HomeMy WebLinkAbout0060 CAPTAIN BAKER ROAD - Health 60 Captain Baker —A c7�.
q= 125—032
Marstons Mills
TOWN OF BARNSTABLE
LOCATION ,D, SEWAGE
VILLAGF � w (�1Sil�s ASSESSOR'S MAP&PARCEL I
INSTALLER'S NAME&PHONE NO.(1,?4X01M6, Z��1
SEPTIC TANK CAPACITY
LEACHING FACILITY:(typg7, e,6g!i (size) 5' -X' l 3
NO.OF BEDROOMS
OWNER
PERMIT DATE. COMPLIANCE DATE: 3
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
l
Fr ^j
f No. t/V Z,70 THE COMMONWEALTH OF MASSACHUSETTS FEE 1C`
BOARDD OF HEALTH
OF /
APPLICATION FOR DISP OSAL SYSTEM CONSTRUCTIrndividu!Components
RMIT
Application for a Permit to Construct ( ) Repair ( pgrade ( ) Abandon ( ) - ❑Complete System
�T ,
Z�Lo ti Owner's Name A.
pfParcel# Address rn
J:jj
0t5taller's ame �esigneme
r�la 161""7
Address Addr ss
Telephone# Telephone#
Type of Building: Lot Siz C)Dn Sq.feet
Dwelling—No.of Bedrooms Garbage Gr nder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.req red) _gpd Calculated design flow gpd Design flow provide��" gpd
T Plan: Date 0 t Numper of sheets / Revision ate
Title 1771F,
TT
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator cj. Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigjqed agrees to i stall the above de cribed Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and furth agrees not ace th stem in ration n Certificate of Compliance has be iss ed by the Board of Health.
Signed Date S —7 ®�
Inspections ^ '
c rA4 v vw
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
j . •( , 4
`9 r
THE CZWS ' FEE
, tHUSETTS
BOARDOF I t
HEALTH
{ APPLICATION FOR DISPOSA SYSTEM CONSTRUCTIO ERMIT
Application for a Permit to Construct ( ) Repair ( y pgrade ( ) Abandon ( ) - ❑Complete System Q901ndividual Components 1,5
1 A(cc elcpm
3
Lo do Owner's Name I2
1,ra
p/Parcel# Addresses'
Lot#
I taller's Name _ y esigner' tame�•'I ti d .
�'
e� i4 I- 77
Address Address
Telephone# Telephone#
Type of Building: Lot Siz Sq.feet
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.req red) D gpd Calculated design flow gpd Design flow provide 5_�pd
Plan: Date 0 A63 2>0 CG Numper of sheets T Revision ate
Title T
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation d
DESCRIPTION OF REPAIRS OR ALTERATIONS
The,undersig led agrees to install the above de cribed Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and forth agrees not ace th"5stem in ration, n Certificate of Compliance has bee iss ed by the Board of Health.
Signed 1 Date S � ZO S
t
Inspections f /
r
1
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 r;
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ndividual Component(s) ❑Complete System
The undersigned hereby 'hcertify that the Sewage Disposal System;Constructed( ),Repaired( graded( ),Abandoned( )
by: Ci�CD1 4 l.J qyt
at Le 1 \ Y 1 • jMKEZ �V-
has been installed in accordance with the rovisions of 3 07MR 15.00 (Title 5) and the approvedesign plans/as-built
plans relating to application No. 1 dated �� i Approved Design Flow (gpd)
Installer C"Z'G�!/iW � A
zt
/ /��
Designer: Inspector / 1.0 f Date `�/ /!�
I {
The issuance of this certificate shall not be construed as a gu ntee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
No. V THE COMMONWEALTH OF MASSACHUSETTS FEE 'W
BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCZbando6n
ERMIT
Permission is hereby granted to Constr t ) Repa' ( Up ade ) an individual sewage
disposal system at as described
in the application for Disposal System Construction Permit No. dated
Provided: Construction shall be completed within three years of the date of this permit. local conditio s must be met.
Date 5 Board of Health t
FORM 2 DSCP— DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON
Town of Barnstable
Ft I rgy�o Regulatory Services
": Richard V. Scali,Interim Director
s ,
+ BARNSTABLE.
