Loading...
HomeMy WebLinkAbout0040 HANE ROAD - Health 40 Hane Road Marstons Mills A= 151-008-007 t r a t YOU WISH TO OPEN A BUSINESS? 1 For Your Information: Business certificates [cost$40or 4 yEar_s]. A business certificate ONLY REGISTERS YOUR NAME in town [which`you must do by M.G.L.-it does not give you permission-t-o operate.) You must first obtain the necessary signatures on this form a.t 200 Main'St.,Hyannis. Take the completed form to the -town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: �` �� l a Fill in please: APPLICANT'S YOUR NAME/S: �Ca MOT) QY BUSINESS YOUR HOME ADDRESS: z' CA M TELEPHONE # Home Telephone Number ?iU�6�`JIn-G��CT AY41 �(0�e1FY}F 2ti�U NAME OF CORPORATION. 1. NAME OF',NEW BUSINESS TYPE OF;BUSINESS, ". Lei► OY Y IS THIS A,HOME`OCCUPATIOW YES NO ` ADDRESS' BUSINESS ! > ;V ` ' J MAP/PARCEL NUMBER d�� (Assessing) �1 �b When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to maize sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO MISSION 'S OFFIC This individ I ha i fo of.a per it r quire ent that pertain to this type of business. COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO Aath i gnature COMPLY MAY RESULT IN FINES, MMEN S: i - 9_S 0 C i I 9 2. BOARD J HEQTH „r This individual ha been{flfa �`e�'p�the permit requirements that pertain to this type of business. - � (AVV6V 1 Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) ' This.individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: s , gnu iiA gE. . d COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A _; CERTIFICATION ::, Property Address: 40 Hane Road 'n (�/J CD t_ Owner's Name: Joan McTernan1 Owner's Address: -_40 Hane Road Date of Inspection: — --6 , c- r- Name or inspector:(please print) Will i am E_ Robi nson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P 0 Box 1089 Centerville. MA ./ Telephone Number: (508) ...775-8776 CERTIFICATION STATEMENT i certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Sec ion 15.340 o[Title.5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails a Inspector's Signature: '0�' �� Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatih'or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies.sent to the buyer,if applicable,and the approxing authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 inspection Form 6/152000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 40 Hane Road W. Barnstable Owner: Joan McTernan Date of Inspection: Inspection Summary: Check A,B,C,D or E I ALWAYS complete all of Section D A. Sy em Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. Syste Conditionally Passes: One r more system components as described in the"Conditional Pass.'section need to be replaced or repaired.Th system;upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,n or not determined(Y,N,ND)in the for the following statements.if"nat determined"please explain. The sep'c tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhib its.substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the - existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septi tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that be tank is less than 20 years old is available. ND explain: Obse ation of sewage backup or break out or high static water level in the distribution box due tabroken or _ obstructed pi (s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of ard of Health): broken pipes)are replaced obstruction is removed distribution box is leveled or replaced ND expl : e system required pumping more than 4 tiles a year due to broken or obstructed pipe(s).The system will pass insp lion if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 40 Hane Road W. Barnstable Owner: Joan McTernan Date of Inspection: . C. Furth Evaluation is Required by the Board of Health: Con 'tions exist which require further evaluation by the Board of Health in order to determine if the system is failing to otect public health,safety or the environment. 