Loading...
HomeMy WebLinkAbout0922 OAK STREET (CENT./W.BARN) - Health 922 OAK STREET, W. BARNSTABLE A=216-009 o � R o i 0 o I FROM :down cape engineering inc FAX NO. :15083629880 Feb. 12 2007 03:12PM P3 • I 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 1 � Z5 • 4 ��t�u ��� �, �` . �� i�'�' �' � � �- ,r 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 - ickr j It eD = ,bg! �o 5 ' No. s. ...« :.a FEE d 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-.�'"� ' t tt No. Q-q17 FEE � d 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-� r 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 L �Kcs� a � 0 o ' 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--- '''` `D XtS � � 5 F4 3 G 46 8 . TK 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