HomeMy WebLinkAbout0250 TREE TOP CIRCLE - Health 250 Tree Top Circle
Marstons.Mills
A _ 126 024
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LOCQT-10N : 5EW&C4E PERMIT IJO.
IMSTQLLER•5 U&NAE � ADDRESS
bUILDER )a&Vff, ADDRESS
DATE PERMIT
DATE CONAPLI L1MCE ISSUED :
1
n NO
No.. ' - x'" i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/✓I1..._ '4!'n �
..--.OF....�11Z ................................
Apphration -for 13Wposal Works Tonstrurtion Prrntit
Application is hereby made for a Permit to Construct ( ) or Repair (/-<an Individual Sewage Disposal
W_S�Y'stem at:
. . --...-----. --•---�---- .. �� --- --------------....................................--_-----------_-:.......
Ldctll -Address or Lot No.
e Address
/
--------------------------- ------•------------
� r
Installer Address
Upe of Buildings Size Lot............................Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons........--...-----.---...... Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------------------------------------------------------------------------------------------------------••-----•--------.
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
W Septic Tank—Liquid capacity.--.------.g ..
gallons Length................ Width .....--....... Diameter---------....... Depth---.....-----...
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.......................................................................... Date------------------------------------.:..
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit..............---... Depth to ground water.------..---...---....-.
fs, Test Pit No. 2................minutes per inch Depth of Test Pit--------............ Depth to ground water-..-------------_------
------ •---
ODescription of Soil----------- - ...................-------------------------------------I---....------ ------•-- ---- ---------------------
x
x ------------ --------------- -------------•--•---------...-•-•----••-•--------•--•-•--••--------------•---------......�...--
V Nature of R epair)lff Alterations—Answer when applicable.....--..--/ ."'.i` ® ....... .... ...... _...---
J --•---------------------------------------------------------------------------••------------- •-•---. -------- -------- ------...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n/issued by the board of health.
Sign . 1 . �
Date
Application Approved ,BY -- -
' Date
Application Disapproved for the following reasons:-------•---•----•------••.............•---••-•-•--------•-•---•-•-------.....................-----•----•-•-----
--•-•••----•-••--•----•--••-•...-•-----------------------------••-•----......•--------•-...--••----•.................-----•.........----•-•-----..........----.....---------------------...--------------
Date
Permit No........................................................ Issued.../-.Tj-- M `"�-- -d--�-.-...4�..-..""...
Date
f
No.. ...-I........ .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........./.. 1 .......--.OF.... . .C.l.<!�!1 - .................
Apphration -fur Bhipoottl Worko Tonitrnrtiun Vrrulft
Application is hereby made for a Permit to Construct ( ) or Repair (4-11'an Individual Sewage Disposal
System at
Al- ...........................................
.y—dca xi-Address or Lot No:
W d�,� /J �/� wner Address
��
�$"w _:./.................:.✓.L;� � �_l ft.�✓ ......
. -.......---••-•-----
Installer Address
U Type of Building/ Size Lot............................Sq. feet
.� Dwelling e—�'No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
`1 Other—Type of Building ---------------------------- No. of persons............................ Showers — Cafeteria
04 Other fixtures -----------------------------------------............-•---------•------•----•---•-....
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter............---- Depth-..--_-_-.-----
x Disposal Trench—No- -------------------- Width-------------------- Total Length--------------------- Total leaching area._.----_.-___--sq. ft.
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. I................minutes per inch Depth of "lest Pit.................... Depth to ground water-..---.--.--.-.--.-.-:-.
fs, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__:---------------------
a --------------------------------------------------------------------------------------------------------------------------
O Description of Soil--------..4 -' --. ----------------------------------
x
W ---------------------------------- ---------------------------- ----- - --- -----------
Ux Nature of Re si� r Alterations—Answer when applicable..._....... �f5
P` --- ---- --------- I.- --------..
Cr-•----------------------------------•-----------•---.--.-----••--------•--------.- ---•-----
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 beenr issued by the board of health.
Sig�ned :._ `F ;----------•- `� �f fit.r<rz ? ......
._ �
i Date
Application Approved By.. � ` jI '' �11 !}._ <:u%-.......................
Date
Application Disapproved for the following reasons________________________________________________________________________________........... ------•------
-------------•--------------•----•-------------------------------------------•----•-----.------•------------------•---------------------------------------------•--------------------.------------------
Date
PermitNo......................................................... Issued.............................................-•--------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
- �
Trrtifirate of 0.11mViiatur
THINS IS TO ER" FY,�i the Indivi 'al Sewagefisposal System constructed ( ) or Repairedj)
y � �, � � Instal �;•Cf �-------------- - - -
----..... ----- --------------------------------------•-•------•
has been installed in accordance with the provisions of Articl_ XI of The State Sanitary Code as described in the
.,.�_
application for Disposal Works Construction Permit No. _.___..__. ........... dated..../!�._..____:__�1..:......................