9� MASS.
aS Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: q �l Sewage Permit# Assessor's Map\Parcel [Is
Designer: y�l*"7 u Installer:0N_ 1L1q ,
Address: &�gT J VLk� Address: �� l
TA 1AG�Vol U
On CV-014 W,—, ` was issued a permit to install a
(date) (installer)
septic system at (co �( based on a design drawn by
ddress)
dated
(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 cq6ify that the system referenced above was constructed in p14%pce with the terms
of e proval letters (if applicable) �µ OFNjgss
DAVID q�
B.
er's Signature) o MASON y
0 No.1066
�Q/STEPS
AtITA ,P
(De gner's Signature) (Affix Design ere)
PLEASE RETURN TO BARNSTABLE 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
,�� :�• 'Town of Barnstable Pm- -7(,P D
Department of Regulatory Services
. EL41U .,BM: Public Health Division Date ta5
,65g, 200 Main Street,Hyannis MA 02601
s ��ff
Date Scheduled 2, Time JW Fee Pd.
Soil Suitab��ijjl//�itty��//��Ayys��sessment for Sew e Disposal
Performed By:_%AV� i�// 601,1 Witnessed By: t v rol/V.
e— LOCATION&GENERAL INFORMAT N
Location Address /J�) "I Owner's N
C1A�/�AK � ame
A� ) Address
T
Assessor'sMap/Parcel: Engineer's Name .Y'YVI �
NEW CONSTRUCTION REPAIR Telephone#
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
FL
�1
Parent material(geologic) Depth to Bedrock T -
r- ea �P.06. �
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level ° Adj.factor Adj.Groundwater Level_
PERCOLATION TEST Date Time
Observation
Hole# Time at 9"
if
Depth of Perc !n•'1 Time at 6"
Start Pre-soak Time @ `i-- / Time(9"-V)
End Pre-soak
Rate MmAnch ( i
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN)
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 Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
r"
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
YN 4
41
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
Flood Insurance Rate Mao:
Above 500 year Flood boundary NoYes 1Z_/
Within 500 year boundary No 'V/Yes
With n 100 year flood boundary No r✓ Yes
Death of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious aal exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth ;eintaP
By occurring pervi us material? _
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Enviro tection an that4he above analysis was performed Vy me consistent with
the re ' training,experti an a en e 11ed in 310 CMR 15.01Q7,.
Signa Date t/ �D ZP
Q:\SEPTIC\PERCFORM.DOC
TOWN OF BARNSTABLE
LOCATION 4�'06,Dj /3Afr-_2 2t�' SEWAGE
VI%LAGE OY� D��� tV (1 ASSESSOR'S MAP & LOT �S'�•11�3
Ik
INSTALLER'S NAME & PHONE NO. �•QG� �j.,si � �S 1��
SEPTIC TANK CAPACITY 100-Z> Grp r s i,
LEACHING FACILITY:(type) C4S / -(size)
NO. OF BEDROOMS PRIVATE WELL
OR PUBLIC WATER
BUILD"ERROR OWNER ' /ZJA//,� l i�� 12,1 (J ,e
DATE PERl IT.ISSUED: f2 15,�;e
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No c.�'
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No.... ...... Fim........6._...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Apphration for Dire. vial Wi urk,i C owitrurtiun runiff
Application is hereby made for a Permit to Construct ( ) or Repair an Sewage Disposal
System at:
n
........ ........... .•-- -•-•�......----�••....-•••••-••••••-••--•...--•-••---•-••••--••------•--.........••---.....••.
L cation-Add css / / or Lot No.
e ✓e s C�7fa.-� �� r A.. A?------------------------------------------•..................._.•-•......••-
O}}ncr Address
G! U ®ram
e
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons._..____________-----__-__. Showers ( ) — Cafeteria ( )
a' Other fixtures _____________________
W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter--..------------ Depth................
Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 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
o4 Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water.........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................
a --•••----•-•-----•-----•--•----•-•-•--•-•-------•--•----•-•--••••••--•----•••••••--•........................••....•••....-•---•--•..............•-•--..--•-•-
0 Description of Soil........................................................................................................................................................................
