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HomeMy WebLinkAbout0123 MOUNTAIN ASH ROAD - Health 123 Mountain Ash qn��; Marstons Mills ,- A= 124-029 oFn� Town of Barnstable �� P# � '. Department of RegWatory Services � a Public Health Division Date MAB,4 200 Main Street,Hyannis MA 02601 t�tt , Date Scheduled Time . Fee Pd. Soil Suitability .A.. sessment f or S �e.Disposal Performed By: - m. t a Witnessed By: LOCATION& GENE, AL INFORMATION Location Address 1�D Owner's Name 4�• I Address jet /� � y , Assessor's Map/Parcel: Engineer's NEW CONSTRUCTION REPAIR Telephone# Land Use. Slopes 96 P ( ) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SIMT'CII:(Street name,dimensions of lot,exact locations of test holes&Perc tests,locate wetlands(n proximity to holes) La Parent material(geologic) D th to Bedrock Depth to Groundwater. Standing Water in Hole: _ Weeping from Pit Foce Estimated Seasonal High Groundwater " rn •r. DET IC'RMINATION FOR sEASONAI,MCI$WATER'I'AI$I.,Iia Method Used: Depth Observed standing in obs.hole: in. Depth to Boll mottles: Depth to weeping from side of obs.hole: _ _ bt, Gruundwuter Adjustment ft. Index Well#__ Reading Date: ►ndw;Well level Adj.factor AdJCUl'nutldwaterLevel e PERCOLATION TEST Time - l/" Observation ' Hole# Time at 4" Depth of Pero Time at 6" Start Pre-soak Time @ ' Time(9"-6") End Pre-soak Rate Min./Inch G 2, •v` tt 5 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 1.00' of wetland,you must first notify the { Barnstable'Conservation Division at least one (1) vv.eelc prior to beginning. Y t Q:\SEPT1CIreRCrORM.DOc # , r c; DEEP-OBSERVATION HOLE LOG Hale# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell Mottling (Structure,Stones;Boulders. onsi§tency.%Oiavel) 1 - n DEEP OBSERVATION HOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other ,. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% ravel DEEP OBSERVATION DOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con 1 to c Gravel) DEEP OBSERVATION MOLE LOG Dole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Cons' ten a Flood Insurance Date Map: / Above 500 ear flood boundary No_ Yes 'V Y - Within 500 year boundary No Yes ood boundary Within 100 year fl No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervioiu ma erial exist in all areas observed throughout the area proposed for the soil a orption system? If not,what is the depth f n turally occurring pervi us material? Certification I certify that on Q (date)I have passed the soil evaluator examination approved by the Department of Environthnien 1 Protection and that the above analysis was perf rm by me consistent with . t the required training,ex rtiS d le r'e a described in 10 C- 15.017. Signature Date Q:WEPTIC F-RCPORM.DOC V TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE AM? //" ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ' "g LEACHING FACILITY:(type) C01'edi e'-e' el,'0'',,eO'e�size) 3 AX-f-,.JeX NO.OF BEDROOMS 3 OWNER I-' 1 Qr 1v J' PERMIT DATE: 0<® :�---"�� 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 ori` 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 BYJ —'J, v 4, XoFy—to ®Ys Pay 9-,e ` l roe tv - �' Fl VON No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computV UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftphtation forMisp08af fps M ConstrULtion 3pErlttlt Application for a Permit to Construct Repair( ) Upgrade( Abandon( ) ❑Complete System Individual Components Location Address or Lot No%�.3 f110��'�/j��"' /�f� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ' Installer's Name,Address,and fel.No. Designer's Name,Address,and Tel.No. \ Type of Building: 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) -�® gpd Design flow provided gpd Plan Date l Number of sheets Revision Date Title Size of Septic Tank 6 /o®O �ieType of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued s Board of ealth. ell ign d P Date G� Application Approved by Date 4a Application Disapproved by Date for the following reasons