HomeMy WebLinkAbout0010 PERCIVAL DRIVE - Health LOT 11 PERCIVAL DR.
WEST BARNSTABLE ��
- A = 111 057 ;-- .
00
No. `h Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
9ppficatiou for Misposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair(-Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
s
Location Address or Lot No. J ?L 01 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel j I I S �� 13,7r h'! `✓r� XJ Z }9 h'i Y �— �
Installer's Name,Address,and Tel.No. J C f6 3 6 Designer's Name,Address,and Tel.No. Ct
t- 1' ��t, �W ���r� Sltiy V��^ C = ��'�� dill+'I% h Cl
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(min.required) -33 0 gpd Design flow provided 352. gpd
Plan Date I1IOV. L4 .49_z,/!! Number of sheets Revision Date
Title
Size of Septic Tank 100 Type of S.A.S.
Description of Soil 5p p $o, fil`enGh �cr i�4 /U " a �' "A 3 —8 `r
Nature of Repairs or Alterations(Answer when applicable)s�P �`pg'�✓� ��Ps✓, it-�
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 t to place the system in operation until a Certificate of
Compliance has been issued by this Board o`f-
Si Date
Applicaion Approved by Date
Application Disapproved b Date
for the following reasons
Permit No.�M{` _0�9 Date Issued s
c No. O " s Fee ou
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pplicatiotl for posal *pstrm Construction joermit
P'+
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ® CR C� `J 2 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 1 1 S as li►S1 q I-t 5 �� /J L
Installer's Name,Address,and Tel.No. 3'p�,y'3 a.3�1 Designer's Name,Address,and Tel.No. $O a S3 '3(D 00
�''��`5
Type of Building: j
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 35 Z gpd
"tom Plan Date i 1/aV, H 4 0 t-1 Number of sheets , Revision Date
Title
Size of Septic Tank 1000 Type of S.A.S. ' 500 1 '8G fka tt
Description Cd �^ h f«gI7�� �U J( � — f'o /( 3 —U
p ' DPP Sorl L �" t% f �
L.
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees totensure 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 t to lace the system in operation until a Certificate of
Compliance has been issued by this Board 65fiVe li. �r
Si Date ""' /S
Application Approved by Date
Application Disapproved b Date
for the following reasons
Permit No.� Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance {
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( )
Abandoned( )by ,f l j,'.S a f c)Imo,'S C r7 Sa
at f 0 ��?/C t 1/401 L f 2 (,y pS",- /39i oPl s been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. "09dated �7 / -
Installer �G�.1. S (rJ d 1 e c�.y �✓1 Designer 1:A S s 64/11=4i-4
#bedrooms 3 Approved des' fl)50L
3130 / gpd
The issuance of is pe it shall not be construed as a guarantee that the system di fun as des ed.
/ i J
Date Inspector (�1
t 1
No t} (/ Fee OV
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) "Repair(� Upgrade( ) Abandon( )
System located at /(/ /1 ��r (/5.C-. IZ �A4 /�°S y" 10 9 J-j
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply wi,.h
Title 5 and the following local provisions or special conditions.
.. f
Provided:Construction must be completed within three years of the date of this pe
Date 'L1 /7 too(} Approved b .-
2oaw�
/Sr�o�
Town of Barnstable
Regulatory Services
4 Thomas F.Geller,Director
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: 69-6- (j Sewage Permit# rf-2 1�-v?1 Assessor's Map/Parcel 1-o 5,
Installer&Designer Certification Form
Designer: �� S ����`f Installer: Q:c-L-1 S
Address: 'F2 ) 7 z 9 Address:
3 4A �-M VA(�L-rl/vu 0
On 4-T 2v i`' �� 15 13 dz-19 S was issued a permit to install a
(date) --�� (installer)
septic system at based on a design drawn by
(address)
YLa k��2i�1 dated �yV � 14—
(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. Stripout (if required) was inspected and the soils
were found satisfactory.
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. Stripout (if requir inspected and the soils
were found satisfactory. N OF 4f,%s c
DAVID
f (Installer's Signature) FLAHERTY,JR. N
No. 1211
�FG/STEA�O
SgNI TAR%P�
(Desi er's Signature Y —(Affix D6foWi Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoffice fomwdesignencectification form.doc
Town of Barnstable P#
Department of Regulatory Services
. BARNSTAntE . Public Health Division Date
MAE&
i-619 ♦ 200 Main Street,Hyannis MA 02601
Date Sclieduled d/ w
Time Fee Pd.-
42�d
Soil Suitability A.ssessmentfor Sea e �
Performed By: Witnessed By: p l
CCATION& GENERAL INFORMATION
Location Address ��. reXC!v44- P2, r Owner's Name OLI/04 C L
li✓e5/ Rj 112S Address A(/O� ell+t
Assessor's Map/Parcel: ` 6�l -7 Engineer's Name
NEW CONSTRUCTION REPAIR G `e
Telephone tk ��J�- 2
Land Use
�
Slopes(96) O Surface Stones
Distances from: Open Water Body ✓f4- ft Possible Wet Area Drinking Water Well
Drainage Way 4�,p ft Property Line ft Other
���g�S/ ft •
SIME'I'CH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands i'n proximity to holes)
71,
• .� alb �
C:� .
