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HomeMy WebLinkAbout0058 BURNHAM STREET - Health a�,' i3 rir- r? h ,,►� S'�-� e TOWN OF BARNSTABLE Ln`CATION �g U t`��c�,p W� � SEWAGE# 0�0�6- ,5 O ASSESSOR'S MAP&PARCEL 3 INSTALLER'S NAME&PHONE NO.QN -i �oo��r scwt SEPTIC TANK CAPACITY`®cDCDGA� LEACHING FACILITY. (type) ���(size) S r V. (`�, r X l NO.OF BEDROOMS j� Cy JJ MM STay.,� OWNER PERMIT DATE:T�0 COMPLIANCE DATE: s Separation Distance Between the: r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J, S 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 Voe,6t--� Qc,.p- 'e, —TcawV\ pp II . � SO v rv\ IAAV" i3 t� 0 1�3- 3c? A3 O�I , � J No.J'/ — �_ 'y Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLation for Misposal bpstem Construttivn permit Application for a Permit to Construct( ) Repair( ) Upgrade(vj'/Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. Sg 13,�N��d„w ', Owner's Name,Address,and Tel.No.50 `fg'd5Q Assessor's Map/Parcel O Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size, G� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 �(`� gpd Plan Date `M�T� C:)k Number of sheets Revision Date Title Size of Septic Tank VOp0(2) ca,p 6: Type of S.A.S. $C�<n Description of Soil Nature of Repairs or Alterations(Answer when applicable)' s�4 ��� �1��� CL..n���„�• ss , �r C1' 0��:-1'0 .. 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. Signed Date 5 r/to Application Approved by Date L 9 (0 Application Disapproved by Date for the following reasons Permit No. ` ��t� Date Issued /' No. �' Fee _ Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplicatlon for Disposal Ppste Ym Construction Permit Application for a Permit to Construct( ) Repair( ,) Upgrade(v)/Abandon( ) [:]Complete System ndividual Components Location Address or Lot No. w..57, Owner's Name,Address,and Tel.No.Ste' Assessor's a /Parcel p v� �� 0<� !s ��C_D�r Installer's Nam ,Address,and Tel.No. Designer's Name,Address,and Tel.No. S` N 3- ;2 33l l Type of Building: -_11 Dwelling No.of Bedrooms,` Lot Size, 6'�4 sq.ft. Garbage Grinder( ) Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) CL) gpd Design flow provided 3 �(� gpd Plan Date `��n�� �(, © Number of sheets �o Revision Date V Title Size of Septic Tank <DZ�O A (C JC'._ v.c�Type of S.A.S. S©O 5A Description of Soil S—::n Nature of Repairs or Alterations(Answer when applicable) ® So0 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. Signed Date 5 r Application Approved by Date ,� q Application Disapproved by Date for the following reasons Permit No. ©& — 15c) Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CCEERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(v"')' Abandoned( )by c. &-A.. at tr y��"�.� d`��4 has been constructe in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No,!-W14 - : 6 dated 5/qk1(j Installer �dUC� ,�xj��'��c �t?;�G Designeru�� #bedrooms Approved design flo 'I gpd The issuance of thi pe it shall not be construed as a guarantee that the system wil n 'onjas desighed. 1 ( n Date ! Inspector �/ �,b { ---------------------- ---- ----------------------------------------=-- -----=- ------- - _--------- ----- No.. }�U _ /Sv Fee lQa THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(u,�' Abandon( ) System located at S`Z3 r A 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. Provided:Construction must be ompl ted within three years of the date of this pe it. Date ��� 7�6 Approved by - Town of Barnstable �oF� r°wo Regulatory Services Richard V. Scali, Interim Director • HARNSTABLE, 9�A MASS. �0� Public Health Division yg rFc . Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: '550 u, Sewage Permit# Qa 6i- �S-o Assessor's Map\Parcel '43 3 Designer: Mejt_�J Sw S In(_ Installer: T Address: oX CjSf Address: @Q oVV1z14 Am On 5 �, JZ�i �,�,��ra, � was issued a permit to install a (d te) (installer))' , septic system at 5 BU JA434JI based on a design drawn by VVL(_ dated N L (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was construct e e with the terms of the IAA approval letters (if applicable) RRE (Installer's Signature) _qA (Designer's Signa ) (Affix Designer ' ' amp Here) PLEASE RETURN T ARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc DEEROBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Still Color Sall• Other Surface(in.) (USDA) (Munsell) Mottling (Stnuctum,Stones;Boulders. a Isistency.96't3rilyell Li DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, A Am I- P"/V r; fir, I b JP" DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Soil thor Surface(in.) (USDA) (Muuscll) Mottling (Structure,Stones,Boulders.. ConsistenoZ DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Sall Color Ball Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Scones',Boulders, a Flood Insurance Rate Map: / Above 500 year Pond boundary No_/"Yes YesWithin 500 year boundary - No V Within 100 year flood boundary No. _ Yes .._ Depth of Naturally.Occurrine Pervious Material Does at least four feet of naturally occurring pery o s aterial exist in all areas observed throughout the area proposed for the soil absorption system? li If not,what is the depth of naturally occurring per sous material'1,._.__._�_...__. Certification I certify that on I b (date)I have passed the soil evaluator examination approved by.the Department of Enviro p ental Protection and that the above analysis was performed by me consistent with . the required t artise nd experience descri ed in�10 CN R 15.0 7. Signature Dam Q:WaFrrIC\PERCPORM.DOC Town of Barnstable P# 604 Department of Regulatory Services I Zwsrae, Public Health Division Date ��7 =,. MAas• p �a79 200 Main Street,Hyannis MA 02601 ' Date Scheduled �%1._ Time A e Pd._ a►il Suitabilio ,Al.ssessment for Sew ge Disposal co Performed•By: Qi (� Witnessed By: V l LOCATION&.GENERAL INFORMATION Location Address 5 .0 L v �•�Qom .v Owner's Name Address S CQ VV\ Assessor's Map/Parcel: `rl / / / "Engineer's Name V-­, NEW CONSTRUCTION � �REPAIR _ Telephone# .5 c-`Q Land Use - R�-s ��.N 1 l 5lopca(96) Surface Stones /Y Distances from: Open Watcr Body >Za) ft Possible Wet Area?/' O ft Drinking Water Well Drainage Way 111 Zoo g Property Line /0 ft Other {I SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) dAeW V9 h jo Parent material(geologic) "�WA15�" Depth to 13edroolt A Q Depth to Oroundwater. Standing Water In Hole:'_ '" Weeping front Pit Fooa N Estimated Seasonal High Oroundwater DET�F . ATION FOR SEASONAL'�GH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Deptll to sail Inottlest Itl, Deilth to weeping from side of obs,hole: lit, Oroundwater Adjustment tk. Index Well• RcadingDato: Index Well Iopol__:_ Atj4hetor, Adj.dround"water1evel,, PERCOLATION'TEST »ate ;, 7 ma_ Observation Hole# Tlmo at 4" Depth of Pero 1 _ Time at 6" Start Pre-soak Time @ ` R Time, End Pro-soak ` Rate Min./Inch . Site Suitability Assessment: Slto Passed^ Sltc Falled: Additional Testing Needed(YIN) Odginal: 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 Conservation Division at least one (1) weelc prior to beginning. Q:1S EPPICAPBRCFORM.DOC . / 1�3LTOWN OF BARNSTABLE � C C.fit ) /. � C n h. rr, `� I,(x'ATION._ � SEWAGE # m SAS, VILLAGE // r L�S ___ ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. W ® , S- 7 6 r ~ SEPTIC TANK CAPACITY n LEACHING FACILITY: (type) 5� gtA i C ;Cr JAa.q§tJ NO.OF BEDROOMS BUILDER OR-OWNER PERMTTDATE: gs�pO� 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 . t3�.k of ��se ��-�' � . . �'� �k � � �� _ � � ® .�. . f� �.i � 4.f � ""�. -� .. V V •,A r �1 No.' id o Fee_ls�d. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprtcatton for Mfi6po5al *pgtem Congtruction Permit Application for a Permit to Construct(/Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components _ _ s Location Address or Lot No. l'� s Owner's Name Address and Tel.No. �O Assessor's Map/Parcel Installer's Name,Address,and Tel No _ 7 Designer's Name,Address and Tel.No. W J;� RP i r h-.5d/1 Ske 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 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_5gnv1I Nature of Repairs or Alteratioq (Ans er when applicable) "��� e&nd o2 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 iss ed by 's B d of Health. Cry Signed Date. Application Approved by Date ! l&tiu Application Disapproved for the following reasons Permit No. Date Issued --2 C,-z� No. '�" Fee 41 ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS` a Application for Migpool *pgtem Congtruction Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Owner's Name Address.and Tel.No. l_. Assessor's Map/Parce n Installer's prune,Add s,and Tel.No - Designer's Name,Address and Tel.No. W � to b 1 rl Td rl 5.tr07kC. ✓' Type of Building: , Dwelling No.of Bedrooms Lot Size sq.ft. " Garbage Grinder( ) y 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 Altgratio s(An er when applicable) 6s� d hd T h C' nc/��-S ,PrP Cis ,2 i Date last inspected: f 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 iss�edyIs Ird of He th. Signed ` l ���,,�, Dade T �� G� Application Approved by r Date Application Disapproved for the following reasons i Permit No. '^- .e� Date Issued ---------------------------- - - - -------- THE COMMONWEALTH OF MASSACHUSETTS Me pa.rmano BARNSTABLE, MASSACHUSETTS Certificate of Compliance ,/ `4 THIS IS TO CERTIFY,that the On-site Se age Disposal System Constructed(�T )Repaired( )Upgraded( ) Aban�°ned( by n F P 0 i _Sen fofi C, . wL-1 at 3/ 3 s-- u r ,tee' S� 19-1,m has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nb 3 dated Installer Designer A AA The issuance of this sh permit 1 not be cLstru as a guarantee that the s siem�wi-llAunctio ,,as designed u , �..T Date p "t '7 /+l%Inspector y 11 i/�� / AJ U ---------^`----------------------------�— No. +,7r7 Fee THE COMMONWEALTH OF MASSACHUSETTS /ham �Pwha" o PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS - migpogaY pgtem Congtruction Permit Permission is hereb r ted to Con ctRe air Upgrade Abandon System located atg �� pg (/Y7 ( ) 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 this rmit. Date: ^ �� �� Approved by • z TOWN OF BARNSTABLE If . LOCATION ��. � 9 3 f'n h q►r, �'r SEWAGE # ? b S✓3�S* VILLAGE /FYI; L s ASSESSOR'S MAP & LOT� '�� INSTALLER'S NAME&PHONE NO. W.Z. ifnbtnsv.7 5e jD f+ G 77L P08 SEPTIC TANK CAPACITY i LEACHING FACIL=: (ty ) ;L At NO.OF BEDROOMS �/� G� BUILDER OR OWNER // c- U2`✓Ylnm PERMITDATE: COMPLIANCE DATE: gI 14-Oa r 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 (4 \o T x O d .. { E ♦ 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS). I,Gv I1. ��-s a i,- Sig- , hereby certify that the application for disposal works construction permit signed by me dated �� �J"�> , concerning the property located at J - SF 16 v e- A-i ° meets all of the following criteria: • I s failed system is connected to a residential dwelling only. There are no commercial or business us s associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system I • The are no private wells within 150 feet of the proposed septic system • Thee is no increase in flow and/or change in use proposed • )austed re are no variances requested or needed. • bottom of the proposed leaching facility will not be located less than five feet above the maximum groundwater table elevation. [Adjust the groundwater table using the Frimptor method when licable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: �7 A) Top of Ground Surface Elevation (using GIS information) 8 / B) G.W. Elevation +the MAX. High G.W.Adjustment. = 3 3 0 DIFFERENCE BETWEEN A and B SIGNED : DATE: [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert L .! •� ' v � � �` `I ���1� .