HomeMy WebLinkAbout0067 TIMBER LANE - Health (2) 67 TIMBER A.,q /I
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COMMONWEALTH OF MASSACHUSETTS
Board of Health, 3 ca r n5ta b le , AL4.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location -7 T L �14 Owner's Name
Map/Parcel# , y-1 05 4-' Address 61 Timber Lane
Lot# Telephone# 5OR•6 Li g— 555
Installer's Name Designer's Name 0Q 1 Mayo
Address )If—TiCA be,`r ` t cA GZ..Lq-, Address S a n pw(Lf-i, R o 2 5 3 7
Telephone# 50K-y b 3 Telephone#
Type of Building e i c1 e.n G2 Lot Size sq.ft.
Dwelling-No.of Bedrooms Garbage grinder ( )
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures
Design Flow (min.required) gpd Calculated design flow Design flow provide g d
Plan: Date �-�2-1(01 Number of sheets Revision Date
Title Slit t ISc a ►an
Description of Soils)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to pla the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
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Board of FZealth,, in. FZAWV
C.1( 1 Ct,U 1VIA.
APPLICATIONS FOP DISPOSAL SYSTEM CWSTRYCTION PERMIT
Application fora Permit to Construct( Repair Upgrade( Abandon(_) - ❑Complete System ❑Individual Components
Locatio n 1° Owners Na1ne
Map/Parcel# M q 0 5�� Address TY.`f l�`>F/ C t,i t~ 'm Cl t j 1 cL: r 5 A
Lot# :. Telephone#-
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Installer's Narne Ct c + 1t T�-(1 Mkt: Designer's Name �I
Address )t� "r `.- �: Address C i it v L? J
I �af�lt t'✓, (�iF- � CS�;c(G C :tI.( ( , /VtA
Telephone# ..5c; " ` .�.`,- Gj Telephone# �cS -. 3 6'7 )(o I
Type of Building lid Lot Size sq.ft.
.. - a
Dwelling-No.of Bedrooms: . Garbage grinderU'V ( .)
Other-Type,ofBuilding l.No.`ofpersons f Showers ( ),Cafeteria ( )
Other Fixtures
Design Flow (min..required) gpd Calculated design flow Design flow provide: g-d
Plan: Date : (2, (0 I -: Number.of sheets Revision Date
Title S t t S�GUU(�Q; I
Description of Soil(s)
r Soil Evaluator Forn No. Name of Soil'Evaluator rz Date:of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned azree.9 to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and .
further agrees,to not to.place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed ) U_r'(S l l Date 3 (,5 Cj
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—fins ections
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NO. v ,. FEE
COMMONWEALTH
Board of Health, ALA
CERTIFICATE OF.COMPLIANCE
Description of Work . U Individual Component(s) ❑Complete System
The imdersigned'hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ') 'Upgraded ( ),Abandoned ( )
by: �tXl. ttyCi`� tC� t 7F(1C> .
/ —�^ �h�16' a At l l l is
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4, has been iristalle� 'n Wacrdn with the provisions:of 30 CMR 15.00 (Title 5) and roved design plans/as built plans relating to
application o. dated ' Approv esign Flow pd�
Installers., (�c. 4 ( !:l s .1 4.\ ,
Designer: T E��t t 1-� /�i 6 �(U t. Inspector Date`.
The issuance of this perinit shallnot be construed as a guarantee that the system will function as designed.
No. FEE
USITTS
Board of,Health MA.
77
DISPOSAL SYSTEMCONSTRUCTION PERMIT
Permission is hereby granted to; Construct( :) ••Repair(') Upgrade( ) Abandon( ) an individual sewage disposal system
kilefil AA1
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at � �`+ , 1 f, t j ,/i'(I't `�:1 y �1 + 't 4 as described in the application for
Disposal System Construction Permit No dated
[aNE:
Provided: Con struction.shall be com leted within years of the date of th'•s;` rmit: All (O al conditions must be met:
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Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date U__ Board of Health ) i'i
Town' U Barnstable
AHE..T. ..
Regulatory Services
Thomas F. Geiler,Director
i iA1iNSTABLE.
