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Home My WebLink About1675 MAIN ST./RTE 6A(W.BARN.) - Health Y 1675 Mein Street/Rte 6AJBWW Barnstable W. A = 196 025 o e { M No. V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migogar *p5tem Construction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. /407 -R fb.4 Owner's Name,Address and Tel.No. �QlC6i�� .e o y.e�s Assessor's Map/Parcel 19b 10—/L. w�Jf /V Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Sox 4/92 7 ied�dQ/e x4w- Z 177 Type of Building: Dwelling No.of Bedrooms S Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow S30 gallons per day. Calculated daily flow 3 7S gallons. Plan Date /b -Z 7—o Y' Number of sheets / Revision Date AJON e Title Size of Septic Tank ez'esl- /000 Type of S.A.S. ,r�f><��G� L',�,0 �.v / .a 7o rJ Description of Soil 'Te e Nature of Repairs or Alterations(Answer when applicable)RIF lrzr.1-eW L-a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this Board of Health. Signe G Date Application Approved by Date Application Disapproved for the following reas&n Permit No. Date Issued V Fee j06� _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Digpogar *pgtem Congtruction Permit Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. ��`7S RT6A !�/'aiN' Owner's Name,Address and Tel.No. �Qic�a�d �d9t.S Assessor's Map/Parcel 19b Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. lJ J_.a"A4.y f'P�c.,�e live &f< Div v. / 3nJe V9 ems 7 f.1.r 0w.f�7 A_6i3Of-jd.4/e 4W_ 0265/'/ *3;? 2177 Type of Building: �\ Dwelling No.of Bedrooms '3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) `Other Fixtures Design Flow T30 gallons per day. Calculated daily flow 373 (1 , gallons. Plan Date /0 —2 7— y Number of sheets Revision Date AJOy e Title Size of Septic Tank P is'`' �ooa Type of S.A.S. S /0�� l'.¢.o �'.vr4 ll e 70�J Description of Soil TOQ �014 4 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 Certifi- cate of Compliance has been issued by s Boar f H al Date y g Application Approved by 1/�/ _ v n /%� � C >1�� Date Application Disapproved for the following reas nv V '/ Permit No. _ Date Issued t/ lr ------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO C$ TIFY,that the On-site Sewage Disposal System Constructed( )Repaired (X)Upgraded Abandoned( )by �tiSlff ie /d fA I-e/"r -e- �7"C- at /& 75 AY 614 61219,N f7") ttefy .#"fV— h b constructed in accordance with the provisions of Title 5 and a for tsposal System Construction Permit N . dated Installer 2�-'s��O� � y Designer ��^ The issuance of this permit shall of be construed as a guarantee that the ystem Date ��gG 5 Inspector -- �---------- ------------- No. Fee r / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ligogal *pgtem Construction Permit Permission is hereby granted to Construct 4 )Repair(,A")Up de( )Abandon( / System located at �6 7� IQf 6 (�/l14/.� l?� _ WpS� �*�.��y 1�� /-e— and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con one u�st be c,mpleted within three years of the date of th* Date: e it. �>� /t/� Approved by I r/,, TOWN OFnB-,A�RNSTABLE LOCATION 105 5 mAptvl sr a4&A SEWAGE # 200�'�Z/ VILLAGE IA1 a-T 640 ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. 1201 fie I8 f1pi-L o/0 SEPTIC TANK CAPACITY '0 0® - LEACHING FACILITY: (type) +✓A!16'S (size) X 3G -Je Z_ NO.OF BEDROOMS ��_ BUILDER OR OWNER it-kArd P--Uc,AP v-!g PERMITDATE: 11'Z 2 O N 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) Z 8 Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by T e J EI I S F� c� Town of Barnstable `"ET°yti° Regulatory Services Thomas F. Geiler, Director * sAxrisrnsLE, 9$A . .39. � Public Health Division 16 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Designer: Installer: &,See /ol y441 -1XI'll f e.l-cv Address: SA4d CU1&G1 ,.17n Address: ge)X (f7.�2_ On I1- Z Z was issued a permit to install a (date) (installer) septic system at 16 41,�, f 7 C27b,4 based on a design drawn by (address) M e- Z/A(14 dated O (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. 