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HomeMy WebLinkAbout0128 GEMINI DRIVE - Health 128 GEMINI DRIVE WEST BARNSTABLE A = k TOWN OF BARNSTABLE LOCATION �1` S 4�'r-2-we' PIZ- SEWAGE # V,L.LAGE ASSESSOR'S MAP & LOT-J�J`013 INSTALLER'S NAME&PHONE NO._ _/gym- /.��.. Cyr'u{i�•� ssi s/1 b' '1G SEPTIC TANK CAPACITY LEACHING FACILITY: (type) tW (size) NO. OF BEDROOMS 3 BUILDER OKQ:&�YnER 4 PERMIT DATE: /—.?7—O'G 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) /S`O Feet Edge of Wetland and Leaching Facility(If any wetlands exist, within 300 feet of leaching facility) I Feet Furnished by /ice'S4.;Z &J, C�wA ���7 '. � ��u+oh \ � �� 7�/pW'� � \ � � �. \ � `. ,� S.� � %off �,5� . , �� ,- �' 4 a s�•y� n 9% �� .,... ��� �� t 1 � ) No.. W D S Fee / 00 THE COMMONWEALTH OF MW HUSETTS Entered in computer: AC. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for Bigonl *pgtem Con.5truction Permit Application for a Permit to Construct( ) Repair(✓j Upgrade( ) Abandon( ) ❑ Complete System LJ Individual Components Location Address or Lot No. /11 �? ����� �,` Own� m e,Address,andTl.No.� l Lo��� � 3 / 0 Ass-essor's Nlap cel �� fdf j� '�/�� [�✓ ®� Installer's Name,Address,and Tel. Designer's Name,Address and Tel No. / goy XP/67 g���� 771 -:Ear 3 Type of Building: Dwelling No.of Bedrooms Lot Size 7 l �sq.ft. Garbage Grinder ( � Other Type of Building I5/ 1?1 Ge No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.req fired , D gpd Design flow provided 33gpd Plan Date Number of sheets l Revision Date Title Se Jam'e&,1a e Size of Septic Tank Type of S.A.S. (/',� JG Description of Soil s 7� ,;Xk 46 Nature of Repairs or Alterations(Answer when applicable) 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 Hea th Signed Dateelk— Application Approved by Date �3/06 Application Disapproved by: Date for the following reasons Permit No. 02.do 0/g Date Issued / a Q ram`� �j :*�yKl � � 4 .� yews^ � r�E� .kak' W ///)i No. ,[wl4—o7C�_ a __Fee / UV ' ~ Entered in computer: - �— THE COMMONWEALTH OF�MKWACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS r anon for ig ogaY p! temp �Cow5truction Permit $ Application for a Permit to Construct( ) Repair(14/Upgrade'(� ) Abandon( ) ❑ Complete System ©Individual Components Location Address or Lot No. ' Owner's Name,Address,and Tel.No. al Assessors Map/P cel f/j-5 1(,�'�/e_ �d ;, � f e Installer's Name,Add ss,and Tel. 9. Designer's Name,Address and Tel.No. for ;� % Sys 9� !'�sle y /,t-��i�� r©r1� Type of Building: , Dwelling No.of Bedrooms J / Lot Size ..i 7 �sq.ft. Garbage Grind': ( © Other 1 Type of Building ke-91Q 8rZfe No.of Persons Showers( )'.Cafeteria( ) Other Fixtures Design Flow(min.required) , gpd Design flow provided 3 J / gpd Plan Date / Number of sheets r/ Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil /7- Nature of Repairs or Alterations(Answer when applicable) 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 Health. Signed'`� Date Application Approved by M/V Date I v Application Disapproved by: Date for the following reasons Permit No. 02 U o b — 01k Date Issued ---------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIF ,that the On/-�ite�S(ewage Di �osal System Constructed ( J Repaired ( l�Upgraded ( ) Abandoned( )by �c/' /. at �AW has been constructed in accordance with the provisions-of Title 5 and thheef ff r Disposal System Construction Permit No. U 6 ^01 k dated Installer VP l D�( G Designer *"'r\ #bedrooms 3 Approved design flow gpd The issuance of this permit, hall not be construed as a guarantee that the system il�y I Encfiori asrdesigned. Date 1 Inspector -------------------------------------------- ado. ..OU tP, —0 r Fee /W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migogar i§pgtemt Congtruction Permit. Permission is hereby granted to Construct ( ) Repair ( r Upgrade ( ) Abandon' ( ) System located at 77 $ t/0G/�I//�l i�/• �, ��/�//',� CYcd and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construct]on must be completed within three years of the date of this,permit. n Date / a 3/ Approved by t ✓ UC f / r.