' a Public Health Division
16.1
Fo a Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 3 b
Designer: cJ�c�lj, �I' -�1. Installer: jj �� 1 ,
Address: . . 'S>Q�,� �`G}-I Address: �j�a�
� v-AGlC1� -7�>
On
was issued a permit,to install a
(date) (installer) p
septic system at l0 L yoZ based on a design drawn by
y
dated / Q
(designer)
. _ :certify that the septic stem referenced above was installed
f1' eP Y substantially according'to
lie design, which may include minor approved-changes such as latcra .i elocatiarz of the
distribution box and/or septic tank.
b.
I certify that the septic. system referenced above was installed with",ina3or.changes'(%;e,
greater than`T 0' lateral relocation of the SAS or any vertical reiocatien'of any component
of the.septi6,system)but in accordance with State& cal;Regiilations. Plan revision or
certified as-bit�t'by designerLo
t6 follow.
_ zDAVID-
(Installer's Signatu Up ` '
(D er s Signature} (Affix gner's Staafip Here}
z ;..
PLEASE RIETU TO BARNSTJ ADLE'PUBLIC.IiEALTH DIVISION CERIMCATE
OF COMPLIANCE NVRJU N(3'I' ]E': SSUED _ BOTH=T$IS FOAM
BUILTCARD ARE RECEIVED}I' ', f`HE:B_ STABLIE PUBLI: [DIiSI
THANK YOU. -`--�
Q:HealtWSeptic/Designer Certification Forr, ,
Department uNEnvironmental.Management/Division of Water Resources
I3 WELL COMPLETION REPORT
WELL LOCATION GEOGRAPHIC DESCRIPTION—.,
r Address—L...tvU.c I/'Ge o
/ �_ N S E of
(feet) (circle)
City/TOwn b..f, — ` ^� f5 t/ 1 t"j
Well owner' �Sd_�'�4 /r� Ins +!yfi) T' (road)
Address ' ` �':�u b o� �.�. <. N E W of
(mi.in tenths) (circle)
Board of Health permit,obtained: yes ❑ no El intersect. w/ �`�C(road)�
WELL USE., WELL DATA
Domestic[J-Public❑ Industrial ❑ Total well depth q 8 ft.
' Monitoring❑ `Other Depth to bedrock ft.
3 Water-bearing rock/unconsolidated material:
Method drilled i r' Z,'
t Description
x Date drilled p inn Water-bearing zones:
CASING 1) From To
Fyne Sr. c✓b �/JJ L 2)`From To
' Length ft. Dia(I.D.)14 —in. 3) From To
Length intq bedrock ft: Gravel pack well: dia.
Pr6fectiv4 well.seal dia.
Screen:
Grout.,❑:•:. Other Slot#/.e length 3_from_c to_$L&_
STATIC WATER LEVEL,(all wells)
Static water level below land surface. 3 /. -ft. Date 7/.)42
WELL TEST (production wells)
Drawdown _ft.. after pumping hr. min.at /S gpm
'Houv measured '``^`� Recovery''r—"`(4'after - hr. min.
LOG.of FOR
IONS COMMENTS
0
Materials From To
3 Driller drs-- �lr
Firm n A c a n n,����., 0
Address
Q. City/Town t14 t.q L421 A-A L Sri
Supervising Driller Re
g.#
4ZD�
Sig ate o supervising registered well driller
Please print firmly BOARD OF HEALTH COPY,
Town of Barnstable P#
_9 F
Department of Regulatory Services _
' Public Health Division
'"HAS&� ' Date
>t>�ss.
200 Main Street Hyannis MA 02601
Date Scheduled Time Fee Pd.
Soil Suitability Assessment for,Se.wage Disposal 6
erformed Byc 4\�(D Z
Witnessed B
��� LOCATION& GENERAL INFORMATION ,
Location Address Owner's Name
�� `�trrl�e(I.Lan2 / �"�' qe( Canni5isCt
Address 6-, Ln
Assessor's Map/Parcel: LA9 05Engineer's Name c-mcm n 50 t1
NEW CONSTRUCTION REPAIR Telephone# 5
Land Use I ' f Slopes(%) Surface Stones
i
Distances from: Open Water Body ft Possible Wet.Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other
ft
-----------------------
SKETCH:(Street name,dimensions of lot,exact locations of test holes c pare ests,locate wetlands in proximity to holes)
. b
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- y <.. ty
_,1,M*/
Parent material(geologic) �- + Depth to Bedrock' a'' M
Depth to Groundwater. Standing Water in Hole: / Weeping from Pit Face
Estimated Seasonal High Groundwater -
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: jfl.