1. Syste will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the syste is not functioning in a manner which will protect public health,safety and the environment: C sspool or privy is within 50 feet of a surface water — C sspool or privy is within 50 feet of a bordering vegetated.wetland or a salt marsh 2. Systen will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is f inctioning in a manner that protects the public health,safety and environment: _ e system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a surfac water supply or tributary to a surface water supply. e system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. he system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a pri ate water supply well- Method used to determine distance ' his system passes if the well water analysis,performed at a DEP certified laboratory,for coliform cteria and volatile organic compounds indicates that the well is free from pollution from that facility and - e presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I I n OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 40 Hane Road W. Barnstable Owner: Joan McTernan Date of Inspection: 6 D. System Failure Criteria applicable to all systems: You must indicate')- res"or"no"to each of the following for all inspections: Yes No _ B kup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Dis harge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clo ed SAS or cesspool Stati liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cessp I Liquid epth in cesspool is less than 6"below invert or available volume is less than%day flow Require pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times t mped Any porti n of the SAS,cesspool or privy is below high ground water elevation. Any porti n of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface water sup ly. Any portio of a cesspool or privy is within a Zone 1 of a.public well. — Any portio of a cesspool or privy is within 50 feet of a private water supply well. Any portio of a cesspool or privy is less than 100 feet but greater than SO f et from a private water supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates( at the well is free.from pollution from that facility and the presence of ammonia nitrogen ai d nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are trigger d.A copy of the analysis must be attached to,(his form.] (Yes/No)The s-stem fails.1 have determined that one or more of the above failure criteria exist as described' 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to etermine what will be necessary to correct the failure. E: Large Systems: To be considered a arge system the system must stiNc a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate ither"yes"or"no"to each of the following: (11e following cr' eria apply to large systems in addition to the criteria above) yes no _ 0 system is within 400 feet of a surface drinking water supply the s stem is within 200 feet of a tributary to a sur face drinking water supply the sy tern is located in a nitrogen sensitive area(interim We Protection Area—IWPA)or a mapped Zone I of a public water supply well If you have ans Bred"yes"to any question in Section E du system is considered a significant threat,or answered "yes"in Section above the large system has failed.The"mer or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR ; 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 40 Hane Road W. Barns a e - Owner: Joan McTernan Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes D/ Pumping information was provided by the owner,occupant,or Board of Health ZWere any of the system components pumped out in the previous two weeks? —Z_ Has the system received normal flows in'the previous two week period? _ v Have large volumes of water been introduced to the system recently or as part of this inspection?,. v Were as built plans of the system obtained and examined?(If they were not available note as N/A) Y Was the facility or dwelling inspected for signs of sewage backup? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? Were the septic tank:manholes uncovered,opened,and the interior of the tank inspected for the condition of the battles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes ..no/ - _ t/ Existing information.For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue aPP roximation of distance. is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 40 Hane Road W. Barnstable owner: Joan McTernan Date of Inspection: -1,G' �-O-S- FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. 3 -Number of bedrooms(actual): DESIGN flow based on 3 1 0,qM4 15.203(for example: 110 gpd x#of bedrooms):._ Number of current residents:k Does residence have a garbag grinder(yes or no): �,6 Is laundry on a separate sewage system,(yes or no):ku[if yes separate inspection required] Laundry system inspected(yes or no): � Seasonal use:(yes or no):,&v Water meter readings,if available(last 2 years usage(gpd)): 2004 — 105000 Sump pumpes or no • / 3 — 1 1 2 0 , 000 Last date of occupancy: COMMERCIAL/1ND RIAL Type of establishment Design flow(based o 10 CMR 15.203): gpd Basis of design flow seats/persons/sgft,etc.): Grease trap prese (yes or no):_ Industrial waste olding tank present(yes or no):_ Non-sanitary aste discharged to the Title 5 system(yes or no):_ Water meter eadings,if available: , Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as pa of the inspection(yes or no):_ If yes,volume pumped:_gallons-=How was quantity pumped determined? Reason for,pumping: _ TYP F SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age f"-11 components,date installed(if known)and source of information: ICJ i Were sewage odors detected when arriving at the site(yes or no): � 6 I'agc 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORI11 PART C SYSTEM INFORMATION(continued) Property Address: 40 Hane Road W. Barnstable Owner:,loan McTernan Date of Inspection: BUILDING SEW/(localesite plan) Depth below gradeMaterials of constrt uon 40 PVCther(explain): Distance Gotn privly well or suction 1•ute: Comments(on con ,venting,evidence of leakage,etc.): SEPTIC TANK:_✓(locate on site plan) Depth below grade: I Material of construction:_t/concrete metal fiberglass__,olyedtylene _oUtcr(explain) If tank is metal list age:_ Is age confirrned•by a Certificate of Compliance(yes or no):_(attach a copy of certificate) r. Dimensions: 4 Sludge depth: Distance GOtn top of sludge to bottom of outlet tee or baffle: l Scum thickness: —S,' Distance front top of scum to top of outlet tee or baffle: (� a Distance from bottom of scwn►to bottom of outlet tee or baffle:TO` ! Ilow were dimensions determined: (5- R t, LoL �n3 Comments(on pumping recommendations,inlet and outic tee or baffle conditicn,structwal integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: catc on site plan) - Depth below grade: Material of cons tion:`concrete tnelal fiberglass_polyethylene`other (explain): — — Dimensions: Scum thickncs Distance Got top of scwn to top of outlet tee or baffle: Distance fr it bottom of scum to bottom of outlet tee or baffle: Date of la pumping: Conune s(on pumping recontntendatiuns, utlet and outlet ice or baffle cunditio:t,structural integrity,liquid levels as rela d to outlet invert,evidence of leakage,etc.): 7 'agc 8 of I 1 , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORII'IATION(continued) Properly Address: 40 Hane Road W. Barnstable Owner: Joan M T rnan Date or lospcclloo: TIGHT or 110 DING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below ade: Material of onslruction: concrete_metal fiberglass__pulyethylene o►her(explabi): Dimcns' ns: Capa i y: Gallons Des* Flow: gallons/day Al m present(yes or no): Alarm level: Alarm in working order(ycs or no):— Date of last pumping: Comrnents(condition of alann and float switches,etc.): DISTIU 7or BOX: (if present must be opcned)(locate on site plan) Depth ol above.outict invert: Conuneox is level and distribution to outlets equal,any evidence of solids carryover,any evidence of - leakage f box,ctc.): PUM/inorking R: (locate on site plan) Pumorder(yes or no):Alar order(ycs or no):Conondition of pump chamber,condition of pumps and appurtenances, etc.): Page 9 of I 1 v OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Hane Road W. Barnstab e Owner:_ Joan McT rnan Date of Inspection: -)% SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type v � leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): _ i, l L/ CJE LS: (cesspool must be pumped as part of inspection)(locate on'site plan) Nnd configuration: _ p of liquid to inlet invert: solids layer: cum layer: ns of cesspool: of construction: I of groundwater inflow(yes or no): Cs(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): /ensions: (locate on site plan) f construction: lids: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 a Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Hane Road W. Barnstable Owner: Joan M T ap. Date of Inspection: / SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply a ters the building. Lt� YI 3 3 , 10 f Page 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 Hane Road W. Barnstable Owner. Joan T �nanJ Date.of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water f7 67 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-if checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) C ecked with local Board of Health-explain: Necked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must des?ribe ow you established the hi h ground water elevation: 8' p EL i v 11 La TOWN OF BARNSTABLE LOCATION b `- �4SEWAGE # 6 _ �U VILLAGh RAJ , (� , ASSESSOR'S MAP & LOT fft _ \ \ INSTA,.LER'S NAME & PHONE NO. 'A- SEPTIC TANK CAPACITY w G O LEACHING FACILITY:(type) p (size) 00 q:Lt1L NO. OF BEDROOMS PRIVATE WELL ORjU.B.LIC WATE BUILDER OR OWNER l.. �' S v�� U y.l DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No // I � ► •i 0 �+ �.6 f y x J t ,I 0 I a � qo 1 1 r 1 f 1 - ho- Noc�� Fss.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH #L40 41"f . 7-° � o Z fi!-s 7-r?53C _ ... . .. . � 9 . .. _ .................. s Apphra#ion for 11iiposal Works Tono#rnrtion Prrutit Application is hereby made for a Permit to Construct ( ✓)"or Repair ( ) an Individual Sewage Disposal System at: Add L cation- a � Q r� or Lot No. r sus , ,� v_s , 13 � �. Owner Q iddr s _.......t' .. ---- ----......... ---------------- �"� Installer Address / ` Type of Building Size Lot........-,J.----_-i. __._Sq. feet V Dwelling—No. of Bedrooms................ --- p }Showers Cafeteria — p, Other—Type of Building -L----ram':-''`-='°---- No. of persons nsion ttic (Garbage nn Grinder a' Other fixtures ................................. W Design Flow......................�4o® gallons per personpe r day. Total daily flow____... _ ..!..... ............pallons� WSeptic Tank—Liquid capacity.l....-_.__gallons Length____...._►.... Width4... ..... Diameter................ Depth........$_._ x Disposal Trench—No_____________________ Width.......i------------ Total Length____.___._...... Total leaching area....................sq. ft. Seepage Pit No.......I-------.._.. iameter___-�...` ...... Depth below inlet_.-:3!�_..... Total leaching area.. .Q 8---sq. ft. Z Other Distribution box ( � Dosin - c a Percolation Test Results Performed nyh f 1�f T ._ .Date... un r_ _f.__. 14 Test Pit No. 1.......!LZ-minutes per i c Dept o Test t Deptht ground water Lti Test Pit No. 2.....4_.Z_minutesper inch Depth of Test Pit........ ...z.... Depth to ground water....J_:�....... 04 ...........................- ------ -- .....................:......:..... . O Description of Soil a-o:�-Se----•�-Q---�-•�d....... `'� j .... ct- C'/.• - p� 9 W ------•---------------------------•----------------------------•----•--------------•-------•-------------•----•------------------------•-----•--------------------------.....F.................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ................---------------- -•---- - --------------------•................----........---•-----------------------------------------.......................................... Agreement: l�, . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITS 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. Signed. .._ ------Vill/ Date Application Approved By................... - ------•------: •--•---------- .------------------ :I __..40. Date Application Disapproved for the following reasons-------------------------------------•----------------------...