iquid capacity y------------gallons Length---------------- Width...._.......... Diameter--..._..-.-.---- Depth.._............. Disposal Trench—No.................... Width....-------.---.--_ Total Length----------.-..--.-.- Total leaching area....................sq. f t. Seepage Pit No..................... Diameter.....--------.-.---. Depth below inlet--------.-_--.-.-. Total leaching area---_------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----------------_-- .................................................... Date------------------- ----- Test Pit No. I----------------minutes per inch Depth of Test Pit.................--- Depth to ground water-----------I------------ (Xq Test Pit No. 2-------_-------minutes per inch Depth of Test Pit.................... Depth to ground water-._---..--.--._----... ..................................................... 0 Description of Soil..................................................................................................................................................................... U .....................................................................................................................I----------------------------------------------------------------------------------- W ---------------- -------------------­-----------------------------------------------­­-------------- --- - -------- ----------------------- --------------- Al bons—Answer when applicalO N aA ---------- U _�e of Repairs or tey! ........... ................................. ............. ,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 VeQssued by he board?f I.th*. Signed...... ..... . ..... ........ .....77......... ................. ---- --- Date ApplicationApproved. By-------- .................................. ............................ - ---------------------- ----------------- Date ol Application Disapproved for thilowing reasons:----------- ---------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date Permit No.-- ------el.z,................................... Issued-1 ...................................................... Date -------------------------------------------------- No......................... FEs....�................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F WEALTH / LJ....... OF............. �JG.......................................... .................. . Applirtt#ion -for Ui,ipoitti Works Toni#rur#ion Vrruti# „--- Application is herebymade for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: ' cation-Address / or Lot No. ..............•. . --..................... -•...........---------•---•--------•...-----•.....-•••-••--•---•-•-•............................ Owne Address I s Iler Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QOther fixtures ---------------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow-------------------------------------------- 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-------------------------------------------------------------------------- Date------------------------- ------------- a Test Pit No. 1................minutes per inch Depth of "Pest Pit-..-___.._-_-.-_-___ Depth to ground water..-___--_____.___-.__-. �14 Test Pit No. 2----------------minutes.per inch Depth of Test Pit.................... Depth to ground water_-._.._-____-..._-___._- P4 ------------------- --------------------------------------•---•---•---•--•-••-•-•-•--•-----•......-•......................................................... 0 Description of Soil--------- ------------------------------`------------------------------------------------------------------------------------------------------------------------------ x c.� --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W --------------------------------------------------------••-•-•-•---•••-••--••----•--•--•---••-••----. ----- ---- - -- ---------------_-_-.