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 of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. (Installer's Signature 0,tlse; (Des' is Signature) (Affix' ¢:.;amp 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 TOWN OF BARNSTABLE LOCATION t1�i�t A SEWAGE# 2'00 VILLAGE fay 2ST' ASSESSOR'S MAP &LOT kLo10 INSTALLER'S NAME&PHONE NO:' i SEPTIC TANK CAPACITY 0 I LEACH NG FACILITY: (type) 1 N{�t ✓a iS (size) 1 �• '.3 X 3 6 le Z NO.OF BEDROOMS r -------------- BUILDER OR OWNER Ark �o PERMTTDATE: I/ ZZ 0� COMPLIANCE DATE: Separation Distance Between the: Feet _ Zarteu im Adjusted Groundwater Table to the Bottom of Leaching Facility Water Supply Well and Leaching Facility (If any wells exist ---� Z b./- - Feeton site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within.300 feet of leaching facility) Furnished by EI t S 13 w � I �� 9/16/03 Notice: This Form Is To Be Used For the Repair.Of Failed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, y 3, OW hereby certify that the engineered plan signed by me dated 10 27 (D4 ,concerning the property located at meets . all of the. following criteria: • 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. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • 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). S�►�V B) G.W.Elevation +adjustr t for high G.W. b _ ► DIFFERENCE BETWEEN A and B �► SIGNED : DATE: Z8 7-13 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. Lor-LL,; Z5Z WVex", 6z), C zcc56) gASepdc\percexmM.doc r Page: 1 CERTIFICATE OF ANALYSIS ,o ` '' Barnstable County Health Laboratory Report Prepared For: Report Dated: 3/15/2004 Order Number: G0424398 Vanessa Rogers 1675 Main Street West Barnstable, MA 02668 Laboratory ID#: 0424398-01 Description: Water-Drinking Water Sample#: 24398 Sampline Location: 1675 Main St W Barnstable MA Collected 3/5/2004 Collected by: V Rogers Received: 3/5/2004 Test Parameters ITEM RESULT UNITS 1V MCL Method# Tested LAB: IC Lab Nitrates <0.1 mg/L 0.1 10 EPA 300.0 3/9/2004 LAB: Metals Copper <0.1 mg/L 0.1 3111B 3/12/2004 Iron <0.1 mg(L C SM 111B 3/12/2004 Sodium 10 mg/L 1.0 20 204SM 3 11B 3/12/2004 LAB: Physical Chemistry OR 1 I Conductance 197 umohs/cm IiOWN or-H UEVT BP .1 3/5/2004 pH 7.5 pH-units EPA 150.1 3/5/2004 Note: Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: Director) Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 i'OF NAR,4' :j CERTIFICATE OF ANALYSIS page: 1 ,. Barnstable County Health Laboratory Report Prepared For: Report Dated: 03/15/2004 RECE `a ED Order Number: G0424 06 Vanessa Rogers 2004 1675 Main Street MAR 1.7 West Barnstable, MA 02668 TOWN OF BAKNSTABLE HEALTH DEBT. Laboratory ID#: 0424406-01 Description: Water-Drinking Water Sample#: 24406 Sampling Location: 1675 Main Street W Barnstable MA Collected: 03/08/2004 Collected by: V Rogers Received: 03/08/2004 Test Parameters ITEM RESULT UNITS MDL MCL Method# Tested LAB: Microbiology Total Coliform Absent CFU/100mL 0 Absent 307 03/08/2004 Note: Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: (Lab rector) ' Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 ASSESSORS MAP:-- TEST HOLE LOGS PARCEL: -4� Z_s- _ __-- =--------- NOTES: FLOOD ZONE: N /C AGE SOIL EVALUATOR:- A I , yV(I� G - WITNESS: 'g �'4 r~/ BGbL /8�'S � '� /Z REFERENCE: ------ DATE:- 1) The installation shall comply with Title V and Town of Barnstable Board of PERCOLAT I ON RATE: .L 2 M t 1 " Health Regulations. 4G� \I f✓j�,,?�j w, 2) The installer shall verify the location of utilities, sewer inverts and septic G�� TH- 1 TH-2 components prior to installation. 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. 4) This plan is not to be utilized for r p operty line determination nor any other Purpose other than the proposed system installation. g M 5) All septic components must meet Title V specifications. /� oT 6) Parking shall not be constructed over H1�i `L� 1.0� 0 septic components. LOCATION MAP�A/7:.5� � / � g) The Property is bounded by property corners and property lines as depicted. ) Property owner shall review design considerations to approve of total i number of bedrooms to be considered for design. Receipt of payment for the t,� plan and installation based on the plan shall be deemed approval of the 1 Vv4, �� number of bedrooms. L Z 9) The existing leaching system shall be pumped and backfilled per Title V Abandonment Procedures. 