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HomeMy WebLinkAbout0040 DEBBIES LANE - Health 40 Debbie's Lane Marstons Mills., A- 011 -009 ` i i I - i TOWN OF ARNSTABLR LOCATION;•&/'q , SEWAGE#&2Dz;�— `VILfAiGE , ESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NIQX. 4 a M f 2 SEPTIC TANK CAPACITY la) ?4V/6,7 LEACHING FACILITY: (typ g;F) e+2 (size NO.OF BEDROOMS OWNER C 6 e- 1A A PERMIT DATE /Sp " 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 �� , as e a�' a�'�a �a _ . �� �� 4 �� � . - No. —�o? FEE$/00PW COMMONWEALTH*-OF MASSACHUSETTS Board of Health, (���� APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT -� CID Application fora Permit to Construct Repair Upgrade ;> ( ( ( Abandon( - ❑Complete System U Individual Components ho a..A Location Owner's Name f; Map%Parcel# Q/� Q�9 � Address (� ¢7E��/��j 1 Lot# Telephone# a Installer's Name Designer's Name Address C07 '77— Address Telephone# Telephone# Q Type of Building Lot Size sq.ft. Dwelling-No. of Bedrooms Garbage grinder( } Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.r qui ed) �� gpd Calculated design flow Design flow provi ed gpd Plan: Date e� 5 re.LNumber of sheets ' Revision Date Title LL -4 Description of'Soil(s) U V 11 AA AA Soil Evaluator Form No. Name of Soil Evaluator •VV 1 Date of Evaluation I 2 201 DESCRIPTION OF REPAIRS ORALTERATIONS qLC�YW G� W The undersigned agrees to install the above descnb d Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furth ee o not to lace the system in o a n until a Certificate of Compliance has been issued by the Board of Health. a Signed Date Z Inspections No. FEE J (J�. _ Q�:� SS HUSETTS 'COMMONWEAUTIV, VP AC Board of Health, � `� .-I"' MA. APPLICATION FOR DIS POSAt/SYSTE I CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( Upgrade( Aba,Sdon( ❑Complete System ❑Individual Components LocationLC/ � ?" / Owner's Name .00 Ma /Parcel# / a P L"�E�✓0 Address � � Lot# • Telephone# n u• I staller's Name. Designer's Name Address ress Tele hone#` ,f �,,—> r / r �' C P r . `�"�,fC"`'"' �!� �t--'� ,� Telephone# Type of Building 1�7`�-11! ,�t �i L r Lot Size sq.ft. Dwelling No. of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),'Cafeteria( ) Other Fixtures 1 J r Design Flow (,min.required) gpd Calculated design.flow, Design flow provi ed R "1"� / gpd Plan:. Date 1 r tDIP> Number of sheets M Revision Date . ,. Title Description c;soil(s) ..-AD1 Soil'Evahiafor Form No: Name of Soil Evaluator Date of Evaluation , DESCRIPTION OF REPAIRS OR ALTERATIONS • f�t��• �',-�'�'�•�,�,�1�>•�� 1;�� � �,��'�.� !fir?�'�� '�� �1(� . � � ,� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furtherpagrees t/o not to lace he system in oeiation until a Certificate of Compliance has been issued by the Board of Health. Signed -a 0- iP Date V*%j inspections : f 1 1. •,A?• :'(r.. C^C^L. .�;5.-,:r�"J, C-.C..c 9C'COMMONWEALTH OF MASSACHUSETTS :f. '•(y!•„_C. {rS l.. �JJ :.1 �' I:t;V•,^ l,r "C'nr,nLC .. n.. .1n. n�^�.n.� ,, F.�`�rf,�y.—,� , =No�_.Y',J 1��'"' �`•�rtJ FEE /l.�.J �, Board of Health, fi A-. .. MA, CERTIFICATE Of COMPLIANCE Description of Work: 0 Individual Component(s) 0 Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired (�),Upgraded ( ),Abandoned ( has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. nJ�+��/�/R dated'4111'I!!A Approved Design Flow (gpd) Installer t� Designer: Inspecton�_a _ Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. < I • .. .. 4 .'fJ ..;,... �f'o f ,�- _r"^, ._ .. _ .._ ">J�C!?4 ,Ct,• fir: -. _ - i No. /+4� v I�f / FEE_ r vr ii COMMONWEALTH OF MASSACHUSETTS Board c f Health, MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( h')"A ab ndon( ) an individual sewage disposal system at "'I /' l .k� [ as described in the application for Disposal System Construction Permit No�,GY1,♦•-JZ1� ,dated / . A, Provided: Construction shall be completed within three years of the date of this permit/All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Chadeslown,MA Date �I Board of Health 1 �" Town of Barnstable Regulatory Services Richard V. Scali,Interim Director ensNsras�, .039. 