Depth to weeping from side of obs.hole: in, t3roufldwater AdJusttneflt fit.
Index Well# Reading Date: Index Well level Adj,factor Adj. mutt water Level,,
PERCOLATION TEST Date Z e.__�__,
Observation
Hole# ���i�iiii 1/ Time at 4"
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak
Rate MinJtnch "'t ��'• ��
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\SEPTIC�PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones-Boulders.
Consistency, vel
0 -7 0 i: 1 /0Y kzlli
1 L
DEEP OBSERVATION HOLE LOG
Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency'* el
'DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.),' (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency., G v l
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Co si ten
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yeses
Within 100 year flood boundary Now Yes—
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervio s tenal exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring per 'ous material? .
Certification 1G
I certify that on 6 I (date)I have passed the soil evaluator examination approved by the
Department of Enviro men 1 Protection and that the above analysis was performed by me consistent with .
the required training,exp s d xp ri nce described in 310 CMR 15.017.
Signature Date
Q:\S.EPrM(.PERCFORM.DOC
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Health Complaints
08-Mar-06
Time: 2:00:00 AM Date: 10/3/2005 Complaint Number: 18504
Referred To: DONNA MIORANDI Taken By: JOAN AGOSTINELLI
o
Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH
Article X Detail: UNSANITARY CONDITIONS
Business Name:
Number: 67 Street: TIMBER LANE
Village: MARSTONS MILLS Assessors Map_Parcel:
Complaint Description: There is all kinds of debris in the yard. The
garage had a"rat'coming out from it. It has
been investigated some time ago by the fire
department since there is hazardous products
throughout the garage.
Actions Taken/Results: DZM investigated and found no garbage.
There are a lot of tools, etc. but nothing that we
can do. His paints are stored under a roof next
to his above_ ground oil tank. A picture was
taken.
Investigation Date: 10/4/2005 Investigation Time:
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No. '" fs Fee $5 0. 0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipp[ication for �Diooga[ bpgtem Cottgtruction Vermit
6 Application for a Permit to Construct( )Repair(x�Upgrade( )Abandon( ) El Complete System O Individual Components
Location Address or Lot No. 67 Timber Lane Owner's Name,Address and Tel.No. 4 2 0—5 6 6 6
Assessor'sMap/Parcel Marstons Mills, MA Michael Cannistraro
Eln,tar's Name,Address,and Tel.No. 7 5-8776 Designer's Name,Address and Tel.No.
LRobinson Septic Sry
ox 1089 , Centerville, MA 02632
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(no)
Other Type:of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Tit-I .- 5 T,Q a r.h i n Q r n n s i .C;t-i n g
of new D-Box and four stonepacked infiltrators.
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 this Bipard of Heal it.
Signed r Date `
Application Approved b Date 01310
Application Disapproved for the following reasons
Permit No. Date Issued
1
TOWN OF BARNSTABLE
LOCATION '3 '� SEWAGE # 7
VILE 0 `� jY/� / / ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. If 6 b d
SEPTIC.TANK CAPACITY 1 6 '0
LEACHING FACILITY: (type) (size)/U
t
NO.-Of BEDROOMS X=
_
BUILDER OR OWNER T K4x b
PERMITDATE: v�-C COMPLIANCE DATE:L5 V��
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Faci
Feet
Private,Water Supply Well and Leaching Facility (If any wells e ' t Feet
bn:site or within 200 feet of leaching facility)
Edge'of Wetland and Leaching Facility(If any wetland zist Feet
within 300 feet of leaching facility)
Furnished by
No. / 15• - _ Fee $5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for �Digogal *pMem Construction Permit
0 Application for a Permit to Construct( )Repair(x;5 Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 67 Timber Lane Owner's Name,Address and Tel.No. 4 2 0—5 6 6 6
Assessor'sMap/Parcel Marstons Mills, MA Michael Cannistraro
Installer's Name,Address,and Tel.No. 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robftson Septic Sry
O Box 1089, Centerville, MA 02632
Type of Building:
Dwelling No.of Bedrooms I Lot Size sq.ft. Garbage Grinder(nd
Other Type of Building No. of Persons Showers Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Sept;c Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Titik& 5 T.pachi ng gon-cgiatin
of new D-Box and four stonepacked infiltrators.
