HomeMy WebLinkAbout0256 WAKEBY ROAD - Health 256 WAKEBY ROAD, MARSTONS MILLS
A= 043 049
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No. d Fee uG
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
9ppliLation for -Mispo8af 6pBtem Construction Permit
Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System �dividual Components
Location Address or Lot No. A19C. Owner's Name,Address,and Tel.No,,k8
O
Assessor's Map/Parcel y3 Mars�&n-s
nInstaller's Name, ddres ,and, el.No.�G�-���- 93 g9 D gner's N e,Addre s,ar4d Tel.No. 8-.�a5-
+7cx`t�1 � T�wT10;l o�Yb • ftf ° i '�/J
1 (s Caw OX
Type of Buildin .
Dwelling No.of Bedrooms J Lot Size 46 5!3 3 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3.3n gpd Design flow provided 5 9 gpd
Plan Date 941V Number of sheets Revision Date
Title J I o�J°-C2 f
Size of Septic Tank T e of S.A.S. ,R
Description of Soil
Nature of Repairs or Alterations Answer when applicable) ow - tS 9 d O
/
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 Environmenta e d not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date 1
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. d r Date Issued a
33 �� tl t)U �
• No. i � ,, Fee
THE COMMONWEALTH`OF MASSACHUSETTS Entered in computer:
F Yes
PUBLIC HEALTH DIVISION - TOWN -.OF.BARNSTABLE, MASSACHUSETTS
01ppliration for ]Disposal *pstrm ConstrUrtlon 3permit
Application for a Permit to Construct( ) Repair/Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. aS(1 LOG L, PJ Owner's Name,Address,and Tel.No��jg'—
Assessor's Map/Parcel y3 7 l �"`r l 5 '�A�v)rs ;�l+a��rLC-4 CLL e�
14
Installer''`s Name,Address,and el.No.66$-7'�/- 53?? ner's N e,Address,a0d Tel.No.:5D8"
1 tt Name,
UL�i oar,.i.- . 1jvLtii) Lei . �
use - M rS �� ,t�5 µit ox,0- z a� 1 AM 6
Type of Buildin .
Dwelling No.of Bedrooms Lot Size aU 5;`3 3 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 33(-) .gpd_---Design-flow provided 9 gpd
Plan Date /8 a70I Number of sheets Revision Date
Title / t 5 C(/1'1 0? SCpLC'.��/'1�ef�t /� 60 A /5
2
Size of Septic Tank ��7q d cr,-C T"pe of S.A.S./z 83 w Xcgs
Description of Soils 6
;y. r
` Nature of Repairs or Alterations swer when applicable)
k.--4 i�X rx,33 /",/ a, Kc2� 1e11CXA1
/GYX
Date last inspected:
Agreement: ,
The undersigned agrees to ensure the construction and maintenance of the afore described'on-site sews a d'hs osal s. stem in
g g g P Y
accordance with the provisions of Title 5 of the Environmental.C�ode did not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed /1 Date c2 /
Application Approved by Date
Application Disapproved b Date <'
PP PP Y
for the following reasons
Permit No d(L/ - Date Issued {
- - - - = = -----=-'---------------------------------------
- I
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the O -site Sewage
/Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by
at has been constructed in?accordance
with the provisions of Title�57d the/for Disposal System Construction Permit No� J dated
Installer J/ I Ya'SJ�G�:�lcr) Z, Designerla;
#bedrooms a Approved desigf fl w gp"d
The issuance of this pe it hall of a construed as a guarantee that the system w' ncti �r es� - e
Date Ins ector/ p r 1 C� 6
No. 0 - Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal 6pste Construction Vermit
Permission is hereby granted to Construct(, ) Repair ) Upgrade( ) Abandon
System located at [p /Ale ' ( S
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
r
Provided:Construction 711st
be completed within three years of the date of this pert t
Approved b I
Date / A
t, � ! ! Y
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SEP-30-2014 00:39 From: To:15087906304 Pa9e:1-'1
FROM !dawn cape engineering ino FAX NO. :150e3629W0 Sep. 29 2014 12:15PM P1
8KAM Public Health-.0tv1don
s6y� w
Tho'F. m,N,O,sG-asin,1LDinWCOY
791110 ajin street,11ymMIlig,MAC.060.