-A - t Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, Jrinlue �P.�lSP.v�' ,hereby certify that the engineered plan signed by me dated.'? ) 5 2e/.11�3'1)nceming the property located at meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering)and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 96 B) G.W.Elevation �_'+adjustment for high G.W. 3 = 1 DIFFERENCE BETWEEN A and B 9 SIGNED : DATE: 1 6-5- 0-0 NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc Town of Barnstable Regulatory Services Thomas F. Geiler,Director BARNSTABLE, MAC Public Health Division 0:19. EONac° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 33 > Sewage Permit# ��'7d�� Assessor's Map\Parcel 3 Designer: 4xjrq $h Y1, 1; �. Installer: k/lh:10//—/ �lSlZs� Address: �67sley wP`ffwti 6rmt-0 Ihc, Address: q�,L,%��G�S ,viwt wkIA j MA O�-5'6 3 On 12_3 kl'2V Ow of was issued a permit to install a (date) '(installer) septic system at 1"10 66u,Ivb+ based on a design drawn by (address 'Saxi� �, G, `7PK-561, 1, dated AA0106 / (designer) V 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. 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 rye ocation of any component of the septic system) but in accordance with State & e ns. Plan revision or certified as-built by designer to follow. SAMUEL J.P. cy� o JENSEN CIVIL N No.46D5g G Installer's Signature) A9oF9FGIS SS��1 (Design Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE 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:Health/Septic/Designer Certification Form 3-26-04.doc No !'=- -----�-- Fee--- `5------------ • BOARD OF HEALTH TOWN OF BARNSTABLE Yication for efr ConotructiouPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: — --- Location — Address — — — Assessors Map and Parcel Owner — Address Installer Driller� J- Address Type of welling ----------------------------- Other - Type of Building--__ _—_ No. of Persons-- --------__—__—_______ Type of Well— ���Q� — -- Capacity -------— —— Purpose of Well ------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate Af Compliance has been issued by the Board of Health. Signe -- ;;q - - Application Approved By sate Application Disapproved for the following reasons: ------- — -------- ------ -- � I— date Permit No. ®� V — Issued-- ----o ----- ---------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Comphance THIS IS TO CERTIFY, That the Individual WeU Constructed ( ), Altered ( ), or Repaired ( ) — ------------------------- --------- ---- Installer has been installed in accordance with the provisions of the Town of Barnstable Boo .of Health erivate Well Protection Regulation as described in the application for Well Construction Permit No- J Dated-- -THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- — Inspector---------- ---------- NO. / Fee---$ ---------- k BOARD OF HEALTH a TOWN OF BARNSTABLE ' = � - _ Application-for lVell Con!6truct oriVerm t = � �--�µ- t'` ,,..-<...._., ,.—�'m•L-��->._za�t:-u r..'� �'��a- `ter:��os3_...-'s.- - .-� « �- --/�""�r'-• ���f�,�/il��� `_�`gyp: -- yes.. ._-:.... Application is hereby made for a permit to Construct ( ), Alter O, or Repair ( )an individual Well at —---� —///Locations�— Address�7 �J Assessors Map and/Parcel _ 4 Owner Address Installer — Drille/r/ Address t Type of Building Dwelling�L ---- ` Other - Type of Building- =- -- No. of Persons=------------------------------ . Type of Well F=- Ca acit Y . Purpose of Well----- --- Agreement: ,A The unde-signed agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed,'--, Gi �te — Application Approved By ® ?L�GY'!