--- Nare of Repairs or A ertins—(-A-fn�siwer when a `--PiJc%A-�-___ ___-l/1 V � -------------- � ' ---- ------ - --------� greement: 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 b n;issued by,he board of e lth. Signed- - �j Date Application Approved BY 1-------------------------------------------------------------•--•---•-------- Date Application Disapproved for theeollowing reasons:............................................................................................Da.t.•.............. ....--••-•••-•-•••-••----•••-•-••---•-••••-•-------•-•---------••------••••-••-----•-•••••---------------I----------------------------------------------------------------------------------------------- Date PermitNo.----------/__7...................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 71 -<- .................. .......................OF....... .= fclTl.hi.-............................----.............. Trr#ifira#r of Toutphattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) -- - --------------••-•--•-•••-------••---•-••••--•--••----•----•------------•--------•-..---------••-. // y Installer at............................../............. �-r! r t ................. _.�!_1-'._................. . f..has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-_--_--_l_.!..I....................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r - DATE � (� ... ............ Inspector--------------- .- '" --- - -----................. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ..........................................OF......�3��.ti.!ti.....t�/........._..----- --------------- No...........�2..-•--- FEE........................ ��i��o�tti ork.� �on�#rttr#iIa$t �rruti# �, ter. �lss =��_ � . Permission is hereby granted.__._.____._�_'___:�______________...................................................................................................... � to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. &_/................................................ Aj' `' -----!.(.._ Ci /ac.... '- s>_._... ... = Street as shown on the application for Disposal Works Construction Permit No..._.Z:7--------- Dated------3.- / ' �� 7 /. ------------------------------------•-• Board of H h DATE-------------------�-�------- _4...:.. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LI'_. _ ,/ TOWN OF BARNSTABLE LOCATION 1��W 2/ah/7D g lPI-x eez SEWAGE # VILLAGE LJSfUi��t�� ASSESSOR'S MAP& LOT. O Sao ) NAME&PHONE NO.RQ(440419 Ca Y S'>t-U f bn Ad do-d'-V-o SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) Co' C'esSPdoJ NO.OF BEDROOMS '? BUILDER OR OWNER . )19 t./G/ 6 &2& SO/ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist 1/ within 300 feet of leachin faci ' ) /Y Feet Furnished b r O �:1 �� ,. �� a4 r � w_ '� LOCL1,T10N__ _ _ _ _ SEWLIC�E PERMIT k10.. VILL l_L i- - BU1 - „_. QLCTE- -P-.ERKA T 1.5SUED.= ', �.�. — — cs� '� Y• � Z. � � � �_'-_,� � s.�.., r hx!yT: a � � 3 i �� BORTOLOTTI CONSTRUCTION, INC. Er' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop Date of lnspec} /� _ M ,,�) � "�7 �� ap,q/ arce© / Owner— y / ff• r F' �'Ot -PART A —C/CHECKLIST j CHECK IF THE FOLLOWING HAVE BEEN DONE: ` 1/PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. �j THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON-INTRUSIVE METHODS. . THE FACILITYOWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE".PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL No of Bedrooms No of Current Residents /1 G Garbage Grinder Laundry Connected to System . G Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: GALLONS Pumping Records and Source of Information: 14 SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED = ; ; GALS 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 ex( plain) % C'esst�/'-�- /.,L.ea.cd P,•t4 A oximat" ea e f pp o all components. ents. Da '9 p to installed,if known. Source of information. > 22�a,cz�o SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? /16 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: Dimensions: .