Office, .508-862-4644 Fax: SOS-71,10-6304
• - rn�'tulY�r�gP��e�'I��PiY4�R¢'�030._ -,��
If 2b: °� j Sewage Permit* o7Q1��3�; A9QQ8Rrar'9 Msti0T',1rcel �`� �•
A ddress: ��. .. �G Address:
C� �� 1 f •.r` ns issued a p�r��itto i�.s�)1 a
septic cyn'tom at_ 60 P- baued,on a dp.3! i drawn b'y
(addrec' .
g 61 le,( 14- Jk fF_?4 dAtca..__--
(deal }
l castifq that the 5to-Ptir, 5yste7xt referenced allcrve was fiwAl led nubytanbally s.ccoulinl •Ca
the C1.rap, which rvq iulode m.6ar appxovad ChRa E S.arll F9 Drat relor-atio i of the
rUjbab'uhoa box sndk aVi.YtLT11C
_ I ce:ttifp that&; Se.plic .7, gfn-L zef wv,ced above,was uaaWIRd wish u�jor �.L��x�es
PTt:&r, 1c1' lalGrai ielocation of thr,IJ.A S or a[ry YerLiCal ielocaticn,n:f any corupo eni
of-the septi!.System) �,;4u�tlaurr'with jtFn,k j-ncal MU Cdationa. Plan.revir,7aa 01
CP !'�td yr to-TU11UW.
4tM OF .lS
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..- ....� ... n .r..a. .t._—I 11,C MA.7....
a TOWN OF BARNSTABLE
LOCATION 01?�9 6LaA66y��2 % SEWAGE #
VILLAGE ���arn�.r/'Y�,'/,� ASSMS
MAP&LOT�G
AME&PHONE NO. �.t � :
SEPTIC TANK
CAPACITY IC(X)/Gl
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OB
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 3 t of le chin fa ' // Feet
Furnished by!ZQae (5� trGl la/� .�L��C < 6j/�,2, fs
�j 370
E
` TOWN OF BARNSTABLE
LOCATION
/S-'—(� 17�t� O�� SEWAGE# P -"33�-
VILLAGE AAA �5oCt..1 AS**-S��ESSOR'S MAP&/PARCEL
INSTALLER'S NAME&PHONE NO. LZ 7.Oto ec t
SEPTIC TANK CAPACITY -0AU ►'e l�(C� 1000 4R-L_.
o LEACHING FACILITY.(type) i 9Z�TCL$$- (size) �=� l+�i � 3�XJ—
P
NO.OF BEDROOMS
OWNER l
PERMIT DATE: + 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 arid.Leaching Facility(If any wetlands exist within
300 feet.of.leacliing facility) A- Feet
FURNISHED-BY
• t A3 101
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Official Website of The Town of Barnstable - Property Lookup Page 1 of 3
Assessing Division Property Lookup Results - 2014
367 Main Street,Hyannis,MA.02601
«BACK TO seai3cH« "Print Frlend r
Owner Information-Map/Block/Lot:043/049/,-Use Code:1010
Owner
Owner Name as of 1/1/13 AMIOTT,WILLIAM R&JACQUELYN L Map/Block/Lot G/S MAPS
256 WAKEBY RD 043/049/
MARSTONS MILLS,MA.02648 property Address
Co-Owner Name
256 WAKEBY ROAD
Village:Marstons Mills
Town Sewer At Address:No
GIS Zoning Value:RF
Assessed Values 2014-Map/Block/Lot:043/049/ Use Code:1010
2014 Appraised Value 2014 Assessed Value Past Comparisons
Building Value: $99,800 $99,800 Year Total Assessed Value
Extra(Features: $17,100 $17,100 2013-$230,700
Outbuildings: $4,100 $4,100 2012-$232,000
2011-$234,500
Land Value: $109,600 $109,600 2010-$234,200
2009-$272,400
2008-$283,800
2014 Totals $230,600 $230,600 2007-$305,600
Residential Exemption Received=$86,566
Tax Information 2014-Map/Block/Lot:043/049/-Use Code:1010
Taxes
C.O.M.M.FD Tax(Residential) $348.21
Community Preservation Act Tax$39.41 Fiscal Year 2014 TAX RATES HERE
Town Tax(Residential) $1,313.59
$1,701.21
Sales History-Map/Block/Lot:043/049/-Use Code:1010
History:
Owner: Sale Date Book/Page; Sale Price:
AMIOTT,WILLIAM R&JACQUELYN L 2001.09-21 14252/244 $0
AMIOTT,WILLIAM R&REMILLARD,J L 1995-07-20 9761/297 $103000
SHUMAN,KATHLEEN O 1994-11.22 9454/315 $1
OCONNOR,KATHLEEN A 1990.03.12 7089/164 $1
BRADY,BRIAN F&OCONNOR,KATHLEEN A1979.08.09 2964/209 $0
Photos 043/049/-Use Code:1010
There are not any photos for this parcel
Sketches-Map/Block/Lot:043/049/-Use Code:1010
VW
As Built Cards:Click card#to view:Card#1 1
Constructions Details-Map/Block/Lot:043/049/-Use Code:1010
Building Details Land
http://www.town.barnstable.ma.us/Assessing/Propertydisplayscreen 14.asp?ap=0&searchpa... 9/12/2014
Official Website of The Town of Barnstable - Property Lookup Page 2 of 3