�' �' l � �_ :, � -- 31 LoCA�T�ION - SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME a`, . . ADDRESS 3' D( s ca 6G f r Vac B U I L D E R OR OWNER*' DATE PERMIT `ISSUED DATE COMPLIANCE ISSUED 1 1 f L o4 S i R� I y 1 r No, FimB THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 7 1.C.�,n.................OF........ �.r.n..7�-a-b�-�_.......-•---............---- Applira#ion for R"viiFal 18orkii Tomitrurtiun runfit Application is hereby made for a Permit to Construct ()t,) or Repair ( ) an Individual Sewage Disposal System at: i . ?:... ....3....... ......� .......... ....... !1 1s-..._•..na----...•............................ «� Location-Address ........................................................ r lEr ............ -. .... ............----•---.A... 45....-- $.......� �� -- " 'o Installer Address Type of Building �, Size Lot.zs_-�J---4•�-3....Sq. feet U Dwelling—No. of Bedrooms.._... ' ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ . W Design Flow..........._5.5........................gallons per person per day. Total daily flow............��••�0....................gallons. WSeptic Tank—Liquid capacityl@�---gallons Length_S7..V... WidthLI A.0--- Diameter________________ Depth.!.5......W. x Disposal Trench—No. .................... Width.................... Total Length.............:...... Total leaching area....................sq. ft. Seepage Pit No.......1------------ Diameter...... Depth below inlet.....6.1._....... Total leaching areaZ(cAa.....sq. ft. Z Other Distribution box (, ) Dosing to ( _ `_ _ �� '-' Percolation Test Results Performed by.... t re _. 4..._____�105 _�QA.............. Date.....5&./�.......... ,aa Test Pit No. 1_.-Z........minutes per inch Depth of Test it----w_-7 .......... Depth to ground water.._ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil o p p-..-. 2Prw� = S o! �`�� f a f .------ n ^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 TITI.% 5 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. gned ... ............ `>................. QA- �. ....._ to Application Approved By....... - -------------•--•-• -••-•--•--•-. ..... Disapproved f t e f ollowing reasons-------------------------------------------------------------------------------------------------------------•••. ............••••••-•-•---••.....•-•--••-•----•--••••-----•-••---•-••--•--•---•--•-----•---•••••••--•-•--.--••-•-••-•-•••-•-•••--••-••----•-••----•-•-•--•--•-•-•••-••-•-•----•-•---- -•---•--•••-•. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ApplirFation for Disposal Works Tontrurtton Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: L�-� ......-......'-_........ !.'r...---- ? .----•-......`.... -_,tor) S �. S--- �.� ..................................... ... _. Location-Address t or Lot No. l�.2.Q 1_....... �c? J......`�`�'t... �` ...... +n ....... ...... Owner �--� ¢lddresst a - --------- Installer Address UType of Building _ Size Lot 2-�-. 5_�-�._......Sq. feet Dwelling—No. of Bedrooms....{_ .............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons......................... Showers ( ) — Cafeteria ( ) Other fixtures ---------------------------------------- W Design Flow............ .5........................gallons per person per day. Total daily iflow.......... -!.- ....-..............._gallons. WSeptic Tank—Liquid capacity.��O_._.gallons Length`_��.6...... Widti+.4' 0C .. Diameter-______________ Depth...... ..... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I.............. Diameter....E.Q..___._... Depth below inlet.... __.......... Total leaching area?-�P(.,P-------sq. ft. Z Other Distribution box (X ) Dosing tank ( ) _ _ /J ' ! Percolation Test Results Performed by_..<�.`� .. .. -1'a l._._._....__ `�A. 't Date. . . r. ....••• •--•-•••--- Test Pit No. 1�t..Z.........minutes per inch Depth of est Pit..._ ........... Depth to ground water--_--a ,,.._.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--__------_--__---_-__-. W ,-------••--- ••---••--•••--••-•--••••-•••----•-••............. V � � ... - --•--------••••---------•-•__... Description of Soil----- ......_L.QA�--- . �--- .............................. f •. •--•-••-•-•-----•-•--••••••----•--•••--•--•-•---•-••••.....-••------•---•-...••••••-•-•---•-•-••••-•-••-•--•------•••-••••••-•........................................... •••. 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 T IT LE 5 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. /IgnedApplication Approved BY••• ---.� ---•...•••••-•---••••---•-•-•••-•....._-•••-••---•-••-•-•... --- ...Date Application Disapproved f " reasons:............................................................................................................. --....---•--•-•.............................•--------------------•-------....------------------....------••-----•---••••••••--•--•--•-----••••---•-•--•-•••----•--••••-•------•-•---•-•----•••------•--- Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF........... . .. ................••... (Irrtifiratr of TompliFanrr THIS _TO CERTIFY, That the Ijnividual Sewage Dis osal System constructed (K ) or Repaired ( ) at------- �` ..----. aJ c' +^1_+1 t 1 !1 ._ler ( .5 0 ! has been installed in accordance with the provisions of TIFit/ 5 of T e tate Sanitary Code scrib�in the application for Disposal Works Construction Permit No.__. _� � _._._ dated_ ..___���-,?f�","'....__...._ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................--� -..•----- Inspector.....•......--•------1�.. .................................................... THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF HEALTH t ..............OF........ { � .. ... Ve ................ No......................... FEE........................ Diavo al Works Tontrurtion Urrmit Permission is hereby granted ----------••--......-•-•---- ........................... to Constr ct 0<, or:,Re air ( an Individual Sewage Dis osal System at No.�t.•••• ....•.L• ---••-•� -' ._�!A_Inurn....... C•" � Street as shown on the application for Disposal Works Construction Permit .......... Dated.......................................... . ............... .•-----•-- ...................................................................... /L/ 11 Board of Health DATE ......................................... FORM 1255 A. M. SULKIN, INC., BOSTON Department of Environmental Management/Division of Water Resources WATEP, WELL.COMPLETION REPORT 1 W L LOC TION Addressh6.� a � h� City/Town)M#,tf -k-M.* My X I '> G.S.Quadrangle Map Grid Location Owner���C.-� V C A<e 0'n 1 i 1 Addressl ILT C,reA.i 1� lKAS� 124 cayl 1 i'yi WELL USE CONSOLIDATED WELL DomesticK Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones To Method Drilled 1) From 2) From To Date Drilled c>l �� 3) From To —- _ 4) From To CASING Depth to Bedrock or Length�"'�Diameter d Type ey UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land sLvface Sand: fine❑ medium❑ coarse❑ Date measured W d--r Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL r Slot#/O length a� from�� toJ� Yes ❑ No Split Screen (or 2nd screen) , WATER QUALITY TESTS MADE Slot# length from to Chemical FV Biological ❑ Depth To