Permit No. an Date Issued No. V" a Fee THE'COMMONWEALTH OF MASSACHUSETTS Entered in com uter: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS . Yes 21pplitation for-Misposal 6pstrm ConBtrUttion Per71n—dii'dual t Application for a Permit to Construct Repair( ) Upgrade( Abandon( ) ❑Complete System Components Location Address or Lot Nor of 7 /9" Owner's Name,Address,and Tel.No. l Assessor's Map/Parcel — o a i, Installer's Name,Address,and fel.No. Designer's Name,Address,and Tel.No. 1� Type of Building: Dwelling No.iof Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Or e—P, No.of Persons Showers( ) Cafeteria( ) Other Fixtures `Design Flow(min.required) gpd Design flow provided 3 :11-Z gpd Plan Date S"-i„�' �'" 24' Number of sheets Revision Date Title Size of Septic Tank .LO' G /op p ype of S.A.S. o� G o Description of Soil J`e,er Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: a i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ° accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by-tkis Board of Health. 4 igned t� Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. G '"� Date Issued ---------------------------_---------- -------- _ - _ :: . . - -- /------------------------------------- Th E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance �.� THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(Repaired( ) Upgraded Abandoned( )by at/ol 3/7!©�//"1"�i/�..A J'/}'�',Or.,o ./s�1.,0�,has been constructed i accor c with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer S/ �E �Ot��'/f- Designer l/.c� f' �'� ✓ #bedrooms Approved desig, flow a gpd The issuance of this permit s7/') l n be cinstrue °as a guarantee that the system will fu lion- ', /ig�nee�,'. U L' Date Inspector r -----------------------: - --------------------------------.---- ----------------- - ------------------- -`—/O' No. / Fee—_— � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS �DispoSal :Oppstem Construction Permit Q Permission is hereby grante to instruct(jeofo' Repair( �) Upgrade( L� Abandon �� � System located at Rl�s D ✓' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu t be co pleted within three years of the date of this permit. Date / Approved by t JUN/27/2014/FRI 11 :03 AM FAX No, P. 002 Town of Barnstable Regulatory Sakes Richard V. Scah,Interim Director BAWMAMA r Public Health Division A' Thomas McK ,Director 200 Maio Street,Eyannis,l'LA 02601 Ofhce: 508-862-4644 Fax: 508-790-6304 Installer Designer Certficition Form Date: Sewage Permit4-740/y= Map\Parcel K;l � � Desigiler: U t3, � Installer: UIV,L � Address: Address- On d` rd l� J 11'� was issued a permit to install a (date) (installer) septic system at based on a design drawn by (address) r,� YAVYZ- dated 7� •�� —I (designer) x 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, Strip out (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 desiper to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the, system referenced above was constructed in com -ance with the terms of the 11A approval letters (if applicable) DAVID taller's Signature /q)1; MAsc �q aj p No.i 056 4 J CO 01sr��E (Desi 's ignature) (Affix Desi p Mere) PLEASE RETURNT TO BARNSTABLE PUBLIC IMAETE DMSION. CERTIFICATIE OF COMPLIANCE WILL NOT BE ISSIJED UNTIL BOTH TEIS FORM AND AS- BUIC„T CARD ARE RECEIVED BY TBE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASepticOrsigner Certification Form Rev$ 14-13.doc i m LeBoeuf From: Flick, Beth [BFlick@commfiredistrict.com] Sent: Thursday, June 5, 2014 2:40 PM To: Jim LeBoeuf Subject: 123 Mountain Ash Road Attachments: 11422.J PG Attached &Below Find the pic you requested! Best regards, Beth Flick COMM Water Dept. 508-428-6691 f e _ RfFelJ:ate{ Ia 4A.:... 4;! '3 AgA11'ai,3iaFn it9•NPq:i�l Ak '� 1 11422 Beth Flick,Clerk Centerville-Osterville-Marstons Mills Water Department (PH)508-.428-.6691 (FX)508.428.3508 1 f: t ,� �'�:Grp► . �1 v t f. , P TRANS.NO.: CITY/TOWN: APPLICANT: ADDRESS: DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204 t Plan proper scale?