- Material of construction: Concrete Metal FRP Other} Sludge Depth Distance from top of sludge to bottom of outlet tee or baffle 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 baffle Comments: DISTRIBUTION BOX: DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: a PUMP CHAMBER: A14 Pumps in working order? Comments: SOIL ABSORPTION SYSTEM SAS IF NOT PRESENT,EXPLAIN: ` TYPE: . w Comments: - E CESSPOOLS: Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool ,j—'� Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) w. SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' a Lea k DEPTH TO GROUNDWATER: . .� .. p DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: v coy S4 /oP � yrQ- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - FAILURE CRITERIA I/ (Indicate Y—yes N—no ND—not determined.Describe basis of determination.If"riot determined",explain why not.) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? i -� Static liquid level in the districution box above outlet invert? , I /V Liquid depth in cesspool, 6"below invert or available volume; 1/2 day flow? F- Required pumping 4 times or more in the last year? . Number of times pumped Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration? tank failure imminent? /1/ Is any portion of the SAS,cesspool or privy,below the high groundwater elevation? A/ Within 50 feet of a surface water? I /N/ Within 100 feet of a surface water supply or tributary to a surface water supply? - � Within a Zone I of a public well? 1 Within 50 feet of a private water supply well? l� Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools &privies only, not the SAS)?. _ Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water j quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for I col'rform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. i PART:D - CERTIFICATION INSPECTOR: ROBERT J, BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 ji CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION i REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY 1 RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE I IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS.- CHECK ONE: I V/// I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC �— HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303.-ANY FAILURE CRITERIA NOT EVALUATED AREAS STATED IN'THE"FAILURE CRITERIA"SECTION OF THIS FORM. i I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS i FORM. INSPECTORS SIGNATURE: j DATE: 7 �I u• , i ORIGINAL TO SYSTEM.OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY Town of Barnstable P# fP ,fly Department of Regulatory.Services Public He ' • / „, Health Division Date t619.A�� 200 Main Street,Hyannis MA 02601 EO M►tl Date Scheduled J —L Time �� Fee Pd. Soil Suitability Assessment for Sewage Dis osal Performed By: �Oo7 �✓ /� .�O'�L E PL WO �Witnessed.By: LOCATION&GENERAL INFORMATION Location Address Owner's NameG�v! !/i �f_ Address L �- / Assessor's MapTarcel: v � �� oR/✓!d aG► s—y Engineer's Name p v y ie NEW CONSTRUCTION _ REPAIR k n 6 p( Telephone# Land Use �9GA6(/7 Slopes(R5) _ Surface Stones �� Al'S'. Distances from: Open Water Body o a It Possible Wet Area _Q� ft Drinking Water Well 1.�o ft Drainage Way ft Property Line / ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands proximity to holes) X� o �.) ¢ ZS ZS 96 -J rn Parent material(geologic) Sig/& Depth to Bedrock A10 7- Depth to Groundwater Standing Water in Hole:6VCo U/U �i?Fl,� Weeping from Pit Pace Estimated Seasonal High Groundwater / DETERMINATION FOR SEASONAL Method Used: HIGH WATER TABLE Depth Observed standing in obs.hole: in. Depth to soil mottle$. jn Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level r� Adj.factor.,,,,,, Adr,groundwater level Observation PERCOLATION TEST ll'ate Zo vt Thna /o ql Hole# ZP-/ 7i0- Z Time at9" Depth of Perc . � 3,7 1� Time At6"�d; 2 :67 Start Pre-soak Time.