t GG2 /�
Parent material(geologic) Depth to l38droclt
Depth to Groundwater. Standing Water in Hole: 412VAA; Weeping$'om PitPpee
Estimated Seasonal High Groundwater > /3
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: 442�_In. Depth to soil mottles., �v�_- In.
Depth to weeping from side of obs. _In, Groundwater Adluatment �_fr.
Index Well# ceding Date: Index We ]evol A tbctor
Groundwater Level
PERCOLATION TESL' buts �a�a��1Yms �y4R7
Observation
Hole# XL194 r
Time at 9" f,� .3¢�.3c)
Depth of Pere �/•� Time at 6"
Start Pre-soak Time @ ��' 7 Time(9"-611) �+t✓1/
End Pre-soak ly�r 32
Rate Min./Inch
Site Suitability Assessment. Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back.-----
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q\SEPMI PERCFORM.DOC
z
DE EP.OBSERVATION ROLE LOG Mole#
Depth from Solt Horizon Soil Texture Sdil Color Soil • Other
Surface(k) (USDA) (Munsell) Mottling (Stnucture,.Stones;Boulders.
reka
an sis ten ey,_yb't3ravell
L� ^ a 'va c�. 2' 7
DEEP OBSERVATION DOLE LOG Hole 96, �
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
ons'sten 90 a
CLIO
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulders.
Con i to c G
)DEFT'OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Sall Color Boll Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders,
Consistency,
e
IF lood Insurance Rate Man:
Above 500 year flood boundary No— Yes
Wrtliln 500 year boundary No_t. Yes
Within 100 year flood boundary No.- Yes
Depth of Naturally Occurring Pervious Material
Does at least four,feet of naturally occurring pervious tntiterial exist in all areas observed throughout the
area proposed for the soil absorption system? Pvious
If not,what is the depth of naturally occurring pematerial's
Certification r.
I certify that on 4v,/ '�S (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
tht;required trainin �ertise and experience described in�10 CNM 15.017.
Signature — Datm
QASRPTlCPRRCPORM.DO C
tic ' -7
No..-L.. . v Fa$..Z
APPROVED THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
S OWN OF BARNSTABLE
A111r, #t it for i��pn ul i rlt� Cnnit�trnr#inn rani
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: G P�. r (.MN 1Z
1 ........ ...........p. .....--- ---- .....
Lorition-Address 1 "'
' _ owner �/� ddress
PQ Installer Address
Address14 �v
g V Sq. feet
Type of Building ? Size Lot...3..�.. ....� _.
..� Dwelling—No. of Bedrooms..__.._..3 3............................... Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------- --
W Design Flow.............5-5.......................gallons per person per day. Total daily flow-------3310. .............................gal Ions.
WSeptic Tank—Liquid capacity-�_b .gallons Length---�.3n... Width....�YZ.- Diameter................Depth...`1'_:'�.F�
x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area..!!_�,,.,_.._._.._.__.sq. ft.
Seepage Pit No.....QglJ ----- Diameter.......11....... Depth below inlet.....-.......... Total leaching area�'L svt.
Z Other Distribution box ( ) Dosing tank ( )
'" Percolation Test Results Performed by..... N �. �F-n NL`_.... Date___-.I—;tt0.._��16......_..
a Test Pit No. 1....___Zn-_--minutes per inch Depth of Test Pit.--_V 6_'...... Depth to ground water...?: .......
(z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
---------------------------------• -------•---------------•----•-----------------•----•-------------------------•---•---
0 Description of Soil---0'.36•.---�>D I°--- ...sV�5Al 1.......11- 9-6------F111C.--Sl hj'�.... nd -q......-U'-I u........---
U Nature of Repairs or Alterations—Answer when applicable......................
----------------------------•-------------•-----•--------------••-•---••-•-•••...__.....-----..--••.-•-•--•-•••-----•--------•----•--------•••-•----•---•-•---.._........_..........---•--------•--•••--
Agreement:
The undersigned agrees to install the afored ibed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environ en 1 ode—T46 u ersi ned further agrees not to.place the
system i�operation till a Certificate of Compliant as een ' s d by e o of health.
Signed ---------- ----
C
.. ...... Date
Application Approved ... ...... .. R
( per/JIr.l._ �'vr
............. ... ........7.""."""........�............ .....e._... .. I JST ..................
..., het.