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................................. .................................. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
N o..
.......... � r/l ............of...-.. z ...f�. � ------------------
.......................
FEE.._. ...............
.��� trnrt•�$t �rr}�tit
Permission is hereby granted._,.__[c� _ _ ._ _ / '.fit-�'.._: ..-`:=- --� 2a ---.---_----•-•---•---------•-•-
to Construft ) or .'air (tan Indvi -ial Sewq sposystem
at
Street _
as shown on the application for Disposal Works Construction �Omit No, : Dated... .`..........
1�-- ----t -------
Board of Hea
DATE../ '.....- �--75�-----------------------------------------
6
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
x TOWN OF BARNSTABLE
LCaC'ATION o1SO �/LpO. ..� 5 � SEWAGE#
VILLAGE Maao�k& ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. Or• O `r AQgS,J�,,
SEPTIC TANK CAPACITY pC�b o1 "
LEACHING FACILITY:(type) (size) aS x NO.OF BEDROOMS 3
OWNER
PERMIT DATE: O COMPLIANCE DATE: $I a I O
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 �
c
8- a 38,6" '
3 3
A 4
C- I ay
4
0- a ❑ 4 0
`i �_----� �qq 5 - SAS
aoo'► -sp s
e
}
o. .-o 07—3;N Fee k) /
* r Entered in computer: V
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZippYication for �Digogal 6potem Con0truction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑.Complete System LJ Individual Components
Location Address or Lot No. L`f�q��,} I✓1�/ (0��'C�e�' ®r�4 Owner's Name,Address;and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,an m d Tel.No. Designer's Name,Address and Tel.No. �.V
tL l«, 5i, y30 Y&Atv i41V 1���ly4t�* As 50ff 30-31.,)-4,
Type of Building:
Dwelling No.of Bedrooms Lot Size 20 .�D sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3j gpd Design flow provided , gpd
Plan Date Number of sheets Revision Date `7 Otis
Title AA
Size of Septic Tank
/I00 Type of S.A.S. d!j,t
Description of Soil -a""
Nature of Repairs or Alterations(Answer when applicable) AY7' C �'tia/
G - A 'IS -
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 by this Board of ea h.
Signed " I'1�� F Date ..2 5 �7
Application Approved by 2 Date -V w
Application Disapproved by: Date
for the following reasons
Permit No. ao d l ^ -z[ Date Issued -7 n z
Fee
1 THE Cq MO..NWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes
r ZippYicatio' n-for �Digogal *pgtem Con!64uction Permit
Application for a Permit to Construct( j Repair O Upgrade O Abandon O ❑Complete System Individual Components
Location Address or of No. �L ✓�i�o P L�d l� o�,�• Owner's Name,Address;and Tel.No. yF
'
��
�
A 5 Assessor's Map/Parcel M !/
k i Installer's Name,Address,and Tel.No. ( Designer's Name,Address and Tel.No.
Type of Building: {
Dwelling No.of Bedrooms L 5 Lot Size 20 'O C sq. ft. Garbage Grinder (" )
Other Type of Building 7((/(J—y(� No.of Persons Sho e s( '�),'Xaf6teria
Other Fixtures
Design Flow(min.required) 33 gpd Design flow provided gpd
Plan Date � �� �'C77 Number of sheets ,� � Revision Date
J
r '
Title * `
i
Size of Septic Tank /0Da Type of S.A.S. - dVZ-1 Z" 'I
Description of Soil s Q Q AN, 3
Nature of Repairs or Alterations(Answer when applicable) 9,1 `4A- `� —opt A-T
i
Date last inspected:
A
Agreement:
The undersigned agrees,to ensure the construction and maintenance of the afore described on-site sewage disposal system in i
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 by this Board of eal
e'er / 5� 7 1 Signed
Date �
/� —7
Application Approved by Date 7�; G-0 r
Application Disapproved by: , Date
for the following reasons
l
Permit No. 20�^3 Z t Date Issued — G'
6 7
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE., MASSACHUSETTS
N
(Certificate of,Compltance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded
Xbandoned( )by
at has been constructed in accordance
(.*vith the provisions of Title 5 and the for Disposal System Construction Permit No. Oo ( dated 7—
Installer Designer ci
#bedroomp Approved Uign flow _ gpd
The issuance of this permits all no onstrued as a guarantee that the system will unction a 8es g
Date Inspector
——————--—————————————————————————————— ————
No. Poc)—7--3 91 Fee 0/�)
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
ligoar *p6tem Construction Permit
t Permission is hereby granted to Co ruct ( � Repair ( ) Upgrade ( ) Abandon ( )
System]pcated at (D .AAi p o. �,c�. WLCX CL 1!�cm r-D' 0,
25
and as described i the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with TMe 5 and the following local provisions or special conditions.
