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HomeMy WebLinkAbout1770 OLD STAGE ROAD - Health 1770 OLD STAGE RD. WEST BARNSTABLE A = 152 004 001 TOWN OF BARN TABLE LOCATION ilzW 0 '0'5 fly' &- Awl, SEWAGE # VILLAGE V' 40-rwv .4 4 , ASSESSOR'S MAP & LOT/SZ-00el.47) INSTALLER'S NAME&PHONE NO. !��f� J ��" 771 SEPTIC TANK CAPACITY -LEACHING FACILITY: (type) (size) NO.OF BEDROOMS J BUILDER OR OWNER PERMITDATE: )!-7 AP 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 leaching facility) Feet Furnished by IA -�3 6 o low Wiffill D `s-z -ao y odl Z. - Fee i' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Migonl *pztem Congtruction Vermtt Application for a Permit to Co t( )Repair(�Upgrade( )Abandon( ) O Complete System [! Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel ii/ � �, � v,01`�wev^ AI'' � � r���- d Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. go/`;'.D G®t`i G©dts/-, 7-21-513W 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 gallons per day. Calculated daily flow � gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank !O900;'4 �il/5,77 Type of S.A.S. s .Description of Soil �/� J 6�"r/0 �/ Nature of Repairs or Alterations(Answer when applicable) T1 �� 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)jy this Bupr4,pf Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARN TABLE LOCATION I ol.d� 1 , e I SEWAGE # VII LAGE �' Q'r�SJ`Q',d�� ASSESSOR'S MAP& LOT/5 2 eel-cP) INSTALLER'S NAME di:PHONE NO. /%k9/'140- OO'L` SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L/ NO. OF BEDROOMS (size) BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: ' t Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet ' Private Water Supply Well and LeachingFacility on site or within 200 feet of leachingacility (If any wells exist Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet ,7. ,t 1 i 77 +. ✓t a� t i i _ of I,n•�V'� f r '"-°�h�. •� � ��~_ � �-, ;Fee ���•- THE COMMONWEALTH,OF MASSACHUSETTS red in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 0[ppYfcation for �Bizponl *pgtem (fongtruction Permit Application for a Permit to Co t( )Repair(�)Upgrade( )Abandon( ) El Complete System [! Individual Components t z Location Address or Lot No.� y� Owner's Naive,Address and Tel.No. 110 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. ' Designer's Name,Address and Tel.No. Apt/4' , L0 ff 7GO5�, Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(�0 Other Type of Building �R'eC No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /l1/11 1T 'gallons per day. Calculated daily flow gallons. Plan Date (-Number of sheets Revision Date Title Size of Septic Tank �QDD �9 Type of S.A.S. //% -Description of Soil Nature of Repairs or Alterations(Answer when applicable) � .�/�� Date last,inspected: Agreement: Th&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 issue y t __ oar f Health.Si ne;ar Date Application Approved by Date Application Disapproved the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that he On-site Sewa a Disposal System Constructed( )Repaired Abandoned )by 0�4 L' Ste- ate © ✓`- �OG�' GJ� /sfS 4 constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer / J t The issuance of this permit shall qot be construed as a guarantee that th/ys em will function a�designed�r Date 1 /'`C- Inspector A No. �� ------------------/ �L-�——7 �l ---Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS XBigogaf *p!5tem Construction Permit Permission is hereby grant d to Construct( )Re air(/Upgrade < )Abandori System located at / 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�tio must be completed within three years of the date of this pew^mt��� Date: �� Approved by. i r i U&" . 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 PE10M(WITHOUT DESIGNED PLANS) L 101'eft hereby certify that the application for disposal works construction permit signed by me dated POY , concerning the property located at / 7?® D/,Q Llyfe W ���Q��s0P eets all of the following criteria: V)The failed system is connected to a residential dwelling only. There are no commercial or business /uses associated with the dwelling. Y The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system Y There is no increase in flow and/or change in use proposed There are no variances requested or needed v The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S. will be located with 250 feet of any vegetated 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 Surface Elevation(using GIS information) ��' 3 B) G.W.Elevation +the MAX High G.W. Adjustment. DIFFERENCE BETWEEN A and B / 3, 3 SIGNED : ��22 DATE: 7 1XII � [Sketch proposed plan of system on back]. q:health folds:art r �V Vill el Opt \� �vf- ;I O r 7 '7 o v UD 14 r A� AO/AJ-) THE COMMONWEALTH OF MASSACHUSETTS v)0, BOARD OF HEALTH Application is hereby made for a Permit to Construct (vo<or Repair an Individual Sewage Disposal System§t: ........ ..t- ..........v,l.......114.1AY.........3j ....................................... -Address Z Other Distribution box Dosing tank Percolation Test Results Performed by..........H4-------4-A.C.1cell----------_-...... Date.........t.&/........ gr The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I TL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu ad boy the bboard of health. IV Date following rea Application Disapprove Zn sons:................................................................................................................ _____ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF................ ............_.......... Appliration for Disposal Works Tnnstrurtiun "truth Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...........................•----....................._.... ----.......----•'•'--- ------ -•--.........----"--- ----••----------- ------------------------------------------- Location-Address or Lot No. ......................_.......................................................................... --'-'------•---'•-•-----•-------•-•-•----•-•-...•--'-•--'-....•-•----•--'-'-----............------ Owner Address W PQ Installer Address U Type of Building Size Lot............................Sq. feet 1--1 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------- -----------------------------------------------------------------•-----------------------------•----------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ 1_4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....................... LT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ M .------•-•-------------------------•----••-•-----•-------........----.....-------•-•"......•--.............................................................. ODescription of Soil...........................................•-'-•-------•--..............------•----------------------------------------•------------•--------------------•--.....-•--•- x U -------•-----•---•-•---•--•--------•---------------------•----.........-•----------------------•••--------•----••••--------•----•-----•--------•--------••-------------------•-•--••-------•------------ W x ----•-•---•---------------------------••-•------._...----------------•--•--•-----------•-•---------•-. •--•-••-------•------•----•••---•--------•------------------•------••••------•----•-----•-----•-. 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 T I T 1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ed....................................... Application Approved By."--� y-' -----••-- ..................................................................... --/-��- -�l _D�.y......_. Date Application Disapproved or t following reasons:_.._:. ................................. . ....................... ................................................................•--------...-------------'...---------=-'.--.......•..----------------.......----•--------------•--------.............................. Dat PermitNo......................................................... "' Issued.......................................................Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..........................................................:.......................... (Irtifirtt e ,laf f�aaut litt�tr�e TH, CIS�3,0 CITIFY, That the Individual Sewage_Disposal System constructed (✓) or Repaired ( ) .... ....... 1 . �---- nstaller� � at.... ,�C... ----hl--------•---_�:_� _ �` ....__1 ------------------•---------------.........-` has been installed in accordance with the provision of TI 5 T e State Sanitary Code as described in the application for Disposal Works Construction Permit No... ............................... dated................................................ THE _ISSUANCE OF THIS CERTIFICATE'.SHALL,NOT BE CONSTRUED AS A GUARANTEE THAT THE i SYSTEM,,WILL FUNCTION SATISFACTORY. --`�DATE = �J.........:....••a ............. Inspector-•-•--. , THE COMMONWEALTH OF MASSACHUSETTS y, BOARD OF HEALTH .............................. ..................... No...................:... FEE.......................... � . n�#rttrivan rrutt� r �.. Permission is h e$y granted......................... ......... to Construct ( o Re it ( ) an Indivedu �S . .age Disp System at No J Aer !