C.-LL s, A AND CERTIFY IN '.
Application Disapproved for the following reasonr: ....................................... F..S:: -i_ '�1.. AS iNSTACLI:D I�.;.., ,........
UCOR.................................................................. ' ..................................... ...... . ......... DANC�TOPLA ................. te......
Permit No. -------.......ZF ....... Issued ........ .............. .` ..��
Date
W 5-7
NO..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH To
WN OF BARNSTABLE
`--f Appliration for Diripwial lVorlig Tomitrurtion ramit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at: AI -'t-'*7 C
A�.-D(LNK............................ AS5.E55&0....ln,4.V....1.11... 5-7
.............. .................... ........ .... .... ......
-Addrcss or Lot,-No...A.fLocation
C.
.................. -...... .. .....va..... . .. ..A.f
Address-,,
At�.=4
.......... ......... ........------------......
Installer (ot Address
Type of Building Size Lot___,___ _..__.55... .....Sq. feet
U 7 7
Dwelling— NoN\f Bedrooms..........3...............................Expansion Attic Garbage Grinder
04 Other—Type of Building ............................ No. of persons........_.__....___.....__.. Showers Cafeteria
04
< I Other fixtures --------------------------------- ...................................................................................................................
Design Flow.............5.5.......................gallons per person per day. Total daily flow.......5 0...........................gallons.
1:4 Septic Tank—Liquid capacity-100 _gallons Length...VZ:.... Width---_ Diameter_______________ Depth..!.'..te-
Disposal Trench--No. .................... Width_.___...._....._.... Total Length...._..._.___.__.._. Total leaching area....................sq. ft.
Seepage Pit No--52k4lEr...... Diameter.......tz....... Depth below inlet.....4............. Total leaching area9ip--<7/--) sq-ft.
Z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed Date......I ........
Test Pit No. I....4-.Z .....minutes per inch Depth of Test Pit.....[5..(.. ..... Depth to ground water...�Jfl ........
44 Test Pit No. 2................minutes per inch Depth of Test Pit-__-__--____________ Depth to ground water....__....._____.__._._.
. ............................................................................................................
3�k9.6------FittC...:�I c. .
0 Description of Soil ..=. ...l�
....vty.9.......
W ....�.[
M - ...5AA2...A!��Q....!��k..............................................................................................................
:1.1 .......................................................................................................... .............................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
.......................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforede-sc�iibed Individual Sewage Disposal System in accordance with
Code —T�,C-undersigned further agrees not to place the
the provisions of TITLE 5 of the State Environmentaall
system in operation,until a Certificate of Complia,\ce,4as been issued by t' e •odd?of health.
Signed .......... .........igned ................ ... ... ............... .. ....
i Dve
Application Approved ......................------- ............
B ........------------------------ ................................................... ........................................
Dare
Application Disapproved for the following reaf ons: .........................................................................................................................................
................................................................................................................................................................................................................ ........................................
Dam
Permit No. ....... .... ....7�; ------- Issued ---- ... ................................
6al-C
——————---—--——————————--I—————————--————— ————————————————————————————
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Tertifirate of Tomplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by ..................................�. Z/-�-
................................. ..........:-----------------------------------------------..........................................
( 7at ......... ...... /�� � e J9----
... . ....... . A / .. .......................... ........................
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ,.77 dated ........................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..........--------
-I/.............--........................ inspector ........�L ..............................................................
-------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE FEE._ ... .........
Billpolial notrurtion ramit
Permission is hereby granted...... N .... V ....
to Construct i') or Repair an Individual Sewage Disposal System
...
..... ..................... ----- --------------------------------------------------------------------------.......
street'l
as shown on the application for Disposal Works Construction Permit/N19 -F5 ated...........................-.............
---------------------------------------------------
'V" Board of Health
DATE-------- .i................................................
FORM 38308 HOBBS&WARREN.INC.,PUBLISHERS
ENVIROTEGH LABORATORIES, INC.
MA Cert. No.: M-MA 063
449 Rte. 130 . Sandwich,MA 02563
(508)888-6460 . 1-800-339-6460
FAX(508) 888-6446
I
CLIENT: Reef Realty LOCATION: Lot 11
ADDRESS: School Street Capt. Percival Dr.
W. Dennis, MA 02670 W. Barnstable, MA
SAMPLE DATE: 6-21-94
COLLECTED BY: Clifford Well Drilling DATE RECEIVED: 6-21-94
TIF".E: 1:00 PM SAMPLE I.D. : 11 CP
JOB #: New well WELL DEPTH: 88'
RESULTS OF ANALYSIS:
Parameters Units Recommended Limit Result
Coliform bacteria/100ml (MF Method) 0 0
pH pH units 6.0-8.5 6.35
Conductance umhos/cm 500 104
Sodium mg/L 28.0 10.4
Nitrate-N mg/L 10.0 0.36
Iron mg/L 0.3 0.09
Volatile Organics
EPA 601/602 ug/L
Ortho-xylene ug/L 1000 1.0
COMMENTS: * See report attached.