Provided: Construc' ` st ble completed within three years of the date of this permit.
Date 'k� � Approved by
N
Town of Barnstable
THE 1p�� Regulatory Services
o�
Thomas F. Geiler, Director
BARNSTABLE,
9 MASS. Public Health Division
1639. �0
ArEp �A Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 1�LZS O7 Sewage Permit# b"1 — 3 A I Assessor's Map\Parcel J 02
Designer: 'M e&.40R Installer: �
_
Address: a Address: a 141p
On (�, p, ; G( was issued a permit to install a
(date) U (in filler)
septic system at a5D Jp-Q- based on a design drawn by
(address)
r fICUL e',, Wg o, dated
(designer)
'I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory. -t` a,g `0_1 0� ,
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
i of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if requir ected and the soils
& were found satisfactory.
Installer's Signature) VI 1_
rA
�M
(Des ner's Signature) (Affix De ere)
PLEASE RETURN TO BARN ABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Forni Rev 03-09-06.doc
,j i5 21[7 1-7^paration of i-1-ms anQ ;;oecmcanu a n 01" i l r 1, . , . r, .,�: •, - r i -
Tnd plans and specifications .for every on-site'system shall be prepared as follows:
(1) -Every system shall be designed by a Massachusetts Registered Professional Engineer
or a MassaclzuSetts Registered Sanitarian provided that such Sanitarian shall not-design a.
system designed to discharge more than 2,000 gallons per day pursuant to 310 CMR 15..203.
Any other-agent of the owner.,may prcpars'plans for the repair of a system.designed to
discharge not more.than than 2,000 gallons per day pursuant to 310 CMR 15.203 provided
they are reviewed by:i Massachusetts Registered Sanitarian and approved by the.approving
_ /authority;
/ .(2). .Every,plan submitted for approval must be dated and bear the stamp and signature of-
the 444/// the designer,
(3) Every plan for a new system or plan for the upgrade or expansion of an a isting"systerrt
which requires a variance to a property•line setback.distance;'must:alsn reference a plan
�✓� which bears the stamp and signature of a Massachldi etts- Licensed Land Surveyor in
accordance with Xt.L. c: 1I2, § 81D;
(4) Every plan for a system shall be of suitable scale(one inch=40 feet or fewer for plot,
plans and one inch.,20 feet or fewer for derails of system components). Ud shall include. :
picti.on of:
(a) the legal boundaries of the facility to be served. _
(b) the holder and location of any easements appurtenant to or which could impact the -
A- stem;
(c) the location-of the all dwelli-tg(s) or buildng(s) existing and proposed on the facility :
and idcn*ifieaaari of those"tb be served by the system;
'(d) =the'iacation of existing of proposed irnperYious areas; inclludng:driveways and
irking areas;
(a) location anddirnensiens of th'e system (including reserve area);
(f). •system design calculations, inclading design daily sewage flow, septic tank capacity
(required and provided); soil absorptior. system capacity (required and provided); and whether system is designed for garbage grinder;
`/( ) North arrow and existing and proposed contours;
� e u including the dace of test, exi sting
on hole i s
yh -.location'and'10 of deep'ob�servau g
' g each test, and hs naives of the representative of the
ade elevations rnarkcd on
approving authority and-soil evaluator,
U) location and results of percolation-tests including the cite of test and the names of
e.rep:escntative of the approving auth.crity and soil_cvaluator, .
} dame and certficatioa number-of--the:-S oil-Evaluator of record;
(k) location .of cvcry'water supply,public and private,
1. within 400 feet of the proposed system location in the case of surface water
supplies,&-Id gravel packed public water supply wells,
2. within 250 feet of the proposed system location in the case;of tubular public
water supply wells, and
/�- 3. within 150 feet of the proposed system location inthe case of private water
supply wells;
g
•- -1)� location of aap surface waters of the Ccmmonwealth,-'rivers, bordering•we emoted
wetlands, salt marshes, inland or coastal banks, regulatory floodway, ysIocity zone, :
surface water supplies, tributaries to surface water supplies,cettiled vcrnalpools,private
v packed water sup�Iies or-suctina lines, g:a ci d or tubular public water Supply wells,
p wells; and she location of any nitrogen
subsurface .drains, leaching catch basins, or dry
NA- sensitive area identified' in 310 CNLR 15.215 within which portions of the proposed
'stern are located.
