HomeMy WebLinkAbout0922 OAK STREET (CENT./W.BARN) - Health 922 OAK STREET, W. BARNSTABLE
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FROM :down cape engineering inc FAX NO. :15083629880 Feb. 12 2007 03:12PM P3
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Town of Barnstable
�"E Recrulatory Services
. Thomas F. Geiler, Director
XAML Public Health Division
a6lP ��
Thomas McKean, Director
200 Main Street,Hyannis,MA 02.601
Office: 505-862-4644 Far.: 508-790-6304
Installer S DesiQner CertificatiOD Form
Date: Se%,age Permitf- Assessor's Map\Parcel
Desi=�*ner. Cr,�_ Installer:
Address: �N4,-• ..�' 1- Address: �o �1a, �--�
On was issued a permit to install a
(date) (' ler)
septic system at Y51+ C-4-.aa based on a design drawn by
(addre s) .
dated *51 c
(desigri )
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
r certified as-built by designer to follow.
^y. ` ARNE HI
(Installer's Si=nature) o�AL�
U CIVIL c1l
No. 30792
\ 4
( esign is S1„ 'ature) _ 0�`f1x Dcat_ tamp Here)
PLEASE_ RETIE-P-N TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE O'F
CONIPLIANCE WILY. NOT 'BF ISSUED UNTIL BOTH THIS FORM AND AS;BUILT CARD A-t:E
RF.C1WED BY THE BAR.NSTABLE PUBLIC HEAI..TH DIVISION. THANK YOU.
Q: HcPii'iJSep6cMcsienarCenifcationF' 3-26-0d.doc _
FROM :down cape engineering inc FAX NO. : 15093629880 Feb. 12 2007 03:12PM P4
Town of Barnstable
Regulatory Services
Thomas F. Geiler, Director
Public Health Division
.
..a�' Thomas McKean, Director
200 Main Street, T3vannis. MA 02601
Offi
ce: 508-862-4644 Pax: 505-7904304
Installer 8: Desiener Certification Form
Date: Sewage Permit# Assessor's Map\Parcel Z` q
Desib ner: mow..✓ e� ..,� Installer:
Address: 3° Address: 3 e �f �.,� �•.7
On C.✓�►.S�--. u zs issued a permit to install a
(date j (' taller i
septic system at based on a design drawn by
(address)
44- (91 dated b ��
(designer)
I certif`' 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 boy and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' iateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance Aith State Local Regulations. Plan revision or
ce:•tiled as-built by desis;ner to follow.
^ �-c�^,� G•+sty..
ARNE H�;c\
(Installer's Signature) �`� OJ/AI.. 'a
CIVIL
No, 30792
Designer's nthature) C;.affix - $tamp Here)
PLEASE RETURN TO BARN ABLE PUBLIC 1JEALTI4 T)TVISION. CERTIFICATE OF
COMPLIANCE V41J, NOT ITF ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVU BY THE BARNSTABLE PUBIAC HEALTH DIVISION. THANK YOU
r r
O; 14eaWScptic/Desir-ncr Cenification Form 3-26-04.doc
TOWN OF BARNSTABLE I
LOCATION S ,rr 77,117W E SEWAGE # -106 Q 2/
V LAGE ASSESSOR'S MAP & LOT All- 002
INSTALLER'S NAME&PHONE NO. � �
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) _,!kQ c�v we-k (size) 1t
NO. OF BE IRO!:!R
.;
BUILDER ' v v.
PERMTTDATE: 7-A COMPLIANCE DATE:-
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of le acility) Feet
Furnished by
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No. D� D f Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes .
application for �hg 5 Y 6p.5tem Con.5trUction Permit
Application for a Permit to Construct( ) Repair( Upgrade(") Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. �b Owner's Name,Address,and Tel.No.
Assessor's Map/parcel o/j-V6 00
Installer's Name,Address,nVel.�To. Designer's Name,Address and Tel.No.
�G�C.Qy Y�
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (J
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
73
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of.S.A.S.
Description of Soil
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.
Sign . 0 Date
Application Approved by 9 Date OVA
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued
- T _
No. . Dz- D _ :
Fee
i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
III HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIppYication for �Bizpozal *p.5tem Con,5truction Permit
Application for a Permit to Construct O Repair Grade(') Abandons
O ❑ Complete System ❑Individual Components
Location Address or Lot No. �° } �� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel _ 6 o0 \
Installer's Name,Address,`nTel.,No. Designer's Name,Address and Tel.No.