Yes No WATER IS SUITABLE FOR DRINKING URPOSES NOR PARAMETERS TESTED.
XXX 0 G,�
Date '�(�
Ro ald J. ari rf
Laboratory Director
LT = Less Than
GROUNDWATER
ANALYTICAL
EPA METHODS 601 and 602
Volatile Organics (GC/PID/ELCD)
Field ID: IICP Lab ID: 8003-01
Project: Reef Realty/11 Percival Dr Batch ID: V62-0406-W
Client: Envirotech Sampled: 06-21-94
Cont/Prsv: 40mL VOA Vial/NaHSO4 Cool Received: 06-21-94
Matrix: Aqueous Analyzed: 06-24-94
PARAMETER CONCENTRATION REPORTING LIMIT
(ug/L) (ug/L)
Dichlorodifluoromethane BRL 5
Chloromethane BRL 5
Vinyl Chloride BRL 5
Bromomethane BRL 5
Chloroethane BRL 5
Trichlorofluoromethane BRL 1
1,1-Dichloroethene BRL 1
Methylene Chloride BRL 1
trans-1,2-Dichloroethene BRL 1
1,1-Dichloroethane BRL 1
cis-1,2-Dichloroethene * BRL 1
Chloroform BRL 1
1,1,1-Trichloroethane BRL 1
Carbon Tetrachloride BRL 1
Benzene BRL 1
1,2-Dichloroethane BRL i
Trichloroethene 1
1,2-Dichloropropane BRL
Bromodichloromethane BRL 1
2-Chloroethyyl Vinyl Ether BRL 5
cis-1,3-Dichloropropene BRL
Toluene BRL 1
trans-1,3-Dichloropropene BRL 1
1,1,2-Trichloroethane BRL I
Tetrachloroethene BRL 1
Dibromochloromethane BRL 1
Chlorobenzene BRL 1
Ethylbenzene BRL 1
meta-and para-Xylene * BRL
ortho-Xylene * 1 1
Bromoform BRL 1
1,1,2,2-Tetrachloroethane BRL 1
1,3-Dichlorobenzene - BRL 1
1,4=Dichlorobenzene BRL 1
1,2-Dichlorobenzene BRL 1
QC SURROGATE COMPOUND -SPIKED - MEASURED RECOVERY QC LIMITS
a,a,a-Trifluorotoiuene 30 31 103 % 87 - 113
1,2-Dichloroethane-d4 30 31 103 % 83 - 117 %
BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable
Halocarbons and Method 6o2 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986).
c
A 05
No.dada-- -------dada-- Fee--- - dada-dada--
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-ftlVe[r Cootructionpernrit
App;cati n is.hereby made fqr a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
ad�
ddadada----- ---dada-- ----X----------�-----dada-- --dada-----------------dada-- --------------dada--
Location — Address Assessors MaP and Parcel
��c�-f�___��L -- --- --------------------dada-- dada--��--��--=�----��---,�e'�rnr_��_---------dada--
/�/ n r Address
------- -------
---------------------- 40�_e_ ,
Installer — Driller Address
Type of Building J
Dwelling------------- ----=----------------------------------
Other - Type of Building---------------------------------- No. of Persons------------------------—dada-----------
Type of Well ---------------------dada-- Capacity --
YP Y-------------------------dada--
Purpose of Well ---------------------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operationSiaertifica .o mp ' ce has been issued by the Board of Health.
Signe -- — - -- P - — —
date —
r
Application Approved By-
A
tete
Application Disapproved f ----------------------------------------dada-- ---
-----—dada
Permit No. --�— ---/ ------------------------------------------------------------dada---- date----dada--
Issued--- -- — - --- --- —---------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate (Of Comphance
THIS IS ZERTI"_-Th-attr d the ndivid 1 11 Cons 6 ), Al re ( ), or RepairedbY �- — _ ---dada--
nsta
ty I-�a
at- - -C4 Vh", ----6 _4 ----------- ------------------------
has been installed in accordance with the provisions of the Town of Barnstable Boar of 1{, ,�.-D ealljt�'vate Well Protection
Regulation as described in the application for Well Construction Permit N . -- -- ated------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------—- — —— — -- Inspector----------------------------------------------------------------------
•�.' r` j-, � ^ ',.,,,'f,L,,�p .r+'F.�.Fa'7+�1��«."�.i•'tit.' - .� � .'"l+fr.trt. . . .,� .'C ^ ..�.t � �`.. - t ..