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 this B and of Heal .
Signed Date
Application Approved by Date 9
Application Disapproved for the following reasons -
�»
Permit No. 1- �7:3727 Date Issued
--------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Cannistraro Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (xx)Upgraded( )
Abandoned( )by Wm E Robinson Septic Service
at 67 RTimber Lane, Marstons Mills has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit N 1 dated p�'
Installer Wm E Robinson Sr Sept service Designer
The issuance of this permit shall not be construed as a guarantee that the syst will function as designed.
Date .. Inspector
————————————————----------------------- --
No. Fee$5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - 6ARNSTABLE,,, MASSACHUSETTS
Cannistraro
1=igpozai *pztem Conotruction Permit
Permission is hereby granted to Construct( )Repair(x)O Upgrade( )Abandon( )
System located at 67 Timber Land
Marstons Mills, MA A
Installer: Wm E Robinson Septic Service '"
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
ns.
Provided: Construction must be completed within three years of the date of this it.
Date: Approved ,
1
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NOTICE: This form is to be used for the repair of failed
septic systems only
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS)
I,William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated°��—9 -7 , concerning the
property located at 67 Timber Lane,Marstons Mills, MA meets all
of the following criteria:
*kTfiere are no wetlands within 300 feet of the proposed septic system.
*(There are no private wells within 150 feet of the proposed septic system.
y/fhe obseved groundwater table is 14 feet or greater below the bottom of the leaching facility.
�4bere is no increase in flow and/or change in use proposed.
here are no variances requested or needed.
7 SIGNED: DATE
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 600
(Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification
plot plan,this plan should be submitted).
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ENVIROTECHLABORATORIES,INC.
MA CERT.NO.:M-MA 063
449 Rre. 130
Sandwich, MA 02563
908(888-6460) 1-800 339-6460
FAX(508)888-6446
CLIENT. Mike Cunnistraro LOCATION: 67 Timber Lane
ADDRESS: 67 Timber Lane Marstons Mills, MA 02648
Marstons Mills, MA 02648
COLLECTED BY. DA Scannell SAMPLE DATE: 2/29/2000
SAMPLE TIME: 12:OOPM
WATER SAMPLE TYPE. New Well DATE RECEIVED: 3/1/2000
LAB I.D. #. 0003001
WELL SPECS.: 48'
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method Date Analyzed
Limits
Coliform bacteria /100ml 0 0 9222 B 3/1/2000
pH pH units 6.5-8.5 4.93 4500 H+ 3/1/2000
Conductance umhos/cm 500 206 120.1 3/1/2000
Nitrate-N mg/L 10.0 1.43 300.0 3/1/2000
Sodium mg/L 28.0 24.5 200.7 3/1/2000
Iron mg/L 0.3 0.026 200.7 3/1/2000
Manganese mg/L 0.05 0.180 200.7 3/1/2000
COMMENTS: Low pH indicates high corrosive characteristics.
Manganese is not a health hazard, but may cause aesthetic problems.
WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES
FOR PARAMETERS TESTED.
Date - L zro
R ald J. Saari
Laboratory Director
<=less than
>=greater than
TNTC=too numerous to count
6(9
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission.to operate.) signatures on this form at 200 Main St., Hyannis.
You must first obtain the necessary � .�
Take the completed form to the Town Clerk's Office, 1 st Fl., 367 Main 5t., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is I
required by law.
, Fill in please:
DATE: 916111lYIN IdM rl t
I
APPLICANT'S YOUR NAME/S:
BUSINESS YOUR HOME ADDRESS:
�° ;! S S .