�!��i 4 � date Apvllcation.Disapproved_for_the following_reasons r OD — — —-- date--_ 49 Permit No. 11///1J -- Issued-- - - date' - ------- t `�.. BOARD OF HEALTH TOWN OF BARNSTABLE . Certificate ®f Com H� ance THIS IS T/C-iC�ErRTIFYY That /the Individ/u�all Well Constructed ( ), Altered ( ), or Repaired ( ) 5 Installer has been installed in accordance with the provisions of the Town of Barnstable Boa of ealth 'vate Well Protection Regulation as described in the application for Well Construction Permit No. Dated---- ---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED'AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. ^ r DATE--- `Inspector �--- - - -- •- -- sus. _ � _ BOARD OF HEALTH -- _ TOWN OF BARNSTABLE ° well �on�truttion�ermit . _ reNo. --- �_� F/ // Permission is hereby granted / Gt/ ���(��///y Ld -- - -__to Construct ( ), Alte ( ), or Repair ( ) an Individual Well at: Street as shown on he application for a Well Construction Permit - No.- — Dated- , V -- Y -- , ------------------------------- I - Board of Health DATE I f WILL-1hAl ,�2�t �— �� 0- c � LOCATION ' I Z% SEW�►�E PERMIT UO. 4 VILLAGE IWSTQLLER'S ►JL1ME F, ADDRESS BUILDER 'S Q &V AE �. ADDRESS DNTE PER",T 15SUED �0_76- - DATE COMPLI W-.4CE ISSUED : Gi4Gt f4 G�� P P .27 � _ J No.._._....... OZ' Fs$....L....................... THE COMMONWEALTH OF MASSACHUSETTS BOAR D ?ILFHEM g _ - -2..-------- OF...... Appliration -fur Biipuuttt Workii Tomitrurtion Vane t Application is hereby"made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: 1 - " Q 1... -------------- .. ... ocatio ddress jk D e or of Owner............................... ... A ee ,W1 ti+ --------------- n taller �' Address �1 S Type of Building No,) _______Size Lot.. (St_� _ d� q. feet U Dwellin l�To. of Bedrooms.--__--_ ..._.Ex Expansion Attic w� Garbage Grinder g P (' ) g aOther—Type of Building --------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Oti fixtures,,. d Width... .. lliameter.. .8. _�De ................ W Design Flcw�P ��_�_._____� allons per person per day. Total daily flow________________ ________________ _____gallons. WSeptic Tank—ciqutd capacf{Jv___.__.___._gallonsLength____ !- 4 � _. `ll�_,/_.____.__... x Disposal Trench—No.........I......... Width.__"!_ ------- Total Length_---_/_�..... Total leaching area...� _.a../-.-_.sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.......------------ Total leaching area.--_...--.---____-Sq. ft. z Other Dist_ibution box ( ) Dosing tank ( ) IdZ C � �'" `l- '74 Percolation Test Results Performed by--------- --------------------••--•--•--------•------•----....-•••-------- Date----------------._..------------------.. Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water_-._.._-__------_.-_._.. a ------------------------------------------------------------------•-----------••--•----------------......................................................... ODescription of Soil................................................................................................................................................ ---------------------_ x 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 Article XI of the State Sanitary.,Code— The undersigned further agrees not to.place the system in operation until a Certificate of Compliance has bee is ed IDo health. Si ....... -•..................... . .......... � -- ---- ---------- ------- - Date Application Approved By- 3.4/. Date Applicaticn Disapproved for the following reasons:..._.... . --•----------------••---------•------------------------------------•-•----------•---••-•-•--------- -----------------------•-------------••-•---••---------------•--------...