Building value $99,800 Bedrooms 3 Bedrooms USE CODE 1010
Replacement Cost $114,705 Bathrooms 2 Full Lot Size(Acres) 0.48
Model Residential Total Rooms 6 Rooms Appraised Value $109,600
Style Cape Cod Heat Fuel Oil Assessed Value $109,600
Grade Average Heat Type Hot Water
Year 3uilt 1979 AC Type None
Effective depreciation 13 Interior Floors CarpetHardwood
Stories 1 1/2 Stories Interior Walls Drywall
Living Area sq/ft 1,152 Exterior Walls Clapboard
Gross Area sq/ft 2,640 Roof Structure Gable/Hip
Roof Cover Asph/F GIs/Cmp
Outbuildings&Extra Features-Map/Block/Lot:043/049/;Use Code:1010
Code Description Units/SQ ft Appraised Value Assessed Value
WDCK Wood Decking 192 $3,300 $3,300
w/railings
PAT1 Patio-Average 144 $800 $800
BMT Basement-Unfinished 768 $17,100 $17,100
Sketch Legend
Property Sketch Legend
132N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only
BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium
BMT Basement Area(Unfinished)FUS Second Story Living Area SPE Pool Enclosure
(Finished)
BRN Barn GAR Garage TQS Three Quarters Story(Finished)
CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished)
CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished)
FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished)
FCP Carport KEN Kennel UTQ Three Quarters Story
(Unfinished)
FEP Enclosed Porch MZII Mezzanine,Unfinished UUA Unfinished Utility Attic
FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story
(Unfinished)
FOP Open or Screened in Porch PRT Portico WDK Wood Deck
PTO Patio
F>'rinL Friendly
Contact '--�
Director of Assessing j
I)effrey Rudziak
i
P 508-862-4022
F 508-862-4722
8:30a.m.to 4:30p.m. i
iHelpful Links to Downloads
Abatements '
SALES LISTINGS
Barnstable FD Residential
C.O.M,M FD Residential
Commercial-Industrial-
Mixed s
Cotuit FD Residential
I Hyannis FD Residential I
Townwide Condominium
W.Barnstable FD
Residential
http://www.town.bamstable.ma.us/Assessing/property0isplayscreen l 4.asp?ap=0&searchpa... 9/12/2014
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Town of Bamnsiable
gyp' Departitnent of Regulatory.Services �
i �ttrtgy �ublac Health Division )Date
MASS.
200 Main Street,Hyannis MA 02601
l
Date Scheduled Izina F i
V ! "
e'e]Pd.
Soil I�`u/ ta z�ity .A.stsessmentfor ,fie e lais * 0 1
Performed-BY. 6aN2!e l 6an�a'y'e s Witnessed By:
LOCATION& GENERAIL INFORPJUT1ON
Location Address �5 w/ Q kJe 6 y rd. Owner's Name ` p
/ Address
Assessor's Map/Parcel: ��/y9 Engineer's Name c4J V)Vti -�
16
NEW CONSTRUCTION ,REPAIR Telephone# &0�� B01 ,
n�,
Land Use: L Slopes(%), (/ — Surface Stones /UO�e
//��, ty',
Distances from: Open Water Body YoG ft Possible Wet Area �1 t ft Drinking Water Well �y ft
/
Drainage Way �r cc/ ft Property P rtY Una > �� ft Other ft
S1MCTCH'(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands•ltn proximity to holes)
• �z
C -c
(D r- C
l,�s���y 2 N
Q s 'J
Ifs3,op
Parent material(geologic) Depth tq liadrgelt
Depth to Groundwater. Standing Water in Hole: N/A. Weeping from Pit Pnea
Estimated Seasonal High Groundwater N'/4
N ETEg� MATZON FOR SEASONAL HIGH WATER TABLE
Method Used: G k/
Depth Observed standing in obs.hole: In. Depth to sell mottles: ht,
Depth to weeping from side of obs,hole: in. Groundwater Adjustment
Index Well#k Reading Date: Index Well]oval_:__,,,,____ Adj,factor,..,,...,_.— At j.GroundwaterLavel_
FEB.COLATI.ON TEST
[Observationole# Time at 9"
epth of Pere 1 i0 ` Time at 6"
Start Pre-soak Time @ _ Time(9"-0)
End Pro-soak
Rate Mln./lnch L
Site Suitabillty Assessment; Site Passed Sitg Failed: Additional Testing Needed(YIN)
Original: Public Health Dlvisioa 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)weep prior to beginning.