Vrr.) location of water lines and other subsurface utilities on the facility;
n observed and adjusted ground-water elevation in the vicinity of the system;
a c6rnpletc profile of the system; '
(p) a note on the plan listing all variances to the provisions of 310 CMR 15.000 sought
N to conjunction with the plan;
the location and.elevation of one benc..hmIrk.within 50 t rr the faciLry;
7S feet of the faci3iry
which is not subject to dislocation or loss.4i.ring construction'o :
(r) when dosing is'preposed, 'complete design an specsfication of the,dosing system
proposed including.but not Bnd-xd to dosing chamber capacity (required and.provide3),'
urnp curves and.specifeations, number of dosing cycles and depth per cycle;
(s) when a Recirculating Sand Filter or equivalent alternative technology is required or
/i/ oposcd, a complete plan and specifcation for the system,including a hydraulic profile;
t) a locus plan,to show the locadon of the facility including the nearest existing street;
the st:cct number and lot number, if any, of the facility; and
Y) the materials of constructioa.and.the specifics dons of the system.
4
FROM :ABODE ,``• FAX NO. :5084202803 Rd. 06 200 f 08:30AM F2
TREE TOP CIRCL E
- - _ S 59'36'10"E
137..92
m
3 3 EXrsTXAoW
Ora'ELLIN6
W
ti � a kid
ti 'U
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LOT 10
201 001 SF.
137.92
N 6936'10'N
"TO THE BEST OF MY KNOWLEDGE, THE' PLOT PLAN OF LAND
SUILDINrs -9"0WN ON MIS PLAN IS AS
,'T ACTUALLY EXISTS AND IT CONFORMS rp �L•OCATED IN
THE ZONING REGULATIONS IN THE TOWN pF SA R INS A BL E — MA SS,
BARNSTABLE. REGARDING YARD SET
PREPARED FOR
DA T.- SEPT.20. 1994
r ANTHONY FIFEr ZeU OAVtp ,�
�
DATE.• SEPT.20, 1994
28w5 SCALE S m30 FT•
FLOOD ZONE NON-HAZARD CAPE 6 ISl..ANOS ENGjNEE,
o-50 `' � ��c�ST�RE°r�� ' MASHP
�., EE — MASS.
i
deck
UP �
i
I
bedroom 4
dining/kitchen " ''I rz/��
:_ living
spiral
unheated porch !
p
living
_; den/office front deck
t
bedroom
Y
p
.ftt
Town of Barnstable P#
Department of Regulatory Services
• ><
Public Health Division
• twwerestE, on '
Mess.
Main Street,Hyannis MA 02601
,
Date Scheduled /01 T ime -
Soil Suitability Assessment for Sewage A. o tl
Performed By: 0 Witnessed By: f..
LOCATI�IN& GENERAL INFORMATION `3
Location Address a CJ� AUe CAI CF Owner's Name
o fiL
Address
Assessor's Map/Parcel: I oZ 610 9-q ,n Y
Engineer's NameNEW CONSTRUCTION REPAIR � Telephone# 508 SG --{ qa
Land Use J Slopes(R'o) Surface Stones At/A_
Distances from: Open Water Body 1 V/� ft Possible Wet Area " l` ft Drinking Water Well ft
Drainage Way 'Y ft Property Line 30 ft Other ft
i
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
4
i,
_ a5" �`V
I
Wo
Parent material(geologic) c/d'�Q `� ' Depth to Bedrock 1 V I
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Poor "1 ►V
Estimated Seasonal High Groundwater 1V
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: F m in, Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adi.factor_ Adj.(Irrauntiwater Level ,
PERCOLATION TEST Dgtg Ia Thne..a—.100
Observation
Hole# Time at h" O
Depth of Perc _ Time at 6" a �...
Start Pre-soak Time @ - Time:(9"-V)
End Pre-soak I S
Rate Min./Inch '� 5
Site Suitability Assessment: Site Passed V/ 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# I
Depth from Soil Horizon Soil Texture a Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Con i tent M ravel
- Y-4
o- 0.0 . 5/
DEEP OBSERVATION HOLE LOG Hole# a _
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(in.) Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consi enc % ravel
0
Qv/
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(in.) (USDA) (Munsell) Mottlin Other
g (Structure,Stones,Boulders.