----------------------------------.............._ ..................................•--.....-----....-------------•-------......_.........--•-------•-......--------------••------•--------------------------------------•-------•----Date------..._..._ Permit No.... .��1�.d----_... Issued_....................................................... Date ---------- -- --t ���—. ------_ ------------------------------� No......................... Fizz............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........�0..`'!//.. .----.OF...�- f.� Z.A✓-S T�r)e .Z .L ... . 6� Appliration for Disposal Workii C>zlonstrurtiou ramit Application is hereby made for a Permit to Construct (✓f or Repair ( ) an Individual Sewage Disposal System-at: ocation-Ad L / / V S /i1ce.. or Lot No. ..........'S .........................---......-----------1-3-!-----d j�.....z.�-.4......L3.z /- .yam ...... _. .............. Owner Address e .................................................. --- o .:�r-..✓...t:.1J .L1: - Installer Address ^ j / UType of Building Size Lot_._..........................Sq. feet 1-1 Dwelling—No. of Bedrooms............................................Expansion Attic .() Garbage Grinder.()- aOther—Type of Building 1-----:-7..^^._.... No. of persons........Kam............... Showers (---) — Cafeteria-(—)- ¢ Other fixtures •'•••---------•-•-•••-•-••......--•-----------•--- -••-------•-•------••-•••....-•--•-••--•-•••••••-•---••••-••-•---•-••-•---------------------- WDesign Flow.........................�:..........•..._gallons per person per day. Total daily flow....... ... ...0.._.._._._.___..._._gallons. WSeptic Tank—Liquid capacity.!.._.''Ogallons Length_ ... ^._.. Width!...!. ..... Diameter---------------- Depth-.`...'.6..'.. x Disposal Trench—No..............•...... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------1..._.__.__....�Diameter.._. ....... Depth below inlet.3:_S...J..... Total leaching area...'.7.4�..sq. ft. Z Other Distribution box ( v') Dosing.tank-(-"-)" _ 14 Percolation Test Results Performed by---%:.._y...::..... ...... Date_-..._ .....-L ,a Test Pit No. 1...............minutes per inch Depth of Test Pit------- ....... Depth to ground water.....r---.--`_f= f% Test Pit No. 2..................minutes per inch Depth of Test Pit........ Depth to ground water_--_?---`- r P4 -••••--------•----------•----•.............••-••--•-=---------.....--------.............. . ----------------.----- -------------------------- - Description of Soil.. == .........•------------- -----------------------------•............---- ........ - U .................................................f FJ_ . ... r Z ----•••-----------------•---•---------•--••-•---•--••-•------••---------------............................................................................................ ..................•..... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ---• ----•-•--••----•••••-•----``...............•--•-. -----------....--- Agreement: Gw The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. M Signed.`� ..�� ......v_V....... ' �v _..._.... -- -. ------- Date Application Approved By --------- '-r=.................................................. _ l. l Date Application Disapproved for the following reasons:-----•--------••-----------••----------------------------------------------------•------•----•----•--........._ ..............................•--...--•-• — - ----------•-•--------•••-------•-"Date-------------- 2 d... PermitNo............ ------•--•-•--••-----------•-----. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T 1��..............O F.....� .-D. a..,�: •- -� ,3 .- ..............................................•.... Trrtifirate of �u t li �tre THIS IS TO CERTIFY, That-..the Individ al Sewa e Disposal System constructed ((/)or Repaired ( ) by......... �.C K � ;� 4- oS ---------------------------------------------------------------------------•---•••-.•--- r.. 7 j l P f Installer /V ,4 at...... ................•--. •-••••-•••-•-•--•-......----------------.:........----..._.`..........-•---------------------------.....-----•.......----------•---------......