Q:1S EPT[C1PBRCPORM.D O C
DEEP.O]BSERV•ATYON HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Shcl Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders,
o i Ccn Y,96'Cravel)
L EL R
DEEP OBSERVATION HOLE LOG Hole
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Corigistonov.%Grave
C, 12
DEEP OBSERVATION HOLE LOG Hole#.
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Co i to c � e
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Soulders,
Ca si ten •
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500yearboundary No + Yes.
Within 100 year flood boundary No.V Its
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perv,ous atonal exist in all areas observed thrpughout the
area proposed for the soil absorptibn system'! 'P
If not, what is the depth of naturally occurring pervious matorlall _
Cert%i�cation S/�/l� • '
I certify 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�10 CUR 15.017.
N
g
Si nature G ��-�" Datb kll�
Q:MPT(CTE'RCF0RM.D0C
BORTOLOTTI CONSTRUCTION, INC.
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Address Prop /
Date of Inspec} /�_ S Map arc I Owner
Co �j/ 0 3Q �ei� Ina
CHECKLIST
CHECK IF THE FOLLOWING HAVE BEEN DONE:
PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH.
✓NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN
RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES 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 IFTHEY ARE NOTAVAILABLE WITH N/A.
(/THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP.
fi THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT.
L ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE.
THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED
FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE,
DEPTH OF SCUM.
f/HE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR
APPROXIMATED BY NON—INTRUSIVE METHODS.
tf/I HE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER
MAINTENANCE OF SSDS.
PART B — SYSTEM INFORMATION
FLOW CONDITIONS
RESIDENTIAL
No of Bedrooms GLCC'i 12` No of Current Residents 9r ge Grinder
. S Laundry Connected to System /YU Seasonal
NON RESIDENTIAL: Ax
—
Calculated flow .7
WATER METER READINGS,IF AVAILABLE: i
ALLONS
Pumping Records and Source of Information:
SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED = GALS
Reason for Pumping:
i
TYPE OF S EM:
Septic tank/distribution box/soil absorption system
Single Cesspool Overflow Cesspool Privy
Shared system (if yes, attach previous inspection records, if any)
Other(explain)
Appr ximate age of all components. Date installed,if known. Source of information.
/is /S . >are �a� Cole 17L'O e ^r
SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? A
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B — SYSTEM INFORMATION (Continued)
SEPTIC TANK:
Depth below grade: V/ Dimensions: f� s• X �O ,XS—
Material of construction: 4-,�Concrete Metal FRP O' Other}
Sludge Depth one Distance from top of sludge to bottom of outlet tee or baffle
Scum Thickness/o Distance from Top of Scum to top of outlet tee or baffle ne
Distance from bottom of Scum to bottom of outlet tee or baffle
Comments:
5 /COO
DISTRIBUTION BOX: DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT
Comments:
PUMP CHAMBER: Pumps in working order?
Comments:
SOIL ABSORPTION SYSTEM SAS :
IF NOT PRESENT,EXPLAIN: /
TYPE: — / o
Comments:
/GW
71
CESSPOOLS: Q Number and configuration
Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer
Dimension of cesspool Materials of construction
Indication of groundwater inflow(cesspool must be pumped)
Comments:
PRIVY: Q
Materials of construction
Dimensions Depth of solids
Comments:
I
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B — SYSTEM INFORMATION (Continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES, LANDMARKS OR BENCHMARKS.
LOCATE ALL WELLS WITHIN 100'
AC' c--F7
l>'II
3>'
CAI
DEPTH TO GROUNDWATER: 34 DEPTH TO GROUNDWATER
METHOD OF DETERMINATION pOR APPROXIMATION:
/ /� 7
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
7 PART C — FAILURE CRITERIA
/ (Indicate Y—yes N—no ND—not determined.Describe basis of determination.If"not determined",explain why not)
_Al Backup of Sewage into Facility?
---�� Discharge or ponding of effluent to the surface of the ground or surface waters?
J� Static liquid level in the districution box above outlet invert?
I ,
Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? j
!-- / Required pumping 4 times or more in the last year? Number of times pumped
ASeptic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration?
tank failure imminent?
4_ Is any portion of the SAS,cesspool or privy, below the high groundwater elevation?
AiAl Within 50 feet of a surface water?
Within 100 feet of a surface water supply or tributary to a surface water supply?
Within a Zone I of a public well?
Within 50 feet of a private water supply well?
Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)?
/V Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water j
quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. !
I
i
i, PART D — CERTIFICATION
INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS
COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 !I
CERTIFICATION STATEMENT
II I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION
j REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY
1 RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE
I IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS.