C nsite c oG ve
DE
EP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(in.) Other
(USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency, l
. A III
_Flood Insurance Rate Man:
t
Above 5W year flood boundary No yes
Within 500 year boundary No Yes
Within 100 year flood boundary No, 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 p iotity us material?
e"= Certification
I certify5 �3 9g
that on (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 CMR 15.017.
Signature l J Date ��
Q:%S.EPTICVERCFORM.DOC
FINE ro,,, Town of Barnstable Health Inspector
Office Hours
Regulatory Services 8:00—9:30
BARNSTA 9 M s& E'�, Thomas F.Geiler,Director 1:00—2:00
Public Health Division. Only
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644. Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT QUESTIONNAIRE
1. General Information:
�.
Address: a�0 Tr e �o G rote �V` Map Parcel Da
Name: C-�- Phone: 8' 2-0-08'37
2. How many bedrooms exist on your property now? 3
2a. Please include a copy of your floor plans.
3. Is.the dwelling connected to public sewer? YES or 0
If the dwelling is connected to public sewer,skip questions 4.9 below.
4. Location of dwelling is INSIDE or ,OUTSIDE Zone of Contribution to public
supply wells?
5. Is the dwelling connected to an ONSITE WELL or to UBLIC WATER?
6. Is a disposal works construction permit on file or NO
6a.If yes,how many bedrooms were approved according to this permit? Bedrooms.
7. Were.any building permits obtained for construction of additional bedrooms? YES or NO A^ �,c�d�►y^�)
y
8. Is there an.engineered septic system plan on file at the Health Division? YES or edF4om
9. Has the septic syste inspected by a DEP certified inspector within the last two years?
YES or
FOR OFFICE USE ONLY
TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY
The Public Health Division has no objection to bedrooms at this property.
e
Signed: 'D Date: 3
Inspector(Print): v- W_
Q;/healthAvpfiles/amnestyapp
JUL. 1.2002 9:31AM BARNSTABLE COM/ECO.DEVELOPMENT NO.865 P.1i3
Town of Barnstable
A Office of Community and Economic Development
367 Main Street,Hyanni$,MA 02601
Kevin J.Shen Office: 8624695 Fax: 8624782
Direetor
FAX COVER SHEET
DATE: O'T COMPANY: ?W414C
TIla: t : 2. ATTN. TO: eft
Fax: ` 4 -43 c)4 _
Phone: , �-�-
FROM:
FAX: 1-508 862-4782
Phone:1-508 862-4678; 8624683 . Number of Pages including cover
sheet
MtESSAOE:
f
tl,�A�r GAM
JUL. 1.2002 9:32AM BARNSTABLE COM/ECO.DEVELOPMENT N0.865 P.3/3
HORTOLOTI'I CONSTRUCTI(IN, INC. NORM,76,S Wake�jr Road �
MARS
TONS MILD, MA 0264$
(609) 771.9399 336� .
-(608)-428.8926
-_
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❑ CA WORK
I r`• r �' F'�L�1 C..-.�(�G�' CONTRACT
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TOTAL,MATIMALG
r TOTAL(Agpp
oar Or YAX
&7gnataro O No ons home total amowrt due
o "` reHy eo>uw fa®bows wefts or be Mad aftw
of d+e a d e w Wago c"ofCdon
of work
JUL. 1.2002`,,. 9:31AM BARNSTABLE COM/ECO.DEVELOPMENT NO.865 P..2i3
TOXIN OF BARNSTABLE
. •, a� A7fION�� /,��/IC�P • sBwACE #.. .. . "
41LZ.AGet ASSESSORI MAP 4 LOT I.d
EI�tIftALLER'S NAMS G PHONE NO ,
SEPTIC TANK CAPACITY
, CHING FACILITY:(ty �
;;•,NOr OF BEDROOM$ ,PRIVATE WELL O PUBL�WATER
BUILDER Ok OWNER
' ZATE PERMIT ISSURD:�,('�
; AB COMPLIANCE ISSUED=a....
.-YARIANCE GRANTED: Yes No
f
i
,r9 Q .°
deck
UP d
15'1
bedroom
5'5Ig
iri o° ° pW O0 oo
� '18'a o04 ° livin0
12'
unhea`:d porch o o stair
14'11
14'5
a
living pup: front deck
1 aa'
bedr om
LIVING AREA
1416sq ft
spiral
stair
N 12-5
N
F 9'3
gym
den
LIVING AREA
368 sq ft
¢.(0"1
TOWN OF BARNSTABLE
LOCATION SEWAGE .. l
ASSESSOR'S MAP & LOT
:10. I'ALLER'S NAME 'PHONE NO
SEPTIC TANK CAPACITY /co
,LEACHING FACILITY:(type)T ,m (size) ..
