The URL can be used to link to this page

Home My WebLink About1239 OST.-W.BARN. RD - Health 1239 Ost.-W. Barn„ Q,� �y—.0ad Marstons Mills A= 125 — 036 I v n ,n � ��SS.►7t"�'�" y 14 Pic` Nj a 2 5*61-b� d r r _ TOWN OF BARNSTABLE LOCATION 1239 ps4cru:11c t-o. S osr, WSEWAGE# C:90/i3 --/ 5%- VILLAGEr�.rS4onS 1A 115 ASSESSOR'S MAP&PARCEL /v'9-5 —0 3 INSTALLER'S NAME&PHONE NO. B 4,,B EXcayo-Aron 14r)`1• OG�3 SEPTIC TANK CAPACITY /000 !jo-1 LEACHING FACILITY:(type) LCG c,.,m Ab (-1) (size) NO.OF BEDROOMS �{ OWNER JOS�Uc� �oc�rt PERMIT DATE: �5-2 y- J$ COMPLIANCE DATE: S'-30 •)$ 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 AI'- Az- s► '911 REAR 32- Z3,G A . 56 {33 9�� O AEI. Zy 'I, -- 3y -all 3- 3 0 -Yo ft,—, Oi No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Disposal *pstpm Construttiun pprmit Application for a Permit to Construct( ) Repair(_-� Upgrade( ) Abandon( ) ElComplete System ❑Individual Components Location Address or Lot No. /a�9 �g�--�� 's Name,Address,and Tel.No.jo51,� V.(>v r, Assessor's Map/Parcel /'L S'—03& rn 'm/ S 9 O $O)t Z)O Cc*+aLti;1 IG Installer's Name,Address,and Tel.No.B-:B Eye Ljva_A iO A Designer's Name,Address,and Tel.No. WO r k S ly'ica.ScrrLi La T;res4J*.Ic. qr 7. ,&53 12 tic-M crossrj'r_lal R,.t Type of Building: Dwelling No.of Bedrooms Lot Size ZO �J�9 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) O gpd Design flow provided qq9 gpd Plan Date Z• Z q• a1 L Number of sheets 1Z Revision Date Title Size of Septic Tank Type of S.A.S. LC& - ChcLw S tT"S Description of Soil l I� Nature of Repairs or Alterations(Answer when applicable) 1D S30X ' LC0,e'ki^!j Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b his Board of Health. gn Date Z' Application Approved by Date 0Application Disapproved by Date for the following reasons Permit No. Date Issued R � 1 i No. 431 � -- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWNTOF BARNSTABLE, MASSACHUSETTS Rpplication for -Mispopt 6pstem'Construction Permit Application for a Permit to Construct( ) Repair(✓ Upgrade'(`) Abandon,( ) ❑Complete System ❑Individual Components t Location Address or Lot No. /a` US t-_(�&4(-n a�ear's Name,Address,and Tel.No.,j osF,ua„ V.ou r Assessor's Map/Parcel 12 T —o3G M` M)I J S Z I U Installer's Name,Address,and Tel.No.(3 B Designer's Name,Address,and Tel.No. 6tJ b Wo r Il S jg-rc�.ScrrH LrJ Foresida i c IZ LJc5.1 Cross's )al y�'1• oG53 � R4 14`71•,$'3l3 Type of Building: ; _'�' Dwelling No.of Bedrooms Lot Size Z O !s 9 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �yO gpd Design flow provided y�� gpd Plan Date 2 - Z q • fL Number of sheets Z. Revision Date / Title Size of Septic Tank f Type of S.A.S. LCL - C�a m Z:1-S s "Description of Soil Nature of Repairs or Alterations(Answer when applicable) _ BOX LC<xc W, �Q 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 b this Board of Health. q'ni;ggn�,d " O , Date t, Application Approved by Date ry - Application Disapproved by �_ v y Date for the following reasons Permit No. 17TY Date Issued v J - •THE COMMONWEALTH OF MASSACHUSETTS ` �•�` �, BARNSTABLE,MASSACHUSETTS , Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(w0f) Upgraded( ) Abandoned( )by at 1739 0S4cru',Dc_ w. 43<a1-c B Wen inW ce with the provisions of Title 5 and the for Disposal System Construction Permit N . �� ed Installer - 3 �Xcn. na o n Designer E/J6 t.JOrk S #bedrooms q Approved design flow _ q gpd The issuance of this perrm shall not,be construed as a guarantee that the system wil ctio e i e . Date o Inspector \\ -' ------------------------------------------f--------- -------------------------------------------------- - --- No. � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS o x �JI� Misposal 6pstem Construction permit J �1 Permission is herebyanted to Construct Repair U G �' Upgrade( ) p (✓f Pg bandon( ) System located at Z 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. t 4)1 Provided:Construe o' mus b�com eted within three years of the date of this permit. Date ` / Approved by / . . _. .. 1. .. 11 . I I I dF fNE t °'�,.I2;e; ul� er� Sevres Rtchard V: Scab, Interim Director " BARN$TABLS, *? 1. 9 , ` �, it I Cealth'D(vision 6 � ,� : + °. . Thomas Nkkean, Director . - 200 Main Street;t.Cyannis,,M -02601 i . .; 6ffice:1. 50 =8G2- 644 Fax 5U3 1I.I; U-E�3(} .. -§ lnstaile & ) esYtriiercCer`tifcation Form i wte: , $e�lage".Perrntit# Assessor'I.s l apLParcei' >I y6- �O 11 i Designer; nt, e ,��,�lat�,- trsc Instalier: 'C� "rC�� ddeess. tZ t1.3i C� �e (� Addre 1.ss: 1 , .___- �C .� � — + ro r 'Su L£ i� Zb �{ i't�S7-Gt�t Q L(o 1. x . On t CCt � as issued a"perti- to.install a•.A (date) (installs) septic system a9. l hasctl on a design.drawn by; Tr'e %. G +PL address) `� Ldesiri:r) 1` 1.certify that the septic system referenced above was installed substantially accordizia to the design, which tnay tAe tde minor ap}roved changes szlcli as ,late reloc atio a of the distri1.bution 1 x. andlor s�:ptic tank Strip oc't (if reclu7r�tl) as i-nspectecl and the Sc�ila were found.satisfactory. . I certify that the septic syfstetii referenced abt»c was installed witk'l Zimior clines {i.c. eat ;' t er tha n 10 later 4 r .g c7ocation of the SAS or any verbcal relocation of dny ' ,Donent Of the septic system) bttt in aceord'ance wtth Stan 8I "I �"L�t��al Regulations Plan.revision or c�rtilied as-built by .estgner to follow. ,Strip t tzt(if regtttreIf'd):was ii spec ted acid the Sol Is vvcre fttxnd salistac#rry. I'certify:that the system referent e l above rnas cc�nstructr rtcc tivith tl i"term ofthe I! approval litters (if applicable) r f I. 7'. 