CHECK ONE: j
I
I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC j
i; HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED AREAS i
ji STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM.
�i I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN
310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS
FORM.
1 INSPECTOR'S SIGNATURE:
I I
l DATE: i
i
I ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY
1
I
�F
LO SAT ION SEWAGE PERMIT NO.
t lO`i"
VIIILAGE
v
2§L, 101V6
INSTA LLER'JS� /NAME i ADDRESS
�1 L) i 6'l/ /T/f' c�/i I�k
B U It D E R OR OWNER_
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
c�
y .
y
NP
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFF HEALTH
...........Toim. ....................0 F.................Barns table.............................................
AVVlirtttiun for 111spas al t urkii Tonstrnrtion aattit
Application is hereby made for a Permit to Conruct ( x) or Repair ( ) an Individual Sewage Disposal
System at:
......_Wakeby Road............ / s.-��-��. ot 25
-,m es or Lot No.
.......... - b, .. ..._............
. ...._. - ....... ........................................
.. --- - -
Owner •Address
Installer Address
Type of Building Size Lot..--........AT..........Sq. feet
U Dwelling—No. of Bedrooms..................3-.......................Expansion Attic ( ) Garbage Grinder (Ald)
`k Other—Type T e of Building No. of persons 6.................... Showers — Cafeteria
C4 YP g P ( ) ( )
aOther fixtures ..................................
W Design Flow.................55......................gallons per person per day. Total daily flow.............33Q_.......................gallons.
WSeptic Tank—Liquid capacity1000__gallons Length.81611..... Width._42.1 n-. Diameter................ Depth....j�1011....
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---------------------- Diameter...-1 ......... Depth below inlet.__-6 t.....-- Tpytal J¢a ga�2... s . ft.
Other Distribution box ( X) Dosing tank ( ) ` ®' � � Cv!
z Ca a Cod Surve Conslts.
Percolation Test Results Performed by....-.P..........................5....._..........................._. ate......11/10(.?.8...............
aTest Pit No. I.......2......minutes per inch Depth of Test Pit.... ....... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ... .................................
O 0 0'-0.6" wood loam,0'6"-2'0" subsoil, 2'0"-3'6" white Cla
Descriptionof Soil .............................................. •-••••......-•-...--------- ------------------------....._.._ .- ...........
3'b"-12'0" med. coarse sand
V ---•-----------------------------------••---------------
-.........
-----------------
...
W •------------------ •-•-•--•---•----•-------------------------------------------------.......--------------------------------------------------------------------....--:----------------------...••----
UNature 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 AiTLE 5 of the State Sanitary Code The undersigned fu her agrees not to place the system in
operation until a Certificate of Compliance has been s ed the aeflth.
Sig _�
Date
Application Approved BY-------- --• ----Li...r
--•-- -------------•---••------- Date
Application Disapproved for the following real ------.....-------•--------------------------------------------------------..._......._.._
........................•------•------------•--•-•---•-------------•---...------•---------•-----•-------......--....--------•---••--•-•-----------------......------................Date....................
PermitNo....................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......Y;O..f^..........I....OF....... ..... .........................
Tatifiratr of fic
Toutpli anrr
THIS T C FY, Tha h�eddi
ivi al Sewage Disposal System constructed ( or Repaired ( )
by...� _ - ........ . 1.
Installer
at.....�.. .. --Gam!!. ... . ,2..... Ax
s
has be installed in accordance with the provisions of TIr 5 he State Sanitary Code as described in the
application for Disposal Works Construction Permit Nol,.:.l l ----------------• :
T
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.... =............. ................ Inspector....................................................................................
No. l ..... Fics.... J�_
THE'"COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ~�
T.,(>,M......................O F.:`_..............$A.2`YISt313le............-----........._......._.......__
_i,A, ppliration for Disposal Works Tow1rnrtion Vrrutit
Application is Hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at
........ .. d..............._....,,+� .--
ocatior Address or Lot No.
................... . .-, ---•- * _.-.--•-_---- ......... --------....................._............------...... ........-...........
ner 7. Address
W
---------- .r
s a er Address `
d Type of Building Size Lot... ......... ........Sq. f
U Dwelling No.-of.Bedrooms.................. ..............Expansion Attic Garbage Grinder
Other—Type of Building .......................:....=No. of persons._...6.................... Showers ( ) — Cafeteria ( )
Otherfixtures ---------- ..-------------------•---•--------------------------------------
__------.:...._-----•--•-
W Design Flow........:........5-___________:__________gallons per person per day. Total daily flow.........._..3.3Q__.__._______::..:._.___gallons.
