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TOWN OF BARNSTABLE
LOCATION a-7 O SEWAGE#"�
VILLAGE ®J'T ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO.
i SEPTIC TANK CAPACITY ;L '",;z®®o���•
LEACHING FACILITY: (type)IE41M%eer (size)
NO. OF BEDROOMS /I
OWNER1�s/� �����`�✓'
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
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS .
01ppliCation for Disposal *pstrm Construction Permit
Application for a Permit to Construct( ) Repair(') Upgrade( ) Abandon( ) ❑Complete System 14nediidual Components
Location Address or Lot No. ;LaO LZ t sw leP T t030�/ Owner's Name,Address,and Tel.No.
O
Assessor's Map/Parcel t5/— /,3 NO N )Qt?4) yYr�✓
Installer's Name,Address,and Tel.No. S70-5-(,4 49oZ Designer's Name, ddress,and Tel.No.
l,"4 t c.�� 6.6 0 sl� N
3£s Q.a l a.'
Type of Building:
Dwelling No.of Bedrooms L t Size sq.ft. Garbage Grinder( )
Other Type of Building of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd )Design flow provided 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) COy_we c—,r ge /H P...t
*Z ram
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. (�
Si \ Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. 2�r(Jv Date Issued j
,. `_a t.. Fw�'NeKro.�i. ..` ., f±'._, y p ';pr. • ..• "^k, -� -.Yn7:-. .T S v.. 1 � .J3
Jj
w r ,
No. Fee
.01 f Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS Yes
PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLE,;MASSACHUSETTS
An cation for MIstlosal 6,pstem Construction Permit
Application fo a Permit to Construct Re air Upgrade( Abandon Com lete S stem° ndividual Com onents
PP ( ') P (�) Pg ( ) ( ) ❑ P . y P
Location Address or Lot No. ';2_A0 LZ r 4 sw Owner's Name,Address,.and Tel.No.
`,
,Assessor's Map/Parcel, `� - / . 30 _ ® �� �.rG✓
Installer's Name,Address,and TeL No. Designer's Name,Address,and Tel.No.
kaCk�� i,��� f `. - J r
Type of Building:
Dwelling,,No.of Bedrooms L•t Size .° sq.ft. Garbage Grinder( ) ?
Other Type of Buildin of Persons Showers' yp ",g ( Cafeteria( )
Other Fixtures
Design Flow(min.required) t gpd Design flow provided gpd
-Plan Date i 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) (` e e 6w we C r n tC- f n es
—i Yam t -�1�S�G '0
ai
Date last inspected: l "
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.systern in operation until a Certificate of
Compliance has been issued by thisBoard of Health.
Si.—g _. -• Tom/ V/ ZG�2/
Date ;
" Application Approved by sa4 ✓ - 'r -< � pt �.:, —
Application Disapproved by Date
for the following reasons '
Permit No. Date Issued.
THE COMMONWEALTH OF MASSACHUSETTS
f,P.W1 AxJ, BARNSTABLE,MASSACHUSETTS
t� Certificate of Compliance
THIS,IS TO CERTIFY`, ,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) �
Abandoned( )by t �.�.o,t C rais s r1
at U f as been constructed in accordance S J�)P v'It E..
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
dated
Installer k C.\L IQ V (.'C�t.��� Designer
#bedrooms !(,tfi Approved design flowA WAL gpd
The issuance of this pe hit shall not be construed as a guarantee that the system will ction as designed.
P y
Date Ins ector '!
No. 9 G 2 f 00 J Fee/(y i
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
disposal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( V) Upgrade( ) Abandon( )
System located ata20 Lj 4K� w gyp iZ try/
and as described in the above Application foriDisposal System Construction Permit. The applicant recognized his/her duty to comply with,
Title 5 and the following local provisions or special,conditions.
. � e
Provided:Construe_tioon must be coinpleted:within three years of the date of this permit. Q
Date 194 ( ,I Approved by # {tG-
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
i
R ppli.ratton for Otq o5a[ ztem Construction Permit
Application for a Permit to Construct(1<Repair Upgrade( ) Abandon( ) ±.Complete System ❑Individual Components
i
Location Address or Lot No.9C2 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building flT'��� No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided "4 -7 gpd
Plan Date Number of sheets Revision Date 9 >
Title
Size of Septic Tank c�C�` .0"C' +� Type of S.A.S.
