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HomeMy WebLinkAbout0879 SANTUIT-NEWTOWN ROAD - Health �rla-sons rn �� N OF BARNSTABLE L�� ' OCANON `57 �Pls/7`Olelh SEWAGE # VILL`AGE /Z&f5AA-7-5 -lg ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1,ooy T� LEACHING FACILITY: (type) ���.�,� Q) _ (size) NO.OF BEDROO BUILDER OR WNER PERMPTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S f' -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 lu�ility) Feet Furnished by �'�� h / 4 �b sb. �r 7�re�9la No. r ' Fee V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[pplicatiou for Migozar 6pgtem Cow6truction Perron Application is hereby made for a Permit to Construct( )or Repair an On-site Sewage Disposal System at: Location Address or Lot No. Owne 's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. ? y/�Q�/y/> Designer's Name,Address and Tel.No. Type of Building: ? Dwelling No.of Bedrooms-�3 Garbage Grinder(✓�� Other Type of Building 7l_4�7zf_eee No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or to ations(Answer w en applicable) be�ea Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by f th. Signe Date Application Approved by Application Disapproved for the following reasl n Permit No. Wa Date Issued q db 0,2 rENO. .t � Fee THE COMM HEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION• TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Mi000al *pgtem Construction Permit Application is hereby made for a Permit to Construct( )or Repair an On-site Sewage Disposal System at: Location Address or Lot No. Owns 's Name,Address and Tel.No. 7J �ewtdl '/� rod 6ij� Installer's Name,Address,and Tel.No. 7 Designer's Name,Address and Tel.No. / Type of Building: ? Dwelling No.of Bedrooms J Garbage Grinder(./J,�7 Other Type of Building /TifglWeee No.of Persons Showers( ) Cafeteria( r Other Fixtures i Design Flow a✓/a gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date 1 ` Title 1 Description of Soil ' Nature of Repairs or Alterations(Ans)er w en applicable) a r r4 1A,q/ D 5 zeo v e dlelz,0 ef 7r 5T�l7rE' b e., 1 j Date last inspected: 1 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- . cate of Compliance has been issued by s B and of Health. / Signed, Date 71, Application Approved by r Application Disapproved for the following reas n • r j Permit No. ... Date Issued THE COMMONWEALTH OF MASSACHUSETTS O2- Y E PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY,that the On-si a Sewage Disposal System installed( )or repaired/replaced(✓)on p by / GD / t�D�57 for i as 9 1VeW K ✓ . 0/5 76F`!5 j / s ben constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.wo dated Use of this system is conditioned on compliance with the provisions s f •w:set-forth bel b j I 1 _ J to 2- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS j 3W.5pooar *pgtem—Construction permit ' Permission is hereby granted t GfolydL��f/ C�`�s�`r to construct( ).repair( n On-site Sewage System located at 4ii'1`D�r7 / i and as described in the above Application for Disposal System Construction Permit. The applicant reco nizes his/her duty to i C comply with Title 5 and the following local provisions or special conditions. All construction st/zp leted within two years of the date below. (, Date: Approved by 1 3 q(e 61 --------------- 1.5 5 r-r�- ✓v AA .v 5 5 � �s:. �-;r t,k°' ' -� .' r fxti� ;}" �'g-r J,a r��� �'�# �� .c�'ti„i�'�,-�.2t� ` �C �k'., t � i� ♦� �- `'� -� a- d"Y. 3 a *a*re vx> a ,a.•r -i xifr� S'�-; 9 �t4�' >'� � am ,t ,d a.:� �-. .�:.Y 9 �: '4 � q ..1''=5'rk-�`�4+x.�x��. .sue „ �'�: '� � .,;se��' � f �,;- "`�,. �t:, .�.�,. -� '.�,s -�,• � ♦ -�a �`�. „�.���`�,`, q�"-t -�.avr:�H �.�� $ �' `�� S� }_ ..rr� ,s �j:,+�,� ,.'.� F+r �, q .��^-r � ,s�'-�t3},;'� � i.�.+ x„�: :�, �• ,aw�r 'x _ r air � r�`�' � ., �� C �1 �� �� � '�`� � �,� „�+�«#�f t� �' _ - �,...xi .r.7r?Z� ..,,�i,`r?' x�..«.�,7.-x.s��. 0 �at.:5c+t- ...'C�, ,.a� .,. ,5; `L, r� �,,tr�,:« r.�• l�r',. . W�` ..,.,. ..v�"-'�r�',.�� '?,".��.3„f`",,,��,;-•t,; rr,d`"�, �� ..`�`- f CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION I'ERIIITT (WI TIIOUT DESIGNED PLANS[ [, �ei oiereby certify that the application for disposal works construction permit signed by me dated '7 concerning the property located at lveV74e�e_ "0. meets all of the following criteria: /There arc no wetlands within Soo feet of the proposed septic system . /There are no private nclls within 150 feet of the proposed septic system TI, observed groundwater table is 14 feet or greater below the bottom of the leaching facility Th a is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also If the licensed installer posesses a certified plot plan, this plan should be submittedl. P � } ,c f*BY"i 9� 3 Z v i�'�W.t J� s..