WSeptic Tank'--Liquid capacitv4QO(}_.gallons Length_$i 6!!_.___ Width__4_!.jQ!!._ Diameter________________ Depth...4!Q!!...
x Disposal Trench—No........... ..:.:Width.................... Total Length..........__........Total leaching area_._" ......_....sq. ft.
Seepage Pit No-___.__I------------ Diameter.....JQ.!......... Depth below inlet..... I ...:_.. T
Z Other Distribution box ( g) Dosing tank
Percolation Test Results Performed by-_Cape...Co-L.Survey-..Czro4ta._'_______..... ate.___..11 1I �$..:............
Test Pit No. 1.......2......minutes per inch Depth of Test Pit........_7.2__..... Depth to ground water________________________
44 Test bit No. 2................minutes per inch, Depth of Test Pit..................... Depth to ground water........................
:, D Description of Soil..Q�Q_-Q. 2".._7otQ�d.: Qs3xri�Q�'.'.-2:!D"__i3�i??, o �:-2tp►/_ .t�'t white-cl$,y--------------------------
U3 Ez1f-12.�.Q". d..__csa�rse an -- -•--...._..---•----••-•--------------------
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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss td b 7the board of,health.
Sign 1{1?t_ �` -
Application Approved BY =% + -a-------------------------- ------. -
w.' Date
Application Disapproved for tide following reasons --•-----------v--•-•----••--•----•--•----------------------------------------------------------------------
-
�.
....................................................... ................................�•-•------•---...._.._._...---•----------•-------•--- ----•.-- -----...- --------------
Date aj
Permit No: ----------••••... r. Issued......................................... .. '
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD' OF HEALTH
y ......, .. .........OF............. .....................
Trrtifiratr of T.untptittnrr
THIS I TO CAE Y, That .the Individual Sewage Disposal System constructed ( or Repaired ( )
by..... ..... . .... . ............................. -- ---••-. -------.-•- ........
----- ..............
Installer
has bee installed in accordance with the provisions of Ti. j of e State Sanitary Code,as described in the
applicatiori,:for Disposal Works Construction Permit No. _ __ _______________ dated--....��.�_� f�s__.______
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT.THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ %::Inspector L..................
a..........
THE COMMONWEALTH OF MASSACF�SETTS
BOARD OF ' EALTH r
f - OF.......... •. d�
.N ..?...f .... FEE.......... +✓.....�---•�
r Disposal �n S ion rantit
t t Permission is here y granted,._.. ..................
to Constr t'' d�Repair ( ) an Indivi ual ewage Ds o ' stem`
r.
Street � r}� ��
as shown on the apphcat>on for Dlsposal Works Construction Permit Da M' ..............
_ �f Board of Health
DATE..... '0 ^ Z ,
___._._...._• __••_•............................ - h
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
-� - _.. __ - �._-rr�-_.rr r.a w�— :._ _.--•r ,4 _�., . ♦. � rt_ �-�. •_ 1 _ r _ _.. • _ _ r ♦.�-yr.� � �- � �w� �.�a.�r_e�-•w.r. .,
+ r _ 301.L 'LPG _.
, .. _ _��AArAA. •s,urn�l.9Lru'�:��u —� I/A _ , � .
TONE y OAN —rIC !2 M4• - a G..1'. �
LI:Y' S F Y vv�T •i D I S T t�., 0. ! '� �• ` 1.SE P
<.. T iJ.-MIN I000 • 7 t ,.vf•+.�-++•^ ...I t,•�! ��e 1000— GAl
} PRECAST OR
4, SAL.
- '_ �w• SEPTIC ' o A
rtA T k'
• � '`•�� ! 6 +' BLOCK I f
I ,S NK tr. �,.+ • ' 'SEEPAGE PIT o r r. �a�d.},,_,• t�.istl
lie-
Jk
t. •; =+20 MINIMUM,
f FOUNDATIONr
flt WASHED STONE
E.LEV.ATIONi; ;SKETCH
10'. — `=-f` 'tKC. RATt >t_�rva = .
it, 'SCALE }" TEST BY 1C,A nc-.err�-it{+e�r
a ill V TOWN INSPECTOR: /p/DLG �A,G±ttNr,{ i
13ACKHOE OPERATOR
TEST MADE ON AA $ A
' � .. r it �r ;� . e•. .,.- , . .. �SVt-r-e+..i•e.w agJ"1lt..t ha< J'!"J��Q�'�' /
•
_ , , ",.; t ,. a +,j - � ' ti, '. - - _ • - ,�.� �° ;,.e��•r••c5.13 /..! -f-'.r�•f•�'r iC'i L'"�� d n�/ .N',.�._��, �9-
*.•�7rvty G/�//CP+ n.f Ta7F 7► sG ON,/�"F'!� • '#
i, , • .`; + * - +�C3"'7=-'1 tS ,,ar�••!G FE'-�r:"C iu.f2!bw,�e+R`.id ' !k w' i��pG • =N.
