HomeMy WebLinkAbout0000 LUMBERT MILL ROAD - Health (9) ' LOT-8 LUMBERT MILL
CENTERVILLE Mom
r WALCOTT AMES
/L S. DATE j o
lJ
TOWN OF BARNSTABLE FEEC�S"
y0
OFFICE OF
RECEIVED BY �
,
} '""'t"" } BOARD OF HEALTH
NCI& 1�
'� ���o• c 3e7 MAIN STREET
'tit r�•'
HYANNI9, MASS. 02601
VARIANCE REQUEST FORM
A1.1 variances must be submitted FIFTEEN (15) days prior to the scheduled Board of Health
meeting.
NAME of ,APPLICANT 2leuAr24> r � TEL. NO.
ADDRESS OF APPLICANT
NAME OF OWNER OF PROPERTY �l01k t
SUBDIVISION NAME � DATE APPROVED
,
ASSESSORS MAP AND PARCEL NUMBER
LOCATION OF REQUEST Z 1 I�DOMiS Lk vjc
SIZE OF LOT 20 DDv 54 : Sq. FT. WETLANDS WITHIN 200 FT. OF PROPERTY: Yes I No
VARIANCE FROM REGULATION(List Regulation) �&A2C> &r- /zf�i6.tG�l�76�
jlTz U'ut2i.11 250 �tgt s�2w���,.� �2o wl �n��O S �
REASON FOR VARIANCE(May attach letter if more space is needed) -hj�r- rRQ? 5Ss 'Pnc
_T�Tzwl tJ►VV Q�ICC A QApa` z� IJ�z�J Q '-3y-og-uv A t6ssg AK3 Q
wW—Qv- a u2a��cZ' LA iC� [ rot+ �?• �`�f��
PLAN - ft-RR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST.
VARIANCE APPROVED a
NOT APPROVED -'
REASON FOR DISAPROVAL
2 1993
Ji
&iJ>f m G.ft*OhA«k'11ou"
Joseph 0,snow,MA
f
APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS
LOCATION /Zg LpONi.S LAIC Gfjpg�e✓/z-LAE NO. 1 17
VILLAGE _419 V/c.`A DATE y
-APPLICANT" . /�lfARD to6F��✓ FEE..
ADDRESS • /V7 Gvo -fps Z4.4- TELEPHONE NO. (Ron-refundable)
ENGINEER !'= .. ,Dar 4'AlcI/ TELEPHONE NO.27/—.65
DATE SCHEDULED 1 o-.Jr -f joxn•►v
(Appjjcantls signature
• n�����dd�� �tA� d Lb'r No, �3� �alu��t/ '
SOIL LOG
SUB-DIVISION NAME DATE_ pc+ober g j 4� TIME I Pt
EXPANSION AREA: YES_2S NO ,, I)SAIC-i 0'Nc�:I ENGINEER x '
...-.-•-�..�.......... &. .%
TOWN WATER, PRIVATE WELL Scv-r BOARD OF HEALTH
A/ Fu//r, EXCAVATOR
SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes)
NOTES:
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0
o
Pj W �rivrw.� •
D
Ext0%
Hourc,
� Wcq ue,�vctt
� ff
Lakc.
Zo
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• PERCOLATION RATE: T,_,,
TEST HOLE NO: d ELEVATION: 9, TEST HOLE NO: ELEVATION:
1 �o o:/ t s��sor Iz '� 1
2 2 .
3 f;., ci��., 3
4 4
5 5
6 6•
7 84v 7
8 8 '
9 ��/. cis�„ 9
11 Ce b b/cs 1� '
12 12
'eo
13 .. �
14 14
15 15
16 16
SUITABLE FOR SUB—SURFACE SEWAGE: LEACIIINO FIELD LEACHING PITSk�
LEACHING TRENCHES
UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONSt
NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: ' COMPLETED IN ENTIRErPv 0Y_ P. E. AND RrTIMM) mn nwinn n" •,,.*. m.. '
Duo
t °`.
f
No...... .. Fps.........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....--....lawn.................OF.....a4r!.-VA ........---.----...------------..........------------
Appliratiun for Eliupuuttl Works Tonutrnrtiurt ramit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
..._.a"n C_-.j--.. .---------
Location Address or Lot No. i
6::1. � ...�-�.CS�S� .... !!�. �' if Q...........................
y .. t_..