W
V .....•-•-•--•---•.....----••••••..................••-•••---------••-•-••••-•--•--•••--------•------...•----•-•-•••••••-••--••-----•-••••--•-•••--••------•-----••----••-...............-•••........•--••-
W .........................----•-- ••••--••••------------.._..•-•-------•----•---------••-••......----•-. ------ --------
U N ture of Rep a' s or Alterations—A�Isw�r when a tic ble__���__._S?_��!.�'....... ... .c_�k.!�.................
a .....� 2) ,e � IS?'/ !!V / C �C' � i y. e h.---... ...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the
system in operation until a Certificate of Compli*h1beenued by t e boar f health.
Signed ....... --------- �Application Approved By - -------- - ....................................... ................Daze.................
Application Disapproved for the following - .cons: . . . . .................. ...................... .......... .................... ........ . .
................................................ ... ... ............. ..... .. .............................................................................................. .................Date..................
Permit No.
....... ....... .... ........... . ................... Issued .
Dare
�1\\[ice'� 4� "L•/)/`� j.r � � 0
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH I
TOWN OF BARNSTABLE
Apphrativit for Diflpwi tl Wurk,i Tnnfitrnr#inn rrrmit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
CIO
................................. ••••!3........ ...-- ...i� -----------------------••••• ••---••• •-••-•-•--•...•--...•-•--•-•---••--------.........
Location- dre or Lot No.
Adss i
iJ r s ��,4. � b i n /, 5'�, ,
O.,ner Address
Installer Address
UType of Building Size Lot............................Sq. feet
►. Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
004 Other—Type of Building ---------------------------- No. of persons.-.-----..--.--.-.---------- Showers ( ) — Cafeteria ( )
0.4 Other fixtures --------------------------------------------- ---------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length---------------- Width...------------. Diameter......-......... Depth................
x Disposal Trench—No. .................... Width.................... Total Length.........--......... Total leaching area....................sq. ft.
3 Seepage Pit No--------------------- Diameter._......--_------. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
1.4 Percolation Test Results Performed by.......................................................................... Date........................................
..a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit._----_----------_ Depth to ground water........................
9 .............................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
W
..........-•------------------------------------------••-•--•--..........-•-••-•....••--•-....--•--••••••--•------•••-••-•••......-•------•••-••••.......-•-•-•••---•...............--•................
UW -•-••-----------------------•--------------•-•-•-------•-• -----------------•---..........----...-••-----•------ = - --- ..................---- --------•--••�•----............
Nature of`Repairs or Alterations_—Answer when _applicable----f ...--..��-d �.`.....---f_y.6'.I.t. .:.................
L/ 1.....�.. ..............................................&11^x i.S t !t"__t/ 5/S r
'7 ._
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliances s�been issued by
tt`h�e�booaar'dsof health.
Signe % r�mac... ............................ ... /...........�...!..- r
0 - II/�A
Dte
Application Approved BY "! .. ..�!/�. /�4......... ..............................
............
Dare
j Application Disapproved for the following re sonr: -. ... ... .... ................................................... .. ............................--.
----------
..........................._........... .. . ......... . ..... . ... .............. ...... ... .........
Permit No. ...�..............."'.'._�........ Issued
---------- ----
--...—.............................................. ce......
Dace
�. _.:_,.__— — V.—_, ---,.-._--,_-:,- ---_..---- —v..-----�-----.— —__ate_..—_...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifirate of Tomp'lianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by
(�cJoL S ( )
Imsuer
at ...h,.o �6I` T .....!� ��,�(c� rc �...s 4-7 i=2 Gam/ ��' .. ................ ....._..... ..- .
has been installed in accordance with the provisions of TITLE 5 e Stat rivironmental Code as described in
_
the application for Disposal Works Construction Permit No. -. ,.�. dated .....-._.............__..........__...._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRUEA AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........ --L - +.- .�.�l..l�.................................... -- Inspector ...-.. �.t�c.. ` ..........................................
------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Nol TOWN OF BARNSTABLE
Rapasal �nirkii Tnni#rurtinn "rrntif
Permissionis hereby granted. r-- .... •-•--.......---••---------•------------•-••--...---•----•.............••-•-•-••-••••.......................
to Construct ( ) or Repair an Individual Sewage Disposal. System
at No -i<o ---------------- --" 7 s.- iZ /-/--� .--------f-•.....:.........