--------------------••-•--------••--•----------------------•-•-•••----------------------------------------------------------••- Date PermitNo......................................................... Issued..----....---.......---•-----------.....---•----------- Date t THE COMMONWEALTH OF MASSACHUSETTS f. BOAR® 9F HE A T -------------------- Xpli iratinn--for Rapaoal Works Tontrnrtimn Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systerrlat: i r __� s ` •, j j j f. ro No: --------------- --- ..... ._ =t ............... lAddcess Installer Address :_Type of Building \,tj A Size Lot.....??._�:._�..�:.�. q. feet Dwelling-moo. of Bedrooms..--_--._�--------------------------------Expansion Attic ( )' Garbage Grinder ( aOther—Type of Building ---------------------------- No. of persons..................._......•. Showers ( ) — Cafeteria ( ) Other_ fixtures -----------•---------------------- -------------------------------------•-•---•---------- •-- z- - ----- -- ---- Design Flow.....__,. r; ` r ._ allons per person per day. Total daily flow.....................�_._......__.---gallons. P4 Septic Tank—L>quid capacX---.--•----gallons 'Length •ngth------_4,.r.,Width-_-1 _ Diameter....... ...... D�e1)th_-------------- x Disposal Trench—No. --------/........ Width....�-------------- Total Length....._/_.:�_.--- Total leaching area_..-.J..__-_._1--._sq. ft. Seepage Pit No..................... Diameter.................... Depth below inl t_-___-__ .......... Total leaching area-.---_._..........sq. ft. z Other Distribution box ( ) Dosing tank ( ) _ G- ,2 - -76' Percolation Test Results Performed by----------------------------------------------------------- --- Date----.----..-----_.----------------_----. a Test Pit No. 1----------------minutes per inch Depth of Test Pit..........-._.•----- Depth to ground water...---.-_.-----.-..----- L7, Test Pit. No. 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water_-._-..______-_---_--. - --••--------•-•-••----- ---•------------•----------------------•--..........--•-----••••--•----------••--••--...••-••--••-•-------•--...-----•-•------------ ODescription of Soil------------------------------------------------------•-----------•-----------------------------_-_-.---.-------------------------------------------------------------- x U w 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 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 ' s•ed by frhealth. W Si ,=_ = 1 ==X ---------------- - - - ------o--f �6 , / (� Date Application Approved By----- k''• ' - - - ---•--------••-•--------. -- �-cl li.l ._'d_/ Date Application Disapproved for the following reasons-------------------•---•--------•-----------•-•-------•--------................._........------•-----••-•-••... -•---•-•---•-------------------•------------------------------•---.---.--•---------•-•-•-----------•----•-----•---•---------------•-•------.-----•---•------------------------------•-•----•-•-------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARDZO HEALT.............OF.... ... .... . ....:. ....'................. x1rrtifirate of f'lantphaurr TH -TO CERTOY, That the Individual Sewage Disposal System constructed ( ") or Repaired ( ) by... _ ll1 L ---------------- ----- - . •--- /' Installe .._at f.� r has been installed in accordance with the provisions of Article XI of The State Sanitary de as described in the application for Disposal Works Construction Permit No._._.?�:...__. _.�. --....... dated��.��— ..:3_y_./.�f.47/ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS �YGUARANTEE THAT THE SYSTEM WILL FUNCTION SATI FACTORY. DATE. ...... --- ----�---------------•-••----- Inspector.- ------- ............................................. THE COMMONWEALTH OF MASSACHUSETTS / o 60 ' .B....O A RD O EALTH OF........... ..........., --.......... N FEE------<............... Permission is hereby granted__ ` �'.