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: ? �' Sewage Permit#v20/&—fa/6 Assessor's Map\Parcel Designer: InstallerI. • e M p aL-0-/Azqf e1,13T, Address: �� f rj�- Address: On l ��aPpi;li� C-�/1��; was issued a permit to install a (date) (installer) septic system at 4Q — based on a design drawn by addreSO dated 7 / (designer) y 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 stem but in accordance with State & Local Regulations. Plan revision o al R ationsr P system) gul certified as-built b designer to follow. Strip out if required)was inspected and the soils Y b'n P ( q. ) P were fo d satisfactory. I ,IT that a system referenced above was constructed'in compliance with the terms of the p val letters.(if applicable) � o�� DAVID s Signature) v 141ASON No.toss a . �a/STE�w S'iNfTAR '� (De ' er s Signature) (Affix Des Here)' 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:\Sepfic\Desiper Certification Form Rev 8-14-13.doc II Town of Barnstable P# 1 4r Department of Regulatory Services �w Public Health Division Date M�►ss. w,. 200 Main Street,Hyannis MA 02601 bo Date Scheduled cy'1he Time / 6 Fee Pd. I —; Soil Suitability Assessment for Se e Disposa Performed By: Witnessed By: _ LOCATION_& GENE INFO_RM_ATION__ _ Location Address O ems►- � ` Owner's Name �'yf /`� AddressM(_3 Y�� 1 Assessor's Map/Parcel: o J/�/ Engineer's NaNEW CONSTRUCTION REPAIR Telephone# V� 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) 1 Parent material(geologic) Depth to Bedrock 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: tn. 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 Tlme Observation Hole# Time at 9" 1 Depth of Perc li Time at 6" Start Pre-soak Time @ G Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- s M l _ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) '' t (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel -25 Zb i _ _ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil IOther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven e DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other y Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven K' _ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency-%Graven 1 Flood Insurance Rate May: Above 500 year flood boundary No_ Yes 1/ Within 500 year boundary No yYess Within 100 year flood boundary No Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ':j Kilo. If not,what is the depth of aturally occurring pe ious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro en 1 Protection and that the above analysis was performed by me consistent with the requited training,expertise xp ' nce cribed in 310 CMR 15.017 Signature Date FAt i V2j7 ®a te �v - 6M Lxt STD -j t� PAIa ►� G G 34 q6L,1;000� YOU WISH TO OPEN A BUSINESS? 'vk'Y ` 4 For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is. required by law. e3{P t�fk DATE: 6 � � 3 Fill in please: t w, APPLICANT'S YOUR NAME/S: oevJl S-r- 4 OY9 BUSINESS YOUR HOME ADDRESS: yd NM TELEPHONE # Home Telephone Number.- :. Lgy-i I- 00,f9 :jr NAME OF CORPORATION NAME OF,NEW BUSINESS + per' `� �^'(o TYPE OF BUSINESS �I IS THIS A. ME HO OCCUPATIONS YES NO — ;,: ADDRESSOF BUSINESSsMAP/PA...RCEL:NUMBER I 01 (Assessi.ng] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of permit requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION Authorized Signature** L� _ U ES AND REGULATIONS. FAILURE TO COMMENTS: TIN FINES. 2. BOARD OF HEALTH This individual has aeen i�flq r}�_ed of the permit requirements that pertain to this type of business. MUST XMIPLYWITH ALL (— P& � I I "AZARDOUS MATERIALS REGI_II ATIMIq Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE Date:�. � TOXIC AND HAZARDOUS MATERIALS ON-SITE NAME OF BUSINESS: SM1. 