\C Rx
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grindep
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures ► r-
`` Design Flow(min.required) �/ gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title '
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The uridersigned 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 0 Date
Application Approved by / � 21/i."I /Date Zo
Application Disapproved by: ! Date
for the following reasons
Jr
Permit No. / Date Issued
————————————————'————————————————. ————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
{ THIS IS TO CERTIFY,that the On-site Sewage Disposal System Cons
tructed ( ) Repaired ( ) Upgraded ( )
_ 'Abandoned( )by s d�
i at t�,\5 C�r. W74c..r w been constructed in accordance /a
with the provisions of Title 5 and the for Disposal System Construction Permit No. 9,0167 dated c' ►/ �!
Installer 6esoa-st Designer
#bedrooms Approved des n-n flow L' gpd
The issuance of this permit sha not be co strued as a guarantee that the syste will' functiolh e,.
Date �� Inspector �- ^^— - --
-------- ------------------------------�—�—�---
No. �D Fee
71HE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Mi!5pozal,,*p!5temt Cong;truction Permit
Permission is hereby granted to Construct ( ) Repair (V/) Upgrade ( ) Abandon ( )
System located at 9 7-Z C)4+.
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: Constru tion t be c mpleted within three years of the date of this pt.
Date A roved b i
D pp Y
TglkN OFF BARNSTABLE L'
LOCATION ) O SEWAGE # ^q
VILLAGE ASSESSOR'S MAP & LOT1 /46- 60 '
INSTALLER'S NAME&PHONE NO.F"- f-03
SEPTIC TANK.CAPACITY C DOC '
f LEACHING FACILITY: (type) )i• I&SRL (size) 16 X
NO.OF BEDROOMS �S
BUILDER O WNER
PERMITDATE: K(041!-COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility OU4 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
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No. s. ...« :.a FEE
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C®MMONWEALT14 ®F MASSAC14USETTS
Board of Health,
APPLICATION FOP, DISPOSAL SYSUM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair(Upgrade Abandon( ❑Complete System 0 Individual Components
Location Q" Owner's Name
r
MapjParcel# j �(,� Address
Lot# Telephone#
Installer's Name Designer's Name
Address Address
Telephone# Telephone#
Type of Building Lot Size sq.ft.
Dwelling-No. of Bedrooms Garbage grinder ( )
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures
Design Flow (min.required) 3 30 gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation i
DES RIPJON OF REPAIRS OR ALTERATIONS a� t+ /-
The under ' ed agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further ees t of to poFe th system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
to F 6 ,a y '
T OF BARNSTABLE Q J
LOCATION O SEWAGE # _l 6
VILLAGE MAP & LOT_ �Ia 15b 7 I v
INSTALLER'S NAME&PHONE NO. n (02.
I
SEPTIC TANK CAPACITY 1000
I -
LEACHING FACILITY: (type) 2 ti)MNO (size) 16 x
NO.OF BEDROOMS �S
BUILDER 0 WNER J.
�LA� ?
COMPLIANCE DATE: IPERMITDATE: `7Q
Separation Distance Between the: ,,pp
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 N
within 300 feet of leaching facility) Feet
Furnished by
r .. � _ 'r,� ♦ . ... . i ... a ... .. ' �.�.� " ` ♦.h. . "k., rtKt M'.�,i�(...� .T YK{^-•Mr- R r+.0 R r. .Y� ♦ _Y-.�'"� '
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No. Q-q17 FEE �
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COMMONWEALT14 OF MASSACHUS ETTS
Board of Health, 1—"o QA�
APPLICATION FOP, DISPOSAL �YSTIM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair(0)0UpgradeO Abandon( ❑Complete System ❑Individual Components
Location '' " aI h Owner's Name
Map/Parcel# Address q , ^' 0
Lot# Telephone#
Installer's Name \kc v Designer's Nacre
Address _ Address
Telephone# I Telephone# '
Type of Building Lot Size sq.ft:
Dwelling-No.of Bedrooms Garbage grinder ( )
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures
Design Flow (min.required) �lculated design flow Design flow provided gpd
Plan: Date � Num'ems o 0� - Revision Date
Title �G!