--------••---------- has been installed in accordance with the provisions of TIT r 5 O�Ibe State Sanitary C .de_a desc ibed in the application for Disposal Works Construction Permit No.- rz ' .dated-------- /... J ------... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTES THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... .-•--••-•-...---••--••......................•-•-................. No......................... FEE........................ Disposal Workii Tomitnuliatt ami# Permission is ereby granted---- j` ----_lam.�:G iv.....:7......................................................... to Construct ( or,Repai ( ) an ndividual Sewage Disposal System •-- f - •- Z Street as shown on the application for Disposal Works Construction Permit=No d="_-� - ted.......................................... r tS�� �•-� i\J "� ........................................................................................................ Board of Health DAT .. :._... } FORM 1255 A. �M.`SULKIN, INC., BOSTON ti BENCH MARK : SP / /<E iiv FOL- li 9 o ti �- [.. e� V. / 3319 G,V. D. TEST HOLE RESULTS *. P#,5-629 N DATE : _�,.� he 6 �` , WITNESSED BY 7-,J o nit AS m 'f lc t3,o. H., I / 23. 38' a G7R` o=j p oq so, SC"q L � §e /-Pn C lit', 'TH I C7 7` / a 7—� . EG /2C� V ca 7-, t l, " ff L / 2.UL CD �j 21 2 4 7 0 T,E T?- I!F AD r 1 60 •�/�14-7- ./--} -- �J © ter V,eF re- r / s T- O - pSTUN S ,b w�_ y��y � �", /Z � F•'t.. .� G �'� vv / T/� �L.F9-,'✓ G, /Z,91/EL 0 oto N N MANFi'OLES AND COVER TO BE BUILT TO - :� Z ELEV. TOP OF 07 I �. WITHIN 12 OF FINISHED GRADE I/$ .. j / 2yt FOUNDATION FINISHED GRADE MIN.. 2% SLOPE !lj -PI P E _. .^^'„�.• ��IN PA� ,•�IIP�T H2O 2 I EVE 2M1:, :-Q MIN- 2'� LAYER OF _�-.�, .... ....._� .�. , _ , AST N E I �r ... MIN. PITCH: --. -:- � . •� � ,.� P E 0 f ti I `• 2 F (0o Ti G, 7'-c� a X7 `PtEa cED I GO:U I/4. �Op �� ,. X, /FT R 010 lam" INVERT l 14.75 GALLON N��R (NV/`EGri�C� ' D '1S INVERT ;40 C� � mom• •„rl l DIA. a vMAgCTED • ;� :J .EPTIC TANK INVERT ` BOX l/S.S '.® 3,5L) ©,. , W E ? \ ©F � 12G n/ R C INVERT v WASHED STONE NCOV TERED PLA C E ON . + INVERT 0. 0 cr Q �.;` ALL AROUND .--� i 10' MIN.) FIRM BASE �--�/2 ate' �:• BOTTOM AT ELEV./ /2. 0 /VO GAR9AGE ( 2 O' MI N.) q, l 4. , GRINDER 7-1) ELEV. I PROF I• LE OF GROUND . WATER TABLE aVV ' PIT P1PE VV 17-H 3/4' 7-01%M SANITARY DISPOSAL SYST-E M 2� S ©NE T 7-0 A E =/V S T�7 LGE/�. 1 �cT Lov✓ tNor To scaLE ) � DESIGN DATA • CONSTRUCTION OF' SANITARY DISPOSAL 3 BEDROOMS �' - SYSTEM ' SHALL CONFORM TO THE MASS. D /`�/ � H s8. /C74 o R Y w.EL c. DESIGN FLOW 3 GAL./DAY TzS �'c t� ENVIRONMENTAL CODE TITLEZ' .� 38,� � � s�nl7� sr�7Ar•� LEACH RATE MIN. INCH LIE714cAlt (REVISED . 7- 1-77) AND T-HE TOWN OF REQUIRED LEACHING CAPACITY : 330 8,4)7e VSTHZ3L 6:-' HEALTH REGULATIONS. . • SEPTIC TANK, DISTRIBUTION BOX AND LEACH— PROPOSED �38 GAL/DAY. '2o ING UNIT TO BE OF REINFORCED CONCRETE : MIN. CONCRETE STRENGTH = 3000P. S.1. TANK :> Prz� p,� / � �� D1�-9/w,q�F- 5y �. '� � REQUIRED SEPTIC � MIN. STEEL STRENGTH 209000 P. S. I. — ` i ----�2 MIN. DESIGN LOADING PROPOSED SEPTIC TANK : o • DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN LOADING IS USED • ALL PIPES AND FITTINGS TO BE WATERTIGHT AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL, DATE SITE PLAN SHOWING PROPOSED CONSTRUCTION ZONING DATA LEG END LOCATION : z -s. o���►v s� �' ti Imo" �� 01 ZON E � — _ — _ � ! TEST HOLE LOCATION - REFERENCE �_2-.0 �" -7 �s s�-�� �� � � REVISIONS Biz ace REQUIRED ` AREA ' _ �43.5iaa} / o� ego� EXISTING SPOT ELEVATION 17.6 l� e_ /2�G,, c�F .l�s Q �� �' EXISTING CONTOUR 16 ���t� of �as�q 22 REQUIRED FRONTAGE :— � 37. p� CRAIG �y 11 n✓ ?�L A�/ 13�C 2 G FG. L l-*G 7�sp — REQUIRED FRONT SETBACK : (30) 30, PROPOSED CONTOUR 16 0HORCJ, CA LE " REQUIRED SIDE SETBACK �� � � �`` PROPOSED WATER SERVICE —W— to t LE (),5) /u ,, E ' PROPOS `SERVICE MSrE- G �F REQUIRED REAR SETBACK : :. w D GAS ss1oNALEN� 4%7 PROPOSED ELEC. & T E L E E B T CRAIG R . S H O RT , P. E . PROFESSIONAL CIVIL ENGINEER BUILDING INSPECTOR APPROVAL , DATE 131 OLD ROVTE 132 .6 HYANNIS , VA. 02601 FILENO. I -S79 ( 7-E ( .17) 362 - 94// SHEET 1 OF I