�'bx"" °:�1'�t�•tr ,.�M�'e.rga � ...:,�.. 7 �'�M'v S f � _»,. ��'9',�K� t, n57*r ,. r `��'�' � 'k x b ;s�"� } k ri TOWN OF BApRIvSTP.BLE LOCATION UADWT-� `-A • SEWAGE # VILLAGE i4 ftK R rJ fAtI LS--ASSESSOR'S MAP &LOT . S 83s INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l Q[g(1 M:1 LEACHING FACII 1717Y: (type) �KJ2 E l�N�Td K.S, (size) NO.OF BEDROOMS 3 BUILDER OR OWNER_ lowlan n 2-0.1<-- _ ?EfdffrDATE: COMPLL4NCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table 2 Fe-c Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ° Fez, Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) F"' Furnished by w f�3-st ' 53_ 56' CO�NIMONWE.kLTH OF NLkSSACHliSETTS r, EhECLTiti'E OFFICE OF ENVIRONME:�TAi FAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION n\INTER STREET'. BOSTO\ 0210E 1617i 292 5:iUu ONE 18 V T CO\7_ earn ARGEO PALL CELLliCCI ;b'�ID B. S1~8 Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM V k `VNT-6 Z t PART A � 0.�9 � LzT-" ©�.S , CERTIFICATION 99 Ca"i•9 Property Address: V?�Ow� 1L-t%t Name of Owner ti Address of Owner: Z Date of Inspection:. �+ ' [ , , �/ 1 rid yu N S G2.(„C I i Name of Inspecto r: Please Print)! [ C �+d c L %f' "EC K U t I am a DEP approved system inspector pursuant to Section 15.340 of True 5(310 CMR 15.0001 Company Name: 147Y r.._ r? P—k .'r�r:=u �+.+ f+ Mailing Address: Telephone Number: So- 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 B the Local Approving Authority Fails Inspectors Signswre- Gate: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS revised 9/2/98 pycetof11 0. Primed on Recycled Paper 1 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) WW1 ��u'�OVy\1 +ropeny.Address: 1 , Jwner: Dante of Inspection: �iINSPECTION SUMMARY: Check A, B, C, o/ D: a � n . A. SYSTEM PASSES: ` �I have not round any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: SYSTEM CONDITIONALLY PASSES: ``"'One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty 120)years prior to the date of the inspection; or the septic tank, whether or not metal, is 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 complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The 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 required 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 revised 9/2/98 Pa e 2 of 11 e,. - . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: C. 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 s failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 1 .303(1)(b) THAT.THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY D THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of 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 WA SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AN SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SA ) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system d the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption syste and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption syste and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analys' 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. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2//98 Page 3of11 4 r � , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) property Address: Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either "Y " or "No" to each of the following: have determined th t one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identi 'ed below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewag into facility or system component due to an overloaded or cogged SAS or cesspool. _ Discharge or ponding f effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the dis ibution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ Liquid depth in cesspool is les than 6" below invert or available volume is less than 112 day flow. _ Required pumping more than 4 ti s in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. _ Any portion of the Soil Absorption Sys m, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is withi 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a one I of a public well. Any portion of a cesspool or privy is within 50 fe t of a private water supply well. Any portion of a \fe r private supply