4e4&j m4h3m.06 BUSINESS LOCATION: 40 OcGIUZS LfQ Mr1P'>10,`'g M S INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: .5109-6 f- coos CONTACT PERSON: %imotJ4 Sao EMERGENCY CONTACT TELEPHONE NUMBER: 4'09' 6-2- 1004 MSDS ON SITE? TYPE OF BUSINESS: r��►s A��T�"'� INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes eu,0'7 S7-044E� , Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers - Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Appl a 's Signature Staff's Initials Bk 22601 P8 28 40-1916 :54tx -q Or damstable ' _..3f1dR H'1A{fr1A A11!l�rPJnf seek legal advlcs to prepare a property worded'deed resbtctlon documerrt. DEED RESTRICTION WHEREAS, (ownePs name) Of (addmss) is the owner of ideated" 11 (add ) at MA(hereinafter referred to as and being shown on a plan entitled "Subdivision of La d in�} Mare{ems A i�S MA, Property of �>^u et al, deity recorded in Barnstable County Registry Of Deeds in Plan Book q`e 7 , Page Or on Land Court Plan Number WHEREAS, ,M ' n� ' `as the owner of"said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number"of bedrooms which can be Included in any home built on said lot as a pre-cohcrdion to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code,Tifle V, Minimum Requirements for the Subsurfaoe Disposal of Sanitary Sewage; WHEREAS,`the Town of Barnstable Board of Health, as a pre-conditionlo granting a disposal works construction permit for a septic system in compliance With 310 CMR 15.200, State Environmental Code, Tittle V, Minimum Requirements.for the Subsurface.Disposal of Sanitary Sewage, and authorizing the issuance of a building.permit for the construction of a•single family home on this property, Is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable Gounty Registry of Deeds by recording this document, dwdr• v Bk 22601 Pg 29 #1916 NOW, THEREFORE, Q-n�oM4 57-�&'�,does hereby place the {owner's.name) , following restriction on his above-referenced land to accordance with his aar�t ,whieh-resbietiart shaft run with the land and be binding upon all.succ essors in title: 9. �10 6--Cbb r-s l��r�,. N(�� � may have constructed (addtessj ' Qupon the of aVhouse containing no more than 4kvw, (3) bedrooms. . ,, aN a • Sear, agrees that this shall be permanent deed (owner's r�asne) restriction affecting located on _.Nt grb4L%,5 'l t MA, and . being shown on the plan recorded in Plan Book goy X-1 , Paged cam-[6. Or on land Court Plan For title of Aj see the following deed: Book. 6 y T7 , Page o Lt 6 . Or Land Court Certificate of Title Number Exeart s a s 1 nt &—day of . Owner' ' nature 0 s signature , Owner's signature COMMONWEALTH OF MASSACHUSETTS ss d Then ovally ap are the bove-named n�M � own to m to be the erson who executod fire foregoing Ins um' -an P reg g i.. acknowied ed the same to b free.act and deed,before me, t Notary, ` .. Public r ,.., My commission:e' 9 `�:' eu• BARNSTABLE REGISTRY OF DEEDS f - Bk 22601 Ps28 �1916 01-14-2008 a 08 _ 54cc ..ot Or damsteble ' -..dMa that fha a1 oicen* seek legal advice to prepare a Property worded deed resst kUoo document. DEED RESTRICTION n nn� WHEREAS, 12a4maj •etoS 00VLMra _q -�ect of (owner's name)`t " om Mysf£JnS l�r MA (address) is the owner of '�� O�bb�e� �,«K�' located _ (address) at F� drSmK, 1�/l;lid MA(hereinafter referred to as and being shown on a plan entitled "Subdivision of La d in MA, ProPerty of et A duly recorded in Barnstable County Registry Of Deeds in Plan Book lv q -7 , Page ©y G Or on Land Court Plan Number WHEREAS, " 'c J- �„+ ,ea h 'as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number.of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit In compliance with 310 CMR 15.000 State Environmental Code,Tide V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; ' WHEREAS, the Town of Barnstable Board of Health, as a pre-condition.-to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface.Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of asingle family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, agar 7� c. TOWN OF BARNSTABLE I_OCATION `r,j r,�(,, �� �_ , � SEWAGE # VILLAGE ASSESSOR'S MAP & LOT ..