4
TELEPHONE # Home Telephone Number
l 11W A,,- E_MA I L: 5t—ci a2 Ce
ae:3t:4IaYr3fri!v!'siGk
NAME OF CORPORATION: N jC6�('Lje�l/v NCI
NAME OF NEW BUSINESS I TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO MAP/PARCEL NUMBER y� �S 7 (Assessing)
ADDRESS OF BUSINESS CJ
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO ISSIO ER'S OFFI E YP MUST COMPLY WITH HOME OCCUPA'I'ION
This individ \I h s in7or f y rmi requireme is that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO
A on S' rlat * COMPLY MAY RESULT IN FINES.
MMENT
2. BOARD F H LTH MUST COMPLY WITH ALL
This individual has been e o permit requirements that pertain to this type of business. HAZARDOUS MATERIALS REGULATIONS
COMMENTS:
3. LICENSING AUTHORITY..__...-_.. __..._
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
TOWN OF BARNSTABLE
f
LOCATION � `'', /-//�` '� SEWAGE #
VILLAGE / ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY .16-6
LEACHING FACILITY: (type) (size)Ad
c
NO.OF BEDROOMS
BUILDER OR OWNER i0 /-` I
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Faci ' Feet
Private Water Supply Well and Leaching Facility (If any wells e ' t
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetland 'st
within 300 feet of leaching facility) Feet
Furnished by
�,� _,
/�, � �- ,�
I�` ` ,
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�' �� %z,
'� � -
TOWN OF BARNSTABLE
LOCAnON 7 ' , ���� C -� SEWAGE #
VILLAGE ��7V,AE )VI / ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /o 00 ,SW
LEACHING FACILITY: (type) ,D L4' (size)
li NO.OF BEDROOMS_ V_
BUILDER OR OWNER�Z?2i 4 C4AIAIIS /12A20
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
Av)-
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No......
F>�s... .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O EALTH
��� IS,f
- -------OF..........
, ppliration -fox Bi,ipuiitt1 Works Tomi"dion Vrrnift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
L o a'on-A ress or t o.
.-.--..-.--..--. - ---------- ----------
w
O e ���� Address
-- -------------------- -- - - -------------------------------
PQ
Instal er Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms_-----------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons------------------.......... Showers ( ) — Cafeteria ( )
Otherfixtures --------•--•-----------•------------•---------------------------------------------------------•-------_--......
W Design Flow...........................................gallons per person per day. Total daily flow-----------------------•--------------------gallons.
9 Septic Tank—Liquid capacity. .00,Qgallons Length................ Width-----------..... Diameter................ De)th---_.---..----.
x Disposal Trench—No..................... Width-------------------- Total Length....... otal 1kea('
i' g ar .. ...........
sq. ft.
----------
Seepage Pit No......... .......... Diameter......Y----------- Depth jbelow nlet__.___�___ u g area____..-_-._._____sq. It.
Z Other Distribution box (� Dosing tank ( ) w �, �� /X_6=7-/
Percolation Test Results Performed by------- ------------------------------------------------------------------ Date---------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit...d;�`......... Depth to ground water-..-.--_--..-.-._---_---
(rq Test Pit No. 2................minutes per inch Depth of Test Pit.................... ept to ground wat
0 Description of Soil----r----- s``�r 1
x - _ -- --
U -------- --
. 1.
----------------------
L •: -
U Nature o Repairs or Alterations—Answer when applicable------------------.--------------------------------
--------------------
---•-------------------------------------------------------- ------------------------
Agreement: ,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance,with
the provisions of Article XI 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 bo rd of health.
igned.. .-- -•-• •• •.•------- •-••----•-.
Date
Application Approved By.........
----4 . - -----
Date
Application Disapproved for the following reasons:................. ••• ...... .................,---------------------------------------------•-------------•--
----------------- ------------------------------------------------------------------••-------------------•-----•-••••---•--------••-••-••-•--------•----••••---•----••-----------••-•---•---••-•-•--•_..
Date
PermitNo......................................................... Issued...................... .................................
Date
- - - -- - ---- - ----------------------- -
/ ....................
No . ............... . KzB
THE COMMONWEALTH OF MASSACHUSETTS
BOARD , E ALT H
OF..................................... ... .... ...........................................