� --- to Constru (�or Repair an Individual Swage Disposal em� ./ at No.-- G`j �f � ............. --------------•-- ----- ------- - - G!�� Street as shown on the application for Disposal Wor(s, Construction Perm / __________ __ ___J Datedv-_.�citiN ................ l Board of Health DATE............. ....................................... ........................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS c6 //576 Ex isTiJvF� •� r\,A:�A i 1 �yECL 4 � PL.B,*-- 33 PG /9 S W147Qp 7/ cd =LG 42�t M /oT 9 E /xo Op - LIB PR►V lgpc zzp D/Z I VC 40,WiD6- CE/ZT`iF/,F0 OZo7- AZOV ✓ SCA7G4 ✓A Oro• 2r) E 1`1WY //, /979 PGon/-,eEF' 96-in/9- LoT V q S/�fo wN R + f'r i C.E.eT F/ TEAT rHE 6k'/Sr/A/C Ft,14DAVC F -sNo wN o IV T'NiS Pl S7N 1,$ 46 C gTTD oN TAT i7' Cen/Fo�/'1S 'Z 7We L`oNiNCr ti LgWS �� 7?f� Tov+�N of f3A�N.�Tx113L�` 'nliLLiAM a�'i7Tn/ - TjET�Tionic2 Ro vTE A, B,9 ZYSj4B4.E 14Ay 11,)976 zc-G. GxnrD II APPLICATION FOR PERCOLAT N TEST AND OBSERVATION PITS LOCATION_ F 0-r 19 --� 1=1�1 f 7�t i U� .3o NO. VILLAGE DATE APPLICANT­X. Cu2T-iS �13Anru-/ FEE �1ADDRESS t C Li�f7G Gc.:WT— TELEPHONE NO. (Non—refUndabic ENGINEER ®— fN� TELEPHONE NO. �& ��t3 J DATE SCHEDULED Aff) (Applicant's signature) • . • • • • • e e o o a e • o • e�o e e e e • e e • • • o e o • e o e o • • . . . . . . . . . • • • • • • • • o I e • • • • • • • e • e • � • e e • e • • • •ASSfiSSOR'S D1AP 6 LOT NU: SOIL LOG SUB—DIVISION NAME i DATE TIME EXPANSION AREA: YES NO _ AX'I'L-7L �o (�y ,Ne_ ENGINEER:'N' ' TOWN WATER PRIVATE WELL J�,1 Dc)/ A//A)!v BOARD OF HEAL? ' EXCAVATOR SKETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: �� f ' PERCOLATION RATE 2M„N on (ASS TEST HOLE NO: ELEVATION: TEST HOLE NO: Z ELEVATION: 1 1 „ 2 2 Sv�solc. 3 Sv�SeiL 3 �L r 4 4 5 r- - 6 5` 6 7 7 4t 8 8 htt . 9 SMJ� 9 10 10 11. -r 17 12 12 13 13 14 14 15 15 16 16 SUITABLE FOR SUB / -SURFACE SEWAGE: LEACHING FIELD. _ LEAC G PITS LEACHING TRENCHES UNSUITABLE FOR SUB—SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED .ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P E ACID- '�'11 RERNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT ' TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. 1,91 PARCEL NO. 1 ADDRESS OF TANK: IV (; Il�IJ`�e� VILLAGE: MAILING ADDR�ESSS` ( I F DIFFERENT 'FROM ABOVE) : OWNER NAME: VJiti PHONE: � �P1tfa INSTALLATION DATE: �_? BY: INSTALLER ADDRESS: � CERT.NO. *TANK LOCATION: E220t\/ rYROAT (OCIOCR I CEI YANK LOCATION WITH R==PKCY TO Bu I I NO CAPACITY U TYPE OF TANK ; ?�� AGE IMRS. FUEL/CHEM I CAL TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [\A CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED r-kOC9 FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK I-�F, N/A DATE � r yy BOARD OF HEALTH TAG N0. [ ] DATE I l/t IL.-� * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK. OF THIS CARD TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL 13 / STORAGE REGISTRATION ��11 MAP NO. PARCEL NO. P ADDRESS OF TANK: r� -�' """ ; `'� = /'r`` "'! V I LLAGE: MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : OWNER NAME: PHONE: l . � E INSTALLER ADDRESS: �! fr, -CERT.1-40. *TANK LOCATION: (DGmOPt Z nC TANK 1-00AT Z ON W Z TH WQOPQOT TO =U Z LD Z NO') 1 CAPACITY TYPE OF TANK . AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION [ ] PASS C ] FAIL DATE' �r' X�_ LEAK DETECTION C ] CHECK IF N/A -TYPE/BRAND . 