( INSTALLER'S NAME Si PHONE NO. Cc% Cp�Q S p O\C-S IQ—g%l SEPTIC TANK CAPACITY 1000 ��ec4�ss LEACHING FACILITY:(type) , C00creSe ize) xy �- NO. OF BEDROOMS PRIVATE WELL OR IO BUILDER OR OWNER ``, �c>tneS DATE PERMIT ISSUED: DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No v ZI) s 3 Fz/ EIOAR%� H Application is hereby Aade for a Permit to Construct )"or Repair an Individual Sewage Disposal Sys L cat' n-Address or Lot No. T of Building Installer Address .....Sq. feet Septic Tank—Liquid-capacity,,�d��D..gallons Length.rc�.Y..... Width./�:Z.... Diameter................ Depth. Z Disposal Trench—No..................... Width X-, Z Other Distribution box Dosin Percolation Test Results Perf ed� t P nc erpth of Test Pit.................... Depth to ground water....................... P4 --__''-------_l^�'---_-______ - �� D c6So�-------'-'--'-'-'---'------'-'-_--'------'-------------------_-'-_'-'---'---------'------_ --------'- '-'--'---'---'---------------'---'-------'--'-'------------'-'---'-'----- | -_-__'-_-_-----__--'----'-'._'_--_----------_'-----------.------.-----------------------'-'-_--- � ! -- Nature of Repairs orAlterutions--Aoowmrwhco applicable----..--.--.-.-----_---_----------..----------- __'-----._--____-__--'--____' --____------_..__.--_--_-_------_-_'-'-___--_ Agreement: The undersigned ogc«ea to install the uboredcacribed Individual Sewage Disposal System io accordance with the provisions f TLIIlE 5 of the S S � C not to l t6 � � operation until a Certificate of Compliance has ee d b e board of health. Si mpliance te | Date � Permit Nn......................................................... Iauood'--------------------'-'----'- 3 No..••-••-•••••-•-....... Fps........ ........ THE COMMONWEALTH OF MASSACHUSETTS B0ARD�QF� TH Alrpliraation for Disposal WorksZomitrurtion amit Application is hereby wade for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System, ... ...... {' � ' `-------•---•--------- ...••••-•-••....--••....................... ••••••••................................. _447, zec;tion-Address or Lot No. Address W >,/•__• •...z..F_6�s+rS} - .........••............................ ...................... ............................. Installer Address Y Typt of Building Size Lot.r�,r..W-4.....Sq. feet ,., Dwelling—No. of Bedrooms... ... �,)... ............. ..._..._..Expansion Attic (1111A Garbage Grinder (414 Other—Type of Building �`- :. No. of persons............................ Showers a YP g ---------- ------------ P ( ) — Cafeteria ( ) a' Other fi res ........._ W Design Flow.......... .---------------------------gallons per person P erday. Total daily flow.....0:.........................gallons. WSeptic Tank—Liquid capacity i=*._gallons Length.�i.._._..._.. Width.V- !n .... Diameter................ Depth.... ........ x Disposal Trench—No..................... Width ....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit ------ Di meter... A,.-:___..... Depth bDel^ inlet..... .......... Total leaching area ,,��q. ft. Z Other Distribution box ( Dosin a ( ) ~' Percolation Test Results Performede:.�.................................................. Date_. . .a�-`" � ,f .. ---------------- ,� Test Pit No. I................minutes p inc epth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes er ' h Depth of Test Pit.................... Depth to ground water........................ .............................. _ iT-------- ...... ---.............. -.............. .---------- •--------------------------------------- ------------- ...... DDescription of Soil.............................................._____....------••--------•-•--•-•----•-------------------------.......------------------------•--•--...---•-------------- 3 W /.. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------•------•-------------------•••••••••-••-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sa$ao —The u dersigned further agrees not to place the s s e i operation until a Certificate of Compliance hed y e board of health.Si ` - DateApplication Approved BY------•--••......