Street C [ („ ! /./ ...................
as shown on the applica ion for Disposal Works Construction Permit No. ..(�_.-._.-. .y. ated_.-..�- .
��/ b .. ..
/ Bd�ard-of Hcalt6 -
DATE. .�.-�... 77--- _••���-///!--------------------------•----
FORM 38308 HOBBS&WARREN,INC.,PUBLISHERS 7
f }
LG_UCAT,Ift N � f3��r AGEG E PERMIT 0•
VILLAGE 1�
INS LL 'S tjAME i ADDRESS
e UILDE OR OWNER
f DA T E PERMIT ISSUED & 0 72
DATE COMPLIANCE ISSUED �'
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No......3.:Ty FEE..... ....� '.rn..
THE COMMONWEALTH OF MASS`ACHUSETTS's`„l�n
T TO Al-P
BOARD OF HEALTH �'` ARix C,�a ®lr
gle
lore
O ..T0,14JAl....... .......OF......... .19.90!457,0.0 ..5 ---------
Appliration for 11hipaiial Workii Tamuurtijan Urrmit
Application is hereby made for a Permit to Construct (k) or Repair ( ) an Individual Sewage Disposal
�Syst atf
_A A
ocation-Address - or Lot No.
f� ,...---!3_�_�: .-----g&°--------------------_.....
Owner Address
a 0- �w-----------------•----------_-_-_______ 1!!1 _ _l.o tid ........._ 1(`f,�------------........-•---•
Installer Address
d Type of Building Size Lot__ a�__Gt� ....Sq- f t
V Dwelling—No. of Bedrooms--- ............................Expansion Attic ( ) Garbage Grinder Q�
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria )
a Other fixtures -------------------------------- .
W Design Flow.........._n .....................gallons per person per day. Total daily ow...........a.�Q_...__..___..._.._.gall�ons.
WSeptic Tank—Liquid capacity./A0...gallons Length.__9.-...... Width.....--..- Diameter________________ Depth...---......
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area............_..__.__sq. ft.
! i
� Seepage Pit No------- _.._________ Diameter_______ ___________ Depth below mlet_.._..�_._.__._. Total leaching area_;?V-O....sq. ft. -
z Other Distribution box (X) Dosing tank ( )
PercolationTest Results Performed by.......................................................................... Date........................................
Test Pit No. -__--minutes per inch Depth of Test Pit______ �--__-- Depth to ground water._/V-0_..._.....
Test Pit No. 2.�.�....minutes per inch Depth of Test Pit------/. ------- Depth to ground water E y V...7, 'e��
------------------------------------------• --•-------- -•----•-----...................._......------------------ -------•-------•------------•---...-----
Description of Soil- --- f`'-�--- ----�d3VEL'------
_`._1`? _�._ 1V�y�
�}} �3 F` Sr -------------------
9---5AN-0_a----------•..............•-----•-...-----------------------.....-•-----------•••----------••••----•---••----•-•-------......------........
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�iTI.
p 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.
Sied.....................--.-----------------------------------...••----•---------------•-•. ................................
Date
Application Approved BY------- ------- - - - - - 1pe --•lR-
r/`�.' A�-7 T- -'��'7-.qe..........
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
-------------------------------------•••...---•-•---•--•-•--•-•••-•-•-----------•--•.........--------------•----•-----------•--••---------•------•--------------•---•---------------••--•--•------------
Date
PermitNo......................................................... Issued_-----F `---------------------
Date
No.......
THE COMMONWEALTH OF- MASSACHUSETTS
BOARD OF HEALTH
...............OF........
Appliration for Disposal Works Toustrurtiou Prrutit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
Syst at
, - -4V ....... ........0.........................................................................................
L cation-Address or Lot No.
.......#R_r,0L_0......A..&Z'_jd .... ------
Owner Address
...............................0.................................................................. ---kl-6 ......... ....................
Installer Address
T of Buildin
ype g Size Lot.._-20---- _090...Sq. feel
U -- t
Dwelling—No. of Bedrooms............a--_---_---------------_Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of Persons---------------------------- Showers Cafeteria
P4 Other fixtures
Design Flow.:._.....