Description of Soil(s) r
Soil Evaluator Form No. Name:6f S6il Evaluator Date of Evaluation
DES RIP�IONOFRERURSORALTERATIONS �t.,/�►�RIPT1 �
r'
w"
The unde ' ed agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further --es not to jqkace i9L system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
zy 7
No. 7 T q (jc FEE J�'
C'®MMONWEA 114 OF MASSACHUSETTS
7
Board of Health,
CERTIFICATE OF COMPLIANCE r
Description of Work: ❑Individual Component(s) ❑Complete System
The a rsigrjed h tify that the Sewage Disposal System; Constructed ( ),Repaired (✓Upgraded ( ),Abandoned (
f
by:
at n
has been installed in accordance with the provisions gof 3 0 CMR 15.00 (Title 5) and the approved design plans/as�l4, ans relating to
application . . " y/ I , dated 7^ 6— / Approved Design Flow 33 0 (gpd) ,
Installer
Designer: Inspectoq Date:! + rt
The issuance of this permit shall�not be con%irued*as-a guaranteefthlt'tlte.s t m will function as designedt f ' J
No. � yJr/7 (FL
COMMON %14 ®F MASSAC14USETTS
fV�Board of Health, I MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby grante Construct( ) Repair/Upgrade( ) Abandon( ) an indMdual sewage disposal system,
at ._1 0-�'�J S dr�bUL as described in the application for
Disposal System Construction Permit No. ���y�� , dated 7_4
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must
be met.
/ �•- 4 ,} , //� 1/
Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date ?-(7— 9s Board of Health--��vi.W e-�
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I
—10/9/97
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
C
hereby certify that the application for disposal works
construction permit signed by me dated , concerning the
property located at 0 meets all of the
following criteria:
• There are no wetlands located within 100 feet of the proposed leaching facility
• There are no private wells within 150 feet of the proposed septic system
• There is no increase in flow and/or change in use proposed
• There are no'variances requested or needed.
• If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the
proposed leaching facility will not be located less than`fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A)Top of Ground Elevation(according to the Engineering Division G.I.S.map)
B)Observed Groundwater Table Elevation(according to Health Division well map) �j 3
SIGNED : DATE: 7
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 13
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
9
health folder:cert
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' TOWN OF BARNSTABLE 3-7- G 30
LOCATION_ 'OW& SEWAGE #
VILLAGE Wks , ASSESSOR'S MAP LOTA=a�` 005
INSTALLER'S NAME & PHONE NO. N(� � '� "n�
SEPTIC TANK CAPACITY 000
LEACHING FACILITY:(type) a 1,T% (size)
NO. OF BEDROOMS 3 ,P . �VATE WE OR PUBLIC WATER.(�gjW
ER R OWNER_
DATE PERMIT ISSUED: /
DATE COMPLIANCE ISSUED: 2,
VARIANCE GRANTED: Yes No r--- '''`
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XtS � � 5 F4 3
G 46
8 .
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Noff.L.L.10 2._9.......—
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................... ......................OF..........................................................................................
Appliration for Uispaual Works Tomtrurtion ramit
Application is hereby made for a'Permit to Construct or Repair �an Individual Sewage Disposal
System at:
.. a-.._....
. ..............
. ......... .
L�cation�Addres; or "t No.
...aaz.... ........................................ ......... ...
-!pDw=r
........... . ..... . ... ..... ..........................Address
I.M.0................. .....G.�
Installer Address
U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........................._..__._...._._Expansion Attic ( ) Garbage Grinder (
Other—Type of Building .....�QCF->..... No. of persons............................ Showers Cafeteria (
Otherfixtures ......................................................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacityl.C.M..gallons Length................ Width................ Diameter._...._..._..... Depth.........-_..__.
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. f t.
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. I----------------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 ---------------------------•---•-*..............*'*'*"**---------------------*---------------------------------*--------------------------------
0 Description of Soil........................................................................................................................................................................
W
U .....................................................;...............................................................................................................................................
............... ....................................................................................................4
--- ---------- .........
U �Mure of Repairs or Alterations--;;.Answer When applicable........... -----------k-----0071
.......?—NIST. ........................................I..........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'T'l-S 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
A.—I
operation until-a Certificate of Compliance has 4et-n-114ued e of health.
V 4="17
2��
.... . ..... .. .Signed-(::��.. ....... ...... ...... ...
Date
Application Approved By.......... ......9n_ox 3.
Date
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................................................................................................................
Date
Permit No__.3..;?.......6..3.0................... Issued_.......................................................