-----•• .... ...•--•-•-•-••--........---•-•---.•-•-- Date Application Disapproved for the f o in reasons---------------------------- ..................... ............. _ ......-•------•------------•----------••-•---------•---------------------•--•-•-•-•-------........-----..............._........._...----••-•-•---•-•---•-----•••••-••-•-•-•-•---------•_.._..-----•--•-•- Date PermitNo.......................................................-- Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F �,�ET ........................OF....! ...................... ! . .... Trrfifiraa#r of Toutpliaatta IS IS T 1#I 7, Tha/the Individual Sewage Disposal System constructed (,,:,)"o Repaired ( ) ....tip ...'� �...?.� 'r i 1 - nstaller L� ' at...... v ............ ----==--R---•-----------------------------•---•---•-------------------•---•------------------------••--------- haF been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... `_.6.. ... dated.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL FUNCTION SATISFACTORY. DATE............ - Inspetor..... f}I:�I�N1 .................... ...•. ... . WGEERt INSTALLATION ST SUPERVISE �+ AND CERTIFY IN yy ING 1HE COMMONWEALTH OF MASSACHR8. }fS6TEM WAg INSTALLED IN $ pG' �RDANCE TO pLAN. T � BOARD, F HEA TF�,a oil,"�,�'.:.....................0 F....... t ..! F r . � Y 4 .-................................ No._. ... � FEE........................ 3.q yi A ' �tittIltt Permission is he b�grante `:._ • '._+.: �t_ _....__ +° ._ _ ._._.__ --._....... ..................P ...a to Constr o R ,pair ( ), victual Se ge isposal System "7 . 1 atNo ._......... -•--•-------•--.......... !........ Street C G r.. as shown on the application for Disposal Works Construction Permit No._z ...:_._.__.` Dated.......................................... .............................•............. .... J ..................................... rd of-Kea DATE----------- --- --- -------- ---��-•--•---•--•----•--._....__......---- FORM 1255 A LKIN, INC.. BOSTON .OH � � N oT JACOB s .Y. . of _ _. WEaL�N � s 1? _ $FPS �y. :�� �' s yi1 3Tb ♦ 1 `w —1 e i 1 J'i i Co ` 17 �. lu Pj 0.0 T- /* , .o. - f a dot �c O� : - � S• IL y _ . .. 3170: Aso i t . h : 4V. � UPPERCAPE. ENGINEERING. � Pa�:>r 4 , aT P.O. BOX 616 LD T' ` � SCA1 %o. E. SANDWICH, MA 025irKt yyam�++ . 'E'"�artment of Environmental Mana'g'ement/�. Division of Water sources S `' 310 WATER WELL COMPLETION REPO // vvecL'LOCA ION Address��6 ^ City/Town� s�/25 G.S.Quadrangle Map Grid Location Owner cDQCeU 1*nes Address ,,WELL USE CONSOLIDATED WELL Domestic Public ❑ .Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones 11 From To Method Drilled. QQ /� 2) From To Date Drilled �7� �(Q 3) From To 4) From To CASING Depth to Bedrock Lengthy CJ �D�iam/gter Q Type '.�i/ UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing'Materia Feet below land surface �-- �jjL Sand: fine[medium[0'* coarse❑ Date measured Gravel: fine❑ medium❑ coarse[] Screen: GRAVEL PACK WELL J slot#��length�from to Yes ❑ No Split Screen (or 2nd screen) WATER O ITY TESTS MADE Slot# length from to Chemical Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days#hours at �GPM. How measured % Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To n. n' m DRILLER Firm Qq J Address F,06 l��77 rp�ef 'V City /—Q y i c.�UYE 160 Registration No. U� Operator s Signature Please print rim y CUSTOMER COPY 25M•10-85.807101 --'-----"--'--- - - _EL. TOP OF FOUNDATION CONCRETE COVER -- CONCRETE COVERS.,;. 4 rnr CAST r IRON 777 >r,�;r`'�fi�.nr-��.nrirrrry t t' I •, ° i MAX. \ m»r• >,.�,m�F�XO ,i- i OR SCHEDULE 40 1y 12"MAX.. P.V.C. PIPE �- 4 CCHEDULE 40 PVC (ONLY) _.T i, PITCH 1/4"PER.F PhFF - MIN: LEACH PITCH I/,;'PER.FT PIT PRECAS -INVERT ^LEACNI N 4 Y SEPTIC TANK( 114VERT GIST . INVERT ° . �w o.: PIT OR INVERT E:L.SSX.Z• . . J. f10X ELrW... >_ EOUIV a U cFi LLI/r..... .. INVERT i, X:. ww 3/4 :TOI EL. I, ELS9XS �y: r ` WASHED STON f i I '/0 6'D I A. D I A.