:::".NO..:OF BEDROOMS _PRIVATE WELL O PUBLIC WATER
BUILDER O O WNE� n
f9ATE PERMIT ISSUED: Q�L
COMPLIANCE ISSUED.
lRIANCE GRANTED: Yes No
.!q Q ��
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"l -boy
TOWN OF BARNSTABLE
LOCHXTION,9j() //`fe� arCle, SEWAGE # 941-,53,9
VILLAGE/l/,0rS�n?3 /�/i�l� ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NOA`klo�x; drtsl �o?? --6
SEPTIC TANK CAPACITY (J' �ZanK
LEACHING FACILITY:(type)T �/ /` (size) l
NO. OF BEDROOMS- PRIVATE WELL O PUBLIC WATER
BUILDER O OWNE� AoMo ,i �
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
Li
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No...?. ....—337
APPROVED THE COMMONWEALTH OF MASSACHUSETTS
7igned
a Conservati rn BOARD OF HEALTH
4' TOWN OF BARNSTABLE
AppliraTife t for Bi-nipai3Ml lVnrk.5 Towitrurtiuri Frrmi#
Application is hereby made for a Permit to Construct ( ) or Repair Oe) an Individual Sewage Disposal
System at:
• ..................... ....................�_ ..il.---....C ��'------•------------- .s. . . ..........--•--•----------•----•----.....---
Loc Address or Lot
iMay..•• No.
?^! roc- "Zr��i...... ••-----•-•--------------•-------- YY� e1� �,.�.....
--•----- ------•--•----
Owner � �/Y Address
�• r✓J t L.t�
Installer 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 ( )
d Other fixtures ..._..
W Design Flow...........................____gallons per person per day. Total daily flow---------- R 0....................gallons.
WSeptic Tank—Liquid capacity/K�...gallons Length---------------- Width.......... _____ Diameter................ Depth................
x Disposal Trench—No. -------/.......... Width....._G__.__-_-__- 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 ( )
aPercolation Test Results Performed by----•-----------••-----••••-•-•-••-•---•---•-••-----•------••-•--•••---_. Date........................................
Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a .----------•-----------------------•••------------•----•----•----••--••-•---•-----------------------.........................................................
0 Description of Soil.............................. ----•--------•----------••-•--------------------------------------------.....----------------------------------------------........--•---
x
x ••---••••-••--------------------------------•-•••--.._.._..._._.....-----------------••---•--------•----••-•----•--•.._._.....-----•-----
U Nature of Repairs or Alterations—Answer when applicable.______.
} - _6!5;7 6,...-----� �- - n/' ----•------------------•-•-------------------.......:......_.
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 Complianc ha been is he board of health.
Signed ............. . ............... -------- - ----------- -- -- -------------------------
v e
Application Approved BY .... .. .. ........ .... .. .....
Application Disapproved for the following reaso .................................
........................-----............-- ...... ............� ..�.l... ................__-----....................................................... .---.-.....---...... .. ........-. .--......Date......----------
Permit No. t9 , Issued
/ Dare
L.�. -----—_._.��---- —— ,_._,__�,__,..�.�.�.�———���•�-�_—— �———————— it
r
a
No..._... ....... / FIzs....�QO. ....
THE COMMONWEALTH OF MASSACHUSETTS
r BOARD OF HEALTH
' L/5�-- TOWN OF BARNSTABLE
JAp.phratiou for Ditj igal Work,i (fouitrur#inn Vamit
Application is hereby made for a Permit to Construct ( ) or Repair 56 an Individual Sewage Disposal
System at:
777&.................................................... -------------------
r Loca6aiis Address or Lot No.
.......Ate /u-�y.--•----�=--' .............. ;�...-G----'Z%���..c�.-------......... ....'1-...r•c.. ...........
Owner _20Address
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 ( )
P4Other fixtures ---------------------------------------------------------------------------------------- ---------•---•--••-•••••••-•-••-••-•----..........--•--------
W Design Flow........................J5..�._._........gallons per person per day. Total daily flow..........-�Q....................gallons.
WSeptic Tank—Liquid capacitvZ_aU...gallons Length................ Width__._-____ Diameter---.------------ Depth................
x Disposal Trench—No. .......e.......... Width_...__4-._-_____-- 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. I................minutes per inch Depth of Test Pit__.______---_-_..___ Depth to ground water._.--._._____-__-__-_.-.
44 Test Pit No. 2................minutes per inch Depth of Te"st,Pit.................... Depth to ground water........................
•---•--•-•---•---•-••...................•----•.........................................................