51 fit' S 'E I .I ,C + iffit �' :1-- � —— (I . ... 11�9 9. I.......... — I . .:. — - 999 --' e': ., I� 9 . .9 9.11, . � 1 9 9 . 1 9 (I?es19 t.gt�ei's Sil;rrature) (,Affix Desirner s , �a..l. e.r.e) PLEASE RETU.ItN;TO SAW TABLE PU1. BLIC HEALTH D��rISC.€3�91,". CERTIFICATE OF COMPLIANCE..,WILL NOT ,BE ISSUlE.t7 UNTIL '.80TH THIS FORM - AS- BUILT` CARD ARE RECEIVED BY THE$ARNSTABLE PUBLIC HEALTH.DIV'IS>i01\. THANK YO,U.: Q:1Septic.'iDcsi=tier Certification Farrri Rear 3-1A-13.doc . . .. Town of Barnstable P# Of THE r Department of Regulatory Services + BARNWABLE, •) Public Health Division Date MASS. a j 9�a 16)9. `gym 200 Main Street,Hyannis MA 02601 Z RFD MPS w' Date Scheduled Time Fee Pd. CiS -Soil Suitability Assessment for Sewage Disposal Performed By: �.1-t�� f�6 G l:il'Z {� S =JM��` Wihiessed By:__. 6a. ley LOCATION & GENERAL INFORMATION Locatio,i Address Owner's Name r a5i:W J Ji� t CS n V' l4 v f j� A- l�S Address pLl'' 00 X- acc Assessor's Ma /Parcel• l Engineer's Name Z5 NEW CONSTRUCTION REPAIR X ig J•v'l e y` Telephone# 53Y 73? -^�?_7 � Land Use 2e S C7 l 11 0� I„„ Slopes(%) 2n Surface Stones NOT Distances from: Open Water Body /yU(NC ft Possible Wet Area Kft Drinking Water Well Drainage Way P^J//1 ft Property Line 2 /'/®'ft Other ft SKETCH: (Sheet name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) � 2 I 1 � �A t�r� GS1 r2v<LLe —W0 GA-(zf`1Sr6 (3L,� d� L� Patent material(geologic) eJ'/ C' Depth to Bedrock lnr7 Depth tolUroundwater: Standing Water in Hole: Weeping from Pit Pace Estimated Seasonal High Groundwater _ O� y of 1/11 e'A9 ,"^ C_3 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\\yell# Reading Date: htdex Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date-- Time Observation -t- — Hoie# I Time at 9" Zl �t of 2W 5�tlaNs — — Depth or,,Perc /3 9 Time at 6" Start Pre-soak Time @ Time(9"-6") — End Pre-soak ka<-i-W,\ N Rate Mid./Inch Site Suitability Assessment: Site Passed Ul-" Site Failed: Additional Testing Needed(YN) OriginaH 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:\SEPTjICWERCFORM.DOC DEEP OBSERVATION HOLD:LOG Hole# Depth froni Soil Horizon Soil Texture .Soil Color Soil Other Surface(in'.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,°fi Gravel)_,_,_ z , t o s� 10 6L yI-Z.Z. _- -51 i� �2 Li � S C.. 1 c?'�1' -- 7"Z—i ?.a C ZL�:<t l c� y(Z V 3 11-I 'l —7 'y(Z-5/�7 -- I S G,ti c'i Z 5`r 7/ ---> 'DOZ.'DOZ. �f — DEEP OBSERVATION.HOLE LOG Hole# 2- Depth fron) Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,4'o rave v A 51 ` lei*2 V Z_ - -Zr j � 5; l G yl2 S/ tr . -7 Z i 2�' C. yupTe CZ i111_>v DEEP OBSERVATION HOLE LOG Hole# Depth froni Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Grave DEEP OBSERVATION HOLE LOG: Hole# Depth fronn Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten ° Flood Insurance Rate Map: Above 500 year flood boundary No— Yes , Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? > If not, what is the depth of naturally occurring pervious material? Certification �- I certify that on (� ct I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature C Date Q:\SEPTI(-\PERCFORM.DOC I e (1st floor): # / �J 6136 \ N 04 T N E t0 lap and lot number.......................................WFITICi !9T musir of Q`' �♦ alth (3rd floor): - INSTAL':7D IN �:OMPQ.j:' ^E !ermit number :. ". r.,�,. .::................... ti:q" TH TITLE t B,Bd9TGDLE. ng Department (3r floor): ENVfl "MENTAL CODE ti, ' �T` �p 1639• 9� number' .....:.:.. ...:........................................................ TO REOULATIOW.3a �OYAY.a. rive Plan Appr,, ed by Planning Board -------------------------------------__- . :ICATIONS P CESSED. 8:30 9:30 A.M. and 1;00='2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR _ N APPLICATION' FOR PERMIT TO ..:.. ........Q....: - TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r ►z �.....i� 11�fa,�fs �S Location .......................... .............................. ............................. ............ ProposedUse r ......................................... ................................. . .............................................................. Zoning District ....r. ............................ ..... ................. ..........Fire District ... .............................../......................................... Nameof Owner .. .. ..... ............................. ....... ess .................................................................................... Nameof Builder .. ..................... .�................... .................Address .............. 1Q-- '........................................ Name of Architect r..!..1N .�/... :`...!`.. .. . dress ........ ............................ cell f anf� Numberof Rooms ........ ............... ................ ........................ oundat'on .............................................................................. �}- ../� . hoofing &y L - Exterior ......w�! '...j Sd! \.... ...:.