Owner Address
a
--------•-------•..............................••••••---•-•••....._.........._--•------...._.. ..._..------------...._.......----.....-------•._.._..._._........_._......--•••••..............
Installer Address
pq Type of Building Size Lot..... .....Sq. fegt
a ,l/
Dwelling—No. of Bedrooms Attic (�) Garbage Grinder ( t.)
04 Other—Type of Building ............................ No. of persons.....................--.--.. Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------- ---------•--.----------------------------------------------........_......................_--•-••-•-••......
W Design Flow..................................MS. -gallons per person per day. Total daily flow............................... ...gallons.
WSeptic Tank—Liquidcapacity.fS�-gallons LengthJO.74..--. Width-5�` -- Diameter_ ....... Depths&'.
x
Disposal =—No. _-------------_-- Width.....(-C>°.......... Total Length.....1.&......... Total leaching area..Z.4 ..... ft.
Seepage Pit No..................... Diameter.---................ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (-,-, ) Dosing tank ( )
'" Percolation Test Results Performed by._V&w,J---®.`..N .i f....................................... Date---.fie 9:1f 1.4----__---..----
`'la Test Pit No. L.J. -...minutes per inch Depth of Test Pit.... ..... Depth to ground water........................
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.----............... Depth to ground water..
04 -•--•............................................................................................................................ As h•�
0 Description of Soil....Q.=a,'°.... ..............•--••-•--------------•..................................... `
e� I rEFIREN
..4�i�1le�r. z.., , �. m�t/-cc..f�&l<4..--------- .....via ....
"�.
U i 2 cu Sri ry
tzl ..... a s
UNature of Repairs or Alterations—Answer when applicable...............................................................: : . fVo.30 1 I
-•-•------------------•-•---•-•--...--•-•-•-•-•-....--••-•••-•-•-•...............-••--•--.....-•-••-•••..............-------•-----••.------........-----------.....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in cc ztahRwviel
the provisions of TITLE 5 of the State Environmental 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.
Signed ............................................................................:.............................. ........................................
Date
ApplicationApproved By ................................................................................................................................................... .................D..a re te. ..................
Application Disapproved for the following reasons: ........................................................................................................................................
.D ....----....----
Date
....................................................... . ...............
PermitNo- ----------------------------....................................... Igsued ....................................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............................................. OF ........---- ...._..................................--.............._..................--.....-
(gEr#ifirate of (famplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by....................................................................................................................I ns Wier... .......................................................................................................--...--...---- ..
at ..................................................................................................................................................................................................................................................
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. ................................................ dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................................................................................................... Inspector .........................................................................---...--.......---------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........................................OF.....................................................................................No......................... FzE........................
Disposal Works Tunutrutiun rrrmit
Permission is hereby granted........................................................................................................................................
......
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo-------------------------•----•-.......------------•-----.......--------•-------••-----.-----•-•----- ------------------------------------------------------...------------------------_-...-
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated............................:.............
..........-•---•--•-•-•.................•--------••-•---•----••-•••....--....................••-•--•--..:
Board of Health
DATE................................................................................
Form 1255 H&W HOBBS&WARREN rct Publishers
No................_....... F$8...................._......_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
------..... r,.,n................OF.......
� n.sf �l._.....-.-...-.._...
Apphratioit for j3iipootti Works Tanotrurtion Vermit
Application is hereby made for a Permit to Construct (;,o or Repair ( ) an Individual Sewage Disposal
System at: / ` / �J �yy� / 2
...{ ... .4Gsicts�Sd......4.b'R6••....._.L.-G-++i+�l 2T.!-�6I.j�.C_______--_ --•.=i�rC.r�GS� CJ^....!!_(_!_C�V._ehl wy:, Il.a............
Location-1{ddress or Lot o.
..................................................... -•1� �•lc s�cn• ►� (�sXa ..a,AQ_..........................
w Owner Address
----•••-•---------------------••-----.....-•-•--•-•--------••----.....-•••••----•----•••-------•-- --..._..-------•-•-•------------•••--•••-••-••-----.....•----...-•••-------•....................._
,4
Installer Address
Type of Building Size Lot......A�1+9?__e_....Sq. feet
U Dwelling—No. of Bedrooms......F,;...............................Expansion Attic Garbage Grinder ( A6
Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures ----------------- -------
Design Flow...................................�• __gallons per person per day. Total daily flow-.__._._____...._...__.___..._4.4-4__gallons.