DDescription of Soil......................................................... ........................................................................................ --••••-•----------••-
x
w _
------------•- -------------------------------------------------------------------•-------------•--------------------......-----.......... --------------------------- _
...... ....._.
U Nature of Repairs or Alterations—Answer when applicable----.._. ______________ _____ (��� �
0 ........./..t••1�-i�-'s/Gl=71I...i
- ----
------------ x SST i.J .:......._....SL:G'7� ._7-/ e�1
Agreement: t
The undersigned agrees to install the afodescr,'ibed 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,,hasobeen issssu/ell by-the board of health.
r Signed .jC_/ � ��/
......... - - ......../.......... ...........
Application Approved By ......-� ..: i. /� o G'/... . .......' �l// 1� -
r
----...:.---•--------------`---I.................... .`.. ..--.......�. --�...,
Dare
Application Disapproved for the following reason.,: ........................................................................ . . .............. . .. -- ............
........................................................._..___.___.._... ._ . ^..,.................._...........................................................................s......,v-..�.[...... .!/..E`-4��.f.('.f"/,
(�//' Issued // / 1 /`� / .Dace......
Permit No. /.. y...; - - !Q/< t
r Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Toxnlaliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
' .1 ta 77 - �
-
------------------------------------------------------------- ------------------------------------ ----------------------------------------------
bY .................................... ............................... U/ — `�
at . Inscaller
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ._.............._..........___------------- dated ....._.........---------- --------------._..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
C p, `
DATE ..........�...'... . ------.. ... ................................................. Inspector .... -'`----..--)....-------- ---------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f �jo/ TOWN OF BARNSTABLE FEE���
No._.1...... ------------------•--•-
r
�iupuuttl urkn�-��n� #r�tuan �rrmit
Permission is hereby granted ' /-'--------------
to Construct ( ) or Repair ( ) an.ridividual Sewage Disposal System
........................-- •--•--••--.......
Street /, I t (�q
as shown on the application for Disposal Whorls Construction P��ermit No -_ Dated____�..�j.� (/
! .................
�, ..........................................................:.__...............•..._..•.
Board of Health
DATE /.._.
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
G /
TOWN OF -S`TM CII �0/
.`LOCATION: Y?i�
VILLAGE: _,_��- xN
LOT # : PERMIT
INSTALLER'S NAME: _
INSTALLER'S PHONE # : 7/ _ 3.
LEACHING FACILITY: (type) / 1 ��� (size)
NO. OF BEDROOMS:
BUILDER OR OWNER: ,Q _
PERMIT DATE: -`l2
COMPLIANCE DATE: 7
4
_ DRAW DIAGRAM ON BACK
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SEPTIC SYSTEM PROFILE TEST HOLE LOG
TOF AT FULL CELLAR OVERS TO BE WITHIN 6" OF FINISH GRADE DATE: 7-17-07
100 BM ASSUMED COVER To WlTriiry 6" TEST BY: MIKE O'LOUGHLIN -
oF FINISHED GRADE WITNESS: DONNA MIORANDI
MINIMUM 2" PEASTONE OR PERC` RATE: < 2 MIN
PIPE TO BE LEVEL t
FOR 2' OUT OF D-BOX EOTEXTILE FABRIC
TEST HOLE # 1 TEST HOLE # 2
TOP ® 93.84 off95.4 EL 0" 96.68 EL
.. I cm O O 00000 -O O O
OOOOC70O0000
TO O O O O O O O O O O "
00000000000 0 2 0 96.51 EL �
94.58 93.0 00000000000 "
94.31 0000000000E _ 95.23 EL
H-�o BOTTOM ® 91.0 ,qp FINE SANDY LOAM
�-BOX 2 500 GALLON H-10 .DRYWELLS FINE SANDY LOAM 12" 10YR 4/3 95.68 EL
WITH 3/4-1 1/2" OF DOUBLE WASHED STONE AP 10YR 4/3
100E GALLON H-10 4' ON ENDS AND 3' 7" ON SIDES 10" 94.56 EL FINE SANDY LOAM
EXISTING SEPTIC TANK 12' x 25' B W
6" COMPACT STONE ' 24„ 10YR 5/8 94.68 EL
OR COMPACTED BASE s'6 BW FINE SANDY LOAM /
84.4 EL 30" 1OYR 5/8 92.9 EL' I
BOTTOM OF - B W FINE SANDY LOAM
TEST HOLE #1 84" 10YR 5/8 89.68 EL
C 1 FINE SANDY LOAM
82" 2.5Y 7/4 88.56 EL 108" PERC 87.69 EL
DESIGN DATA 132" FINE SAND 2 5YR 7/33 .4 EL FINE SAND t
N TES C2 / 84 132" C2 2.5Y 7/3 85.68 EL ;I
0
WATER NOT ENCOUNTERED
DAILY FLOW: (3) BEDROOMS X 110 GPD = 330 GPD
SEPTIC TANK: 330 GPD X 2007 = 660 GPD
USE: EXISTING 1000 GALLON H-10 SEPTIC TANK WATER NOT ENCOUNTERED
DISTRIBUTION BOX: 1 . PLAN REFERENCE: CERTIFIED FOUNDATION
USE: DB-5 H-10 PLAN OF 250 TREE TOP CIRCLE B ARNSTAB LE, MA, PREPARED BY
SOIL ABSORPTION SYSTEM: CAPE & ISLAND ENGINEERING MASHPEE, MA, DATED
USE: (2) 500 GALLON H-10 MONO DRYWELLS WITH
SEPTEMB ER 20 1994. THERE HAS BEEN NO ADDITIONS
DOUBLE WASHED STONE 4 ON ENDS AND 3 7 ON SIDES. GENERAL NOTES
SIDEWALL AREA: 74' X 2' X 0.74 = 109.52 GPD TO THE DWELLING.