Appliration -for BhiposW Works Tatuitrurtion Prruld
Application'is hereby made for a Permit to ConstVuct or Repair an Individual Sewage Disposal
S jjtem at:
............. ............................ ........ .................................... .................................
0 cc ;L 4 " 11'
:a•
I &Ar.�s .. . . ...A.I......,.,C---------------- - -- -------- -----------------------7 0 ........ ..................................................................................................
...... .... ..........
Installer Address
...... Address
U
Type of BuildiP4_. 3_ Size Lot____________________ Sq. feet
Dwelling—No. of Bedrooms..............................................Expansion Attic Garbage Grinder ( )
other—Type of Building --------------------_---L. No. of persons......... Show_e� Cafeteria ( )
Other fixturi�s ......................... ------------:...........................................
1�------------------------------------
Desigtf_.Flow___________ .-gallons per person per day. Totaf daily flow-------------------------------------------gallons.
............. t.4 '..
ej)�'c Tank—Liquid capac-it.V.........gallons Length................ Width....... ...... Diarq�jer..... epth. ..........;44 S .. P_� -*o,-
Disp7sal Trench— 0. .................... WI i.................... Total Length-----
a �.. ..... -----------sq. f t.
Seepa e Pit No_____________________ Diameter_....___.________.._ Depth belo inl .................sq. f t.
Other istribution box Dosing tank Zj,�,w
Percola ion Test Results Perform qd by------------------- ate.......................................
--------------------.......
'Te�t Pit pj inch - Dtp�th of "Pest P ------__.'D th to ground water-------------�:.........
..........Test'TitNo. .............minutes per inch 13�pth of Test 11t...... h to. ground water._.._....__.___.__.._...
A ....... ............ -4
..... . ........ .e
...... ..... . ---------- -------
Description bf SoiLeZ. - ------------ �-, ;oI,
0 ..... ..�t;
V4 ------
............... .............. ........
------------ -M- wo---—---------------------- .......
------------applicable..----------------------------------------------------- --------------------------------
U Nature of Repairs or Alterations—Answer when ..............................................................................................
......................................................................................................................... .. ...........;"Agreemettl
The undersigned a-grgeg to install the 'aforedescribed Indtvidual Sewage Disposal System in accordance with
the provisions of Article Xr%of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bQ sued* tlig"aril oQ=jtjL__
SigneS.
. .... ... . . ........................................................
a
Application,Approved ................................... ............. ......................._------ .......
Date
Application Disapproved for the following reasons:.................................................................................................................
\, -- ' �. I., -
..........................................................��11........................t...................................................................................................... -----------
Date
P5F,mit No.......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
Ilk BOARD Off HEAL
.. ................OF........................... .............................................
..........
I
Trryfiratr of TJIM11fianu
THI R�IFY the n(jjkiduaY/Sew' isposal -stem tructed or'Repaired a 4al Ztem ,
......... . ...... .......... .0�41Z....... . . ..... . ... .......................................................
b, . ...... .2�*e
L�st
ns
at X04"J*
..... ---------- ----------- ......................... ......................... ------------------------------------7---------------------------------------
-------------------------
:A .1 1 V
has been installed in accordance with the provisions of Arti* f,�X�jo The State Sanitary C-de as describ.14 in.tbp
application for Disposal Works Construction Pert4t No.---';---------------I....... dat
t .. .......
.........r..y
EATE tHALL N'OT BE CONSTRUED AJ� GUARANTEE THAT THE
THE ISSUANrA,OF THIS CERTIR
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-----7.7t?w----rt------..................................... Inspector._.-------THE COYMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
jloe_o/ _0�....................... .02t
.................. .........
..........
................FE
...............................OF..... ........
aJ
Permissiop hereby granted--.--. ---- -- ----- . .......... . .�•-.............. ........ .....................-6,........... ... ....... .. ......
or er*4 to Congtuc� ri R a n.ivii a w isposal.4
atie+. ......... ........... ... _%_ ........
* .... 61%Street
as r shown on the application for Disposal Works Constructi ermi Dated?---------- ...................