�r►ci s..�r.+ �+� �c7.+6NA:'�"'+•'��`++ Fey►�"`�:5 , ' ' i. x >
.. ,. �_..��-L..,. 'y. �`+... _..x''• _Lo. i +�.-.-..---'��awro ri_ .►«+,�-..,.s. ..-w-..-.mow.....-r-x-•--•.�•...w _... _.. _ - -..�-�,..`. •�.17.�i-.. � -c. `, '..
AI 'Al
ro
t
T.
i�v � ,• 0,�. fy. • � I � t, - ,... u r�T
_. 4
.. - .. • ` '_` \�`+ r ''�' .: `, �` ' �.�'I�p + � � / , r '3' a , 7
c•3/
ob
mow.. ,......
� ,,.,p "f G - c/ " ^7.,R .r� .' , ..",W°,:,,,-,y-•�-•,i,M.,,,,,L.+•.w,;r.,;� 9 Zk 8 . . �
t 3:,81; aca�ae' CFvo` a 3S n►Gr Ct tt/FArG L ,i r ��a , ii& • s.3:�s y,�v.d, ,f .� `' ,,
d.
Nt
?V Ate F<':kAPMI�N`r
x ,> 11AC
I • I
.` ELEVATI S.CH£DULE
PROPOSED SITE PLAN
I I N V AT F0UN0Aif0N ��;,Q4 •
Q� (� SEWAGE SYDTEM DESIGN j
2. ,I NV- INTO SEPTIC TANK `� IN
3. f NV; OUT OF SEPT+C TANK.. _ .4
4;,,INV " rtiTO DISTRIBUTION BOX, `' _ = O� iYAV. t
- - _ SCALE !1 Z �19�.8
+5' INV OUT OF OISTRJBUTION fBOX' = I-AZ y � �����" 1,
.6 1NV INTO SEEPAGES PIT �„•ta CAPE COD SURVEY CONSULTANTS
r ROUTE 132
7. BOTTOM OF PIT = '6b!tiQ '' HYANNIS, MASS. r
A DIVISFON BOSTON SURVEY CONSULTANTS, INC. •-.;
B. BOTTOM OF STONE LAYER `
3i
.....
ALL SYSTEM
S SHALL
SYSTEM PROFILE MARKED WITH CMAGNETIC TTAPE OR BE NOTES
COMPARABLE MEANS FOR FUTURE LOCATION. Rd
PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS ASSUMED
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE
2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING
\ TOP FOUND. EL. 88.5' FILTER FABRIC OVER STONE
0 I I I
MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 84.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.Vi W W fin$
nd
PRECAST H-10 NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST
THICKNESS REQUIRED BLOCKS OR UNITS TO BE AASHO H-2Q o9
RISERS (TYP.) PRECAST RISERS
.k 2'0 85 9' 4"OSCH40 PVC MORTAR ALL H-10 es{ea
PIPES LEVEL 1ST 2' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. o
.. : H-20 D'BOX 4 (TYP.) 4
ENDS SIDES 81 .0' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE ��06y
10" EXISTING t 4~ f,
TEE SEPTIC TANK 0000 ., 0001-jr
o 000 ° oa
� ** TEE ° ���0 E 0 O_ �00� ° ° WITH 310 CMR 15.000 (TITLE 5.) ° d
84•,5t '• �0000000 o< 0 0 0 0 0 0 0 0 O 0 0 >°�°o°o°o
* o 0 0 0 0 6" MIN. SUMP ° ° ° ° �0�(�Ej0EjM00mm0�(M ° ° ° ° WakebY Locus
o�o� 00,0o� b '°°°°°°°° o 0 0 0 0 0 0 0 °°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND
GAS BAFFLE �4000_00000° 12" MIN. INT. DIM. °°°°°°°° ��®���®00� �������� °°°°° 0�0
�o���o�0J0 NOT TO BE USED FOR LOT LINE STAKING OR ANY Q
80.47' 80.3' 78.2 OTHER PURPOSE. te�sh d
°_°
o Wa
8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. m
`H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. e.
3/4"-1-1/2„ DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED pow Ele
9. COMPONENTS NOT TO BE BACKFILLED OR Q� es
ALL AROUND PRECAST STRUCTURES CONCEALED WITHOUT INSPECTION BY BOARD OF in
6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.0' X 12.83' HEALTH AND PERMISSION OBTAINED FROM BOARD
COMPACTION. (15.221 [2]) 5.7' OF HEALTH.