BOTTOM AREA: 12' X 25' X 0.74 = 222 GPD 2. FLOOR PLAN .PROVIDED BY HOMEOWNER.
TOTAL AREA: = 331.52 GPD 3. LEAVE EXISTING S.A.S.. 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION
4. AN OVERDIG IS REQUIRED TO THE ELEVATION OF 88.56. OF ALL UTILITIES, ABOVE & UNDERGROUND, PRIOR TO I
ANY EXCAVATION OR CONSTRUCTION.
2. SEPTIC SYSTEM IS TO BE INSTALLED IN COMPLIANCE
WITH 310 C MR 15.00: TITLE V.
3. THIS .PLAN IS NOT TO B E_ US'ED FOR PROPERTY LINE
DETERMINATION. - 4
4. DESIGNER TO INSPECT & CERTIFY OVER-DIG, WHEN I
REQUIRED BY PLAN, AND FINAL INSPECTION BEFORE B AC KFILL
5. CONTRACTOR TO PROVIDE 48 HOUR NO
TIC E FOR ANY
LOT 10 20,001 SF
REQUIRED INSPE0TIONS. 4
6. THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A
Q GARBAGE DISPOSAL.
• 7. THE TOP OF ALL SYSTEM COMPONENTS SHALL BE MARKED
WITH MAGNETIC MARKING TAPE OR�� A'' COMPARABLE MEANS IN
ORDER TO LOCATE THEM ONCE BURIED.
8. IF SOILS ARE FOUND UNSUITABLE OR DIFFERING FROM THOSE
E FOUND IN SOIL LOG CONTACT J. O'LOUGHLIN INC..
-----'------- 9. IF AN OVERDIG IS REQUIRED IN PLAN OR IF UNSUITABLE SOIL
DEC FULL CELLAR ------------i RESERVE CLEAN GRANULAR SAND MEETING
37'_0" ,� 51 , „ 3 0C MRFOUND In15.255(3) SHOLDB EU'SED AS FILL MATERIAL, 5' AROUND
33'-0" ' ! o��i z AND UNDER S.A.S..
T.0 BACK WALL OF PORCH D SE R COME
E1-
T.BACK WALL OF /
3
CRAWL ) l 1 l /
N SPACE
N 8'FENCE STOCKADE S 1
Ljj
HEALTH AGENT APPROVAL DATE
ry
r RW� ► .
..�
Q 6' STOCKADE i WOOD
FENCE DECKIL
(rip S E WAGE PLAN
DRAWN B Y:
FMARYB ETH MC KENZII=
s a 970SFIE(p,� lit LOC ATION• REGISTERED SANITARIA
-� <V
N c 2 250 TREE TOP CIRCLE B ARNSTAB E, MA '
a 33' I = ~ �, -a4 PREPARED FOR: ANTHONY FIFE S
F
Q Ex�s,iNc S.A.S.----' ppboa y�q. �� ,; ��� - SCALE: DATE: 7/19/07
' •----- ----- ----- -----• -- and t 1 = 20
5' OVE IG-'' / ID
i se.o JOB NUMB ER• REVISION: WE
07-008 7/25/07
R SHEET NUMBER �N m
95.4 EL J. O'LOUGHLIN INC. 322
2s' 714 MAIN STREET, YARMOUTH PORT, MA 02675 tip
LOC US (508) 362-4942
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