well with no cesspool or privy is less-than 100 p water P acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia itrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria abov The system serves a facility with a design flow of 10.000 gpd or greater(Larg 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: Yes No the system is within 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 Is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or a mapped Zone II of a public water supply well) \ The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST r'roperty Address: Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. x _ 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 part of this inspection. As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. k _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. J( _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles `-� or tees, 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. For example. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) The facility owner (and occupants.if differeni from owner) were provided with information on the propermaintenan".of SubSurface Disposal Systems. revised 9/2/98 Page$of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C ./ SYSTEM INFORMATION 'roperty Address: �� � ��• i Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL- Design flow:yg•p•d./bedroom. Number of bedrooms (design): Number of bedrooms (actual(: Total DESIGN flow Number of current residents:- Garbage grinder(yes or no): t--11 Laundry(separate system) ( es oo P: If yes, separate inspection required Laundry system inspected y or no) Seasonal use (yes or no): Water meter readings, if av ilable (last two year's usage (gpd): Sump Pump (yes or no): Last date of occupancy:—i Wko") low—dn/ COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes 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)hA If yes, volume pumped: .gallons Reason for pumping: TYPE OF SYSTEM _ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) .I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date Installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no) r revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n SYSTEM INFORMATION (continued) 'property Address: �t"�1��'I N t Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction: _cast iron_40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site an) tl Depth below grade: Material of construction: concrete_metal_Fiberglass _Polyethylene _other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: Sludge depth:---�4� 1 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness::!_ �( Distance from top of scum to top of outlet tee or baffle:_ t� Distance from bottom of scum to bottom of outlet tee or baffle:—J,�L How dimensions were determined: Vl�ti(�r� 'omments: (recommendation for pumping, eonditio of inlet a d outlet ees q�affies, depth of level in relation to outlet i ert, structur integrity. evidence of leakage,etc.) I2 d w v GREASE TRAP:A1P (locate on site plan) Depth below grade: Material of construction:_concrete_metal_Fiberglass _Polyethylene,_other(e xplain) 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 baffle: Date of last pumping: Comments: tion of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity. (recommendation for pumping,condi II evidence of leakage,etc.) revised 9/2/98 page 7orit . • C � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (� SYSTEM INFORMATION (continued) 'roperty Address: Owner: Date of Inspection: TIGHT OR HOLDING TANK: b1) (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal_Fiberglass _Polyethylene_other(explain) Dimensions: Capacity: _gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes _ No_ Date of previous pumping: 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: (+wlf'l Comments: - (note if I vel and di rib ti n i eq al, evidence of s li s carryov r, evidence of leakage into r t box, etc.Zi _.. PUMP CHAMBER:VW (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,•condition of pumps and appurtenances,etc.) revised 9/2/98 Pagc8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) -ropefty Address: Owner: 1 Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): S (locate on site plan, if possible; excav tion not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: _ ��,'%��I � leaching chambers, number: leaching galleries, number:_ . leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition soil, signs h draulic fail re, del of o ng, dam soil, ondition of egetation, etc.l ' U CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth 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:v�! flocate 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 9/2/98 P+ge9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,, SYSTEM INFORMATION (continued) 'roperty Address:$?