@ /11,©9;OD /V .3 Z O d Time(9"-6") 2• 47 End Pre-soak It'Z.3, Z.0 /D; Z'V G 4-t- Rate Min./Inch M 'C Z /W/AJ 4 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original:Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conselivation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# / Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(im) (USDA) , (Munsell) Mottling (Structure,Stones;Boulders. ConsistencLravel `/7- l0 3 2'' s,9�t/v J L or9� 5YR vlq- 3 2``-16 7 c� m&A,sy-�a /OP? C Z ca4,e56 13 �3 DEEP OBSERVATION HOLE LOG ` Hole# Depth from Soil.Horizon Soil Texture Soil Color Soil Other Surface(in.) h b (USDA) (Munsell) Mottling (Structure;Stones,Boulders. consistency.%Gr Z19 s 1A7 75yP �3 28 -I ZZ' C -5 N.o f6yP, 6�7 DEEP OBSERVATION HOLE LOG Hole# .3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cnitec Gravel) 13``- 3 3 ,B `S4�0 19 In to YR 33`'-13 Z" NI EP., Y- A AD DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Con ' ten Flood Insurance Rate`Map:_ / - V Above 500 year flood boundary No— Yes Within 500 year boundary No ' Yes Within 100 year flood boundary No Yes Depth of Naturally 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? -5 If not,what is the depth of naturally occurring pervious material? Certificatt°g I certify that on l (date)I have passed the soil evaluator examination approved by the Department of EnAronmental Protection and that the above analysis was performed by me consistent with . the required trai 'ng.expertise and experience described in 310 CMR 15.017. Signature Date /2 — ZO Q:\,SEPTICIPI?RCFORM.DOC TOWN OF BARNSTABLE + 1 LOCATION /�-1 / �- G✓it w�r� a,f/ SEWAGE # — 14 l vII.LAGE o ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. /AJ c3`lB S 7 SEPTIC TANK CAPACITY �Sp� LEACHING FACILITY: (type) � E TI'ehGlt (size) 2— �/1C S� NO.OF BEDROOMS -3 BUILDER OR OWNER A 0AI Cd PERMTTDATE: ! COMPLIANCE DATE: Z Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet . Edge of Wetland and Leaching Facility(If any wetlands exist I iwitlun 300 feat of leaching facility) Feet Furnished by j . -y 0 ` - \ I i t , f No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Digpool *pgtem Congtruction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) U'Complete System ❑Individual Components Location Address or Lot No. /W,4 IV/aq A-V t1 /9 VC Owners Name,Address and Tel.No. 7 0�6 —3 V Assessor's Map/Parcel 0 5T e A v i LLIF_ 76 Al J{_0 64(Ct'�d Installer's Name,Address,and Tel.No. LlPT- 0 Designer's Name,Address and Tel.No. P F--9131 �3 8 5� ` Type of Building: t Dwelling No.of Bedrooms 13 Lot Size 8, 37-5- sq. ft. Garbage Grinder(A40 Other Type of Building W00b F,2A 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 l 5- Q d A -64Y Type of S.A.S. Description of Soil A-5 P ie P Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5, f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by oard ealth. - Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. `" �` Date Issued rJ — ,� � No. Fee O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppricatton for Mie;pozal *pttem Cow6tructior. CrMit Application for a Permit to Construct( Re air Upgrade Abandon �C//om plete r System O Individual Components` � _ ! f Location Address or Lot No. /W,4 U/14 Nd/Q /9✓j Owner's Name,Address and Tel.No. /�4 o2dr — ,j IM Assessor's Map/Parcel0 5?e 9'.