( 5.-!.`R ............. `^,"" 6C� .. . .. .. U ./ G/ Interior ........... ...� ..F loors .,...... .... ........... .. ....................... .... Heating �`� .......Plumbing ff Fireplace ..................................................................................Approximate Cost ................✓./„ .......................... . . Areg. ............ .. ........... Diagram of Lot and Building with Dimensions Fe OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. aLi—Z Name ...............................:....... ............ Construction Supervisor's License .. ............... dd .......... 71 I/Cz 411t 1 4 71J t7 III L111� AsBuilt Pagel of 1 TOWN OF BARNSTABLE n v LOCATION_�t,c 3 ,13`i n« �� ';emu i i'La SEWAGE # �'•�- '��f VILLAGE MhcLcr oN S ^ �,c ASSESSOR'S MAP & LOT Z -03-l. INSTALLER'S NAME & PHONE NO.�/C�� SEPTIC TANK CAPACITY / 000 .ALL wJ LEACHING FACILITY:(type)_ P/% (size) 6tt, NO. OF BEDROOMS— PRIVATE WELL O UBLIC ATER BUILDER OR OWNER_ DATE PERMIT ISSUED: •5`1S7i►� ,�p�r,r;f p ��3�58 DATE COMPLIANCE ISSUED: ' VARIANCE GRANTED: Yes No 7 23 '� D http://issgl2/intranet/propdata/prebuilt.aspx?mappar=125036&seq=1 1/15/2016 Commonweafth of Massachusetts Executive Office of Environmental.Affairs Department of Environmental Protection. �. Wllllam F.Weld Gommw �-S '� dy Coxe Arpeo Paul Celluocl `6 s___V/ U.car,« u '(David S. Struhs/ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 1^^CERTIFICATION Property Address: �� Q.✓J• C V Y I'� iv ��5 Address of Owner.u i- Date of Inspection: 6/3 l/`� (If different)G lv[� C ;-t t �Al v.4",f a ++ .� Name of Inspector. A11_1 v'A Tv-tC g _ t�^1 " 1 J 13 >,✓j S Company.Name,Address and Telephone Number. �v q 3 t CERTIFICATION STATEMENT MT I certifythat I have `� Pe �Y inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ F Inspector's Signature: a Date: -7/1 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A. B, C, or D: Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no,or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked structurally unsound, shows substantial infiltration or enfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) l �f One Wlntw Street a Boston, Massaehusetts 02108 a FAX(617)556.1049 a Telephone(617) SS00 292- ii " Pnnted on Recycled Paper f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 1 Q I CERTIFICATION (continued) Property Address: 1� l o 5S c�'V `'c A +A Owner. �G"W► w e✓� ..'tdv A .t}cam c�°� Date of Inspection: 613 7 J. BI SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or static water level oboe— � rued in the distribution box is due to broken or obstructed r si or due to a broken, settled or uneven distribution box. The p system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced — The system requite pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CI FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER. IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for eoliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) Property Address: i 3q 1 0 S k C--1 V.1 l4- Owner. Date of Inspection: DI SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1,2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no .acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for ooliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is withia 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system y well)located in a nitrogen sensitive area water supply (Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.()0 and 6.00. Please consult the local regional office of the Department for further information. i (revised 11/03195) 3 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: l C):'4(.'f V,lI (_ Owner. lJ. Date of Inspection: J Check if the following have been done: X_Pumping information was requested of the owner, occupant, and Board of Health. _None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as of this inspection. W ,s<_ +s vo+ oGL,_,pi A � has -io{ .��1�, As built plans have been obtained and examined. Note if they are not available with N/A The facility or dwelling was inspected for signs of sewage back-up. KThe system does not receive non-sanitary or industrial waste flow The site was inspected:or signs of breakout. All system components,excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or teen, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address Owner. tyo'1ML G' -c;•�G�s /�UA�Ta� +L Date of Inspection: FLOW CONDITIONS RESIDENTIAL Design flow:_, LO p1lons Number of bedrooms:- Number of current residents:Q Garbage grinder(yes or no):AZV Laundry connected to system(yes or no):4L S Seasonal use(yes or no):_IIV T Water meter readings, if available: Last date of occupancy: iL✓t K tic COMMERCIAL/INDUSTRIAL; Type of establishment: Design flow:_gallons/day Grease trap present: (yea or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yea or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) AJU If Yes,, volume pumped: gallons Reason for pumping. TYPE OF SYSTEM _ Septic tank/distribution boxlsoil absorption system Single cesspool Overilow cesspool Privy Shared system(yes or no) (if yea, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known) and source of information: t�✓L K-'Ve ,.. Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART C 1 SYSTEM INFORMATION (continued) Property Address: i 3`� C`S Owner. ` ' �) J J a tc��y•G_ Date of Inspection: SEPTIC TANK - (locate on site plan) Depth below grade:-21,� ' Material of construction: Xconcrete_metal_FRP_other(ezplain) Dimensions: _A Dip✓cox >C� Sludge depth:(a Distance from top o sludge to bottom of outlet tee or baffle: Scum thickness: Distance:ism top of scum to top of outlet tee or baffle:_�� Distance from bottom of scum to bottom of outlet tee or baffle: 3 " Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, ety rC.cd-MAA e-^ v." a v.a c cC'.� f-ov of( c o .�,� � �C GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or bathe: Comments: (recommendation for pumping, condition of inlet and outlet tees or banes, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) (revised 11/03/95) 8 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address: 13� S C r V c PA. Owner. e— Date of Inspection: 613 TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP—other(explain) Dimensions: Capacity: gallon Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches. etc.) DISTRIBUTION BOX:>< (locate on site plan) Depth of liquid level above outlet invert:_ Comments: ( if level and distribution is equal, evidence of solids carry° evidence of leakaminto oz out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 11 11 SYSTEM INFORMATION(continued) Property Addreex t j_3 1 O ST c.-/ V I l C_ P�11c1- Ovaaer. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible;excavation not required, but may be appra dmated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: d K C_ leeching chambers, number:_ leaching galleries, number: leaching trenches, numberjength: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condi ion of soil, signs f hydraulic failure, level of ponding, condition of vegetation.etc.) ` 1 v`c tL1/L L CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1 c� ( SYSTEM INFORMATION(continued) ss; Property Addre �3 l S t L✓v.A(� Owner. I'tG.t,�L �`�✓�c sS •'�V�4✓t�.�.Q C. Date of Inspection: Gf.3i/9� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all weW within 100' T, O �c6 c , DEPTH To GROUNDWATER Depth to groundwater. ly feet method of approximation: (Tya✓nc� kJ 4�t,r (G�,t �' ��- /k,D,O✓t� (revised 11/03/95) 9 Po ` r _ - �I 1_ R �� I I L #Z8 A I #1251 I 1 AP i................................ ,'I I ----- 0 46 AC t5l )�C ' I, # 239 ' : ` 1 � i 1 62 . 3 0.52'AC #1+223 I , r n l Yn 0 G � � Commonwealth of Massachusetts 1/ Executive Office of Environmental Affairs Department of Environmental Protection VAIMm F.W*id Trudy Cox* Gorvmor sKrat" Ary vid ao Paul Celluccl Oa S.Struhs Lt.CVWNM r �-;:!w Cotrtminiorw � wr. S E P 5 ,.90 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP>r:CTION FORM; G CERTIFICATION , ,s ° PropertyAadress t 23 0S- ¢vi� -Gt/ mot/ #f� Ow - 'G' cl � Address of owner Date of 14opectlon: g_r�9G, A. (If different) Name of Inspector. 1*16,/Z/.ij Company Name,Address and Telephone Number. "J P 1/-rDe;" .5e-lotie-6 7 5' SA-(t 4 r- tell ISA44). CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _. F Inspector's Signature: Date: $7—• 10i f-," The System Inspector shall bait a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the.system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y,N,or ND). Descnibe basis of determination in all instances. If"not.determined",explain why not) 'The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556.1049 • Telephone(617)292-5500 ` Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) Property Address: Owner. Date of Inspection: B)SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed is the distribution box is due to broken or obstructed pipe(s) due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of H ): broken pipe(s)are replaced obstruction is removed distribution box is levell r replaced The system required p ping more than four times year due to broken or obstructed pipe(s). The system will pass inspection if(with approv of the Board of Healt : roken pipe(:)are placed o ruction is re ved Cl FURTHER EVALUATION IS REQUIRED BY THE OARD OF HEALTH: Conditions exist which require further evaluati by'the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. �\ 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH ETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT E PUBLIC H TH AND BAFETY AND THE ENVIRONMENT: Cesspool or privy is within 5 feet of a surface water Cesspool or privy is within feet of a bordering vegeta land or a salt marsh. 