9 Septic Tank—Liquid capacity_./_504,gallons Length._//_=.Z_'. Width___ Diameter..._.
Disposal �$%3 No_ ____________________ Width......I.Q'_....... Total Length......I.8........ Total leaching area___.'-.�4_2,....sq. ft.
3 Seepage Pit No..................... Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (x) Dosing tank ( )
Percolation Test Results Performed by____ ...40!..tJ4z'-t..................................... Date...../a1—TI—43__........_..
as Test Pit No. 1___.-t,.,c,__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.......... ..__.___..
�+ •---•------------------------------• ......
.--....
O Description of Soil..___
.... ; �
r� �' '
P —!•� t T o+�--L-S*.4��4a --•---------•-----•-----•-----•-•--•-•---•---•----•-•-••----••-•--• ...... tie. ...........
V ..................•^---^••---•---�Z-��^. ! ..... '-girl4'.---.L./ctxw?---.dFar[�'s --------------••.....
(zl ...._•....................... s`4" 4�Y1cc1i G.�cai
UNature of Repairs or Alterations—Answer when applicable........................................ _ -•••WILSON
...----•....................•--•..............._..-•-----•-•------••----•--•--...--••••--•-•---•-•------•----•-•-----------------•-••---------------••- ---.. f
Agreement:
< .The undersigned agrees to install the aforedescribed Individual Sewage Disposal System r " �ce�with;• /O�sa
�rr't.;"tom.
the provisions of TITLE 5 of the State Environmental 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.
Signed ........................................................................................................... ........................................
Dare
ApplicationApproved By ...................................................................................................................................................... .......................................
Dare
Application Disapproved for the following reasons: ........................................................................................................................................
.....................................................................................:......... ............................................................................................................... ........................................
Dare
PermitNo. .................................................................... Issued --...---....------...-...--...--.-...-.......-----...-....--.-......
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............................................. OF ..................................................................................................
(�.exttftra#P of Clompliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-----------------------------------------------------------------------------------------------------------------------------
Insraller
at ........................................................................................ -------..-......---...-......------.......-..-.--....--.-........_......---.....--.-.-...--.......-...--------------------.-...........--------.......-
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. ................................................ dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................................................................................................... Inspector ......................................... ...................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF.....................................................................................
No......................... FEz........................
Disposal 18orkii Tonstrnrtion Verntit
Permissionis hereby granted..............................................................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo...............................................................................................................................................................................................
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
......-•-••.............•----•-••-----•-•-------•---•---•-----............__...._._._.......---........_
Board of Health
DATE................................................................................
Form 1255 H&W HOBBS&WARREN na Publishers
L— _ I
K
B ENCHM R
. MINIMUM_ 20 FT !� ES S0 � T ;P- 8�2
TC, 7)
FOUN DA 11ONTOPOF
DATE OF SO IL TESTrr. . 0c!-crb+netn-tr
5T
19510 FT. MINIMUM CLEAN SAND
467 WITNESSED , YLE
1
n
CONCRETE PERCOLATION RATE �� .M
IN. NCH.
O C VERS
VC PIPE SCHEDULE »4 SCHED
.... » - -.
8 R FT.
2 LAYER F
OBSERVATION HOLE OBSERVATION HOLE 2
N PITCH 1 PER „
. � MI IT / ,
1 TO 1 2 _
8 9, _
CONCRETE
ELEV _... ELEV:
WASH ;:STO _ .
COVER
S
ED NE 0
'
IOP AN
. 12 MAX.
T D
3
UBS
.m 4 ..:CAST IRO
N PIPE
SOIL
: . .
!2
. , OR :::EQUAL MINIMUM
» b z
nc Glc .r
' T.4 P R F —PITCH 1 E
E
a
N
FLOW LINE
10
f
Sitra'f. Go�6f ,
ELEV.
w
O .
;.. ..MIN. _ 45:2 »
19 ELEV, r o
No W.f�
ELEV.
2 0 0'
. LU 5
LEVEL o
0
:
ELEV.
5
f- o
ELEV. —
o 0
o WATER AT E
o WATER AT_ EL. W L=.