4�VGAOt
No. --- �
------ ------------- _ . Fee ------ - I
BOARD OF HEALTH
�r TOWN OF BARNSTABLE
Application-*rVell Congtruction Permit '
x
Ap0cati9n is hereby made for a permit to Construct ( ); Alter ( ), or Repair ( )an individual Well at: I
Location — Address Assessors Map and Parcel
— ---------------------------- —— — �� ( l �j�r/7r� —-------------------
Owner Address
%-�----.eal--- !LC- ------ ------
Installer — Driller � Address '
Type of Building
a. Dwelling � '
. Other - Type of Building------------------------------------ No. of Persons-------------------------------— ---
Type r�`'o i - - - - - --— —
YP of Well ---- - -- - -- - Capacity-------------=------- ------
Purpose of Well ��- ------------------- --------
Agreement:
The undersigned agrees-to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation t-I a Certificat .o C mp ' ce has been issued by the Board of Health.
4
Signe - -- - -- - - - ----- - -
C C k
Application Approved By ------ - ------ -
ddte
Application Disapproved for the,following rea s:----------------------------------------------------=-------
?Y.
date
PermitNo.-- -- -- ---- ---- -- ---- Issued------------------------------------------------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS C;E -TIFY That the Individual.Well Constr ed )t I , , Al re ( ), or Repaired ( )
by- -Y-�-I- 09?�,�-----� - � �.. ----------- - - —--------
P
�t Insta®er : — — —— — — — — --
�Ls.been installed in accordance with the provisions of the Town of Barnstable Board of ealt bate Well Protection
Regulation as described in the application for Well Construction Permit No� -- - ��&Dated--- _-----------
----------
'
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- --- — -- —-------- ----- Inspector--- - ------------------------------- - ---
{
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ivell Con5truct ion permit
-- ----- ---= — ----------
No. � - p e. Fee------
��=roc' Gt�6 DRii1/ -- -
Permission is hereby granted-- ---- - ---------------------------------------
to Con str ct ( }`Alter ( or Repair, ) an Ind'vid al Well at:
No. - --- �- �L -wa- Y��---------------------------------
Street J
as shown on the applicationAor a Well Construction Permit /
No. - -f '�'- --- --- --- - -- -- - Dated ------------
Board f ealth
DATE---- -:-
/ N ASSESSORS MAP: 111
PARCEL: 57 _
CURRENT ZONING: RF
BUILDING SETBACKS:
F:_301 S: 15' R: 151
q FLOOD ZONE: C
5
BINCHM
LOCUS URVATION- 88.2 M AT CATCH BASIN IV
�J
LOCATION MAP �g 9
LOT 11 ee ,O�
35,258 t S.F. � � 92
(0.81 ± AC.)
ti ,94
/
104 ,d
oe too
94
fob
92-UTILITr
CLUSTRR
I
PROaDWILL
\ \ I 1 I 1
84
84 /a /
es-
no
90
94' !°' / / / 112
LOT 12
/
/ i
104 / l / 112
106 /
lot _ — —
i
/
KEY:
EXISTING CONTOUR: — — no
PROPOSED CONTOUR:
EXISTING SPOT ELEVATION: 25.5
PROPOSED SPOT ELEVATION: 25
TEST HOLE:*
UTILITY POLE: •0-
FENCE LINE: —
HYDRANT:
RETAINING BALL: DaMA"ST-McLdLLAN B
24 SCHOOL ST"ST PO.
0
DM # 94- 2= 1 WIST DXNNIS, YASSAc
T TOWN OF B�ARNSTABLE
LOCATION I® PgrG!�!q I SEWAGE # a,0'S 077
VILLAGE S} &02221651�_00P75 ASSESSOR'S MAP & LOT 00
INSTALLER'S NAME&PHONE NO. Q t,'S (3-r&1?4c (2ciiV i
SEPTIC TANK CAPACITY tS7ffyC
LEACHING.FACILITY: (type) 2,-!�'0D C1q$W64ft5 (size) 3`X5 to
NO.OF BEDROOMS _S
BUILDER OR OWNER yy►4I'lL
PEWMITDATE: "[ I 1 COMPLIANCE DATE:
_Separation Distance Between the:
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
within 300 feet of leaching facility) Feet
Furnished by
pie c.VAL—
B
t At- L40
—2_ �� t ► �..- -- -�— —
�_ 3 _ arc r 13� 30,(o
6-3 V.-
I
r TOWN OF BARNSTABLE
-61
LOC
ATION �/vo./-�11-r4 /0 SEWAGE # 9�/- 3S"7
VILLAGE fiJ 4fw4,-f74pd/ ASSESSOR'S MAP & LOT _Q
INSTALLER'S NAME & PHONE NO.A14, L . _. d- Sop 3 JRF-3c;L/Q
SEPTIC TANK CAPACITY /000 Goo
LEACHING FACILITY:(type) 41 (size) 10V0
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ,(✓,y
BUILDER OR OWNER ,f444 IYVY �,gi��. 1�®G✓Q'.4��
DATE PERMIT ISSUED: 9- 0?02 - 9c/
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
1
117
/S -A , to �
7 f
F
WEST BARNSTABLE
1 / o�
Fti -
�/ ST
/ SAq STAFF � / LOCUS
C' p� SS TBM: COR. �0
Fly 25rs P A TI 0 oPQ- q
�° y 3� EL=9 5.58
C�
/ C`� / g6 1000 GALLON
SEPTIC TANK
C� �o
C�l TO REMAIN LOCUS MAP
C')\� GARAGE 10" 1 0 LOCUS INFORMATION
22j PUMP, CRUSH, PLAN REF: 413/99
UTIL Uj �� AND ABANDON TITLE REF: 9388/345 r
UTILS #10 �p �� LEACHPIT PARCEL ID: MAP 111 PAR. 57
12"0 , ZONING: "RF"
LL 132 3—BED. Q / ss { PER TITLE V FLOOD ZONE: "X" NEIGHBORHOOD WELL DIST.