Bedrock PUMP TEST Drawdo,wn feet after pumping days hours at GPM. How measured Recovery feet after hours.' LOG of FORMATIONS COMMENTS: (On well of water) Materials From To SAno ^ b% 0 Cb DRILLER 5-4 Firm CLIFFORD WELL DRILLING ; Address 5 Blue Rock Road City S0.0th Yarmouth, Regi ration No. pe ator s ignature ease printrrm y CUSTOMER COPY f 15M-2 84-17s471 Log Number: 3783 Bottle # C097 Date: 6/27/84 BARNSTABLE COUNTY HEALTH DEPARTMENT 'Z SUPERIOR COURT HOUSE 7 v BARNSTABLE, MASSACHUSETTS 02630. ° AtAS$ ' DRINKING WATER LABORATORY ANALYSIS PHONE; 362.2511 EXT. 331 Client: Jack McKeon r collector`: Fred Clifford Mailing Address: breat Ma-r-s-F-Rdo-a-dAffiliation: Clifford Well Drilling - en ery7 e, MA U2632 Time & Date of Collection: 6/24/84. 4:00 p.m. Telephone: Type of Supply: well water Sample Location: Lot #23 Well Depth: 56' Burum Rd. Date of Analysis: 6/25/84 Marstons Mills Parameter Sample Result Recommended Limits Total Coliform Bacteria/100 ml 0 0 pH 5.4 Conductivity (micromhos/cm) 100. 500.0 Iron (ppm) 0..05 0.3 Nitrate-Nitrogen (ppm) 0•82 10.0 Sodium (ppm) 3. 20. XX Water' sample meets the recommended limits of all above tested parameters. Water sample has higher than average levels of nitrate. Future monitoring is recommended (2-3 times per year) . . The low pH of the water may shorten the useful life of the house's plumbing. Water sample may present aesthetic problems due to Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. Water sample is not recommended for human consumption due to Retesting is suggested. REMARKS: cc: Barnstable Board of Health CC: Clifford Well Drilli ng Lab Director / 11/7/83 y t Ti��GvC.4Ti0r✓ U�.An/y�XISTINrr nb�/Z �RO?JNip emu/E2s1 �.dEL cs��D� arH-E2."!J T'/L/TICS /5 A/-PRO XIMA7E SUJ-�1'G1E:%� 3y Mom. L�5'rF�K` Ld/�D� >:o�f'IckC"DN`Gd/1/5,7"�t�cTr��'✓ S� . p. SS U NI E /✓c�?�S�N s I/3 Lrf Y F v 2 D A MA � .S l 4 iti �- (/V A Ski vt-DAY /UTi�J'ri�s /,�/c.v rz 2 cp i9 N o R, /A/A c C_tJ2 A THY-y Sys Gr//✓ x j ^p n fv Y. ,�� i� o� ,�,� �d. +Y�:' fir: --.. �oj►. �� ..`�-: . V r t Yy �5 t k O MIA" � P �is►►/ /` to S;f LEGENDsac r' fr , 3g r� x .ryortnL�°' J k EXISTING SPOT ELEVATION Ox0 ' 1 #' rii # 4 CERTIFIED PLOT PLAN EXISTING CONTOUR -- 0 -- - H r'Fs " ` FINISHED SPOT ELEVATION.' FINI SHED CONTOUR 0 R08ERT G v EL R APPROVED BOARD OF- HEALTH lgT A DATE AGENT �o sub BCALEi Jr,� gyp' DATEi.S °i" TW M -i� PN t ' L DRE06E ENG/NEER/AIG:Co l CLIENY CERTIFY 1HAT THE' EOISTERE REAISTi:RED , ,IOB N0 t. `BUI4DINO 6HOMIN ON,.'TH19 �ILL At CIVIL LAND GONFORM8 :TO THE. "ZONfN® LAWS ENOINlER 1IRUEYOR '� O.F BARN3TABLE, ; MAS9 :: fi �j x sc 712 MAIN STREET ,. CH BY,% HYANN I S, 'MASS." MASS 3HEETr.L'OF E" < EO• -,IAND ;:SURVEYOR { 2G PT M/� NOTE /F E/TNeA? Ti+,fE.SEPTIC TAN/C OR LEi4GN//VG P/r ARE MORE TNAJV I2'"0ELOW /O PT M/a �rRIO 0E, 2�'O/mot M E TER CONCRA6 7'.0 CO F�ER }t— SMALL BE D..V0V4//T TO.4/TAOE.�AN EXTRA -vopvc tiEAYy C�'15T/RO/Y C0VZYr S//,gLL L3E USEO #� �L /p7 o CpNCRETL• iy/N. P/TCN /F/" OR/Vk=WA Y s:••- COVERS A'FP�. _ R MiN. CO/1/CRL�TE A _ a1"Off Co VER CL EAJV SAND _ BACXF/LL LqU/O LEVEL r *LAYERti 4 4"CAS� . o•oe QF /8a-'SIB` IRON P/PE . /vo o GAL. ° e • • . . . • • p M/N.P/TCI✓ D/ST. 0 4 yY•,SNED 57nNE SEPTIC TANK , 4 • • . . • • , • BOX o • • $ , • e • • • 1�• e �♦ � • • IF�FFCT/VL • • ♦ ,� •A�4 e= 1 �2~ ...