. _ o
O
0
0
_ Gj
ELEV � o
DISTRIBUTIONtj
0
» » O
O
(�
DESIGN : CALCULATIONS
34 - T011 2 0
: -o- o-, w
0
t,B0/\ o {►
WASHED STONE - a , NUMBER OF BEDROOMS-. o w o
b
w
TO BE WATER TESTED ELEV. 41 4- _ 'GARBAGE'DISPOSAL UNIT nn
1 00 GALLON -
0 E OUTLET FLOW
IF MORE .THAN N TOTAL ESTIMATED
SEPTIC TANK ( //v
GAL./BR./DAY X 4- BR.) 4t GAL DAY
,3
3 GAL.
PRECAST LEACHING �-
REQUIRED SEP11C TANK CAPACITY 1�,,,_
GALLEY OR EQUIV. z L WE N
AL E OF SEPTIC :TANK L2 4.52 GAL.
'ACTUAL SIZE L AC
ZONE
LEACHING AREA RE
UIREMENTS Q
INDEX
SIDEWALL AREA a-5 GAL/S.F.
1
�-
ADJUST
G
BOTTOM AREA GAL./S.F.
SEWAGE E DISPOSAL SYSTEM PROFILE
CI 0 OM + SIDEWA GAL. AY
`NOT TO SCALE
LEACHING `CAPA TY (B TT LL) /D
- - U ua Q v, .,. 4_- Lake-
e -
RESERVE LEACHING CAPACITY � � GAL. DAY
BOTTOM OF EST GS PROBABLE . .
OBSERVED WATER TABLE ELEV. _ 6414
- NOTES.
.
1. ALL WORKMANSHIP AND MATERIALS SHALLCONFORM 0 TO D:E.P
LEGEND:
TITLE :5 AND THE TOWN OF RULE AN
REGULATIONS FO O THE SUBSURFACE DISPOSAL OF SEWAGE.
R
EXISTING SPOT-ELEVATION 00 0
BROUGHT TO
,. UNITS SHALL B
t
2. ALL COVERS TO SANITARY N TS L E
_ . _ GJ f n.✓s »
EXISTING CONTOUR 00
S GRADE. ,
ELEVATION .0
WITHIN ,12 OF FINISHED
_ 'FINAL SPOT 00
e
THE SAME.
r
_ 3. EXISTING AND FINAL GRADES SHALL REMAIN.. ESSENTIALLYE
w NA CONTOUR 00
FINAL{ -CAP e OF
..: 4. ALL COMPONENTS OF THE SANITARY `SYSTEM<SHALL .BE ALE
2 u
SOIL TEST LOCATION
WITHSTANDING H .10 LOADING UNLESS THEY ARE UNDER OR WITHIN
UTILITY POLE
x : _TOWN WATER W W
10 FT. OF DRIVES DR :PARKING AREAS. H 20'LOADING SHALL BE
10 OF DRIVES OR PARKING AREAS
W _ e / � USED UNDER OR WITH N FT R
l
3
b
CATCH BASIN \ l 6,. �. 3 0 G COVERS TO GRADE SHALL
� ,� e _. 5. ANY MASONARY UNITS USED T BRING VER L
BE MORTARED IN PLACE.
3
6. N0 DETERMINATION HAS BEEN MADE A5 TO COMPLIANCE WITH
t0
4 a
x.
.�-' •. ® DEEDED, OR ZONING REGULATIONS. OWNER APPLICANT IS TO
QBTAIN SUCH. DETERMINATION....FROM APPROPRIATE AUTHORITY:
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6 � OF HEALTH
APPROVED. BOARD
.74//e d wrNr a. r ,
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A AGENT
Gas E vJ ics- sc u� eS -�o � DATE
be rcloca.+tc1 -Fea west r ,A
-+1C1a c� r-:a�Cs I'100St � x _
U ,Y _D PLOT P
.� _ y � �. -� ;PROPOSE -�-
..- .•. FOR
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Ac
PROJECT LOCATIONCID
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CC k, I , vY�a s s
�9I'
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t DANIEL D. 0 NEILL
. � N SURVEYOR
. � .. PROFESSIONAL LADS Y
_ BOX 307 36 PUTTER LAN
qa r+
508
HY NISPORT MASS.
_ ; WEST AN
771 _7217 02672,
..,
DATE
DIV
STEPH
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:.
REVISED REVISED
k AL��ty
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WILSO
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ET OFBch�km�rk - P►� ZC� �.. , , . �. LOCATION MAP 3, FSH�_l I ,� 1
art tnf- c 4 N t7v
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