. ............. ..... .. ........... ...... .....I............. ..........
6- - d of Hea lt bar
DATE...1'7 /
.........................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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K)1na ' 1141 dt �NU aC ' r c472 LAW
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TOWN OF BARNSTABLE
LOCATION 1,'7 SEWAGE#,Poo9- tayL
VILLAGE M. r ;)1 S ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. B a B ExcAV ATXPAJ
SEPTIC TANK CAPACITY /000 oa..)
LEACHING FACILITY.(type) Soo ccJ c1,a.vn-S 3) (size) 13 x 33 x ;L
NO.OF BEDROOMS q
OWNER_1j,'chctc Cann;5-fraro
PERMIT DATE: 3.3 -O 9 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility.(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
Al
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B`�- yS BEAR ,gwEct=Nb
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ASSESSORS MAP :
TEST HOLE LOGS
AC E; 1-�--I PARCEL : t�- �j� NOTES:
FLOOD ZONE: -- -45-1 � I �- (,��- SOIL EVALUATOR : AUI 1? .7 � G
-- WITNESS : i W Ib(LV''`l 915 REFERENCE: DATE : 1) ..The installation shall comply with Title V and Town of Barnstable Board of
-bC�VS GEc2?7r"/ ' ' �'i 1�. Health Reulations.
- � t.r 1�0\/. )( �17 PERCOLATION RATE : g
2 NCI 1 + 2) The installer shall verify the location of utilities, sewer inverts and septic
I OD-1 d �/ _'���►Ib y _ components prior do installation and setting base elevations.
TH- 1 TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first
a L° rn n1 two feet out of the d-box to the leaching shall be level.
,► Ib Z_Z D , (� Z z.-- 4) This plan is not to be utilized for property line determination nor any other
tD ►4 � Loft SAS/ purpose other than the proposed system installation.
10 / 'Q 5) All septic components must meet Title V specifications.
.-----•-� � "`1 6) Parking shall not b►e constructed over H 10 septic components.
LOCATION MAP -_..
�` _ 7) The prperty is boiunded by property corners and property lines.
/✓v7 �! t. r ) property hall review design considerations to approve of total
�9 ��. hl0 �'✓�'J v� ?� � �1 �� ? ��D 8 Theowner s
design flow and nuimber of bedrooms to be considered for design. Receipt
`Ol 77"��^-� /60 77-/C of payment for the plan and installation based on the plan shall be deemed
approval of the deign flow by the owner.
IC47 . 6y, ,10 �T-0, SR.,.Io 9) The existing leachiing or cesspools shall be pumped and filled with material
,1per Title V abando►nment procedures. Those within the proposed SAS shall
`7
be removed alon 'with contaminated soil and replaced with clean sand r
0 Crri�J17. WW'SI"r1t, 1 ►.. o . IW� g P per
Title V specs.
— � QL3i 2y7 10)System componenits to be 10 feet from water line. Sewer lines crossing the
water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
SEPTIC SYSTEM DESIGN - . ,
applicable. The SAS �s bung installed below the water service
line. The line is too be sleeved as aforementioned and maintained in place.
to' mq "J FLOW ESTIMATE 11) If a garbage grind(er exists it is to be removed and is the responsibility of the
�1 En h � — owner to ensure suich.
/�, `� � BEDROOMS AT 110 GAL/DAY/BEDROOM - GAL/DAY 12)The installer is to take caution in excavation around the gas line.
13)The installer shall verify the location, quantity and elevation of the sewer
� tr1 ) SEPTIC TANK lines exiting the dwelling prior to the installation.