2) SYSTEM WILL FAIL UNLESS E BOARD OF HEALTH (AND P C WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYS M IS FUNCTIONING IN A MANNER-THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRON ENT: _ The system has a Sept' tank and soil absorption system ands within 100 feet to a surface water supply or tributary to a surface water supply. The system has a se is tank and&oil absorption system and is within a Zone I of a public water supply well. The system has a se tic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a tic tank and soil absorption system and is leas than 100 feet but 50 feet or more from a private water supply well,unless well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution fro that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 9) OTHER (revised 11/03/95) 2 r s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner. Date of Inspection: Dl SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine.chat will be necessary to correct the failure. Backup of sewage into facility or system component due4to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to overloaded or clogged SAS or cesspool. Static liquid level in t e distribution box above outlet invert due to an overl ed or clogged SAS or cesspool. Liquid depth in cesspool less than 6"below invert or available vol is less than 1/2 day flow. Required pumping more than times in the last year NOT due o clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption stem, cesspool or vy is below the high groundwater elevation. Any portion of a cesspool or privy is w i 100 f of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is wit ' a ne I of a public well. Any portion of a cesspool or privy is wit feet of a private water supply well. Any portion of a cesspool or privy is than 00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. the well hss been analyzed to be acceptable, attach copy of well water analysis for eoliform bacteria,volatile organic mpounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to ge systems in addition to the\criteria above: The system serves a with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and environment because one or more of the following conditions exist: the system within 400 feet of a surface drinking water supply the m is within 200 feet of a tributary to a surface drinking water supply the m is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public r supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 C'QR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PfMw ty Address: Owner. Date of Inspection: Check if the following have been done: ` _Pumping information was requested of the owner, occupant, and Board of Health. _ one of the system components have been pumped for at least two weeks and the during that period. Large volumes of water have not been introduced into the system been receiving normal flow rates system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage backup. 11_ _The system does not receive non-sanitary or industrial waste slow ��lhe�site was inspected for signs of breakout. _� system com nents exclu ding udin the So' �� 6 Soil Absorption System, have been located on the site. _The septic tank manholes were uncovered, opened, and the interior tees, material of construction, dimensions, depth of liquid, depth of of septic task was inspected for condition of balDes or sludge, depth of scum. size and location of the Soil,Absorption System on the site has been determined based on wing informs.on or approximated by non-intrusive methods. L� _The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C //SYSTEM INFORMATION �/,,� Property Address: I.13 ct O s{le�u P l.11/ C!`a°' u / Owner. Date of Inspection: FLOW CONDITIONS RESIDENTIAL Design flow: 330 gallons Number of bedrooms:—!Z:- Number of current residents:Q Garbage grinder(yea or no):_Ak..., Laundry connected to system(yes or no): Seasonal use (yes or no): 4, l/ Water meter readings, if available: U/V 6 Last date of occupancy: COMMERCIAL/I h'D U S TRIAL• Type of establishment- 1-Design flow: 82`110 Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes Non4anitary waste discharged to the Title 5 system: r no) Water meter readings,if available: Last date of occupancy: OTHER ( `� Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of info rmat' n, System pumped as part of inspection: (yes or no),g&<--? If yes, volume pumped: gallons Reason for pumping: TYP OF TEM Septic tankMistribution boa/soil absorption system Single carpool Overflow owspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Ocher 1'explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: I? 7 < Sewage odors detected when arriving at the site: (yes or no)!10 (revised 11/03/95) 6 a i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Inspection: SEPTIC TANK (locate on site plan) Depth below grade: Material of oonstruetion _concrete_metal_FRP_other(ezplain) Dimensions: )L Sludge depth: r Distance from top of sludge to bottom of outlet tee or baffle: _ Scum thickness:�� 41 Distance from top of scum to top of outlet tee or baffle:. Distance from bottom of arum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and Qutiet tees or, dept of liquid level in relation outlet invert, structural integrity, r evidence etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _ooncre metal_FRP_other(e:plain) Dimensions: Scum thickness: Distance from top of!ofsalza to top of outlet tee or Distance from bottom to bottom of out or baffle:Comments: (recommendation forcondition of islet and out tees or bafIIes,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Pro perty l�.3�' Q /!e IVl C ( (S r. Date of Inspection: 71GBT OR HOLDI ANK_ (beate on site plan) Depth below grade: Material of construction:_concrete_ tal_FRP other(explain) Dimensions: Capacity: eallons Design flow: ¢al1ons/day Alarm level: Comments: (condition of inlet tee, condi ' of alarm and float switches,etc.) DISTRIBUTION BOX:-&.