� 2L'`'�••••w � )wner: Date of Inspection: SKETC H OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 1=._I ,y ° 35 -SI' i33 - SO revised 9/2/98 Page 10or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) roperty Address:8-7 p Owner: Date of Inspection: NRCS Report name_ �� - — ------- - Soil Type_ _ -- ---- ---- Typical depth to groundwater____._ —_ USGS Date website visited r) Observation Wells checked Groundwater depth: Shallow Moderate SITE EXAM Slope r-V Surface water Check Cellar (YI-Li Shallow wells 4it— Estimated Depth to Groundwater324'Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 5�,g revised 9/2/98 Page 11oru ' TOWN OF BARNSTABLE LOCATION8'?9 4eu4ow � SEWAGE 3- VILLA}GE j�,� ASSESSOR'S MAP & LOT -6-�:lj INSTALLER'S NAME & PHONE NO..- CYD 64( SEPTIC TANK CAPACITY LEACHING FACILITY:(type) !S (size) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WA BUILDER O OWNER csd-�#j DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4. �� , �s. { .. . �. I\ � _ `�--_� �� _-�____ �� ,t U 3S No??" Fwm............... .. "ROVED THE COMMONWEALTH OF MASSACHUSETTS c==b!o6==*MAe"nmentBOAR® OF HEALTH - jSOWN OF BARNSTABLE Date lipliratiuu for Di►pwia1 Mirbi Tomitrnrttnn 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair X an Individual Sewage Disposal System at %�rJo.J / /GLS �q........1...! ------ ---- Loca ion-:\ddn•s Oa•nc _ ddr W O LQ1> I Installer Address UType of Building Size Lot............................Sq. feet .� Dwelling—No. of Bedrooms--------- 2---------------------_----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtur s d •---•............... W Design Flow..................................._--__--_gallons per person per day. Total daily flow..---:-_-----_1Z 0__.........._...••gallons. tY Septic Tank—Liquid capacity!Q _.gallons Length................ Width---------------- Diameter................ Depth................ Disposal Trench--No. ......../....... Width......7.1....... .Total Length-.<;:;O.s?��__Total leaching area....................sq. ft. 3 Seepage Pit No........... ......... Diameter-_---._-.-.-.-._-_ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by............................... -----------•----- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ aj ----------- 0 Description of Soil--------••••-----•C. •,. t;�---- �C! ------� � '= O/C. =-- -�_; ^ ................................ W •------------------------------------------------------------------------------------------------------------------•----------------------------------••-•--.--•-•••................................ U Nature of Repairs or Alterations— swer when applicable/^...-s%.��L._...._1!0B S 'i7...................�- ' � / 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 Compliance a b n is ue by t - oard of health. Signed ......._�,P ..... ......................:.................... . ........ •. ........ ......�....... ... ..... to 19 Application Approved By .............::........:............_ .....- Date Application Disapproved for the following reafonr: .-------------------------------------_ .................................................._................................... ................................................... ...�......`..`........---- - ..... ... ....... ------- E � - PermitNo. ............................ ........... Issued ......... . Date n...�.r�.+.s.iy;�,�y;;..:�stl`•`^^til—„V+v::w.[�'vA..+I"'fy^•'.�,.Li....s._.�i'�-.:r�..�v:'�^,���r'''.•.^ii...- � "...�:'�.•V.��.W j-�J�d�.1.:.s�..e`�'.:..:j^^''��:-.�ril�'.tb�:..1�t'BL�i`wr�*fs,�'iirrotd:".,y.,�,.,...l:e:it'Sr`s'w.',,►�,�'y 3 5 N07.; .. ` FEB...............-�j .... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -3 S 3TOWN OF BARNSTABLE Appliratiun for Ali►ipuuul Wurk,5 Cfuntitrurtiun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair (/<) an Individual Sewage Disposal System at: - .............•---------------........-------•---------......--------------------------•-----•-- ••••• •. •---•-•--•---------••••----•-•-----------------------------------•• Location- Address or Lot No " A,2 br G �^2% ...... J wa_r--h----/-••--- ss . ..... Owner. Addre _ ----------------------•----•-_..