'y ZONE OF CONTRIBUTION [ ] YES [---j�L NO , DATE TO BE, REMOVED '�- 1 FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE ` R CONSERVATION C ] CHECK IF N/A DATE BOARD OF HEALTHI TAG NO. C ] DATE * PLEASE PROVIDE .A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD „1 d J / �f�J�"v / / � v _____— V r s r TOWN OF BARNSTABLE PyOFTHElp�� OFFICE OF BOARD OF HEALTH NAM DAAT<9 � 367 MAIN STREET C. p 163q. ` ' HYANNIS, MASS. 02601 �D s. 1 e � , 1988 ear c to Please attach to Enclosed is brass valve g the fill pipe of your underground tank. You must do the following as indicated. ---- Remove your tank. I have enclosed informa tion for you regard i„R tank M-moval . k tested startin ��_ You must test X = Have your tan f th a and 3th 15th M and 19 during the 10th., 1 , annually thereafter. RemovaT�n the year ' In order l have enclosed information regarding tank testing. order to have your tank tested you must first contact an engineering company (see attached) to have a monitoring well installed. Once the monitoring well has been installed you can then orall 362-2511 ,George Heufelder at4theand ask for Charlotte Stiefel to have your tank Barnstable County Health Department, +.es+Ad via the Soil Vapor Analysis Test. Currently, the test is done free of charge under the auspices of an EPA grant. Due to the unknown age of your tank we must presume it is twenty (20) years of age. You must have it tested every year please follow it by the a the procedureasl993 . To indicatedhave t tested plea above from the ** (asterisk) on. If you have any questions please feel free to call me at 775- 1120 , Extension 183 . Tdnna� you Miorandi Health Inspector GENERAL NOTES TOP OF FOUNDATION = 106.63E 4" SCH. 40 PVC DISTRIBUTION 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION LATERAL SLOPED AT 0.57* METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE PROVIDE HIGH DENSITY POLYELYLENE ENVIRONMENTAL CODE AND THE RULES AND REGULATIONS OF THE BARNSTABLE �'• RISER WITH CONCRETE COVER TO WITHIN BOARD OF HEALTH. 6" OF FINISH GRADE WHEN NECESSARY. FINISH GRADE OVER TANK 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BARNSTABLE BOARD ,, ,,: EL. 104.5t , .j of lr ✓ v FINAL GRADE OVER D-BOX= 01 4.3E ~, - 1`- - p�Q►/- r _._- _..'__..___'_.___ EL. 103.2- _#!# i _--�, != _ �I 11�1L!-L ice;� 1 L:ALL_i1}-i i I�! i#�_-__� OF HEALTH AND THE DESIGN ENGINEER. r•. ,._'`rT.__,r -,-..r. +-,^r--... .1 an,.,._._-._.._,,._ .-__._.- 104.4± - ____-__- -__--- _____________ ___.__._______.._._, -r : { ,- ,1._, _,. _,,(__..(,_a.. !,__, PROVIDE RISER TO WITHIN ----------- -- _--- ___________ _._ _ -__-_----____ 9 MIN. „• ._I„_! t---.,:-#lt�-.Ir, i, �,;,_I= ,� r:--_, .i , .�t, 6 LOAM r-„-r- ___ ;�_,;-,,_ BACKFILL- -_ _____ __ _____ __ _. .___.-_____,_.__ __ ______.___-_ ____________ _.._._.__,_______ _..try_ r_ - ._.,i ,i_._ .__. __ _ _i._i __{ __ __._ __ii __: _ :; -. . _ ___ " __--__________________ _..___________ _______ ______ _______________._ " ___._ _______ __________BACKFlLL________________________, 3. USE 4 IN. CH 4 PV ,•_-____-- -_-- ---------------- -_---------- s of FNAL GRADE --_____ .________ ---____ __ __-- -----.------ __ -..___ ____.._,___ .- 3s MAX. - _s=p_ _- ____ ,_- m s__ --=4.- --- i S 0 C PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE •r,•: i t.-.,.__• t 1- # {..-_-..__,-- --- _-------_--- -_ .�s: ___-_ _ _ _ -_ _ _ _ _ _ _ _ _ ___ _ __ _ __ _ -d - -- --- --- --- NOTED ON PLAN:.•-.::; _-- -------------- - - ------- x EL. 102.34- _ - - __ --------CLEAN ----- ----------- W _; t f - --- - -- BACKFILL __- ___ --- _ . 4 s'yaw z _ �... -10 MIN _ _ NOTE. -• „_ 1Oi.s4 I i 2 _ 1 _ ----- -- ----- _--- - - _ T � � ". � " PEASTONE 102 15 -- -- -= ------------- - --- -- - CONTRACTOR ----- -- -_-- __ __ _- EL. t01.65 _ ----------------- --------- - ---------- -- _--_--- 3 4. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH :..•._ _ #� v ----.: - ., - --------- TO CONFIRM ----- - , ;� - -# _ 1 2 DOUBLE WASHED STONE -. .'.'- _______=_ --- - _- . ---r -- , : .