Date
No&LL_3.Q Fins..... Q.......—_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ -----...................OF..........-:............................
Appliration for Diaposal Workii Tomitrartion Prrmit
Application is hereby made for a Permit to Construct or Repair (.-<Individual Sewage Disposal
System at-
C
.....(.f�.....ON... .......k'a" .........................................................
... .. ..........................................
-------------mv� "). Location-Address .. .........Ce T. oZ
V� . . rr—,Lotr E'Ns r�o
...UC)
......
Installer4�res .................
Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms...................5.....................Expansion Attic Garbage Grinder
Other—Type of Building .... ....... No. of persons............................ Showers Cafeteria
Otherfixtures ........................................................................................ .............................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid'capacitj.000..gallons Length................ Width..............._ Diameter._.............. Depth................
W Disposal Trench—No. ....................
Width..............._.... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No_____________________ Diameter........_...._...._. Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by.......................................................................... Date.......................................
Test Pit No. I................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._....._.............-..
.............................................................................................................................................................
Descriptionof Soil......................................................................................................................................................................
U .........................................................................................................................................................................................................
.......................................................................................................................iK------- ------------- ..............
U Mture of Repairs or Alterations—Answer when applicable..... N) -- ---*- - --- ------------ ...............-------
Q10-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T-1;T L_ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en sued of health.
23
.......... .... ... ......... ..............
Signedl: . .�. ......M... .......
Date
Application Approved By......... .. ............................ ............
Date
Application Disapproved for the following reasons:................................................................................................................
........................................................................................................................................................................................................
Date
PermitNo.---Fr ..................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........../Cz :>..........OF....... ...................................
...........*...............Tatifiratr of Tompliaurr
THIS IS T110 CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by-------------ct�
�4:1 ...............................................................................................................................
Installer
at............ -....0....\.S�........::�J---------------lu........ ............................................................
has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No------?,_2........ .dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................. ..........0............... Inspector............ ................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........OF...... ....."..�q7......................................
Raposat Works Trwanotrudion "tirrmit
Permission is hereby granted........-a,X........ ..........................................................................
to Construct or Repair V an Individual Sewage Disposal System
atNo......... .........C)..e4...�*'�.......S�,...T,.............. ........................................
SEreet
as shown on the application for Disposal Works Construction Permit NoF C Dated..........................................
.......................... .... .....
IDATE............... ........ ........Z..)............................. oard of Health
FORM ➢255>HOE38S & WARREN, INC., PUBLISHERS
No. Fee-- -
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zippritation-*rVell Con0ructionpermit
Application is hereby made four a permit to Construct ( ), Alter ( ), or Repair ( L-yan individual Well at:
- � Og j(-S!— `a _/Ja'-"' -�'t`'�=-- - ------------------------------
Location — Address Assessors Map and Parcel
- - -- - - - - - -- -- -- ---------------------- 9J -Q t s,T- = l _• -M --_—__
Owner Address
oa G
Installer — Driller Address
Type of Building
Dwelling---------- ---------------------------------------
Other - Type of Building----------------------------------- No. of Persons--------------------
----------____—_
C �r
Typeof Well-1--- -__- ----- - - - - - Capacity---------------------------- ---- -------------------
Purpose of Well_A---b tit--r---- e/------------- -
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 Certificat of Compliance has been issued by the Board of Health.
Signed ��t_ _- u!- _--------------------------------- 4 .)h-55
date
Application Approved By- � r - -- ��--'-z-----�
date
Application Disapproved for the following reasons:-, ---------------------------------------------------
- - - - -
date
Permit No.=--` � r '' I --------------- Issued------------------------------ - ----------`--- -- -- - — -
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual W 11 Constructed ( ), Altered ( ), or Repaired (4/j
by---- -- c�� �1LL _e_ 1�0.�- �-------
------------------------------------------------------------------------------------------------------
Installer
at �1'0�° -- 6{ 5 T -/_j !,'cr��? - �e----------------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No.AI.Yn_aYDPr�ated- ____ �_�✓
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------------------------------------------------------------- Inspector------------------------------------- - --- ------
_
No.-- Fee----------
BOARD OF HEALTH
TOWN OF BARNSTABLE
ApplitationiforWell Con5tructiou Permit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( <-)'an individual Well at:
7x on /( S% 'i /jo., M'k.