�. • D • r • • DEPTt/ • • r • e � � WASHED STONE 2.... !s/. X.'Z.S-=37O � •�a • • • e . • •• • op ® PRECASTSEE.fA aZ' 3 X I O _` ! ' �v s A P%T OR EQU/V AIV4vT�&LEVA7"/aW s• PIT CAAA c.'rr T AT 00/LD/NG c'�•v FT 6•�T t�//4M. /NVER INLET` .SEP'T/G `Ti4NK : 01 y FT /2 F. O/AM. C CSEE T�IBI/LATJON�4 404/71-E7-SEPTIC TANK /by"` FT. :INLET D/STR/p//TtON-BOX vy'` � SECT/ON OF GROUNO N��9TER Ti4BLE 0071tCrDJ'3 rRiBtn-/ON daX .S�WAS&' 01 SPaSA 4 SYSTEM //vLET tEACN//VG iaiT : �Fr TA WLAT1D/Y T LEACH/.NC PI scALE .006 D,ES/GN, CftlTEft/A , / D/JMEAfg N �t N!lMBER OF G4,gaAGEDlSP05AL UNIT k/VaA1� _ SOIL LOG TaTAL EST/IiTED FLOrt/ 0 G.4L�D.4S".. SOIL 'TEST Ati $oil 7�ST2 SD/L TE1T _ NUMBER OF,�ACXINtr.PITS I ELe''Y. '/O G,� _ EL�Y, GW TE OG'SOl L TEST S/DE L erACHING PEft P/T RESULTS wi-rovESSED BY RO UA�" r BOTTOM LFi'ICN/NG PER P/T l/ 3" $Q. �tT.' i O -- PE/1tCOLAT/ON RA ro y / Ss MI I/NCK -ro7A*L'LEACH//YG AREA 6 FT ' sv3 sro/L RCOL�IT/ON'RAT'Er �E2' M!N f lNC/I f a-�o¢SQ. FT. z,u RESERVE LE4CNlN6 AREA �NOF 4AVf _ MBURAIH ��( u� P�-tNk OF Af.4 ROBERT �`<. 9 /i✓L'S�NL7 cSTD /V S� , /"1, J L L S ;A BRUCE: a p ALBE a ELDRE v •, �, tA��sE _ ELQh?EDPsE EIVG//1/"WING CVIVC. No.10951 O O9�FGIST���e�``� [=L q >Ft 7t2 NJAIN 9'T�..:/-/YANK/9, MASS•' `,ND cr To'JND,YYATt�R:�1VCOUNTI�REO CL/ENT:'Nf I�E�: D�(TE �? �l0 NAL E r __ Ols [ C T„'EL8'N _ JOE� NO. �4 � 3 7. SHtET "� �. LOCATION A-- VILLAGE M S+b S DATE APPLICANT - FEE ADDRESS Z - �-f�%(X UJ etW TELEPHONE NO. (Non-refundable) ENGINEER - _TELEPHONE NO.��; -Z DATE SCHEDULED J C5. PM t Q � (Applicant' s ei- nat re) . . .-. . . . G`O. 0 O O . O . O O . . . . . . . . . . O . . . . O . . . . . . . O . . . . . . . . . . . . O . . . . . . . . SOIL LOG SUB-DIVISION NAME _S 78<. DATE_ TIME ld 00/" EXPANSION AREA: YES NO _ _ Ge J . ,j _ENGINEER TOWN WATER PRIVATE WELL BOARD OF HEALTH I.J-KE4y EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES : J A, T T o CAM j P`ERCO TION RATE : � •T/HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: T�S Lor9M 1 2 �v3S'ois- 2 3 3 I; 4 4 - t 5 5 6 '_ rz ° 6 7 7 8 8 M E D r uM '0 if 10 10 11 0 11 " II 12 12 13 JVa y-14TE P 13 14 14 �`3 15 ? i15 16 i i :, �16 SUITABLE FOR SUB-SURFACE SEWAGE':'•-LEACHING FIELD,,' LEACHING PITS_ LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE . REASONS : a " NOTE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION :;; ORIGINAL: COMPLETED IN ENTIRETY BY P . E . 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Y.1�-f..� l�: ��/` � r► 11_,�`��e., .. r..r-- ��Wit"., L' y, *'^! �J '�3.y.�"�.s�.� �h �5 ..1h•'�T,y,� 1 MARSTONS MILLS - - Q� LOT 23 \ � 219.7g• �� � AREA = 23604 sf+— o' LAND CL`�IJRT PLAN 351 86—B / vent — — P-1 WAKEBY RD. Q ASSR MAP.43 LOT 39 1 4,� TPA2� Q Q --- 10 ft LOCUS LOCUS MAP EXIST' 1.00 G LOCUS INFORMATION SEPTIC TANK PLAN REF: LCP 35186-B 1 0 �, '' PARCELS D: MAP 1 0431 PAR. 039 ZONING: "RC" -00 /\ SEPTIC SYSTEM Op- c �0`0' 0 REPAIR PLAN ` 8P F��.nN LOCATED AT: 58 BURNHAM STREET MARSTONS MILLS, MA PREPARED FOR McDERMOTT/ READY ROOTER EXC. ' MAY 4, 2016 < 0.8.3 OF SAS D A I�1 i` eOcE Or No. 1140 MNITAR\a� MEYER & SONS, INC. SCALE: 1"=20' LEGEND P.O. BOX 981 BENCH MARK PROPOSED CONTOUR EAST SANDWICH, MA. 02537 * ® PROPOSED SPOT GRADE PH: (508)360-3311 PAINT SPOT ON -- 98 -- EXISTING CONTOUR FAX: (774)413-9468 BULKHEAD CORNER + 96.52 EXISTING SPOT GRADE meyerandsonstitle5@gmail.com 88. 28 W— EXISTING WATER SERVICE USGS DATUM ASSUMED TEST PIT SHEET 1 OF 2 J#1813 f F ELEV. TOP NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS, .FOUNDATION BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE. (Existing) FINISHED GRADE (88.0) = 88.01 F.G.EL: 88.0 F.G.EL: 88.0 F.G. EL: 88.3 VENT 4 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA .Q7 2" OF 3/8" DOUBLE WASHED F.G.EL: 85.57 3/4" - 1-1/2" STONE OR FILTER FABRIC DOUBLE WASHED STONE a 6" A. 4" SCH 40 PVC •e 10"1 6 ®®®®• O ®®�® A'. TEE'S ARE TO BE 14 C° S= 1% (MIN.) ®®®®�®®®®�® 4' SCH 40 PVC INV.84.0 F ®®®®®®®®®®® INV.84.25 2 E F. DEPTH- ®®®®®®®®®I�® INV.83.80 4' 2 X 8.5' 4' ?� EXISTING OUTLET BAFFLE PROPOSED DB-3 , INV. 84.50 4• °' '` DISTRIBUTION BOX EFFECTIVE LENGTH = 25 g (H20) INV. ELEV.