✓/1- F �01)Ek(C'\ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 8, 37S"sq.ft. Garbage Grinder(Nq Other Type of Building 9)00D FA110115-No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33d gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 0 6'4z lv Type of S.A.S. - Description of Soil /`35 Pjc�Q PLfjN l;s Nature of Repairs or Alterations(Answer when applicable), Date last inspected: -- Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 54 the Environmental Code acid not to place the system in operation until a Certifi- cate of Compliance has been iss d by ' oard of IrIealth. Signed ~— Date �y Application Approved by -Date Application Disapproved for the following reasons ` Permit No. Date Issued -—————————— ——---———--- ————---—r—-------- -,,THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS R �' Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage isp�oJsal j�ystem -on ttnutctt�ed�(�epaired (.. )Upgraded( ) Abandoned( )byt �.rl -1 AT_ at /y/)q A//4"j) V,£ . tf jy 7;F_WV FC IE has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer I Designerh The issuance olp's pe t hatl no?be construed as a guarantee that the s Lm will function as des'nedf� Date Inspector 0 ___ _ No. ` Q Fee � 1d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi!6po5al *pttem Cougtructiou Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at &//l UJI19A1411) fjl/E 0576- ✓I -L-E and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/hetduty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completedwithin three years of the date:0f thMeit. Date: '" 7' // Approved b r r Town of.Barnstable P.H Department of Health,Safety,and Environmental Services- F° Public Health Division Date �. 367 Mein Street,Iiyannis MA 02601 r eAtwatAel$ !i .� VF�V, , °rE � Date Scheduled Time Fee Pd. 1 00 Soil Suitability Assessinent fofi Sewage Disposal Performed By: Slrr , Wi I.aA l Witnessed By: 1JbY1N . Id I orrj j I oration Address (A-1 A . Wsav`vvrb .Ave Owner's Name roc�e.r�d� c,Lai+ a"4A4.&1.R Address I41 A i,Ji4k,-,- �. Assessor's Map/Parcel:, N'l OP 1�t0 Y'14Y,�t:. G �6 Engineer's Name-13pty'T-t6 r P. W NEW CONSTRUCTION �✓ REPAIR Telephone N !4z,$ 9131 Land Use s�dteNti<.:Q. Slopes Surface Stones r7an e Distances from: Open Water Body ft Possible Wet Area R Drinking Water Well R Drainage Way ft Property Line /6 R Other R SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes), ` 34.8 .C.B. CA 32,s x ' N48'2 '20'E" FND: qe FND. 34.1 / 126.13' 36.9 Q�' 1 �34.8 5 � 0y 34 - x. Existing septic system plotted QS 32.9 �32.9 x 33.5, 34.4 1 from Inepectlon cord prepared .TP? by Bortolottl Construction Inc, 7P sting 6/19/95 36,1 7r �? o I 33.9 d6es al I�J1. r o 32.3 Wo a I exlatlny % 4.9 exletlnt�l leach ppIt \�.. N x 34.5 o .p x 35.3 - 32.1 33 6 ff 5I J�9100 34.0 M 1 I 33.6 x x34 .0 \"x BENCHMARK 33. r1 4- 3, _,o7�1 EL 75 S,\ C.B. 1 35,1 Ac. �c.B. IT OFF 120,00'. 32-91 F D•. 16 ' TO-PMANNO AV 31.531 S49'36'50'W d — 34.3 ,5 dirt 2.3— � / 2 —* 33.3 � j3731.5 �Z� VTE. WAY 20' WIDE_.._ 33.4 Parent material(geologic) G(c—ik yut sLN. . Depth to Bedrock Depth to Groundwater: Standing Water in Flole.:,. Weeping from Pit race. Estimated Seasonal High Groundwater. :. .R. . AL>HY. H:<VVA" '._.R.:.... .....r., �:.> >"< < > >'> :»>>>.;::;:>;::;::::>»::;D . .a✓lt1VYYNA 'L .:.... "Q:......5 .0 G.:::::::.::::::.:.::..........................................:........,,:.....::. Method Used: Depth Observed standing In obs:hole: in: Depth to soll mottles:. - in. Depth to weeping from side of obs.hole: In. : Groundwater Adjustment ft. Index Well a___,_•_ -Reading Date:`•-__ Index Well level .• Adi.factor Adj.Groundwater Level_ Observation Hole N Time at 9". Depth of Pere /oOtr Time at 6"i Start Pre-soak Time a Used L4 c t�, vor. Time(9"-6") IN �va�e,a.►C End Pre-soak Rate Min.Anch _ ltss 4-f4h 2t4Nin1tncG1 Q Site Suitability Assessment: Site Passed Site railed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j AI' a�3SX 'VA 'Z(.:N HCJ� T�CtC� Hale # .. . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. e RI S�ncQ 6-s A. 5 = 20 C �Sa.Rcit !o Vk G�6. P o U(a® 47' 3 z n G, 01,c�odRr� /a I/Z 7/Z .............. '; DEEP OB;SLR,'V,A,TI�N I�Q,L� LOG • Hole:# Depth from Soli Horizon Soil Texture Soll Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. a j1 Sa.;cic, ::: r n .............. �3SE�` A�'zdN H��I✓ �• :.::.:::... . ... ... ... Depth from Soil[iorizon Soil Texture Soil Color Soll Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldcres. D�EP..OBSERVATIbNL(C4G ::::.: :;;:�:•>H�1iv#: `` :.: >:; . . .. Depth from Soil Horizon Soil Texture Soil Color Solt Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. / Flood Insurance Rate Man: Above 500.year flood boundary No_ Yes_� Within 500 year boundary No- Yes Within 100 year flood boundary No Yes Depth of Naturally QccurrinEPervious 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? r If not, what is the depth of naturally occurring pervious material? ' Certl cation . 1 certify that on 9 S _(date) I have passed the soil evaluator examination approved by the U� Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience.described in 310 CMR 1.5.017. `'r� Signature ` . Date .3 �5= NO T ESQ u 1. THIS PARCEL IS NOT LOCATED IN THE,FLOOD PLAIN. ZONE 'RC nn 2. THERE .ARE NO WETLANDS LOCATED WITHIN 100' OF THIS LOCUS. -=--__ ' R �"'['. C.B. S /r 3. REMOVE UNSUITABLE SOILS•xBENEATH. PROPOSED SYSTEM, BACKFILL FRONT SETBACK = 20' . c B. `9 N48°2 '20'E • FND• WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED' AS FOLLOWS: NOT — ,.. 4^ t. .MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED SIDE SETBACKS — 1 O ,�^�' o, FND•, 126.1 � ON No. 50 SIEVE, OF FRACTION PASSING.No. 4, 10% OR LESS TO PASS No: °j 34..1 /o' 100 SIEVE AND .5% OR LESS T0. PASS N.o. 200 SIEVE, .SOIL TO BE .APPROVED REAR. SETBACK = 10 , f c� r i E.B � shed � 1-!• BY ENGINEER FOR COMPLIANCE PRIOR TO. PLACING ON SITE., BUILDING HEIGHT.— 30 1 + t = .a ff 4. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS„ ` _' <` t'' _ y �! system plotted . w 1 / 33. z Exisltirig.septi ` PRIOR. TO ANY EXCAVATION FOR THIS PROJECT ,CONTRACTOR SHALL MAKE - -` �P� '• �32.9: (`" •51_ '. "`u`'�' � from ibspecti�n card prepared ; ' 88-344-7233 AND APPROPRIATE . 32•9 I by ilortolotti. onstruction Inc. THE REQUIRED NOTIFICATION TO DIG SAFE 1 8 .. $ - o..t` . .�. c.' do.�. r Q ZD:Ifniii lO wtr 34 ..r7 i6 15 I WATER DISTRICT;.TO DETERMINE,UTILITY LOCATIONS.. - Z - ]9�1. x _ " f'��s"�',n ce is f ss O ool 2 pc Qs�o n ..�Z�- �. t .�I a .�q N 1 SINGLE FAMILY BEDROOMS a ' - ex 4 a -P 1 4.. 9 0: �trf .. �,� 'ao _. f �� �� ��� ��� , t+ng. �' ro # fisting - I o NO GARBAGE GRINDER 3i t_ + - �, ex5.3 x h pit �' uAz,.hCj S �,a house. p 32.3 36 _ logairm. E�• ' P _ 33.5 f.f.e1= 35.9 �C . 00 e 1 M t UDC— b0 l� . iass� Se � _ : h�nc�i,NG. sYS-1 t�l. -.. 33o G d;-- 0.,7� �e/5 �� I } v? s' / _ �. .yea E 4.0 � v US c K�. T nc t1 CHr:flARti - �. C ! c I t BENCHMARK C.S.. 51 -. w,,.. yy n p .. - ._ F . .'.'a y�` - i {?c'9.. •a.. 6.4 �/ .I..G4C�lira S Y-C YL C . _ .. ` T3a tta�,_. 5 �► - �- 13 375 S.F, EL 52.7/ .A_..UP.ED �.. f B. tOc. e HIT OFF 120.00 ._ AC r16 TO. WIANNO AVE. 31 i - x S49°36'S0'W� 32 � 'dirt a, •� `34.3 43 -. :: -. — — a. :a 1 To . o;:rcPn,-35,5 RIVATE WAY.20. WIDE I. s R • P L s1:5 32.E ..2.7 � ti � . . S ,,. • rn p p sq _.�.. . .. , T - ' No.Sur .6- .. - �✓ arm.-m.�,.: F`�°ti'.y�'m.��'.d""` • GsMIS d g 7 ALE; 1 — E Q v�Ca .C�Ilc� SC '3 � 4 a y E t Tc i. 1"7 s; I. .'a n - s SAXTER & NYE INC —w g 3 5 - - •4' s+�.uz S � : a MARCH #14.1 A WIANNO AVE: i OSTERr�V-� ILLE ?%S�:: /oFEB. .23; 1999. ;EB 'a 0 .�. fl zZ�o P tt /o Y 2 .S�/a -- -- w� �S. �2r C, .'rr'1«0, �Gn� z4; E. .99 A 6j6 C. 40, P 6 f BOOK- 172 ASSESSORS MAP 1 PARCEL 5 CERTIFY THAT THE PROPOSED FOUNDATION CZ yYIcJ/. Scn ��: Sa.cc�:.: �_�^_wa`c3�-t_v t. IES WITH THE TOWN OF BARNSTABLE SIDELINEWails- AND awl yR ..7 :. JOH 'T K COMPL >6� / f2 N A; BRODERIC ur1 cry �Kce c{=., o Ajs!ne c9 SETBACK RE EMENTS AND IS NOT LOCATED � g WITHIN THE FL❑ D LA P P BAXTER &.NYE -INC. LAND SURVEYORS CIVIL ENGINEERS. i t DATE:3'10-11 R.L.S. 13Z / t Fc 22:o zl 23.5` OSTERVI 1E.MASS. a THE .OFFSETS OWN SI OULD NOT BE USED TO DETERMINE LOT LINES. #99007