(1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220(4)(f)] daily flow septic tank capacity(required andprovided) soil absorption system(required andprovided) LZ whether system designed for garbage grinder North arrow 310 CMR 15.220(4)(g)] Existing and ro osed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i) Percolation test results match loading rate? 310 CMR 15.242 Certification statement by Soil Evaluator[310 CMR.15.220(4)0)1 Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located[310 CMR 15.220 4 m if water line cross see 310 CMR 15.211(1)[1 Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer 310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as approved for an upgrade under LUA at 310 CMR 15.405 1 (k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3) Benchmark within 50-75' of system [310 CMR 15.220(4)( ] Materials specifications noted? [various sections of 310 CMR 15.0001 System components not>36" deep (unless Local Upgrade A roval or LUA requested) [310 CMR 15.405(1(b)] Address Sheet 2 of 7 I N/A OK NO SEPTIC TANK Size OK? 310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5"per foot for increase ft depth[310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(l)] Separation between inlet and outlet tees (no less than liquid depth) 310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two fors stems>1000 gpd[310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done 310 CMR 15.221(8 H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Multi-Compartment Tanks Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and 3) "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter[310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING Located at least ten feet from any water line? [310 CMR 15.222(2 Disposal piping at least 18" below water line(when water and sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided? [310 CMR 15.222(8 Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) 310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/(leachfield below pump chamber) Endca s or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" 310 CMR 15.232(2)(b Minimum sum 6" 310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PUMP CHAMBERS Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 same as septic tanks Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE 310 CMR 15.231(5)] Service components accessible(not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? 310 CMR 15.221 8) Address Sheet 4 of 7 N/A OK NO SOIL ABSORPTION SYSTEMS (SAS) GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240 13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] GALLERIES,PITS,CHAMBERS 310 CMR 15.253 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I' minimum- 4' maximum. 310 CMR 15.253(1)(b)] 2' sidewall credit maximum 310 CMR 15.253(1) a In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] TRENCHES 310 CMR 15.251 Width T minimum 3' maximum 310 CMR 15.251 1)(b) 100 feet-maximum length 310 CMR 15.251 1 a Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours 310 CMR 15.251(2)] Breakout OK? 310 CMR 15.211(1) 4 and Guidance Document] BED SAS (Maximum size of bed or field 5000 gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f) Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address Sheet 5 of 7 N/A OK NO DID THE PLAN INVOLVE Pressure Dosed System ? Provided pump and piping calculations as required 1310 CMR 15.220(4)(r) Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000 d) good to note on plan[310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? V// Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer 310 CMR 15.255 2)(b Retaining wall must be designed by Registered Professional Engineer[310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gravelless System[,VA Approval Letters] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Alternative Septic System[EA Approval Letters] Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance pp p manual? Has applicant submitted a copy of a maintenance Variances Are the variances listed on the plan? [310 CMR 15.220 4)(g) RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414 Address Sheet 6 of 7 J N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone 11 for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? 