10)System components to be 10 feet from water line. O 4044t?, wL4•(t?f, 11)Septic tank to be a minimum of 1000 gallons. If tank is less than 1000 gal., - then replace with 1500GST. U) 140 f t +- _ 12)Excavate 5 feet around the proposed leaching system and below to approx. SEPTIC: SYSTEM DESIGN elevation 50.93 and fill with clean washed sand per Title V specs. FLOW E!,T I MATE t t 3 -BECROOMS AT Ib GAL/DAY/BEDROOM GAL/DAY - " SEPTIC TANK Ln �— i / \ \ C Ii GAL/DAY x 2 DAYS - 0 GAL USE 1000GALLON SEPTIC TANK S j 1 t (0 1 EXISTING AC&&qalwoe-q ►► 0T !6,111 \ SOI L ATION SYSTEM 3 BEDROOM M y5f,15 HZo 01 G[qp IWALT&1ZQ.-5 to �I' SDWr, DWELLING \ ' TOP OF FNDN ca i EL -5T75+- \ I \ •7 Q `t 1 DE AREA: Z x �m.Zr,+ iD,6'� XZ DC Iob IZD DAV.1J i BOTTOM AREA: ��25 � ID�$ZJ�: � Z w UAM= \ >_ O tt3 1 N SEPTIC SYSTEM SECT IONLn ►.t�:s. t i IL►�'4 wax. '► 0 y �rA 9 ft lGt��7 GAL t ,g7 BO �Z d e . . F 12 z Q SEPTIC TANKLij ED �A- 0 ozz PA RKI` t,I RE �0T1C>wI GG �� 1�1✓ 1r�-1/. '35 LLO< t P U o<o t \ z > / 4395 {t EDGE OF PAVEMENT m �w� SITE AND SEWAGE PLAN 16.47 fi TO MAIN STREET LOCATION : :0 1415 4A PREPARED FOR : �3006FIFL D crE-bvL M a 0 SCALE: DAV I D B . MASON,25 DATE: is 27 z DBC ENVIRONMENTAL DESIGNS - DATE HEALTH AGENT EAST SANDWICH . MA W ( 508 ) 833- 2177 ASSESSORS MAP: TEST HOLE LOGS -- i PARCEL: � Z i�________ _ NOTES: �n � FLOOD ZONE: _Nam- ��/G-�13GE _ _ SOIL EVALUATOR:- )�1 I , 1'vl�t � WITNESS: �-16r REFERENCE: _- _ �— DATE: _ 1) The installation shall comply with Title V and Town of Barnstable Board of PERCOLATION RAT: : .L 2 Mt4.41w , Health Regulations. aGt�l lay. 2) The installer shall verify the location of utilities, sewer inverts and septic G�� components prior to installation. TH- 1 TH-2 I 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. 4) This plan is not to be utilized for property p perry line determination nor any other ti Pose Other than the proposed system installation. �g AM 0 5) All septic components must meet Title V specifications. 6 Park') mg shall not be constructed over H10 septic components. I 7) The property is bounded by property corners and property lines as depicted. LOCATION MAP /' t,T �"�� LIG 8 The Property I' G iv�uq 1 ) p perty owner shall review design considerations to approve of total J,0.3 number of bedrooms to be considered for design. Receipt of payment for the ` (r ; 7" plan and installation based on the plan shall be deemed approval of the if number of bedrooms. 9) The existing leaching system shall be pumped and backfilled per Title V Abandonment Procedures. 10)System components to be 10 feet from water line. 11)Septic tank to be a minimum of 1000 gallons. If tank is less than 1000 gal., then replace with 1500GST. f 14O f1 12)Excavate 5 feet around the proposed leaching system and below to approx. �`— - SEPT i C SYSTEM DESIGN elevation 50.93 and fill with clean washed sand per Title V specs. - - - FLOW E TIMATE BEi ROO- IS AT I Ib GAL/DAY/BEDROOM -3?1a GAL/DAY 4 - _ I un -_�_ - J SEPTIC TAti'9C � Q � � h � �G, L/DAY x 2 DAYS - 1000 GAL I 1 Q I � USE IC SEPT I C TANK (q,)<�151^l t� \ EXISTING 1 - � SOIL AIS�RPTION SYSTEM 3 BEDROOM i I5 HZo NI GIMP IWr L70g1D2-5 tO �I %Wl I I TOP OF FNDN �i 1RQV� .l� U►, LVV, • `--J,. ° u .., / EL I -says+- Q : l 3t,zr, + 10. xZ K , �ti = IZD r ah `D I 1 w i:OTTOMRAREA: X. l0.$ / P o 3 ' v SEPT If" SYSTEM SECT ION (►.ems) LnLij c. I I cry F _ M I '.SZ►fo�1� 3/ _ ' k `� _,. _• � rid � f ;i L D-BOX5Z. a , 15 fr � / c I - ,� 27 79 Gt�O GAL 7 uhge TW ` , i o o SEPTIC TANK 1'LU b4- s �� 31.25 "x 10.63 . Q J 0z37 I I PARK I G :/1tREf1, P / _ o I— Q UC XE#f H:)IlE i U/ 0< o Z > cr) 4395 f� EDGE OF PAVEMENT W o�� SITE AND SEWAGE PLAN i CD � w� 7 f t TO MAIN STREET LOCATION : 11,15 _P!0k31-F_ 4.41 PREPARED FOR : 7R006F/CL D SAC.. S�}w�wlGhFL �� w O SCALE: �_ZO DAV I D B . MASON,es DATE: DBC ENVIRONMENTAL DESIGNS — EAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833-2 1 77