'yC)GAL/DAY x 2 DAYS 0 GAL
USE l GALLON SEPTIC TANK
, QI Vt rJ Cf2 V-1 OT
JAWr __ SOIL ABSORPTION SYSTEM "
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BOTTOM AREA: /3 Oi _ tfiAON �,
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1-- -t SEPT L C SYSTEM SECT 14N `'
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SEPTIC T NK aHc* 471 ►► 1�
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SITE AND SE
WAGE - PLAN
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LOCATION : e7 05�
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SCALE: �
W DAV I D B . MASON ?,5 DATE: Z Z'1
�T LW{y/ DBC EfWV 1 RONMENtAL DES1 GNS
EAST SANDWICH . MA
W
Z '•, � DATE HEALTH AGENT �
3 - ( 508 ) 833-2177
W
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ASSESSORS MAP : I
G l_wI PARCEL : �#- TEST HOLE LOGS
NOTES:
FLOOD ZONE : U`{ 4 r>!f'.' SOIL EVALUATOR : ! fh/I . 1�►q�jb
WITNESS :
REFERENCE :
Gc2-'r7I'"'! f G07 DATE _ 1) The installation shall comply with Title V and Town of E,arnstable Board of
- Health Re ulaHons.
� -(�dJ OV, �1 ��1� PERCOLATION RATE : 2 KAIt I I g
- + - 2) The installer shall verify the location of utilities,sewer inverts and septic
�_/ II w✓ OD.1(� �! �1 i Id ! components prior to installation and setting base elevations.
1 g -
TH- 1 TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first
two feet out of the d-box to the leaching shall be level.
4 This
plan is no t t o be utilize
d forproperty) line determination
0 nova Pn other
y
Lo Poq4 � Laq>'v1 ,��vJ
purpose other than the proposed system installation.
I � y
10 rev/ fD 5) All septic components must meet Title V specifications.
p po
LOCATION MAP ,- �� . , .. ----� ti -�-- 2 ;-.-.-�._.- ---________ 6 Parkin shall not be constructed over H10 septic coin vents.
�� 7) The property is bounded b property corners and ro ertylines.
/ /✓ram i� .' �f�' r,� — �-� �'�� ,�r�t i' ��7 8 P P Y Y P P Y P P ,
Qom. 1�/p Ite J v k1 7 G / ) The property owner shall review design considerations to approve of total
design flow and number of bedrooms to be considered for design. Receipt
73 of payment for the plan and installation based on the play►shall be deemed
approval of the design flow by the owner.
��✓ Yk�
`v (ICj � ,ljW�-l.C� 9) The existing leaching or cesspools shall be pumped and felled with material
- } r per Title V abamdonment rocedures:
_ ____.. ;._�_._,� _ ,.._ ._.. � lO �� � P P Those within the proposed SAS shall
_._.. ~ o Wt4(2, WtA, 1 t o tlr U, be removed alom with contaminated soil and replaced with l
_�- �� ,. g p clean sand per "
�t �r,IZ(�# 2. Title V specs:
10)System components to be 10 feet from water line. Sewer lines crossing the
water line shall be sleeved with 4 inch SCH 40 PVC with en '
SEPTIC S ends grouted if
�- SYSTEM DESIGN
CN .
applicable.
Tho ro
• _. _ _�._._ ._ ._ __ . _4 ___ . _ __ _ __ ._. ____.___ __ pp proposed SAS is being installed below the water service
line. The line LN to be sleeved s a `
r FLOW ESTIMATE 11 If
and maintained in place.
f a garbage grander exists it is to be removed and is the responsibility of the
P Y
�} owner to ensure; such.
11f�{ 1 N C• (�'( 1i�'
O I i BEDROOMS AT 110 GAL/DAY/BEDROOM t GAL/DAY 12 The installer is tto take caution �' '
. { _ ) t on m excavation around the i`s line.
- 13)The installer shall verify the location quantity and elevation
� fY , 9 Y of the sewer
SEPTIC TANK lines exiting the: dwelling prior to the installation.
g
�
- _ `
/l,J GAL/DAY x 2 DAYS S�U GAL
�
l.r r
U -USE LOCv vt�LLc7N SEPT t C TANK e-X 1 i l u i ► ��3��
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'SOIL ABSORPTION SYSTEM TEM
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SEPTIC SYSTEM `SECTfON
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sPREP,ARED FOR ,
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SCALE :
DAVID 8 '. MASON 2 Z?
'Rf`..`J DATE
Z / DBC ENVIRONMEN� AL `DESIGNS
N-rs
W EAST SANDWICH . MA
3 DATE HEALTH AGENT j
z ! f ( 508 ) 833- 2177
4A, -Lab 1�V l y --Vtl 31? Wt 1,.51
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