310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Miscellaneous Pumping to septic tank ? 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 r�. DWN OF BARNSTAf4LE LO-�ATION ( D SEWAGE # VII.:,AGE 7�d��S F fiNS /LL ASSESSOR'S MAP 6r LOT INSTALLER'S NAME si PHONE NO. ,T= r SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (sue) NO. OF BEDROOMS - PRIVATE WELL OR PUBLIC WATER ' i?lt�91r'_ 4 BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No TOWN OF BARNSTABLE, MASSACHUSETTS tSUILVIIjU NCIK t A---124-0L9 �� �2fl2 DATE i'�a^ 2! 19 $�� PERMIT NO.. ^ r de.i:. APPLICANT_ Owl Ic!r _ ADDRESS. s ' � -1 _ Own eY. ! (NO.) (STREE-TI�• (CONTR'S LICENSE) �( NUMBER OF PERMIT TO Add STORY r )r? 1�'itr..�i 1`r T)j,7piI LlIL4-DWELLING UNITS (TYPE OF IMPROVEMENT)1 NO. (PROPOSED`USE) AT (LOCATION) 123 f(ULIIIL`.[].in Ash 'Llo d, ir lcll53t0i' t3 Mi 1.1 ^ ��...I.).t', A/ D ZONING CT (NO.) (STy EEti1') y BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE ' BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP - BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: ac., 14 114 AREA OR r ! • PERMIT �- VOLUME aC3r3 :ti('f. if_. ESTIMATED COST $ 1,000 uo FEE 50 00 (CUBIC/SOgUARE FEET) OWNER i;:- I; .� BUILDING DEPT. ,�s.✓+'''/ ADDRESS U 5 x•:.<iY.11l L.<.1].t t t.'1a11 A`C,t:�t,.l i`2::IY:i f l?d!`3 .�'L]-1.1..`.3 BY 1fs� i l v i r% THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK 00 ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMC-�.NTS'•ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND.LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT P'ELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ONE"JOB AND THIS' WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR - CARD KEPT POSTED UNTIL FINAL INSPECTION HAS-BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: - ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURIL. QUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). t 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS °CARD SO IT IS VISIBLE. FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 --- -- 2 3 J HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 1 OTHER BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. I �c yz „J ' "., ..f •:.i;' r:m: t:.;,.yt, .''.., /• ,. _ 1 n•. ..-. 4 xP•.7.:,, .�' /a;.ik::',,u� k '... I TOWN OF BARNSTABLE, MASSACHUSETTS a� Er BUILDING PERMIT DATE May ,25, 19 39 PERMIT NO. � L➢2 �- APPLICANT U4JTIC:Y' ADDRESS I REETlow f)GJT1F?t" INC.) .(ST (CONTR'S LICENSE) OF PERMIT TO Add De. (_) STORY Sinfjl.0 }��FaY111 � t7 YDWEBLLRNG UNITS . (TYPE OF IMPROVEMENT) NO. . (PROPOSED lllgEt) ) i•n[ SE) j ZONING AT (LOCATION) 123 Viowntu.in A? ati Road, 1�iarsj-.olul [Ai 1 I (I.tc��l 161 DISTRICT— (NO.) (STREET) 1{Lv i ' BETWEEN AND (CROSS STET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE ° BUILDING IS TO BE FT. WIDE BY FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION i TO TYPE - USE GROUP BASEMENT WALLS OR FOUNDATION I (TYPE) REMARKS: :ieb pcfi? #79-4;4 • i AREA OR PERMIT �� VOLUME 2RR E{(7_ j"t+ - ESTIMATED COST $ 1 , 000. 00 FEE $ s0 _ go I (CUBIC/SOUARF FEET) OWNER AJiait c LGI[lOII1We / BUILDING DEPT. ADDRESS lJ;.) 3 j'aU1171taiii cash Road f 1''IFIYs•f•.ons LN97 1 1 4 BY 9 mot— f _ i ....FI i LE `,`..�... rA THE-'COMMONWEALTH OF MASSACHUSETT$ �s�' BOAR® OF HEALTH /+ jay v�� 3 �• ;I�S W--au................OF......../ AtZ�v.s_Ti4-- ...........---................ r` VA t.r�atiun for Bholp a al nrk i (�nnitrnrtiun - rrntt#. pplication is hereby made for a Permit to Construct (V) or Repair ( } an Individual Sewage Disposal System at: .� ... ................................ Location-Address or Lot No. .. j '�: ' : 73.� ............. ------•----.....