.................:...gallons per person per day. Total dail flow..._..__._..........
3 Z.0.__.__....._.__...gallons.
_1
9 Septic Tank-L Liquid*capacityl ..gallons Length_...I........ Width..... Diameter---------------- Depth... .........
Disposal Trench—No..................... Width.................... Total Length__...._............. Total leaching area--------------_----sq. ft.''
Seepage Pit No--------/------ .... Diameter.._..__43......... Depth below inlet................ Total leaching area..?0.0...sq. ft.
Z Other Distribution box (X) Dosing tank
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. -_-_minutes per inch Depth of Test Pit....._. --,f---- Depth to ground water---&0_1...........
f14 Test Pit No. 2_4..��_-.....minutes per inch Depth of Test Pit__._-_- Depth to ground water.4��7-,E
04 ................................................................................................................................................
0 Description of Soil..�#.J... ...0'-I' _LQA A4 4�,5L,!.4-KS -t /I-. -VE4- -, /Z, 'D,
.... ............ ..................... ..q.1.4.. ............f_,,5"e,�1................4.............
..AA-, :F a
U 7 .. .........................r....................
W .1.................
�i .... ... -- ---------- .............----------------applicable.-*-----------------------------------------------------------------------------------------------------0--------
U Nature of Repairs or Alterations—Answer when' ------------------------------------------------- ............................................
..................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TTTLE, 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.
Signed...................................................................................... ................................
Application Approved By....... Date-
---_--------------------- ----
Date
Application Disapproved for the following reasons:................................................................................................................
..............................................................I........................................................................................... ..............................................
Date
Permit No--------- --- =--
.................................. Issued...............................•......
Date
FIE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. ........OF...........
(9rdifirab of Toutpliattre
TH IS ERTI T the Individual Sewage Disposal
Systemconstructed
Zor Repaired
by....._... � ......
. ...................................................
Install
at.... ..............-------
�
... ......... .....
.n... /1.r
►
has been installed in accordance with the provisions of TY-IMP of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...M.-I.17vI/.............. dated_....4V/-_1
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
%�%/2�
DATE......... Z./............................................... Inspector ...............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH I
...........
........................... `.d
F
7 X T ..a..h...........OF.........
No....................
i
Disposal ork onstrudwitt rrrmit
4"
'ission is hereby granted......
Perm V41-c-e
I .. ....................................................................................
to Construct or XWair ( ) ndividual Sewage )os System
0 .......
at N .... _jq....Ah
Street -
as shown on the application for Disposal Works Construction Permit ------ Dated.....
41o_-13�'77.............
...........sw
................. .......................
Board of filth~
.........
DATE......
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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N- 20 DES /GN LO1`9D //VG /S USED . P;eOPOSED LEAeH 200 ,g7'
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f3F3,etiJST�C3�.E �-/EF� LTH �EGULAT/ONS SILL ELEV TO BE > FT. /;ROVE eD.
TOP OF Aeoopo-w T y P / C tq �L O F l L E 2 47
FO UNDAT/ONE 'Z,,$' N Q S C A /_ t ARE,q ��OVE LEAef�
✓ 1/'-'IPIEeV/OUS
Mf�NHOLE4 COVER TO EXTEND TO 7'O P)eEVEn/T F/NES
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L O C A T / O N . MfA, ,570 �tAL�J yG
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R E e,E ,e n/c E : Z3 E/nJ G L o 7- z S S Sr/O No. us �
O/-/ A P L A n/ E D /!V T,-/ EE AJ-
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PL �nJ �Oa/c 2'�4 F'�GE 3
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SHOT✓ N O,U TN lS PLEA-) / 5 P20PoSED • `it( OF � ,9nJD BCD F e 0/"1 F_100 T/OAJ.
on/ Tr/E G /e o U/.1 D s S H O 4,✓ E/e Eo>v
D T ,y�: T / T D G�E S C O Imo'F O�l�1 � ceORGE —
a ' LOW, P. DATE T/ TL E
7-o THE 8 U/ L. D / ^iG —
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p- /S; � SU0E DATE B OBI e D OF �! EVIL H
D/' T9 AEG � f1ND SCF� VGYox- 1,9PPRoV_ F� GEn17
i
ASSESSORS MAP : -4 �Z�j
- - --- -- TEST HOLE LOGS
PARCEL : -At �j '
tit I) 'I lie installation 51ia11 co"oply with Title V m;a 'f own ol,??� fftllmlld of
0 � �� SOIL EVALUATOR , �1 Vvl Ilealth I?egu1,1601is.