(-C?-.-8-% SLOPE) ( 1 % SLOPE)
10. CONTRACTOR SHALL BE RESPONSIBLE FOR
LEACHING CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP
FOUNDATION- EXIST. SEPTIC TANK 59' D' BOX 9' FACILITY 72.5' BOTTOM TH-1 & 2 VERIFYING THE LOCATION OF ALL UNDERGROUND &
NO GROUNDWATER FOUND I OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
*THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT WORK. NOT TO SCALE
UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE _
PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED
CONDITIONS IF NOT SUITABLE SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 43 PARCEL 49
PROPOSED LEACHING FACILITY.
x 84.80 TOWN WATER - _ 12• EXISTING LEACHING;FAC%4T_Y_SHALL BE PUMPED
AND REMOVED OR PUMPED AND FILLED WITH CLEAN
SAND.
PROP. VENT WITH CHARCOAL FILTER / �S'38'x 8 4.3 0
AND BUGSCREEN (FINAL PLACEMENT BY
CONTRACTOR WITH HOMEOWNER o-
CONSULTATION)
/x 86.00 x 84.80
/ \
O x 86.30 SYSTEM DESIGN:
� /� \�
t6'cD x , �� GARBAGE DISPOSER IS NOT ALLOWED
i86.10 7 ��• 83 83.20 I DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD
1 / _00 82.7 I USE A 330 GPD DESIGN FLOW
7 �
/ f 0 83.20
1 SEPTIC TANK: 330 GPD (2) = 660
� I - � 83 OSHED
50 / �._- - _ ._ "RE-USE EXISTING `SEPTIC TANK_._
03
03
LEACHING:
o x 86.5o SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD
9. 0 (X85
.�0
TEST HOLE LOGS x 4.30 1�b 1 , BOTTOM 25 x 12.83 .74 = 237 GPD
o,
x 84.0 / TOTAL: 472 S.F. 349 GPD
DANIEL E. GONSALVES, SE #13587 8s
ENGINEER: 00 S5 ,10 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
WITNESS: DONNA MIORANDI, RS �� �R o / 0 WITH 4' STONE ALL AROUND (H-20 LOADING)
DATE:
8 13 2014 / O 86 _` �o °0 x 87.20
/ /
PERC. RATE _ < 2 MIN/INCH
A -x
TOWN WATER / JBRICK
CLASS I SOILS P# 14459 x 89 80/ PATIO 87 87 6
DECK 7.10
ELEV. z ELEV. x 87.50
1 87.20
0» 4 83.5' 0" 83.5' /g
A� A/
EXIST. DWELL.
�10YRS3 2/ UNSUIT. 10YRS3 2 UNSUIT. TOP FNDN. _ MA
EL. 88.5' APPROVED DATE BOARD OF HEALTH
620 /// // 6„ / ///// /�
g g s7.90
`BENCH MARK - CORNER TITLE 5 SITE PLAN
CONC. BULKHEAD. L. = 87.8'
�SL UNSUIT. ESL UNSUIT. 88 0 go - s �o
OF
22" .90
/10YR 5/6/ 22„ 10YR 5/6 /4 3: 8� 810 256 WAKEBY ROAD
8.10 EXIST. WELL MARSTONS MILLS
C1� C1� 8.10 GRAVEL DRIVE LOT 25
20,933 S.F.
S1 LOAM UNSUIT. �/Si jOAM UNSUIT. . 30 0.48 AC. PREPARED FOR
% / �8.\ 88.0o BORTOLOTTI CONSTRUCTION/AMIOTT
2.5Y 6 2 / 2.5Y 6 2 8.3
8.2o s8.y
38" / / Z/ 80.3' 32" 80.8 88.20
I 87.50 AUGUST 18, 2014
PERC C2 C2
R=9 7 �N �q ``� 'v Pn� t off 508-362-4541
,�
88.10 3 • 14 �� ��� fax 508-362-9880
M/CS M/CS A= 13 I downcape.com
0 . O� 87.60 c. �. �>
88.00 (�.[, _may . . •
2.5Y 7/4 2.5Y 7/4 _ crOWN cope en inee�in Inc.
a;;;l S I 4 �, �' I'✓
87.90
132" 72.5' 132" 72.5' f
/ - civil engineers
i 87.60 87.50
_ � � land serve ors
NO GROUNDWATER ENCOUNTERED Scale: 1 = 20 "T. _ R, 11� _ 1 °, ',(��pL y
x o ► 939 Main Street ( R to 6A)
WigKEBY Rpq x `87.1 o DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
A_ 1 S6 0 10 /20 30 40 50 FEET
Ir
I I � II II