� PROFS LE_ OF +ND GROUND 1UATER TABLE g:. SEWAGE DISPOSAL .SYSTEM NO SCAL!: 7S i . S I L LOG WITNESSED BY * ATE TIME. . . .. . . :. DOAFZD OF HEALTH 4.11 .JEST HOLE I TEST HOLE z VPPERCAPE. EN.GINEER.ING ENGINEER ELEV. ELEV. .. . . , . P.O. BOX 616 . E.` SANDWICH; MA 02537 362-6 6TSIGN DATA NUMBER OF BEDROOMS 3 , , TOTAL .ESTIMATED FLOW .. .3 <� , GALLONS/DAY I DOTTOM. .LEACHING AREA l/3, , SO.FT. /PIT SIDE LEACHING AREA . . .. '.���. SO.FT./ PIT' GARBAGE DISPOSAL ,. . ! (250 % AREA INCREASE) '101'AL LEACHING. AREA �63 . SO.FT' E D a �( � --— ' PERCOLATION . RATE/�S S. . 2. MIN/INCH LEACHING AREA PER PERCOLATION RATE . . . . . . . SOFT. ..N.a.WATER ENCOUNTERED Nl.!^NDER OF LEACtJ�ING . PITS oft; APPROVED . . . . . . . . . .. �k 3r/430 - 113 /BOARD OF HEALTH J. DATE. . AGENT .OR INSPECTOR 4T JACOJOHN BI i } N0. 814 �RCE.Y /0Z t S PETITIONER Y i t Upper Cape Engineering P.O. BOX 616.EAST SANDWICH, MASSACHUSETTS 02537 I (617)36Z6281 I \ I I I I I / I ���r„y��� k.; � . AsBuilt Page 1 of 2 �..r� �fn TOWN OF BARNSTABLE ff` LOCATION -'� Imo' , SEWAGE VILLAGE C '�c�Y�� t 1 C ASSESSOR'S MAP 4 LOT 11 INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY �ceCASv LEACHING FACILITY:{type) Ccmc re e ize) )(q c- NO.OF BEDROOMS 3 PRIVATE WEL OR O BUILDER OR OWNERQ�pQ.y \&pme5 DATE PERMIT ISSUED: Q DATE CO3IPLIANCE ISSUED- VARIANCE GRANTED: Yes No y ti 6S W v n h dive I) http:/!issgl2/Intranet/propdata/prebuilt.aspx?mappar=011009&seq=1 8/21/2017 l ASSESSORS MAP: 1� TEST HOME ! LOGS PARCEL: l The installation shall com with "Title V and Town of [ oard of i ` SOIL EVALUATOP: I l(I G I lealdi Regulations. FLOOD ZONE: WITNESS: .2) The installer shall verify the location of utilities, sewer inverts and septic REFERENCE: 2x _2 - DATE: , components prior to installation and setting base elevations. PERCOLATION RATE: •� 2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first ' -- -- `'!-- -- --- two feet out of the d-box to the leaching shall be level. 164 -1, I yr/' ,TH�O� 4) This plan is not to be utilized for property line determination nor any other I u� purpose other than the proposed system installation. _�_ ( I_ � 5) All septic components must meet Title V specifications. ; 1 6) Parking shall.not be constructed over 1110 septic components. /, 7) The property is bounded by property corners and property lines. ✓� 10 �-10t I'0 (oj qq ,'� ; 8) The property owner sliall review design considerations to approve of total I 7�t Vv ;. design flow and number of bedrooms to be considered for design. Receipt ' LOCATION MAP 4 ►�!�D, of payment for the plan and installation based on the plan shalt be deerned approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material ! ' (� '� I �'b`�VL� per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per ' 4 Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossingthe I water line shall be sleeved with 4 inch SCII 40 PVC with ends grouted if , applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place. SEPTIC SYSTEM DES I G N 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. FLOW E 31'I MATE 12)The installer is to take caution in excavation around the gas line if such I exists. 77 �z BEDROOMS AT �1d GAL/DAY/BEDROOM - GAL/DAY 13)Tne installer shall verify the location, quantity and elevation of the sewer lines exiting the dwelling"rior to the installation. 7 176 I 14)This plan is representative only that a system can 6t on a property meeting 30 ~ 2.8 E .� Io ►�tr�, SEPTIC TANK i Title V requirements. �— 3_X�'GkL/DAY x 2 DAYS -� GAL �Z � % ° Zt USE �' GALLON SEPTIC TANlG> 0 to `S01 L AE3SORPT ON-SYSTEM ' f O r�r 4 ' 50 / DAVID SIDE AREA: 2 X �✓ "4- 01 I �� o B. G. i MASON m M " t BOTTOM AREA: -+ No.1066 v may, Go SEPT I C SYSTEM SECTION �- - 1 - MARK to ���EY3 +� 1� l0" I`I� r I)Fjr c q 1 L O I GAL �bg ;1^ ° ;. v�° (o(o►tJ� J L7 i SEPTIC TANK I t ` pb K AoGv j lb AND SEWAGE P �I SITE A LAN LOCATION PREPARED FOR : � L►W G'o N 01 M T SCALE: ( = . iF DAV I D B MASON I6 DATE: 15 Z DBC ENVIRONMEN AL DESIGNS EAST SANDWICH , MA 6 DATE HEALTH AGENT ( 508 ) 833-� 2177 z ; i - --