I TOF=96.58 6, 0 ni °'* COMMUNITY PANEL: 25001CO532J DATED:07/16/14
LLA
G G oFLOOR 096 a Tw oAK SEPTIC SYSTEM
90 EL=89.15 N
o REPAIR PLAN
gg 0 30 1 .o I LOCATED AT:
BB 0 10 PERCI VAL DRIVE
1 LP J S WEST BARNSTABLE, MA.
1 ,. ca ^ TW/HE I LSD
rn °' •0 / j PREPARED FOR
0 12,0 8 0 °F MARK D. & LYNNE A.
/ / �� '� DOWDALL
F 0) O ^ I �9 NOVEMBER 4, 2014
Cb 0) /
sy /
F
jH OF �ZN OF^,�.aSs
p MqS `ate q
o`er E D WA R D DAVID 4' A.
LOT 12 / F, STON Cn
CQPG N 2 p o. 2 0 0-
I �G/STEV'
SgNIT R� N L010
LOT 11
AREA=35,244t S.F.
E. A. S.
SURVEY, INC.
GRAPHIC SCALE ' P.O. BOX 1729
SANDWICH, MA. 02563
30 0 15 30 60 120
i
( IN FEET )
1 inch = 30 ft» BUS:(508)888-3619 CELL:(508)527-3600
SHEET 1 OF 2 J#1709
TOP OF FOUNDATION C 2" LAYER OF EXISTING GRADE
ELEV= 96.58' 4" SCHEDULE 40 P.V.C. PROFILE OF - 2
MIN. PITCH 1/8" PER FOOT
' EXISTING GRADE SEWAGE DISPOSAL SYSTEM DOUBLE WASHED STONE
►�
(NOT TO SCALE) OR FILTER FABRIC
10' MINIMUM
EL= 95.0' EL= 95.0'
;;, PROP. EL= 95.0 PROP. EL= 95.0
6„ MAX.,,,,,,, 6
6 MAX." ,,,,,, „ 6" MAX.
Y4-
ADDADD ,,,,,,,,,,,,,, . ,,:.�::,.,,,,::RISER ISER & CONC. INVERT CLEANSAND FILLCOVER COVER RISER & EL= 91.0 � PER 310 CMR 15.255 36"
EXISTING (IF NEC pF NEC. EL= 94.28 LEVELCHEDULE 40 P.V.C. 5.0' S= .3 COVER FORS . �\ EL= 92.0
FLOW LINE "� s=.o1
EXIST. INVERT 110" 14„ INVERT INVERT INVERT o 0 0 0 0 0 0 0 o� o °o
INVERT EL=93.20' MIN. ADD EL= 93.03 EL= 91.31' 6" SUMP EL=91.14' 24" o °° o 0 C� C�0 C� 0 C� C� 0 C� CPO 'p �
4' GAS % 'P co
BAFFLE 6" BASE OF MECHANICALLY ° 0 0 0 000 o� EL= 89.0
COMPACTED SAND
PROP. DB,3 4 0' 8 5' 4.0'
DISTRIBUTION
BOX W/"T' (TYP.) ,
EXISTING 3/4" TO 1-1/2" 25 z
1 ,000 GALLON TANK DOUBLE WASHED STONE 2-500 GAL. (H-20) DRY WELLS (4'-10" X 8'-6" X 3'-0") �n
(TO REMAIN) SOIL ABSORBTION (TRENCH FORMATION) L6 CD
SYSTEM (S.A.S.) 13' X 25'
GENERAL NOTES I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF BOTTOM OF TEST HOLE #2 ELEV.= 83.5'
ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT (NO GROUND WATER)
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE
FOR SUBSURFACE DISPOSAL OF SEWERAGE. DESCRIBED IN 310 CMR 15.017. 1 FURTHER CERTIFY THAT THE RESULTS OF MY DESIGN DATA
2. ALL ACCESS PORTS OVER TANK TEES SHALL BE SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM,
ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING ARE ACCUR ND IN ACC D CE WITH 310 CMR 15.100 THROUGH 15.107.