---------•----•-------• W g Owner •Add3ss a •........................ .... ..._.. ------------------------------------------- ---.-----------------•-----`----..-----------�---��j-•-•---------------------.-.-------•-------- Installer Address d Type of Building Size Lot..!.0_.&2;>..Sq. feet , Dwelling—No. of.Bedrooms................ .........................Expansion Attic (�Vq Garbage Grinder (Nd) 04 Other—Type of Building ...P JIA------------- No. of persons__---__________-----.-.___ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------•-•--�----'--••-•R -------------------------.----- W Design Flow.•..../ ....................•-----gallons per Pei per`�day. Total daily flow........�.�G�..........:_._._...gallons. WSeptic Tank—Liquid capacity/,q.P z..gallons Lengths..'6.". Widths YY?!2`"Diameter................ Depth_S_`-..`.� x Disposal Trench—No. ................... ',Width.................... Total Length......3............. Total leaching area....................sq. ft. . ......... Depth below inlet_............... Total leaching area_-.._.®a..s ft. Seepage Pit No.___---/-.-_--_-. Iamefer..� p g - q. z Other Distribution box ( Dosing tank Percolation Test Results Performed by.ZPA442!X- >..... &.!K:... Date.....19//�1._%� ._.. ,aa Test Pit No. L.e!:_3—r7..minutes per inch Depth of Test Pit---- ........ Depth to ground water.J)..oAj_ ... Test Pit No. 2................minutes per inch Depth of-Test Pit..........;. ....... Depth to ground water........................ -----------------------------------------••---------------------•..........-........7.....----------........................................................ 0 Description of Soil--Q--'- -- --- -c�.�t- t-----.A/via.......571.>�Sgr -------- -- =----S'.'.--1? U /1.�1.e� -1 _.._......4rZZ ILee ........ _'-_/_.3.....----���1.t1�'2------Co./I S.-C.....3A n�->------------•---. W ....................... ------------------------------------------------------------------------------------------------- -,---.-- -----------------------....-------------------------------------•--- UNature 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 iI'i 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. Sign --•-- ••-•-------------••-•-•-•--------------•----------------•-••--••.... Date Application Approved By. •................. Date 7 .g Application Disapproved for the following reasons:........................................................................ ......-----•..... .............. ...........................•-•---------------•-------•--------------•-------------------•----------.......-•--•--------•-------------•-----•----•---------------------....._--••------••-••-•-•--•---•-- Date PermitNo......................................................... Issued-....................................................... Date NoV_n Fxs �� �THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1. € t .J1R+.................of.......t �7�f�.11A.,.?..,'---r �: ----------:.................... ' AVVVfiravvu for BispiW Workli Tonstrnr#inn Vantit Application is hereby'made'for a Permit to Construct .( or Repair ( ) an Individual Sewage Disposal 21 System at: CAS? I- '`-4` •Gv r / Rat.?_'z / = /4's m_r tt�' 14-{ '7- . ............. Location-Addr'ess or Lot No. ..............•--..---..-----------••--:•--------_................................................ ..........--...................................................................................... ,/'Owner Address ............................................S,�-------------------------------------------------- .................................................................................................. Installer Address Type of Building Aa Size Lot. .D.j�5 .;."..Sq. feet Dwelling—No. of Bedrooms_._.. - ................ ................Expansion Attic (/V& Garbage Grinder (,VO) p Other—Type of Building i yp g ............. No. of persons---------------------------- Showers ( ) — Cafeteria a Other fixtures ----------------•------------- - Design W Flow....... ............. ..