----------------------------------------------------------------------- -----------------
Location — Address Assessors Map and Parcel
- qua s T
------- ----------------------------------------------------------------------------------- --------------�-- ----------�=---��err--M ----------------------
Owner Address
--------------------------------------------
Installer — Driller Address
Type of Building
Dwelling-----------�---------------------------------------------
Other - Type of Building------------------------------------ No. of Persons--------------------------------------------------------
Typeof Well --------------------e------------ P( Capacity---------------------------------------------------------------------------------
Purpose of Wei l-�6'-`--`-'---`-`--t`'- - - -----------------
Agreement: r
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 Certificat of Compliance has been issued by the Board of Health.
Signed--=li'y - ----------------- G�a��13
------------------------------------ --- -----------------------------
/! date
Application Approved By---- _ -`�1
date
Application Disapproved for the following reasons:--------------------------------------- --------------------------------------------------------------------
----------- -' -------------------------------------------------------------------------------------------------------------------------------------------------------------------------
date
r^-
Permit No.- `' � ------------------ Issued----------------- " J07----1a -------------------
date
s
BOARD OF HEALTH t
TOWS!! OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERT Y, That the Individual We11 Constructed ( ), Altered ( ), or Repaired (�
r
J Installer
at-_-F-d-------OG+/( - 5?- - t")- �---`-'-------A(- --------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No.kl-� -'----? ated '�--+�- "--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------------------------------------------------------- Inspector-----------------------------------------------------------------------------------
BOARD OF HEALTH"'
TOWN OF BARNSTABLE
Well Con5truct ion Permit
No. --------=-------------
Fee
----------
Permission is hereby granted�Q-=�----------------/r✓G��_/_-//4kdL-/------------
to Construct ( ), Alter ( ), or Repair (t-f an Individual Well at:
No. a�------OG/(--'7------- - ---[5G�~'-----..1AU - ----------------------------------------------------------------------------------------------------=
Street
as shown on the application for a Well Construction Permit
No.--------- - = - ------------ - Dated------y-- - " r- -`"' '- -----
�' _
-----------------------------
DATE------ - - -/g` -- --------------------------
LEGEND SEPTIC DESIGN. TOP FNDN. AT EL. 95.7' SEPTIC 'ROFILE NOTES
ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT TO `aALE) ASSUMED gP
100.0 PROPOSED SPOT ELEVATION GARBAGE DISPOSER IS NOT ALLOWED ACCESS CO\3t (WATERTIGHT) TO 1. DATUM IS RTf Bq ��
F 27G SLOPE REQUIRED OVER SYSTEM MINIMUM .75' OF COVER OVER PRECAST WITHIN 6' 01' FIN. GRADE 2. MUNICIPAL WATER IS AVAILABLE
100x0 EXISTING SPOT ELEVATION DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD 92.0
100 USE A 330 GPD DESIGN FLOW ELEV. 90.8' RUN PIPE LEVEL 2' DOUBLE WASHED PEASTONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
PROPOSED CONTOUR FOR FIRS' 2'
SEPTIC TANK: 330 GPD (2) = 660 �� 3 MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-10 �.
100 EXISTING CONTOUR GALLON SEFrnc 89.4't*
USE A 1500 GAL. SEPTIC TANK TANK (H- 10 ) � \ 89.0 5. PIPE JOINTS TO BE MADE WATERTIGHT. gCopN
RE-USE BAFFLE 88.45' o000 88` 28 Q Q Q Q Q Q Q I=
LEACHING: 0 88.18' Q Q Q Q Q Q Q Q Q o 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
s" CRUSHED STONE OR MECHANICAL ENVIRONMENTAL CODE TITLE V.
LOCUS
SIDES: 2 (30 + 9.8) 2 (.74) = 118 GPD � Q O Q Q Q Q Q D
COMPACTION. (15.221 [21) 2' Q Q Q Q Q Q Q Q Q c 86.18'
BOTTOM 30 x 9.8 (.74) = 218 GPD DEPTH OF FLOW - 4 1 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
TEE SIZES. ( X SLOPE) ( 1 x SLOPS 3/4" TO 1 1/2" DOUBLE WASHED STONE
TOTAL: 454 S.F. 336 GPD USED FOR ANY OTHER PURPOSE.
�
INLET DEPTH �[
USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) OUTLET DEPTH = 14
» 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
TL
WITH 2.25' STONE AT ENDS AND 2.5' AT SIDES 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT LOCUS MAP
FOUNDATION 10' SEPTIC TANK 95' - D' BOX 12' LEACHING 8.78' INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED NOT TO SCALE
FACILITY FROM BOARD OF HEALTH.