ACCESS PORTS BROUGHT TO WITHIN 3" OF FINISH GRADE.
NUMBER OF BEDROOMS......... 3 _
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE
CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE GARBAGE DISPOSAL................._-NO-
UNDER OR WITHIN 10' OF DRIVES OR 'PARKING AREAS THEN THEY EDWARD A. STONE, CERTIFIED SOIL EVALUATOR TOTAL ESTIMATED FLOW
MUST WITHSTAND H-20 LOADING. (110 GAL./BR./DAY X 3 BR.) __33_0___
4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION TEST PIT RESULTS: P #14514 330GPD X 200% = 660 GAL
OF ALL UTILITIES PRIOR TO ANY EXCAVATION.
5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE USE EXIST. 1000 GAL. SEPTIC TANK
OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE.
6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE SOIL TEST DATE: OCTOBER 14, 2014 INSTALL: 2-500 GAL. DRY WELLS (W/4' CRUSHED STONE
OVER THE S.A.S. AND DISTRIBUTION BOX. B.O.H. AGENT: DONNA MIORANDI
7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF ON THE SIDES, 4' ON THE ENDS) AND BACKFILL
SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE SOIL EVALUATOR: EDWARD A. STONE WITH CLEAN SAND FILL PER 310 CMR 15.255
THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND BACKHOE: ACI (CHRIS)
LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. SOIL CLASSIFICATION................
8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN DESIGN PERCOLATION RATE..... <2 MININ.
2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT TP#1 EL. 99.3
ELEVATION of THE OUTLET PIPE. EFFLUENT LOADING RATE.........__74____
9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES. ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER REQUIRED LEACHING CAPACITY.....3_3_0 GAIDAY
10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS LEACHING CAPACITY PROVIDED.....352_GAUDAY
BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. 98.5 0"-10" A LOAMY SAND 10YR4/4 N/A
11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND 96.8 10"-30" B LOAMY SAND 7.5YR6/6 N/A SIDEWALL: (13' + 25')x2X(2 SIDES)(.74)= 112 GAL/DAY
FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL ' x 25'13 74
BE LEVEL. 91.3 30"-96" Cd1 SANDY LOAM 10YR7/4 N/A BOTTOM: ( )( )= 240 GAL/DAY
12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION g6.3 96"-156 C2 MED. COARSE SAND 2.5Y7/6 N/A 10% GRA TOTAL- 352 GAL/DAY
TO EAS SURVEY, INC. FOR B.O.H. AND DESIGN
ENGINEERS REVIEW AND APPROVAL. NO GROUNDWATER ENCOUNTERED
352 GPD PROVIDED - 330 GPD REQUIRED = 22 GPD RESERVE
13. LOT WITHIN ZONE II
TP#2 EL.= 96. 0 (PERC @ 64"<2 MPI) NF �c = s�c.
^'�,
CONSTRUCTION NOTES: °`~ D lU o` F_DWARD ` SEPTIC SYSTEM DETAIL PAGE
1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND
ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER `r' 10 PERCIVAL DRIVE
'' �
ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 95.7 0"-4" A LOAMY SAND 10YR4/4 N/A F �' #
WORK ON THE SITE. 1 s�O° WEST BARNSTABLE, MA.
2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE 91.5 4"-52" B LOAMY SAND 7.5YR6/6 N/A � o � .,3 r�
WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 83.5 52"-150" C MED. COARSE SAND 2.5Y7/6 N/A PERC �cISTeR F r NOVEMBER 4, 2014
IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. SgNI AR�PN ssi �;yR }
NO GROUNDWATER ENCOUNTERED -�°_�`
3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING / SHEET 2 OF 2 J# 1709
TAPE OR A COMPARABLE MEANS. , lq
I
N
ASSESSORS MAP: 111 TEST HOLE LOGS NOTES:
PARCEL 57
_
41 1. VERTICAL DATUM: ASSUMED FROM QUAD (NGVD +�)
CURRENT ZONING: RF ENGINEER DOYLE ENGINEERING 2. MUNICAPAL WATER IS NOT AVAILABLE.
WITNESS: THOMAS`MCKEAN
$ s� BUILDING SETBACKS: 3. SCHEDULE 40 — 4 PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM.
8f F: 30' S: 15' R; 15' DATE: ,9-30-86 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 & H-20 1
cx PERCOLATION RATE: < 2 MINZIN LOADING SPECIFICATIONS.