__ ----- -----.............................. 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 ( ) 04 Other fixtures _______________________________ _ _ W Design Flow..................: .............gallons per person per day. Total daily flow------------� Q..................gallons. 1:4 Septic Tank—Liquid capacit✓r ...gallons Length________________ Width---------------- Diameter................ Depth................ Disposal Trench--No. ....... ........ Width...... Total Length.. ��>Total leaching area....................sq. ft. 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 Test Pit No. 1................Ininutes per Inch Depth of Test Pit.................... Depth to ground water........................ (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ pi ---------------------------------- ..---------------------•----••---•-----•-••-----.......-•-........•...........-----•r-......................................................... D Description of Soil.......................). ..... .....`5--<e '!s%�_SG�C =... - •/ ._.... .,...........5....��Fo:!..................................... W ....................................................................................................................................................................................................... UNature of Repairs or Alterations—Answer when applicable._. --------/ 4 5:' .... >> =__! r• = GEC.....----- `- ......`f-/ G� ...............................................T t ................................................. 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 Compliance,has been issued by/the board of health. Signed ..........---- .../(..../.. 1...`/�------------------------~.-- -- Application Approved By ! ..................................... - 1-,��......... ............... ........ Dare Application Disapproved for the following reasons: ------------------------ ..................I.................................................................................. ............ ............................ ....... .......................... ..... .............................. ...............................-- ............ .................................... Permit No. .......... Issued ...... ''` ....�' .. .- Dale THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE QuI ertifirate of lbomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......................................... / L i L U Trl..... .S%�Z.UC.�7 ....... ........ lnsrall, r� ... ..... ; ..................................�4-�.. ...........�' 1.�. .�................. at ..................... ................... ......... has been installed in accordance with the provisions of TITLV10.1 The State Environmental nvironmental Code as described in the application for Disposal Works Construction Permit No. ''' l PP P .. �'' -. .. ._.... dated .. .b'.....wil T Y THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL �FUNCTION G�SATISFACTORY. DATE......_.......1. .'...!..�...'..1-�........._._._ Inspector ........ ... --.•........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH b � � TOWN OF, BARNSTABLE No...., FEE..:�U_...... Disposal Workv Tunstrudiurt Vern fit Permission is hereby granted................ ''GL/ /..C --- ----.-------Gr�'rv��L�'>C'-I( � to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. -7n......................................../V t_..t t j .-.rf .: .........................................../ -- ------------••••--••••----------••-_..._ St. Ft as shown on the application for Disposal Works Construction Pertrut Ircovf.!7:7�._ _.�Qated.._..� ........_... Board of Health / DATE_..--•R..................... �--- FORM 36508 HOBBS h WARREN,INC.,PUBLISHERS ♦ i �w No.lz/.Z .�..,... K FES.S ............... THE COMMONWEALTH OF MASSACHUSETTS b lOAS BOAR® nOF HEALTH ................... �1�.............---------...OF........ !1� c'e.---.........---------------.------ Applira Lion. for Dispoa al Works Tonstrurtiun ramit Applicatiohhereboy made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ` A...�.N......... ........••---.....-- -r`` :..... ..........-................................................................................ g �/ Location-Address or Lot No. ......................_"'•'r'...7`��.[1 es—.---•--...•..................-^............. ..........--.....................g ............................................... Address Owner ---•-•••--•-•------ a ......................... -••-••• ' ` G Installer Address Type of Building Size Lot_..17_�.