FLOOD ZONE : �-p� "
WITNESS . 2) 'I lie installer shall verily the location of u(ilifies, sewer inverts and septic
REFERENCE: � " �
� ��Jit� �b✓v _ _ � � � � DATE : .�V K_I 1 components prior to installation and selling base elevaliuus.
—4 �� �� PERCOLAT I ON A'E: L 7i�1 A 3) All gravity septic piping to be 4 inch Sell III PVC at I/8" per li>ot. "I he first
� I Y �SQt I two Ieet out of(lie d-box to the icaclung shall be level.
TH- 1 I 11-11-2 4) 'I leis plain is nol to be utilized for property line deterniinn(ion nor ally other
purpose other than the proposed system installation.
y� jly�/ 9 4 �r Cep 5) All septic components must meet 'Cille V specificalions.
6) Parking shall not be constructed over If 10 septic components.
1L5(o t LD to 7) The property is bounded by property corners and property Imes.
-3 /& 1(p�' 1 8) 'Hie property owner shall review design considerations to approve of total
LOCATION MAP �I design flow and number of bedrooms to be considered (or design. Receipt
�Wt�j ,l� of payment for the plan and installation based on the plan shall be deemed
Capproval of the design flow by the owner.
lb R.7 9) "I he existing leaching or cesspools shall be pumped and filled with material
I per"title V abandonment procedures. 1 hose within the proposed SAS shall
be removed along with contaminated soil and replaced with clean sand per
"Mille V specs.
�► 10)System components to be 10 feet from wa(er line. Sewer !roes crossing the
water line shall be sleeved with 4 inch SCI1 40 PVC with ends grouted if
applicable. "I'he proposed SAS is being installed below the water service
line. "I'he line is to be sleeved as aforemeniioned and maintained in place.
SEPT I C SYSTEM DES I GN 1 1) If a garbage grinder exists it is to be removed and is the responsibility of the
owner to ensure such.
FLOW ESTIMATE 12)"I he installer is to take caution in excavation around the gas line ifsuch
�biq
- exists.
to � 13)"fire installer shall verify the location, c uantil and elevation of the sewer
BEDROOMS AT 110 GAL/DAY/BEDROOM GAL/DAY Y 1 Y
lines exiting the dwelling prior to the installation.
- --- — 14)"1 his plan is representative only that a system can fit on a property meeting
SEPTIC TANK
"I ide V requirements.
to GAL/DAY x 2 DAYS - GAL
;.� USE «�t) GALLON SEPT I C TANK Ej<l 1�`c3V MAST 0%
41
o o 1�1Vei � _ .;�( 111�1� Q07r 3``�� QPg� 1 4p�j o,+
S01L ABSORPTION SYSTEM--- --- oz �PSON �:`..� �� �?,q��
DAVID
to i7�4
t - (tti tut 1,Uu1 I `J Ul�.lcfLL7l�1�1� 0 /i 9 s`<.t R�r� 366
i
_s l_71 f( -- - QQ
SIDE AREA: Zx Z`J ,+ Ise
NIASO �1 ♦ Qt......r: •
B(ITTOM AREA: �p 1 �C ��—1 z��j,S v No tassj -,
PP /STE
\D SEPTIC SYSTEM SECTION DAVID
VI
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MASON .T I
yi 'v 9 N0.1066 ~�
CO b i-(O
�lST
id I
(0 1 /4 1
cue,fr, rF X4 x,
Co C)GAL wv?71 I '
E� SEPTIC TANK �,ACV w�4hl � �UtnlF,
CDJQXLy ►Aavk, TO 8� —__--_ -- )- -----
�--- pV.-_q,� u ; 1C, raa,,pblf;? i 6J,vq4_,d? SITE AND SEWAGE PLAN
LOCATION :
I -i- 0 6
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PREPARED FOR : �1�N,4AL a'UL_3ZUCrl
l
SCALE: -
DAV I D. B . MASON R5 DATE : 8 I�
DE-C ENV I RONME14YAL DESIGNS
EAST SANDWICH . MA
�� DATE HEALTH AGENT ( ` 08 ) 833- 2 177
}
ASSESSORS MAP : -4 IZ�j _
P �- 3 1 EST HOLE LOGS
PARCEL :
,� L+ -- ,'� 1) 'I he installation shall cornr:,5 with Title V a!;:l 'fo\�n of� Iwtllmud of
FLOOD ZONE: _ I� 01 � C�O�� SOIL EVALUATOR :D ) �VVI L I leallli Itegulalions.