Description of Soil
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 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this of e p
Signe ate
Application Approved by ate
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued
-
i •}. � .. � .... _.�_.-...� ..A-�. -'.�, ...i - _• ^• ,,..: .MVyy-ytr3>-^' - "-•�,. .h..�,r"4'•'4rGa.+n''.,. ' J
No., Fee
Entered in computer:
,HE COMMONWEALTH OF MASSACHUSETTS Y
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ;
� - -Apprication for �Digpoga[ 6p 5tem Cougtructiou Permit
Application fora Permit to Construct(ff Repair 9
Upgrade O Abandon O Complete System ❑Individual Components
Location Address or Lot No.gc2 0
o�T y Owner's Name,Address,and Tel.No00
/
Assessor'sMap/Parcel n/�
A
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
- Type of Building:
s Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building ®f'G�.- No.of Persons Showers)( ) Cafeteria( )
Other Fixtures
f Design Flow(min.required), gpd. Design flow provided,, gpd
Plan Date �-1 9�O�. Number of sheets Revision Date 9 ,�—O>
Title
Size of Septic Tank ��`.�` !t.`/.r/��� c' Type of S.A.S.
Descy rip ,on of Soil " I
Niture of Repairs or Alterations(Answer when applicable)
o
Date last inspected: 4, � 1
Agreement:
The undersigned agrees to ensure the construction and mainten na c of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and hot o place the system in operation until a Certificate of
Compliance has been issued by this of e h 9
Signe ate
Application Approved by , ate
a�
Application Disapproved by: Date
for the following reasons
Permit No. '"' Date Issued �-
_
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( � Repaired (J`) Upgraded ( )
i Abandoned( )by
at O Grii.v6�'!�/L%/dT lil/.4y 10J'� has been construsted_ia acc rdance
i47
with the provisions of Title 5 and the for Disposal System Construction Permit No:' dated
Installer r��3 C Gr"�OG�y/t .,---Designer •Oid yl7 •� / �✓'o.J ���
#bedrooms o0:00' A' r Approved design flow .,J „/.-- "� gpd
The issuancdof Otis permit shall no bqconstrueed a a uarante th t the system*' nction as designed
Date � 5 [► nspector d ,
No. Fee
Y4E COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Bi5po5al 4p5tem Construction Permit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( )
System located at ..� O Z!!r- �O , AO-.. 1 h,4
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: Construct io must a co leted within three years of the date of this p it.
Date O Approved by J
i
Town of Barnstable P# q1
Department of Regulatory Services
i Public Health Division
Date.
03s ♦� 200 Main Street Hyannis MA 02601.
DMlti� t +• . ��
Date Scheduled 14 1w, '
Time h Fee PdflL
Soil Suitability Assessment for Sewage,Disposal I
Performed By: ���/o Witnessed By. l Vf/1/ ZM
LOCATION& GENERAL INFORMATION
Location Address �" Owner's Name
Qs'T !�j'✓'PCt� ���?7�J' Address
Assessor's Map/Parcel: Engineer's Name
NEW CONSTRUCTION / REPAIR "Telephone#
Land Use Slopes(` ) Surface Stones 1�
Distances from Open Water Body �dd ft Possible Wet Area y�ft Drinking Water Well
Drainage Way ft Property Line=�1 y ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
Le
is -•r °' � � +a • .•y
1 %'J w
a J
' + i f • �a
Parent material(geologic) ` .' { Depth to Bedroelt
Depth to Groundwater. Standing Water in Hole: W:k Weeping from.Pit Fpce
Estimated Seasonal High Groundwater 4
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Obsery d standing in obs.hole: In. Depth to soil mottles:
Depth to weeping from side of obs.hole: in, Groundwater Adjustment fr.
Index Well# Reading Date: Index Well level Adj.faCtor Adj.Oroundwater Level
PERCOLATION TEST bate,. Thee
Observation
Hole# t i 7 'Time at 9"
Depth of Pere _ Time at 6"
Start Pre-soak Time @ �'�I�Ioq 75me(9"•6")
End Pre-soak �f ,t
Rate.Min./Inch
Site Sui lability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back----------
***If percolation testis to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:ISEP11'ICU'ERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,% ravel
O 4
2
r
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil . Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,% ray
D -t5
- .
4,96L L/A*
DEEP OBSERVATION HOLE LOG ° Hole# _
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con i to c Gravel)
_1'2
DEEP'OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Cons' en
Flood Insurance Rate May:
t Above 500 year flood boundary No_ Yes
Within 500 year boundary No= Yes/
Within 100 year flood boundary No— Yes ,
d
Depth of Naturally Occurring Pervious Material
Does at least four feat of naturally occurring pervj!o4s material exist in all areas observed throughout the
area proposed for the soil absorption system? LfIL
If not,what is the depth of naturally occurring pervious material7. `
Certification '' `
' I certify that on �� (date)I have passed the soil evaluator examination approved by the
Department of Envir mental Protection and that the above analysis was performed by me consistent with
the required training,expe 'se ex a ce described in 310 CMR 15.017.