*- (locate on site plan) 1%. Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal evidence of solids carryoyer,evidence of leakage into or out of box,etc.) PUMP CHAMBER (locate on site plan) Pumps is working order:(yes or no) Comments: (note condition of pump chamber,conditio ps add appurte etc.) (revised 11/03/95) 7 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART C SYSTEM INFORMATION(continued) n Property Addm, l 13� O i2 S+e v'1"e Ct� 3�g2itJ Owner, Date of Inspection: g" SOLL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number:"' lad a leaching chambers, number:_ leaching galleries, number: leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool, number: Comments:( condition of s ' , signs of hydraulic failure, level f pon ' g, ndition of vege ,tic ,etc.) CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top o uid to inlet invert: Depth of solids la : Depth of scum layer: Dimensions of cesspool: Materials of constn ilo:n: Indication of groundwater: inflow(cesspool moat be ped as part of inspection) Comments: (note condition of soil,signs of hydra fail level of ponding, condition of vegetation,etc.) PRIVY:_ (locate on site plan) Materials of co on: Dimensions: Depth of soli Comments condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 13 � G DEPTH TO GROUNDWATER Depth to groundwater. _feet method gf otermination or approximation: y (revised VIS/95) 1 s" • z�i 1 S.�/SF a 1 .3 M kn o � M N �pdlip,._ lo 41, 'M +-1 s o-7 38M� ,�-- A NSTA'i3�� RDI I 'Q R 9'oal-'` u S�rJ/l-.-: ru7 •�� -::c':ir'u.J fpk, o� CERTIFIED PLOT PLAN LoT 3 0ST. W, 8,9RNSTgBc�c D ROBERT BRUCE ELDREU M 4IQ S TG+eVS IA 1 Z C - �i IN 8CALEe DATE 1 EERINQ 019TERED� CLIENT shy I CERTIFY THAT THE Fo�n�l�rfaiv REGISTERED aNOWPI ON THIS PLAN 19 LOCATED CIVIL, LAND JOB NO. 83.�_ ON THE GROUND AS INDICATED o-two �NAINEER. SURVEYOR .®Y, CONFORMS TO THE ZONING LAWS CKby 7 OF bARNSTAHt,E M,�SS,,., y 712 MAIN STREET ... � F_ ,'HYANRISI MASS. 3�7!r � SHEET -- f' p _.�. -L-.�F.�._. DATE REG. L ANn --- _ _.._..._. 8t► VEYOR i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 02 f fe Application# ;?OD 716 L' Health Division Date Issued Conservation Division Application Fee 1 Tax Collector Permit Fee V-1XFO Treasurer 3Se `o Planning Dept. W , Date Definitive Plan Approved 1'� pp by Planning Board �L � 0 k Historic-OKH Preservation/Hyannis 1 I _ 1 Project Street Address__ 'M Village )Jvv ` Owner Tc9 y`� �� U r , Address Telephone (� �'4e � �D � Permit Request , /sue sF Aov ` n��: ► 5 r r Square feet: 1 st floor:existing proposed f 2nd floor:existing proposed _Tot4new_l Zoning District_ Flood Plain Groundwater Overlay Project Valuation ® OD U Construction Type i Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family 0 Multi-Family(#units) Age of Existing Structure 2 Historic House: ❑Yes QN4o On Old King's Highway: ❑Yes ANo Basement Type: Q '�ull ❑Crawl ❑Walkout ❑Other Basement Finished Area( q.ft.)s �, �1 ) -�,� �,_� Basement Unfinished Area(sq.ft) 1� Number_of Baths: Full:existing new Half:existing new Number of Bedrooms: existing_ �' new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: W-Gas ❑Oil ❑Electric ❑Other Central Air: 111'Yes O No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑/existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Jdexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial 0 Yes ❑No If yes site plan review# Current Use Proposed Use BUILDER INFORMATION t / - N e Telephone Number? ^ Q T Address / License# L I ' `�5 `�- Home Improvement Contractor# tom^ l-, ` c Worker's Compensation# ALL CONSTRUCTION DEBRIS RES 7IN FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Town of Barnstable P# "1 __ .,a �oF�►+e p o Department of.Regulatory Services p v' BARNSTABLE, Public Health Division Date—1z� p y MASS. 1679 200 Main Street,Hyannis MA 02601 1. AlfO MAC a 1� I C CrC! . + Date Scheduled Time Fee Pd. tTi F Soil Suitability Assessment for Sewage Disposal ,® Performed By: �.�-t�fG l:/IYZe SJ . Witnessed By: LOCATION & GENERAL INFORMATION ocation;Address f Z?J Owner's Name t A J �S :li(.' ��r✓1 I' ?�►�,j f T�s o ct Zr,^i Address 10 61 L-?U X ZC(7 assessor's Map/Parcel: / .Z j - 0U' Engineer's Name o� e.,y r . liClesv {. 6;'v-L NEW CONSTRUCTION REPAIR /' Telephone ft 52 Y—73? —It-7 CL' Land Use 2e s 'd�f'l 11 0� ' Slopes(%) — Surface Stones NOr>ti� Distance's fiom: Open Water Body /yUrt ft Possible Wet Area NdNefl Drinking Water We11ft� Drainage Way A)/A ft Property Line 2-0 4 "eft Other ft i SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i s C s i G sr�►-zv�c,�E —w�� 3�}-2nlsr� t3�C d'�''=' Parent material(geologic) tJ"(-Weif Depth to Bedrock_ A— Depth tolGroundwatei: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater /f << L/tJ �'�� Qh Yf" � v ��y �l.4 L"3 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Osed: Depth Observed standing in obs.hole: in. Depth to soil mottles: n. Depth to weeping from side of obs.hole: in. Groundwater Adjustment _ft. I idex Well# Reading Date: Index Well level Adj.factor Ad.j.Groundwater Level PERCOLATION TEST Date Time C>.bscrvat'ion -- — Hole# ,` I i Time at 9" _ f 21 'r ,1 24 Depth oflPerc C>JC7'^S/3 I Time at 6" Start Presoak Time r@ I N Time(9"-6") End Pre-soak ) �''� t 1�' ` �` �`� 0 Rate Min./Inch Site Suitability Assessment: Site Passed L/ Site Failed: Additional Testing Needed(YIN) i Griginal:i 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:\SEPTiIC\PERCFORM.DOC i i DEEP OBSERVATION HOLD:LOG Hole#_J _ Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in,) (USDA) (Munsell) Mottling '(Structure,Stones;Boulders, Consistency,%Gravel) i f3 . — Zy _ -7Z G; - -7-Z.