WI TNES9 :�I r� 2) I Ire installer shall verily the location ol-ulilifies, sewer imcrls and Septic
REFERENCE: 1�'i _ �o � �� DATE: _�ULM I Z1N1i5components prior to installation and selling base elevations.
PERCOLAT I ON A I E: .G 1 3 All gravity septic piping> to be 4 inch I1 'V a " per to re
�� ) 6 Y I P I 6 Sc,h I I C , t l/8 I ot. I I lust
--i Io�J, two legit out of the d-box to the icaching shall be level.
P
� Z - _YL 4) I his plan is not to be utilized for property line deterurinntion nor any other
�N- I TH_2
purpose other than the proposed system installation.
t-t)42OWN , 1-}At2`�J�I,Cct 5) All septic components must nieet 'Citle V specifications.
LI 6*1 � � � 6) Parking shall not be constructed over I I 10 septic components.
j l � 10 ;r1.� 7) J'lie property is bounded by property corners and property lilies.
2� /� ��' 1 7A [g (o" ` 8) '['lie property owner shall review design considerations to approve of total
LOCATION MAP 1 design flow and number of bedrooms to be considered (or design. Receipt
SNvof payment For the plan and installation based on the plan shall be deemed
Capproval of the design flow by the owner.
9) '1 lie existing leaching or cesspools shall be pumped and filled with material
per"title V abandonment procedures. Tliose within fire proposed SAS shall
be removed along with contaminated soil and replaced with clean sand per
Title V specs.
10)System components to be 10 feet from water line. Sewer !fines crossing the
water line shall be sleeved with 4 such SCI 140 PVC with ends grouted if
--��� applicable. 'I'Ire proposed SAS is being installed below the water service
line. "the line is to be sleeved as alorernen6oned and maintained in place.
SEPTIC SYSTEM DESIGN 1 1) If a garbage grinder exists it is to be removed and is the responsibility of the
owner to ensure such.
N FLOW ESTIMATE 12)'I he installer is to take caution in excavation around the gas line it'such
�biqexists.
I - l3)'fne installer shall verif the location, c uantit and elevation ofthe sewer
BEDROOMS AT ID GAL/DAY/BEDROOM �� GAL/DAY Y l Y
lines exiting the dwelling prior to the installation.
—� SEPTIC TANK I d)'I his plan is representative only that a system can fit on a property meeting
1 �j` _ _ "1 ide V requirements.
GAL/DAY x 2 DAYS - GAL
W OF
ZN Of M
! j 2 USE IL GALLON SEPT I C TANK E)1� �����AVR) DAVI
qss�
Vj
DSO IML_ _ BSORPTION SYSTEM f f ON7i ti
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f 1 (, `J.�b '� l�-1 J `��; ►Tay �j ��
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SIDE AREA: x Z�J' �' I� f�r1 �Z.
�ailb II — BOTTOM AREA: 2.0 1 X ��-1 _ Z�a,S" 1VlASON }
1066 b0.