�I.....Sq. feet Dwelling—No. of Bedrooms.._..._..__. .......................Expansion Attic ( Garbage Grinder (Are p, Other—Type of Building __ e��______________ No. of persons................_----------- Showers (j ) — Cafeteria (i/'13 Pa Other fixtures ................................................... ... ---------------------------- ---- ----------------------------------------------- Design Flow..........5JF .....................gallons per person per day. Total daily flow........ v......................gallons. WSeptic Tank—Liquid ca$$a'city../ allons Length....lo....... Width.......4...... Diameter--------4�..... Depth................ x Disposal Trench—No. .NFL . Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.._, ....`f-_.sq. ft. Z Other Distribution box Dosing tank Percolation Test Result Performed by.................l._.t.- e _ .._t_..___�____________________ Date.....rf .1.3_ _� ._.. minutes per inch Depth of Test`�it........ ....... Depth to ground water--_--_____-_.__---___ .Test Pit No. 1........r.�. ._ Test Pit No. 2................minutes per inch Depth of-Test Pit.................... Depth to ground water........................ .........................................................: .........-•---•-------•---......................................................... ODescriptionof Soil-------------•-.• -- - Z -------- ---------------------------...-----------------------------------•-•--------- V --------------------------------------------------------•---------------- xW � -- ................................................... - ------.56-t......--- -�-----------------------------------------•-•--------------------- 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 TI'LU 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. .............. ........ ........le. ApplicationApproved By------------- --- ---------------------•---•----•......_............................... Date Application Disapproved fort f oll ing reasons---------------------------------------------------------------------------------------------•---•-•-•-••-•-••--- .................••••••-•........-••••............-•-----•-.....-•-••••-••-•--•-•...........•••-••--...•.--••----•-•----•----••--•-•------•------••-----------••---•••-------•------•••----•--••--•••••- Date PermitNo......................................................... Issued-....................................................... Date No....................... Fi&s.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ""."...................OF.........a r�-'K � .' Appliratiun for Disposal Works Tonstrurtiun Permit . Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ....................«««......�..5. f W ................................................ ........_•_________-............« ......_..................................«..._. Owner Address ...................... = +. ....................... ...................................... ---------------------------------------------- .. Insta.� ller Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_____________ ......................Expansion Attic ( Garbage Grinder (NJ aOther—Type of Building ___ �O______________ No. of persons............................ Showers ( p ) — Cafeteria (Av 4)' dOther fixtures ••---•••••--•-•-•-•------••--••••-•-•-••-------------•.••••---•----•-••••-•-••••••••--------••--••••••••._.....••--••---------._...__----------------- W Design Flow..........�_`�__........................gallons per person per day. Total daily flow..........ZA %......................gallons. 9 Septic Tank—Liquid paci�G__:____.' allons Length._.__?�__.____ Width........�.�....... Diameter--------- Depth................ W P q P � x Disposal Trench—No. ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ("- Dosing tank ( ) Percolation Test Results Performed by.....................................................I.................... Date........................................ Test Pit No. 1___ .�.2.-.-._minutes per inch Depth of Test Pit_______1_2_______ Depth to ground water________________________ . r3;4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 -----•--•---------------•---._._____.___._.__-----____.____.__...---.______........-----•._..................................................................O Description of Soil _ 'Z ..��.....--•-�--•�ca !Vitro........-•------••••......-•---- U --•.._......