MA
10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE ASSESSORS MAP 216 PARCEL 009
APPROVED DATE BOARD OF HEALTH LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR IN-HOUSE VARIANCE REQUESTED UNDER BOARD
BOTTOM TH 1 EL. 77.4' TO COMMENCEMENT OF WORK. OF HEALTH POLICY DATED DEC. 12, 2002:
PROP. SAS TO BE GREATER THAN 100' TO
ON-SITE WELL (FAILED SAS, NO WORK PROPOSED)
*THE INSTALLER STALL VERIFY THE
LOCATIONS OF ALL UTILITIES AND ALL
BUILDING SEWER U AND IONELEVATIONS TEST HOLE LOGS
PRIOR TO INSTALL!!G ANY
Y PORTION OF
SEPTIC SYSTEM A.
THE INSTALLER SHALL MNFIRM MIN. SEPTIC TANK ENGINEER: A. H. OJALA, PE
�00 SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR DON DESMARAIS, IRSRE-USE
WITNESS:
DATE: 2/1/06
EXIST. FAILM SAS PERC. RATE _ < 2 MIN/INCH
+95.66 l.+ates
CLASS I SOILS P# 11210
472 13
FAILED ELEV. n ELEV.
EXISTING :v // // }91 ,54 S6, ON 91.4 p" V' 92.3'
/ R
-OJ / +41.42 4-0 96
+91 4z TH1 I SL SL UNSUIT.
1 OYR 3/2
\+42-w 12" low
i
�1000/ - - - � LOT 1 SL SL UNSUIT.
�- , WIREs cE / s Kc^� - \ 48,890 SFf 24" 30" /4
89.8'
2.5Y 5
/I Cl\ sQ,
12 atAwLSF' 014 WIRES C 1
_ -
BENCHMARK - / \ -
NAIL IN TREE \ \ I ` \ .� / \ - ,� PERCHED WATER AT LS UNSUIT.
ELEV = 93.5' \ \ zY3 EXISTING , 3' SILT LOAM
DECK DWELLING EXISTING LL MOTTLES
\`\ TOP FNDN=95.7' WE 2.5Y 5/4
C2
�� �' MCS
C2 O�
/ SL COBBLES
2.5Y 6/4
VEGETATED ISOLATED // - - - // o�cESSPOOL / ) I '\ ,'' 168" 77.4' 156" 79.3'
VEGETATED i / / / \ `
WETLAND � � /// f - /� + ,�1 /l \% ,n q ' CO i'� NGWE
i
DRIVEWAY \, /� ,� ,C
pow 63 \ / ' \ NOTE: NO GROUNDWATER AT ELEV.
+KIM
/ `
79.3', WHICH IS 4' LOWER THAN
$ / / \ \� \ ' ISOLATED WETLAND ELEV.
5' REMOVAL OF / 1 / / / n Q`PC'�
UNSUITABLE SOIL I OO �� / \ GPii / \ \` // O N
REQUIRED AROUND /' �/ °1 ��0 - \` 43
PERIMETER OF / \
LEACHING FACILITY,
DOWN TO SUITABLE +9&53
SOIL LAYER. REPLACE 13 NOTE: EXISTING
WITH CLEAN MED. C - - - - /5 CESSPOOL IS IN AREA
SAND. 00 - i 7j� OF PROPOSED SAS.
�, % - - - TITLE 5 SITE PLAN
OF
922 OAK STREET
7.02 WEST BARNSTABLE
M
PREPARED FOR
\ .�
\ +97 '
92
's STEVEN MANNI
+,�06 -
' DATE: FEBRUARY 6, 2006
+r&.0
i Scale:1 30'
o ;
0 15 30 45 60 75 FEET
1m.faa
off 508-362-4541
fax 508-362-9860
�y�HOFi��ss�a HOFMgSS9C down cape englneer ng., inc.
a`� ARNE H ARNE 5c
EXISTING
OJALA
H.
CIVIL ENGINEERS
'g LA y
WELL CIVIL OJA N°. 3 792 o-, �" .20 LAND SURVEYORS
ago °FPS E� 939 main st. Y P armouth ort, ma 02675
DATE IE H. OJALA, .E., P.L.S.
06-005
XXXXX.DWG