Signatur Date
8 �a 07
Q.\S EPTIC PERCPORM.DOC
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Rug 30 07 08: 28p 508-833-2177 p. i
David B. Mason, RS
August 30,2007
Mr.James LeBoeuf
James LeBoeuf Septic Services
71 Beth Lane
Hyannis,Mass 02601
RE:220 Windswept Way,Osterville,MA
Dear Mr.LeBoeuf,
As you are aware,this office had conducted percolation tests for the design of septic systems to service the
dwelling at the referenced property.
On that day of the percolation tests,August 29,2007,the issue of member of bedrooms at this property
was discussed with Ms.Donna Miorandi,RS,Health Agent. Due to the number of bedrooms and the age
of the property,Ms.Miorandi,toured the dwellings to verify that a total of eleven(H)bedrooms eAsted
in the dwellings. Based on Ms.Miorandi's determination,this office has designed septic systems to
accommodate a total flow from eleven(11)bedrooms that currently exist in the dwellings.
Attached is the engineered site plan to represent the design requirements for the eleven(11)bedrooms.
There is one system to accommodate seven(7)bedrooms and a second system to accommodate four(4)
bedrooms. This design is based on discussions and determinations made by Ms.Miorandi.
Please call with any ques-ions.
i
Sincerely,
Da,,zd B.Mason,RS
Project Engineer
F,x,
�Ot �-
v fie
4 Glacier Path, East Sandwich, MA 02537
508-833-2177
Co7-U, r )3AY �. ASSESSORS MAP :_-. #5� -
ti ► L.ocu -----� �... l _ TEST H O E� O G..
r1 PARCEL : ,
SOIL EVALUATe ..i •
Y 1 FLOOD ZONE : LfG { t- _ M �- 1) The costa latloaj shall comply with Title V and Town of Barnstable Board of
W I T N E S S : � �`. !ti i + � lb�l 11E;a1th F.egulations.
__ _-
'- REFERENCE : ���i t o� J-,gt,JZ:> Fb/-2 '7-14 _b, MC?, Q _ DATE : A�r_y�' �� �;��" `� i l', _ 1
�, PERCOLATION R. T:= : .� Z t � 1 � �) The eomponenler shall vei 1 v the location ts prior to installation d setting
utilities, sewer inverts and septic
1� I ; rEP ?eFp c3y w��L!�11. W'�+ u-'�� � :>
� fl �' oY3r�,e yAQ� " �.G, /� Z ----i--- ��tting base elevations.
3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first
L E /SG.
two feet out of the d-box to the leaching shall be level.
4 This Ian is not to be utilized for io�.,rt line determination nor an other
l,5 L.Si . �' ��41 LSi ) plan p 1 Y Y
,fie al�r ose other than the mi�osed system installation. ,
AiI septic components must n eei Title V specifications.
g shall not be const
61 Parking over 1110 septic components.
11117
--""'r eD 'i I 1 `.._ �____►__�_t`' 7) The property is bol,mded by property corners and property lines.
I g) Thero property owner shall review dcsir p n considerations to approve rove of totalh
__ . �""�� — -- — - ►a�-� �lt�� ! >=1Wr fl�l� p 1 1
LOCATION MAP
design flow and number of bedrooms io be considered for design. Receipt of
Al�40 ro"V) I �', payment for the plan and installation 1-ased on the plan shall be deemed
15 61 i approval of the design flow by the owner.
6�1 ��� �— - """ —�— ---- � _ V I n-�1� I 4� `� ��'•) 9 The existing leaching or cesspools shall be pumped and filled with material
�61�� 2,9i7� per Title V abandonment procedures. Those within the proposed SAS shah be
_ -
12" 7Z`>p O ,� �-- �) __ te,� ,��� t ___1 removed along with contaminated soil and replaced with clean washed sao.l
per Title V specs.
_l, 0 C Wr)•WWY>'. N!i C _W'7. VV6�l
1 - fi� 10)System components to be 10 feet from water tine. Sewer lines crossing the
wafer line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
r SYSTEM
C. applicable,
-- --- — ? S P T I C, S T EM D E S I G N
� `' 11 If a 7arba�Te Trinder exists it is to be 1emoved and is the responsibility ofthe
Uj yTl�,.4 tt G ) g g P Y
owner to ensure such.
kP
(� 12)The installer- is to take caution in exca\ation arourod the gas line if applicable.
FLOW �.:�,�1 PAP,T E
13)The inst•3iler shall verify the location and elevation of the sewer lines
�.,� � Y , quantity
��_ ���`t� `, ,� ��� B=DW OCMS 1�T ��d GAL/DAY/E,EDROOM � K _C Ai /DAY citing the dv cuing prior to the installation.
S E P T I .: TANK
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