• as shown on the application for Disposal Works Constructio ___________________ Dated.._._.,____........ .-- -----------------------••--------- .. _ /_. ! .Q (yJ I.............. Board of Health DATE........................... FORM 1255 A. M. SULKIN, INC., BOSTON j _ 1 <_ Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT L WELL LOCATION n Address—Le 't � 'Old 6 Q om-• City/Town N-j r yz�prPL.v, S rA We— G.S.Quadrangle Map Grid Location V 2©� Owner x> A t C- �� �.4 V Address ) 1 WELL USE CONSOLIDATED WELL Domestic IV Public ❑ industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled C 1) From To 2) From To Date Drilled 3) From To -- _ 4) From To e CASING rf Depth to Bedrock Length!^^� Diameter Ij N _ Type y C— UNCONSOLIDATED WELL STATIC WATER LEVEL 1 Water-bearing Materials Feet below land surface �� Sand: fine❑ medium❑ coarseX Date measured ®ag —FV Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL o Slot# J-1, length from /3. t6_1t Yes ❑ No Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot# length from to Chemical Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 841/ 0 3 � IR 3 CLIFFORD WRI DRILLING 0 41 Firm ue RockRoad Add Oa . city outh Yarmouth, Mass. 02664 R " tration No. "2414 01 o /Z p ator s Signature ease print irm y CUSTOMER COP 15M-2 84-176471 #r��w fT aros>' . c%� Ttitir .�- fv� �T o.0 Co�s�� G�U • Log Number: 3789 Bottle # 8020 _ Date: 6/29/84 O4 BA.9 BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR COURT HOUSE v BARNSTABLE, MASSACHUSETTS 02630 ° AS$ ' DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511 EXT. 331 Client: McNealy Associates Collector: Fred Clifford Mailing Address: U. main Street Affiliation: 01r ord weli Uriil7ng Hyannis,s, f-A U`LbU i Time &Date of Collection: 6/27/84, 4:00 Telephone: Type of Supply: wei i water Sample Location: LOG k, UIti -)Ld§e KO. Well Depth: W. Darnstabie, FA Date of Analysis: 0/40/b4 Parameter Sample Result Recommended Limits Total Coliform Bacteria/100 ml 0 0 PH 5.7 Conductivity (micromhos/cm) 250. 500.0 Iron (ppm) U.29 0.3 Nitrate-Nitrogen (ppm) tU.U4 10.0 Sodium (ppm) 27• 20. - "t F__ Water sample meets the recommended limits of all above tested parameters. Water sample has higher than average levels of nitrate. Future monitoring is recommended (2-3 times per year) . The low pH of the water may shorten the useful life of tYe house's plumbing. Water sample may present aesthetic problems due to XX Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. Water sample is not recommended for human consumption due to Retesting is suggested. REMARKS: cc: /'arnstable board of H3alth f� cc: Clifford Well Drilling Lab Director f 11/7/83 - IL SO LOG NON 1 N 0. 2 ° s, I T � E PLAN 0 2 / T 3 4 / l cx,r•1:.� .. r : . TOP Of FOUNDATION El.. _ 00 6 . . . f 1Q ep, IN,EI. , o r o• e y e .' • • o + , e S�O IN.EI. IN.EL. 11 _ ., _ :, ry —_ - �— r b .. . 2 COVER 1/8 . 3/8 WASHED STONE IN.EI> _� _ d 12 13 - .� N. ELKS/ o fl o „ .� 11/2 W SHED STONE . - D/B W/ 6 SUMP. o r, � � � p ,3/4 A •O , - C•) b 4 LI UlD IEVEI Q 4. o 0 0 14 I n L..16 _-i • [�o �� o w 15 , v a 6 EFF. DEPTH ' r V 1 b e . . • � PERC TEST ESULTS a � _ pP D 000 l - o PERC RATE:SEPTIC TANK WITH PRECAST LEACHING PITS D - - . WHIT SSE D BY,..CAST IN PLACE INLET AND y NO,. 1SIZE, �� ti�G� OUTtET T SPEQ TITLE B/O7A.iR'.DJ"A OFC©H 8EAYLT H _ DA vd DATE, SIZE : ALA � xo'D lQE ,sEF' , t PROFILE OF ' PROPOSED SEWAGE SYSTEM D B Y THE TOWN O F_ .�,�.�,Ys�.�,e�E REGULATIONS U L A T I O N S AND SYSTEM DESIGNS , STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE ;, Bj ? t B . A 1. ALL PIPES SNAIL BE SCHEDULE 40 P.V.C. SEWER PIPE 2 ALL PIPES SHALL BE SLOPED 1/4 PER FOOT - EXCEPT FOR l W l BE LEVEL � isr: P/T 1 SHE FIRST 2 FEET OUT OF THE D / B WHICH SHALL � - >t ..� 1 Y R AL/DAY. 3. ASSIGN FLOW BEDROOMS AT 10 GALDA PER BR. G � x � �••'' c / _ 49s , SEPTIC TANK SIZE 3,3 X GAL. T K J ES _ r : I U c o T USE o GAL. W/ GARBAGE DISPOSAL `. LEACHING SYSTEM: U E 0> � t r a LV � jJJ s f , JJ/'/ter .�'EFFECTIVE AREA. SIDE �_ ., �` � � r T BOTTOMS TOTAL FLOW �laT� L 7 T ' 3.3c� / d 330 Csv - . I TOTAL REQ D :FLOW X W/ . GARBAGE DISPOSAL _� I '78 a3.3 08 I, RESERVE FLOW GAl/DAY.- _E , N REFERENCE PLANS . - _-4 IV _. _.- o of B APPROVED Y - BOARD OF HEA TH DATE . SITE AND SEWAGE PLAN PROPERTY OWNER : ,��z r_p ., , . _. ., . ,. BEDROOM SI GLE FAMILY DWELLING NGLOT : A- .:,. DAT ; r 0OYLE ASSOCIATES FALMOUTH , MASS . J 7