= 83.55 EXISTING 1 ,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON P��� �F Mgss91 BREAKOUT OUTLET TEE AS MANUFACTURED BY REW M. Cys ELEV.= 84.55 TUF-TITE, ZABEL, OR EQUAL ` Y R _ TOP CONC. ELEV.= 84.55 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING I 11 0 INV. ELEV.= 83.55 *®3r ®® PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®E3®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO �FG/STERN ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX 'A01TAR0 BOTTOM EL.= 81 .55 ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN I�A ' �� 3.75' 5 FT. 3.75' 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 5.55 FT. EFFECTIVE WIDTH = 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGED, NOT H2O LOADING, OR UNDERSIZED. BOTTOM OF TESTHOLE EL: 760 SOIL ABSORPTION SYSTEM (SECTION) . 4) INSTALL INLET & OUTLET TEES W/ a GAS BAFFLE AS REQUIRED (500 GALLON H2O LEACH CHAMBER) GENERAL NOTES: SOIL LOGS P#:15029 DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOOM BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: APRIL 28, 2016 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., CSE #.1614 - 310 CMR 15.405 (1) (B): DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. 1) A 0.45 Fr. VARIANCE FROM 310CMR15.221 7 TO ALLOW LEACHING WITNESS: DAVE STANTON, BARNSTABLE HEALTH ( ) GARBAGE GRINDER: NO (not designed for garbage grinder) TO BE UP TO 3.45 FT (APPROX.) BELOW GRADE VS REQ'D 3 Fr. (H20/VENT PROVIDED) 2) A 2 Fr. VARIANCE FROM 310CMR15.211 To ALLOW LEACHING SEPTIC TANK: Elev. TP- 1 Depth Elev. TP-2 Depth 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK TO BE 18 FT FROM DWEWNG VS REO'D 20 Fr. _ �- = -�� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKF 88.40 A 0" 88.00 A 0"ILLED PRIOR LEACHING AREA REQUIRED: (330) 445.94 S.F. TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE LOAMY SAND LOAMY SAND .74 `` DESIGN ENGINEER. 10YR 3/2 10YR 3/2 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING USE TWO 2 500 GALLON H2O PRECAST LEACH CHAMBERS W/ 4, FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 87.82 7' 87.42 7' ENGINEER BEFORE CONSTRUCTION CONTINUES. B LOAMY SAND B LOAMY SAND STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 10YR 5/6 10YR 5/6 BOTTOM AREA: 25 x 12.5 = 312.5 SF 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 85.24 38" 84.84 38" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF C C SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF HEALTH FOR PROPER INSPEC11ONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. PERC ® MEDIUM SAND MEDIUM SAND TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED EL. 84.0 25'Y 7/3 2.5Y 7/3 DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. . 9 IT SHALL BE OF THE CONTRACTOR TO VERTH THE LOCATIONTHE OF ALLPONSIBILITY UNDERGROUND UTILITIES, PRIOR TO EGININGE PROPOSED SEPTIC SYSTEM UPGRADE PLAN CONSTRUCTION. 76.40 144" +76.00 144"10. EXISTING LEACHPIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. - 58 BURNHAM STREET, MARSTONS MILLS, MA 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION <2MIIN/INCH IN 'C" SOILS Exc- 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY NO GROUNDWATER OBSERVED Prepared for: McDermott/Ready Rooter A AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY Engineering and Survey by: SCALE DRAWN 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. • I, Darren M. Meyer, R.S.. CSE, hereby certify that I am currently approved by MAOEP pursuant to 310 CMR 15.017 PO MEYER&SONS, INC. N.T.S. DMM 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. to conduct soil evaluations and that the above analysis has been performed by me consistent with the EA BOX 9B1 DATE CHECKED SHEET N0. 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. EST SANDWICH,MA 02537 508-362-2s22 05/04/16 DMM 2 of 2