__.gallons per per day. Total daily flow__......�...__rO...................gallons. W Septic Tank—Liquid iquid capacity.&P.&..gallons Lengtl-1 --6"__ Width.�' o.� Diameter---------------- Depth S.1��.._r' x Disposal Trench No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. � Seepage . --r--'---- ------ -Diameter _.`�.._ Depth below Inlet_............... Total leaching area_. _��-sq. ft.Pit No Z Other Distribution box ( Dosing tank074 ( ) rr Percolation Test Results Performed by.7+' ± _I ....... .__ Date___.. ' ...1.-..._...._..... Test Pit No: I__ _..! -..minutes per inch Depth of, Test 'Pit----�.2Ft........ Depth to ground water_./J_GA!__e___. G%, Test Pit No. 2................minutes per inch_ Depth of Test Pit________•.-.____.___ Depth to ground water------------------------ --------- ------------•-- .............................................................. ,.-- •--•----••------•----•--------•. D Description of'Soil..0.•a� ' ,�.r2/�.N2-...... � ����3�C✓�.-------� v °- _.. `� / =- ��. 1.,1_` .. ,,�`t. ......C_0/'a_A d.-----Ste?M-p................. W --------------------------------------------------------------------------------- --------------------------- -----------------------------------------------------------------••-•......--•---........ UNature 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 TITTLE 5 of the State Sanitary Cpde The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign S Date Ap -ication Approved By. 1 Application Disapproved for the following reasons-------------- --. ---•---------------------------------------------•-------------------------------- -•--•---•-----•-•---•--•=------•-....-•-•--•••--•---••••-•-•••....--•----•--------•---•-.....--•-------------••-••••-----••••••--•-•-••----•----••............••••--••-•---•-•--------•--••-•--------- Date PermitNo.....................................................----- Issued............................=-.......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ........ .........OF............... 2ds........:.:......................... (�r�#ifir�t#r of f�nnt�fittnrr THIS IS O C TIF T the Individual Sewage Disposal System constructed ( tor'or Repaired ( ) by........... . --•- •-- ---------- ---•...__ ................................ at....... - --;-J-Q '! ------ r'- ------- -- ----- -----_W-- -----"!`•14------------ has been installed in accordance with the provisions of TIT12 ` of The State Sanitary Code pis d scribed in the application for Disposal Works Construction Permit No....... _ � _^'_ �___-__. dated_-.. 7 .................. THE ISSUANCE OF THIS CERTIFICATE SHALT. N BE C0NSTRVED,AS A GUARANTEE THAT THE SYSTEM WILL OUN�C Y'_TION SATISFACTOR DATE.................- .- • ? ---- ------------ -••-•............. Inspector--------- .............................................................. THE COMMONWEALTH.OF MASSACHUSETTS BOARD] OF` EAL H OF.............No..i,� .^.d.. F � •.......... Disp asaf Vorkv TunnstrUdinn pantit Permission is hereby granted............................... ........ -•-- -----•-•----...... ....::......__._.,....--••--•.................•..---•- to ConstrucV( or jZeWir ) Ind'vi ual wage Sys at No.••--•a Q/ .... ---"�t .....:!WP-�--- - •-- 4e Street . as shown on the application for Disposal `'Forks Construction P mit ............... Dated...........��_.��. DATE............................ ............................................ FORM .1255 HOBBS & WARREN. INC.. PUBLISHERS - •,# TE sT H- 0�LE i ,e L 0 PAVL:" M UR( .A ' SN S PECT6R'. " '"-��` � _ ��..� - - �.E..'/�'';r-r pry' • ' - _ s ,q ^ ' LEACH. tt p. : l;G M -AMID Q P, /T I SUQ SO/4 + TEST 50! RSERYt O 1�. • A/V•A LT„'!a"r`RAYL HOLE 01 OIS.T 5ANb `}( 1,�PTIC 13OX 3: HoLts "LANK t 4 ELE1r. .Q.b , c.B. A$scr M N Q LJ6I7'ER EN C OUN 7W R:E a. 6LEV. 4zO 0 36'+ ExI, S-r k1£LL YK /O3, l • Sao• w j�;� - e)U/4-_0//vG S F_tO 1 Ck E��y Cl/,��ME�/TS S G,Q'L E, / ' = 'q0' G"20/V T• 1.5 5/zDE 'TEE 4 Tom' P2o�o.