-1 zo I c, y(L s13 1 "_1 1 -7 r2 s/� 1. -f+��i t^'I SC1v`14 2 -S'C 7/ DEEP OBSERVATION HOLE. LOG Hole# Z- Depth fron! Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency.%Gravel) Z� 7 Z ':�t F•-L 5 CwLd Z, -- 72- 12' e.z S; l t- �cb�►ti. j.o Y1'( /3 115 t� .�,��125% DEEP OBSERVATION HOLD LOG Hole# Depth fron! Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel)__ DEEP OBSERVATION HOLIE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones Boulders, Cons! to YIi)._ Flood Insurance Rate Man: Above 500 year flood boundary No— Yes��r Within 500 year boundary No_ Yes Within 100 year flood boundary No L�_ Yes Depth of Naturally Occurrine 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? -> -- If not, what is the depth of naturally occurring pervious material? Certification I certify;that on (t I `t 4 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CN4R 15.017. Date Signature — -- Q:\S.EPTIC\PERCFORM.DOC TOWN OF BARNSTABLE ` LOCATION i- t 3 ►i35 os-r. L,3,71 . -y,J �LZ SEWAGE # dJ- �ll VILLAGE ASSESSOR'S MAP & LOT L Z 5 U3-4- INSTALLER'S NAME & PHONE NO. Z-}/Cl{ C Y ('-6)u S i SEPTIC TANK CAPACITY ,,O AL1.0 LEACHING FACILITYAtype) ?/! (sue) 60D NO. OF BEDROOMS-PRIVATE WELL O UBLIC ATER BUILDER OR OWNER ),La L _ '�OLLLQ DATE PERMIT ISSUED: k6 e 04-1 f. DATE COLIPLIANCE ISSUED- VARIANCE GRANTED: Yes No �n o Ua Assessor's,map and lot number ..� �a�'.� � ....,,,�� e3- Y�i. a Sewage Permit number .............. .....................................*--- Z SY4! STEM MUST ru�-r House number ��•- �9 INSTALLED IN COMPLIAN cw TOWN OF B ySsf, ARN , : I 9. s ; f BUILDING 1N, $PECTOR APPLICATION F / /\ OR PERMIT TO Q N� TYPE OF CONSTRUCTION 1.� ,90. ........s1= r' - ..-'G............................................................ 2 ..........................19.......1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following inform on: Location ..1�!?.� ✓ D� �.4 �rl.! 5 /' �� /.../....:..:.1.../....:.�..11../........ ProposedUse ........ ........ ..................................................................................... ........... Zoning District .......P...�.... ... ......................Fire District m J, /6 �.. l (� �.... Name of Owner J.,PIX).....�. � ....................Address �. .1.. ?J� .�.....E S�........ Name of Builder .G4�:.IJ�..�......�� . .I. . .v .......Address ...............................`.............................a..................... Name of Architect Address 1��I. ( .(�/ly ,6,.Iq �1 l� D r( ........ .. Number of Rooms c ......... ......................Foundation .. . .. .. Exterior Roofing ..L........ 5 g �. �..r��.. .. ... Floors L!"�! :. ...F.'::�.w ...Interior .... ,E!l ............................................ Heating -� � ........A..............................................................Plumbing .. li �..1 ..1...`.�jl Fireplace ........�:. ............. ..............................................Approximate Cost .............1 .. ................................... Definitive Plan Approved by Planning Board -----------_____________---19 , Area ........................ Diagram of Lot and Building with Dimensions Fee ..... . .................. SUBJECT TO APPROVAL OF BCARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above v construction. Name ............................. �iConstruction Supervisor's License .................................... i � I `M LEGEND 0 TOP N --100-- EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE m Q m —W— EXISTING WATER SVC. m m~ 4 —G — EXISTING GAS SVC. 61 TOPRED DR &H.-W.-- OVERHEAD WIRES 7,1 TEST PIT ➢ D OLD S14GE RD 20 BENCHMARK P8 286-PG Z CAPT STUDLEY RD °0 - D £ LOCUS a o p 0 PROPOSED S.A.S. CAPi DEY UNG RD STRIPOUT BOUNDARY LOCUS MAP (SEE NOTE 11—SHEET 2) NOT TO SCALE EXISTING LEACH PIT X 96.2 FILL CONTRACTOR & ABANDON. 96.32 N 16. WITH 18'05" + . . . . . . . �. . . • 1001.00, I.T 86.79 DOG PEN BENCHMARK _o 1:;:::. `t:; :` ''. ��+; CORNER/BOTT. STEP : O O / :� / -�� g E.L.=98.64 � � - ; ��:, O 20,159 SF 9 MBL: 125-036 96,32 it + 5, 1 E PIT 96,11 O :•:. 97.19. . } + 97.02 SHED 48' • o oaA / +•S7.40 ,+ 96,44 � /� 00 X 97,4 / EXISTING SEPTIC TANK - • TOP OF TANK, EL.=96.0 /If 97.03 ,08 °14' � 96.99 INV.(OUT)=94.67t �'\� // f (:j .97.41 + 0 / 7,79 / 97.42 { W :PA] DECK DECK / x (below) I/ (obove) I .� EXIS77NG I �w t HOUSE (#1239) T.O.F.=99.5f I co C 9) + 6,84 �. 1 .+. 5�. p 97 �� 98,56 GARAGE \ 96.60 t\' �f \ y �\ T. 97.05 �0.87 X. ° 9 .5.7 X 98J ;�•.:, 00 F>_ C . 