---•-------•.._...------•._...... -----•------- •��«V- -- Y � ------------------------••-------------.__.__-----�•`'-'..`......---••-ll+ � �`c ..� ...." .................................................................... 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 TIT12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance a been issued by the board of�health. ................................ Date Application Approved By_____ ___ _______ ____________ ....................Da--te Application Disapproved for the following reasons:-•--••-----•••••-•---------••---•--•----•----------•-------•••------•----•-•-•-••----------------------------••. ..........................•...---•-------•--•-------•----•-----•----------•-•---------•---...------__.-•-._______---•---•--__.__._____-----•-----•--•------__.--•------------•--------..._._____..------. Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,� ............... 1?:QJ""t:........OF................. sL zi7:.` .................................. Tertifirate of Tumplinure THIS IS TO CERTIFY, T4at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------ ----------------------------------------------------------------------------------------------------------------•-•.----------------------- ��• Inst 11,x has been installed in accordance with the provisions of �i ,j o The State Sanitar Co as d b d in the application for Disposal Works,Construction Permit No � _1__-__ ................... datefl /� -______________- THE ISSU?kNCjE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS UARANTEE THAT THE SYSTEM/WI F C ON SATISFACTORY. DATE.6 1� .-•.................•---......-•------•------------- Inspector-- ............•..._..........................................._................. THE COMMONW OF MASSACHUSETTS BOARD OF HEALTH ( ' '2 ..................7..................OF.............. �2.�!1�_�.�' .................................... No......................... Fs .. .... Disposal lutrkg dunp1rurtion rrmit Permission is hereby granted. ` .......... ' ................•----•-•- to Construct 'V/ or Repair ( an Individual Sewage Disposal System at No t ----------- Street as shown on the application for Disposal Works Construction PxiI�T______________________ Dated.......................................... ............... ---• ----- --------------••---------._____...---____...______----•___•-•-•....__.._._ ____________________________________ Board of Health d 4 DATE..............�.__�U----� FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 41 Poi L F r Sc b _ *' '1 , ,sb`�2 ��` LQ T 7 1 n ton• ��L'���E �, Q fl� • I top 1 Y ` pv �H OF fl o ORSE` ru C.3 N i No.10951 G4 '9p �G1sTE� �FSS/ONAI LEGEND EXISTING SPOT ELEVATION ' 0„0 . .. CERTIFIED PLOT PL'AN` ' • '# '' EXISTING CONTOUR .--- ® _ S'A/v'7'ui7 , .v FINISHED SPOT ELEVATION °' ' °T T' FINISHED CONTOUR O axc "4,� ST"rd ELDREDU 1 N AP PROVED BOARD OF HEALTH AJtkl t\ d ` 40- DATE.: AGENT SCALES ,C Q AkTk � 6 D-RED GE ENGINEERING Ca INd i 'CERTIFY ,'THAT THE .: PROPOSEQ % EGISTERE RESIST@"REID3'�'� : : JOb ,I Qr .,.. :.�UIIaD1N0 .8H6�1N'N ON THIS Pl' iN x� ,. CIVIL LAND 'A ' ',CONFORMS THE; ZONING: * t,Al�/$# �F N ti'°I N E ER UR Q9�.I�Y,� .�. ,� v ' ,OF, 9ARNSTA6LE 712 MAIN STREE # MAS CH 8Y HEFT� r f T3 , zr I "' $ "...: 'gig • t D a t e.• n.+s 1 s r �tA N E/TflCR TXiSEPTIf;; Ta4N/�' t�� �O FT. . MIN. ITTF ;.,•/F • _ LAFACHLNG P/T .4RE MORE TN/F'N 7�2 B�ii01V �., /O pr. M/N:• GRAOE�A 24'O/AMET,�R CO/ytRFT� CDNRR' SJti/AL L 494F S•?OeJ6N7' TO 4J?A DOZ.�f1/V Ei1C`TRA CONCRPTE MIN. O/TCN rEAYY CA ST/RO/Y CO{/4*R' S'N14 L L B E US�O O-Z O COVERS /F//V DR/✓EJ•VA Y '. 2 Rf, nl iN. 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GA.44SAGED/5,005, 1-vIyJT ffOAlE S0/L LOG To7AL -s'r/M.4TE,D F'LaA-v 3 yGAL.1DAy SO/L TEST #/ SQ/L TEST**2 SO/L 7,E57' NUMBE,P QF L,�ACNING PITS t �FLEY. �`-EL4r ,DATE OF SO/L TEST �/2 3� &� S/OE LEACH/NG PER P/T P SCE PT. 0 _ -Z I ''=' i/ J �E /"RESJ BOTTOM L.04CqlAtCr PIER P/T / 3 ". A-r• COLA7-10N RATE At/ L s s ^?j/y/INCH PER TOTi4L LEACH//VG AREA Zb �So. FT. a'. S�3 s n�� AEJeCOLAT•/GN RA7,E yk 2 �`'`'��'I►�I N.�/NCB'/ REsERvELEACN//VG AREAS SQ. FT. 2 , - 7 CL.ta tea- ��°ma z 3 S u OF k1 ��K cr r.A "7- l z ` L s 0 7` 7 -AIVT✓i ..a ROSERT �� Sep N b tRSE BRUCE -" ELDRED No.0951 O �L S �,.' 7!2 MAID/ .S F., HyAN/1//9, 'MASS. S 4 St; rs�CNAL Ea � NO G/TOV VP: YY�tT&M A VCOIJNT,REO CL/E/VT r�,� �5'/A'E DATE // 1 of e' • 0 G/�Ouvo 1-+/1#TER AT LEY. JOB /NO. 193 2SHF.L'!" OF