- r EL. 101.15 A GARBAGE DISPOSAL. ----- :. -- " " -------- TANK SIZE AT --= y �: - - 6 3 -------- ow Ftow Flo►K -- - _ , TIME OF ; E _______ _ _ I - ----' - 5. ELEVATIONS BASED ON FIELD SURVEY BY THE HORSLEY WITTEN GROUP, SANDWICH, ! '' _ - 1 " ; -_== - INSTALLATION. ►=102.1 ov 4 MA. AND AN ASSUMED DATUM. i- -__--' --- -- -I ----- _ --- ----- xl I# �„r ! ii; I=101.93 12 ►=1 02.42f 5' MIN. 6. IT IS THE INSTALLING CONTRACTORS RESPONSIBILITY TO CALL "DIGSAFE" AT t ' ' REMOVE CONCRETE (CONTRACTOR I--� '�� ! X, _=_- �" L A TYPICAL DISTRIBUTION LINE PROFILE B FIELD SECTION TO VERIFY) 2" MIN BAFFLE AND INSTALL _--;�I , -, ►=102.17 s" CRUSHED STONE LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION AT 1-888-DIG-SAFE ZABEL FILTER MODEL AND ANY OTHER APPLICABLE AGENCIES NECESSARY TO FIELD VERIFY LOCATION - __ NDISTURBED EARTH OR COMPACTED BACKFl 3" MAX. A100 _t ! UNDISTURBED EARTH OR " ;_ OF EXISTING UTILITIES. ? I -'- • ": _ I i --I # PROVIDE 3 OUTLET DISTRIBUTION BOX COMPACTED BACKFlLL = - I jj I T SEASONAL HIGH GROUNDWATER R E . 96.15 ij I--� I ;=_ , ,- - _ = = ; { � ---# � ;� INSTALLED ON LEVEL STABLE BASE. 7. PROVIDE WATERTIGHT SEALS BY USE OF NON SHRINK GROUT AT ALL POINTS s -_ UNDISTURBED EARTH OR WHERE PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. ;__�.,� � ,�I i I�i ; I-----� , ;� � ! ____• .-r• -" /, --' '• ••- :•'•. ! I ;. I t - INSTALL FIRST TWO FEET 1 � i a ; i I- 6 CRUSHED STONE I i OF OUTLET PIPES LEVEL. p COMPACTED SACKFILL _.t I '= UNDISTURBED EARTH OR COMPACTED BACKFILL�� � { I 1-- 14- 8. REFER TO SITE PLAN KEY NOTES FOR LOADING CAPACITIES OF INDIVIDUAL SEPTIC PROPOSED SYSTEM COMPONENTS. LEACHING FIELD DETAILS EXISTING 1500 GALLON SEPTIC TANK PROFILE (TO REMAIN) DISTRIBUTION BOX DETAIL 9. ALL STONE TO BE DOUBLE WASHED AND FREE OF DIRT, DUST AND FINES. NOT-TO-SCALE NOT-TO-SCALE NOT-TO-SCALE 10. THE CONTRACTOR IS RESPONSIBLE TO REPORT ANY DISCREPANCIES FOUND IN r _ SITE CONDITIONS FROM THOSE SHOWN ON THE PLAN TO THE DESIGN ENGINEER. 7 . . .` •, `K �� `� F a` TEST PIT DATA -. 11. CHANGES TO EFFLUENT FLOW, GRADING OR LANDSCAPING EITHER ON-SITE OR SOIL EVALUATOR: Samuel J.P.Jensen ADJACENT TO THE SITE OR FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC Ll ey TANK MAY EFFECT THE PROPER FUNCTIONING OF THE LEACHING SYSTEM. DATE: APRIL 23,^2005 12. THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK EVERY 2 YEARS. 7 �`� ` TEST PIT#: 1 '{ 13. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO / 4 l LOC U S ELEv WATER= 96.15 CONSTRUCT THE PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON IT AND R_g4 24 � ' PERC RATE_ <2 MIN/IN SHOULD NOT BE USED FOR ANY OTHER PURPOSES. n_6 .24 r y TEXTURAL CLASS: 1 L'10 0 91 " # fi ` 14. ASSESSORS MA P#: 131 PARCEL: 33 0 0 0 0 CB/DH MAP 131 ' f OWNER OF RECORD: JAMES B & ANN S CRADDOCK TOP OF BANK(APPROX.) FND " PARCEL 22 ADDRESS: 128 GEMINI DR. WEST BARNSTABLE MA 02668 % CB/DISK v N/F " ► '° '`' ' _ • :;' 15. PLANS OF REFERENCE: "SUBDIVISION PLAN OF LAND IN (WEST) BARNSTABLE, MASS. FND UNGERMANN 0 103.32 FOR 50 CALUMET STREET REALTY TRUST," SCALED 80 FEET TO AN INCH, DATED Fill Fill JULY 23, 1969, AND RECORDED AT THE BARNSTABLE COUNTY REGISTRY OF DEEDS r _ 12" 102.32 '� ' ;�` "`' Sandy Loam 10YR 4/2 ON PAGE 19 OF PLAN BOOK 233. „CERTIFIED PLOT PLAN," SCALED 40 FEET TO ` . � ; : b - 2` & Q ' A Massive;Very Friable AN INCH, DATED MAY 11, 1976. O`C- �� �� o� " ,� +► - p Ry 19" 101.74' ., `�. 