97,05 _ -99 �-3:2 /i 98.75 99 _ 99.01 0 125.00'— 98- 97,92, N 0;7 12'38" E .. ..:. .i. c 99,70 98,66 98.83 98.96 99.14 99.42 . edge of pavement 99.65 OS TER VILLE - WEST BARNSTABLE ROAD Mgss9�yG o PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN McEhTEE 1239 OSTERVILLE—W. BARNSTABLE RD, MARSTONS MILLS, MA CIVIL No. 35109 Prepared for: Joshua Kouri, P.O. Box 210, Centerville, MA 02632 FS£G/SiF-W�� `�� Engineering by: SCALE DRAWN JOB. NO. S N.L OWNER OF RECORD Engineering Works, Inc. 1"=20' P.T.M. 104-16 KOURI, JOSHUA 9 9 P.O. BOX 210 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (508) 477-5313 2/24/16 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 94.45 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL WATERTIGHT RISER INSTALL RISER & COVER OVER ONE CHAMBER(MIN.) OUTLET AND SET TO 6" OF FINISH GRADE & COVER SET TO WITHIN 6" AND SET TO WITHIN 3" OF FINISH GRADE TO SERVE T.O.F.=99.5t OF FINISHED GRADE AS AN INSPECTION MANHOLE. ../-F.G. EL.=97.7t F.G. EL.=96.5t EXISTING F.G. EL.=97.1 t F.G. EL.=96.5f Ruiz mm L = 35' L = 20'(MAX) ® S=1% (MIN.) 4® S=1% (MIN.) 4"SCH40 PVC "SCH40 PVC R6c 2" LAYER OF 1/8"s ®O® TO 1/2 DOUBLE 14" 12" WASHED STONE EXISTING 48" LIQUID INV.=94.67 (OR APPROVED FILTER FABRIC) LEVEL INV.=94.15 PROPOSED GAS BAFFLE 3.5' 3' 3.5' 3/4"-1 1/2" INV.=94.32 D-BOX INV.=93.95 EFFECTIVE WIDTH = 10' DOUBLE WASHED H-10 RATED STONE EXISTING SEPTIC TANK USE 7 LC-6 LEACHING CHAMBERS IN SERIES WITH 3.5' OF DOUBLE WASHED STONE-ALL SIDES H-20 RATED NOTES: TOP CONC. ELEV.=94.8 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=93.95 ®®®Q®®® -BREAKOUT INVERTS, PRIOR TO INSTALLATION. ELEV.=94.45 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND ®®®®®®®BOTTOM ELEV.=92.95 TRUE TO GRADE ON A MECHANICALLY COMPACTED 3.5' REFER TO SKETCH 3.5' SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' OF NATURALLY OCCURRING 310 CMR 15.221(2). PERVIOUS MATERIAL REFER TO SKETCH 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE LEACHING SYSTEM SECTION AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. EST. HIGH GROUNDWATER, EL=87.1 = SEPTIC SYSTEM PROFILE N.T.S. GENERAL NOTES: SOIL LOG 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL DATE: JULY 30, 2014 (REF#14,447) BOARD OF HEALTH AND THE DESIGN ENGINEER. SOIL EVALUATOR: PETER McENTEE SE#1542 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS WITNESS: DAVID STANTON R.S. HEALTH AGENT OF LOCAL RULES THE STATE AND ENVIRONMENTAL REGULATIONS CODE, TITLE V, AND ANY APPLICABLE ELEy. TP-1 DEPTH ELEv. TP-2 DEPTH 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 96.6 A 0" 96.5 A 0" TO INSPECTION .AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. SANDY LOAM SANDY LOAM 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 95.8 10YR 4/2 10„ 95.8 10YR 4/2 B B 8.. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN SANDY LOAM SANDY LOAM ENGINEER BEFORE CONSTRUCTION CONTINUES. - 5._ALL ELEVATIONS-BASED , _ 10YR 5/4 10YR 5/4 _ - 94.6 C1 1 24" " �96:5..C 24" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF F-C SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF F-C SAND HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 2.5Y 6/4 2.5Y 6/4 90.6 C2 72" 90.5 C2 72" 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. SILT LOAM SILT LOAM 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 5Y 5/3 5Y 5/3 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS (UNSUITABLE) (UNSUITABLE) AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 87.1 MOTTLING a 114" 87.1 MOTTLING 115" DIRECTED BY THE APPROVING AUTHORITIES. 86.6 120" 86.5 120" 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY C3 C3 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING MED. SAND MED. SAND CONSTRUCTION. 2.5Y 7/4 2.5Y 7/4 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 82.6 (DRY) 168" 82.5 (DRY) 168" IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND * "Cl" HORIZON MORE RESTRICTIVE THAN "CY HORIZON REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). PERC RATE: < 2 MIN./INCH 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE EST. HIGH GROUNDWATER, EL.=87.1(MOTTLING) INSPECTED BY DESIGN ENGINEER PRIOR +0 BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC .SYSTEM PURPOSES ONLY AND �- -�NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. DESIGN CRITERIA I - ' -- 28 28 T� BOTT. AREA_ o = 490 SF ~�2$' NUMBER OF BEDROOMS: 4 BEDROOMS -I F ' 1�PERIMETER=118 FT.I SOIL TEXTURAL CLASS: CLASS I �---18, PROPOSED SED S. ' DESIGN PERCOLATION RATE: <5 MIN/IN L� DAILY FLOW: 440 GPD SKETCH OF DESIGN FLOW: 440 GPD SAS N GARBAGE GRINDER: NO DIMENSIONS EXISTING SEPTIC TANK: 1000 GALLON CAPACITY LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF .74 GPD/SF n rn n� 0 cD USE 7 LC-6 LEACHING CHAMBERS IN SERIES WITH �i 3.5' OF DOUBLE WASHED STONE-ALL SIDES AND SIDEWALL AREA: 118'(PERIMETER LENGTH) x 1'(EFF. DEPTH) = 118.0 SF BOTTOM AREA: 490.0 SF(BOTTOM AREA) = 490.0 SF °� 0 TOTAL AREA:....................................................................................608.0 SF 6� DESIGN FLOW PROVIDED: 0.74 GPD/SF(608.0 SF) = 449.9 GPD DECK PROPOSED SEPTIC SYSTEM UPGRADE PLAN (below) DECK (otove) 1239 OSTERMLLE-W. BARNSTABLE RD, MARSTONS MILLS, MA EXISTING Prepared for: Joshua Kouri, P.O. Box 111, /HOUSE (#1239)/ Engineering by: SCALE DRAWN . JOB. NO. Engineering Works, Inc. N.T.S. P.T.M. 104-16 S.A.S. LAYOUT 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 2/24/16 P.T.M. 2 Of 2 1