FLOOD ZONE: C T,FI- - TH-2 5. PIPE PITCH =,1 4" PER FOOT.
106.0 6. FIRST 2' OF PIPE OUT OF D-BOX TO BE LAID LEVEL
5 alav
TOP 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE j
,o BENCHMARK AT CATCH BASIN SIVBSorZ- 103.0 USE OF A GARBAGE DISPOSAL.
LOCUS ELEVATION = 88.2
FINE 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE
SILTY
SAND ( )
LOCATION MAP / g e HEALTH REGULATIONS.
STATE OF MASS. ENVIRONMENTAL CODE TITLE FIVE AND LOCAL
9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR
LOT 11
35,258 S.F. / 82 96" 980 TO CONSTRUCTION.
Y a!" ! FINE
(0.81 + AC. � MEDIUM 10. DESIGN ENGINEER TO INSPECT AND CERTIFY SUITABLE SOIL CONDITIONS
loo, SAND TO A DEPTH OF 4' BELOW LEACH PIT AT TIME OF CONSTRUCTION.
GRAVEL W CATIONS ARE IN ACCORDANCE
AND;
156" 93.0 11. PROPOSED SEPTIC SYSTEM AND WELL LOCATIONS I�
i 98 WITH MASTER PLAN ON FILE WITH THE BARNSTABLE HEALTH DEPT.
eg s � � � 100,402
/ 104 tf NO GROUNDWATER ENCOUNTERED
106SEPTIC SYSTEM DESIGN {
C FLOW ESTIMATE:
24, i
ss J
-BL BEDROOMS AT 110 GAL/DAY/BEDROOM _&M GAL/DAY PROPOSED GARAGE
\ \ D1��I BEDROOM 24'
SEPTIC TANK:
4
�\ \
T.F. 101.
0
� .• �• '•. \ 330,GAL/DAY 1.5 DAYS 495 GAL
107 �. \ USE��GALLON SEPTIC TANK 60'
/ � .. � � •.\ r'r,\ DECK I
o., LEACHING AREA: WALK OUT
.•' `: \. \ USE ONE LEACH PIT (6 x 4) WITH SIT OF STONE
96 94 - :` �.' $911 \ \ OZ EFFECTIVE DIAMETER x 4' DEEP)
•. _: PROPOSED DWELLING
9z— o g4���4$yy j \ \ SIDE AREA: 12 x 4 x PI = 151 SF (2.5) _ 377 GAL/DAYgo—
.
BOTTOM AREA: 6 x 6 x PI -113 SF (1.0) = 113 GAL/DAY
`j
\ TOTAL CAPACITY = 490 GAL/DUTILITY
AB'
CLUSTER
PROPOSED 9 \; ► l
WELL
. SEPTIC SYSTEM SECTION z„ PEASTONE
e4 , I I I ..
\ OF 314 1 /
8s— i /'. ...� / / ! I TH-1 101.0 WASHED STONE
88- / / q no TOP OF FOUNDATION
94' 112
98 106 i / / / l ,3 1000 GAL ELEV. D-BOX 96.64 4
LOT 12 / ELEV. SEPTIC TANK 96.81 ELEV. 92.44
m 98.0 ELEV. .---♦ *-3,--*ELEV.ELEV. TEE SIZES: 96.44 3' 3'
INLET: C UP, 10" DOWN ELEV, f---- 12' ----4
104 "2 INLET:
LEACH PIT 6' x 4') WITH
OUTLET: 6A UP, 19" DOWN ( )
106 / 3' OF STONE (12' EFF. 'DIAM. x 4 DEEP) (H-20)
BREAKOUT CALC.; (97 - 86) / 68' x 150 = 25'
� J
/
' SITE AND SEWAGE PLAN
o,
0
KEY: , ,Z5' -: �-
EXISTING CONTOUR: 110
LOCATI0IV'
PROPOSED CONTOUR: .............................. _
����� , ,�r�-'`-I��9'� LOT 11 PERCIVAL DRIVE
EXISTING
SPOT ELEVATION: 25.5
EVATroN zs ��' WEST BARNSTABLE, MA
PROPOSED SPOT EL .[]
. ..o
TEST HOLE: CIVIL
„i . ;�$ u PREPARED FOR
UTILITY POLE. -O-
FENCE LINE: crs �
� DM -
REEF REALTY
HYDRANT: DaMARasT-McLELLAN ENGINEERING , �' SCALE: 1" = 30' DATE: 5-25-94
RETAINING WALL: N
24 SCHOOL STREET P.O. BOX 463
WEST DENNIS, MASSACHUSETTS 02670 REFERENCE: PLAN BOOK 413 PAGE 99
DM # 9_4.._02—J1 THOMAS McLELLAN, P.E. JOHN Z. DEMAREST JR., P L.S.