4 16. ZONE: RESIDENTIAL - RF, RESOURCE PROTECTION OVERLAY DISTRICT, AQUIFER M � .1 B Loamy Sand 7.5YR 5/8 PROTECTION OVERLAY DISTRICT OJ o d' � �. Massive;Very Friable; srf' co 3 100.49 17. THE LOCUS IS LOCATED IN FLOOD ZONE C AS SHOWN ON F.I.R.M. MAP CB/DISK 7 pCq � ` ` _'5 250001 0011 D DATED REVISED 2 JULY 1992. O� FND 2� �S� � .s". � `' ► ►„- Med.Sand,2.5Y 7/6 1� s, C Loose, Single Grain; 5- / 15%Gray.,Cobbles 18. NO SURFACE WATER SUPPLY OR GRAVEL PACKED WELLS WERE FOUND WITHIN 400' OF THE PROPOSED SEWAGE DISPOSAL SYSTEM. NO TUBULAR PUBLIC WELLS WERE EXISTING SEPTIC �� ► . FOUND WITHIN 250' OF THE PROPOSED SANITARY SEWAGE DISPOSAL SYSTEM. � • ,vO OVERHANG PS• „�_ �, � c ,�., � _ �i rn o TAN TO REMAIN AR 19. NO PRIVATE POTABLE WELLS WERE FOUND WITHIN 100 OF THE PROPOSED Off' / r p11��S FND EXISTING WELL; m 40POSED _ SEWAGE DISPOSAL SYSTEM. BENCHMARK 0 Groundwater ObservedSTAKE AND TACK. �/ 11��O O� 86" (Estimated Seasonal High) 96.15' OF�P'�i I EL. 100.65' � `D-BOX ��0 #128 GEMINI PIPE LOCUS PLAN 20. THE PROPOSED DISPOSAL SYSTEM IS LOCATED 1 14.80' FROM THE PRIVATE OQ ASSUMED INSTALL 38 x12 MAP 131 `'FND "_ POTABLE WELL SERVING THE SUBJECT PROPERTY. i LEXICHING BED/ ' EXISTING PARCEL 43 SCALE: 1 - 1000 ' kv 3-BDRM Sb� 36,542 SFt 21. NO PRIVATE POTABLE WELLS WERE FOUND WITHIN 150' OF THE PROPOSED 750, I o / -��� SEWAGE DISPOSAL SYSTEM. DWELLING 7 S'�c` rn 14,4' v, 102" 94.82' -96 T6q % "" T.O.F. 106.63' DESIGN DATA O O / EXISTING ^p`�' -0 150' S DESIGN FLOW INSPECTION NOTE JD-BOX O 2 ETBgC p -I / 3� = '� �' C� ram, s A�'OLL��O DESIGN FLOWNUMBER OF EDROOMS: 110 GPD/BEDROOM TOTAL FINAL CONTRUCTION INSPECTION OF ALL SYSTEM COMPONENTS INCLUDING 11 EXISTING _ Q O ,,n11 / � . t o��r� S A.S. � � �' �, DECK � R DESIGN FLOW: 330 GPD INVERT ELEVATIONS ARE TO BE CONDUCTED BY THE DESIGN ENGINEER AND THE \ o ' 1� SLAB ON BOARD OF HEALTH OR THEIR REPRESENTATIVE PRIOR TO BACKFILLING SYSTEM. o. ( SEPTIC TANK o o o 41.5' / '� `GRADE) REQUIRED CAPACITY: 660 GAL(200% OF DESIGN FLOW) J / / USE EXISTING 1500 GALLON SEPTIC TANK VARIANCES �Z v - c� 1 C �o El M PRV�D/� . LEACHING FIELD q� -CODE WAIVERS ------ T k10 / ^ LENGTH: 38.OFT REGULATIOON _- `� lYV - -v-_w - _REOUIRrtED� PROPOSED- _-- EXISTING LAMP(IYP.) / / N _... ____ _. .n____ _____ ____ ______._____.____ _. __ _ � S WIDTH: 12.0 FT '' i.____ SETBACK FROM OWNER'S WELL- _-�i - I 150 114 80 LTAR: 0.74 GPD/SF (CLASS 1)'10 �- N AREA REQUIRED: 446 SF _ LOCAL U PvG R A D E P R O V IS 10 N S _ Q / - S -�`_ AREA PROVIDED' 456 SF REGULATION - __�._____V-�__ - 1 - REQUIRED _PROPOSE D EXISTING ELEC. LINES VP CAPACITY PROVIDED: 337 GPD _ _- _ _ TO BE REROUTED DURING INSTALLATION o'3 MASS. T I C E 5 VAR/A LA C E S _-__-- c��� _-- __ _-------_._�______.-_____. _ __ -_.- --_ -_ N 0�j� REMOVE AND REPLACE `b 10 wF UNSUITABLE MATERIAL / MAP A P 131 �E G U L A T.1 O N-� a� � W` REQUIRED" P R O P O S E D� WITHIN 5-FT OF PROPOSED �p I`/�/.��'" PARCEL 44 __ _____�.__ _�_ .E SYSTEM AS REQUIRED N/F _ ---____--�- - �_ _ _-_ N o WE __ _____ INSTALL 40-MIL GEOLINER \ ��S POYANT FROM BOTTOM OF 1 1/18/05 Si Si PER HEALTH DEPT. STAFF COMMENTS o EXCAVATION TO EL. 102.34' \ CB DISK / REV. DATE BY APP'D. DESCRIPTION FN BPS Legend / v - 50 - EXISTING CONTOUR TEST PIT LOCATION PROPOSED SEWAGE DISPOSAL LO �\ SYTEM UPGRADE 'ten 50 PROPOSED CONTOUR O O EXISTING SEPTIC TANK � A LOCATED AT: ® O 6�� EXISTING ELEC. UTILITIES 4"SOLID SCHED.40 PVC PIPE 128 GEMINI DRIVE �- �� �o °° WEST BARNSTABLE, MA EXISTING WELL AS LOCATED D �, - W - EXISTING WATERLINE 0 DISTRIBUTION BOX PREPARED FOR: BY CLIFFORD WELL DRILLING CO. 1 ego MR. JAMES B. CRADDOCK C> JUNE 15, 2005 - " �� C✓ - GAS - EXISTING GASLINE - 4 PERFORATED SCHED.40 PVC o BOG SCALE: 1" = 20' DATE: 1 JULY 2005 MAP 131 T O / EXISTING WELL 0 10 20 40 80 FEET L PARCEL 49 1� FND BOARD OF HEALTH APPROVAL: ��`' =• MAss PREPARED BY: a N/F o SAMUEL J.P. tiG GRACE ® o� MENU Horsley Witten Group " ENSEN C'"L y Environmental Services F " Co No.4605E _ o °F G� P ` 90 Route 6A Q Sextant Hill Office Park 9FF IS �a ss,r. cti�.r Sandwich, MA 02563 phone:508.833.6600 SITE PLAN fax:508.833.3150 E )11,91626 Drawn By: SPJ Designed By: SPJ Checked By:SPJ JOB No. 5054 U) ��� SCALE: 1"=20'