�ED . � ' ,E3ED200MS SEP7'/C SYSTEM CONST2CICTLOiV SHA L-L CdNFO/Zr!I TO' A-7ASS . CUES' GAL/C),4 Y. E�/v/mown-fG-n/T.4G Goc�� TirLE 1T - cA/ 2A7,F- � Z. M/n/. 1//VC1 T'/ZOPo5�t7 .�EQU/l2GD G EACIV �12�413�2.a ' • TOP OF NEA TN ��GfJL 4 T/O/t/S Q 1T . j OF 14 S7-0AJE ; M,awNoL� co, To' Ex TEnlD•70 TO.�2G V�n✓T G/.�/C-5 vV/ Ts1/A/ / .OF.. F/N /Z-T2A7/�!� /U O iliZS _ . I S TOn/E . 77 0/0 CleAr-if / 'i l/i j� t'i -DIA. !fir. 4" pia, 4 %O LC.4 C C C �4��FaOT /4.; /4�XFOo7 Mini �.rcf, _ ^_ T D/A. Y MiN., �. C?.� WAS N a O = - /Nl�E T oZ ,6 \C . - G L_;L o�i f. S rD nJE /NVF2T CA PA G/.TY /N VE 2T + C• CWATG>z•T/G N?�.. /NVEfZT Q s� .•.. _ /V.O GA - -.- Zo !mil/n//M;Uti �.y� ✓ '~� LOear-Fo/�/ . PLAN It A jar f 1'� .SEPT/G' TANS �7/ST2/B.U^T.�,U�/ 80X 007 _,F ;4 ill D L 4iC_A11 A10 .a%T O E3E OF .�e�in/�O�CED GOnl�1�E:7 ay° �ecl G- . ` , .yGOz �oAr�,,�G �/> nf�/,� ✓�y NET ' N� t�•7 T". a va.e s�s TE� uti s CERT r-�Y 7'M E ".001/-D//VCr S'�IJcv v any THIS L O� DES/6n% D/tiv .�� USE S N 0WIV Alit� PT Does �..Q Nl PLY Lsl P"7`�! GUILD INCr S, 7-78 CK RE6LUtR �v4 r,�'' .z !:2YJ'J . y OF THE TOWN OF PfA N 5 , A E i l f i ASSESSORS MAP : i2 1 PARCEL: TEST HOLE LOGS � �' I2 1) The installation shall con,i.;� with Title V and Town of� ,113uard of. , < � FLOOD ZONE: ��01 .(��C ( SOIL EVALUATOR: '! IlealtliRegulations. — 2) The installer shall verily (lie location of utilities, sewer inverts and septic I OLMI'gc�l REFERENCE: �l WITNESS : components prior to installation and setting base elevations. t �C` ' � DATE: Z � � 1 p g - - --- - - --- -- -- 3) All gravity septic piping to be 4 inch Sch 401'VC at I/8"per toot. 'l�lte first ! PERCOLAT I 0 RAT : Z Uk ,.� IL two legit out of the d-box to the leaching shall be level. � > - \ V � i 4) This plan is not to be utilized for property line determination nor any other -�^- — -- TH- 1 TH-2 purpose other than the proposed system installation. ' 5) All septic components must meet Title V specifications. j � 0 ,t 1 6) Parking sliall not be constructed over 1110 septic components. 2� ti {J 7) Tlie property is bounded by property corners and property lines. ., �� 8) The property owner sliall.review design considerations to approve of total LOCATION MAP design flow and number of bedrooms to be considered for design. Receipt ! of payment for the plan and installation based on the plan shall be deemed I approval of the design flow by the owner. ! GG f 9) The existing leaching or cesspools shall be pumped and filled with material i 1J (� per Title V abandotunent procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V specs. ! ,��� �� 10)System components to be 10 feet from water line. Sewer lines crossing the i r.. ' ��, � ' water line shall be sleeved with 4 inch SC[1401 VC with ends grouted if ''" applicable. The proposed SAS is being installed below the water service I line. The line is to be sleeved as aforementioned and maintained in place. SEPTIC SYSTEM ( DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the I owner to ensure such. 0 12)Tiie installer is to take caution in excavation around the gas line if such FLOW ESTIMATE I 1 exists. �3)Tlie installer shall verify the location,quantity and elevation of the sewer BEDROOMS AT 110 GAL/DAY/BEDROOM - GAL/DAY lines exiting the dwelling`prior to the installation. 14)'I'his plan is representative only that a system can fit on a property meeting I o ° L p SEPT I�: TANK Title V requirements. ` LiAL/DAY x 2 DA I S - GAL r i USE Iq GALLON SEPT I C TANK h - 1i` P l fy 1 SOIL ABSORPTION SYSTEM fr7a1't}-!' ss NN ` :NoFxis rr � p ;o II SIDE AREA. 7i zw + I tea' Z x t� = I l , o BOTTOM AREA: X �( t� Ot c,s s _ = ) ' 2 / /0 3. 13 A �: .- ti . i y - -SEPTIC SYSTEM SECTION o o ��� bl% �rTl ( 1 ------------- ��L Lj BO GAL (, ,�I �ff,�Z. 0( �2, SEPTIC TANK �D�G G�iY�-bl�f� y --�/z ►� '"' �NPNP� yet + 1 � Jllli SITE AND SEWAGE PLAN LOCATION ! OUHNI PREPARED FOR b�� bw[y f SCALE: 1� ;;I• DAV I D Q , MASON,RS DATE: f DBC ENVIRONMENTAL DESIGNS EAST SANDWICH . MA ' DATE HEALTH AGENT ( 508 ) 833- 2177 > i �I �