353 IMP s , OF
SEPTIC SYSTEM SECTION
f�as 1D �G 1
(� SOIL
No.106 4D �\
/STEJ,
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- b �� - =�U . �3�81 ;
GAL (a?j V��1 a�11
SEPTIC T K ''Il,f�/O��� 'j -) CCU �t4h11� W�
jt;�, ' if _rk 112 fib V Uw,'7�fi� � -
►� CoOPIJ-y A4,� Th ?�C -tD 12-AP& liw ftub► ,
-- emu—
�� SITE AND SEWAGE PLAN
!"— off.c ►�- ►Q.c�-_ _ ► _ _c � _ 1
L.00AT I ON : #CAD C V�I� "3AKjrk D
PREPARED FOR :
o ,
SCALE :
l DAV I D B . MASON RS DATE : 8 8> (5,
DBC ENV I RONMENtf AL DES I GI4S
w DIST SANDWICH . MA
z DATE HEALTH AGENT ( `_;08 ) 833- 2 177
ASSESSORS MAP : � �Ztj
- - - - TEST HOLE LOGS
PARCEL :
I) 'I he installation Shull cunttAy +vith "l'itle V ali,1 'town of?41,J%V-bhmard of
FLOOD ZONE : 1~of SOIL EVALUAT )R : 04 I leallli Regulations.
_ W I TNESS : —D—,�.' I ) Y l
2 'I lie installer shall verif the location of utilities, sewer invt:rts and sc ttic
_ REFERENCE: _ I�i --�o �� �� DATE : JOU4 ZI 1 components prior to installation and seltinV base eleva(ions.
PERCOLAT ION i ATE : .G. 2,m . 1 3) All gravity septic piping to be 4 inch Sch ,10 Pvc, at 1/8" per loot. 'I be first
two feet out of the d-box to the icaching skill be level.
4) 'fhis plan is not to be utilized for property line delerinina(ion nor any other
- TH- I TH-2 purpose other than the proposed system installation.
I y �lyli/ — � �� 5) All septic components must ineet Title V specifications.
LI "1 6) Parking shall not be constructed over 1110 septic components.
6 C 1'o( "�'`� 7) The property is bounded by property corners and property Bites.
Z� �� �' 8) The properly owner shall review design considerations to approve of total
LOCATION MAP �W design flow and number of bedrooms to be considered Ibr design. Receipt
of payment for the plan and installation based on the plan shall be deeuted
Capproval of the design flow by the owner.
iC�,�-� ►� l� �`� 9) the existing leaching or cesspools shall be pumped and filled with material
I I per'hille V abandonment procedures. l'hose within the proposed SAS shall
be removed along with contaminated soil and replaced with clean sand per
'title V specs.
l�� ,..,, "� �► 10)System components to be 10 feet from water line. Sewer !;nes crossing the
�7__ water line shall be sleeved with 4 inch SCI 140 PVC with ends grouted if
applicable. "l lie proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
SEPT 'l C SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility ol'the
owner to ensure such.
A� FLOW ESTIMATE 12)"l he installer is to take caution in excavation around the gas line if'such
- exists. , .BEDROOMS AT (�� GAL/DAY/BEDROOM GAL/DAY l3)"Fite installer shall verity the location, quantity and elevation of the sewer
lines exitinfj the dwelling prior to the installation.
SEPTIC TANK14)'I-his plan is representative only that a system can lit on a property meeting
I 5 _ 'I itle V requirements.
\`
l to to � � / GAL/DAY x 2 DAYS - � GAL
USE '-LAU GALLON SEPTIC TANK
t
71 o t L aBSORPT I ON SYSTEM
lit
U
Zt
ZX + 8
t - AVID cy
S 1 DE AREA: Z5 I� x Z�
— ✓MASON
BOTTOM AREA: X 0 C- zed,S
N0. 1066 (� �
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S�E
tNNAR� �.
° SEPTIC SYSTEM SECTION
a-ri Cie
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d q
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)GAL �o�J� l Ft�. I,f�+r' (E!�{j ��7,�, , I f + I ��
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� � � � (o _ dam_' _l�' -(�IFL -DfL►�(�t. Ih � �l�i I'��U�t� /� �. � ,�� c�
amy - A&k/ Tb iDC --M
'�F I�(i �v�1i-_l y _�-�J�i SN�U�_ -
�-_ � � - -;� ;i SITE AND SEWAGE PLAN
LOCAT ION : #C�o Cvvi"Al"
��-
t PREPARED FOR :
l 9
I
SCALE :
DAV I D. B . MASON RS DATE : 8 ��
DB.0 ENV I RONMEN�AL DESIGNS
EAST SANDWICH . MA
W DATE HEALTH AGENT ( 508 ) $33- 2 177
y
Z