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HomeMy WebLinkAbout0009 MILL LANE - Health (9 MILL LANE West Barnstable A 15 5 — 042 1�4 a 9 i r n --- Fee --------------- ��� �- BOARD OF HEALTH TOWN OF BARNSTABLE t ,Application-*rVell Con5tructionPermit Ap lication 's hereb made for a permit to Construct (Alter ( ), or Repair ( )an individual Well at: � �o---� '------------------- - -- --r - -P an --- -- _-----_- _ Location — Address , / � ssessors Ma and Parcel Owner Add s . z _ - - = ----------------- � ------- -_�- - -_ Installer — Driller Address Type of Building Dwelling —- -------------------------------------------- Other - Type of Building------------------------------- No. of Persons----__--___--___ Type of Well . d Z) 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 He lth Private Well Protection Regulation — The undersigned further agrees-not to place the well in operation unti Certificate of b in y liance s been issued by the Board of Health. Sign ---G4�'�''_ J�----- -- -------------- ---- _ date Application Approved By-- - -- ------ - = —— date Application Disapproved for the following reasons:---------- -------------- ---------------_--------------------------------------------------------------- -------------------------------------- -- - - - - date Permit No. JA ---- Issued-----------------------_ date BOARD OF HEALTH TOWN OF BARNSTABLE Crrtificate ®f C", Altered ure THIS TQQ, CE TIFY, T at the Individual Well Constructed ( ), or Repaired ( ) --Wi( Q_ ° - _----------— - — ---------- Installer -- - ------ �' by — has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private 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- ------------— -— -- — �As��--7�---_ No.- Fee= �=------------- r BOARD OF HEALTH TOWN OF BARNSTABLE �2 A ' litat ion-for Vell Con5tructionpfrmit Ap h tion 's her b made for a permit to Construct (Alter ( ), or Repair ( )an individual Well at: ) -� - - -_-- -- - - -- - ------------------------------------------------------------- �— ocation — Address, / / cy ` ssessors Map and ddPaParcel --------------------------- —//_l__ i.11 .. — 1 _---------m----------------------- 3— _✓e,------------------—----------------------------- W —A dre s -- ifl(.r� --------- Installer — Driller - Address // Type of Building Dwelling--------------------------------------------------------------- Other - Type of Building-------------------------------------- No. of Persons---------------------------------------------------- Capacity = -� -�' --- Type of Well - �s`!C - tAL�r�� - YP - — - - - 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 unti Certificate of myliance s been issued by the Board of Health. Sign ---/�^/- —- ----------------- ——— date Application Approved By-------- date Application Disapproved for the following reasons:---- ------------------____---------------_-----------------------___----------__----------_-_________ - - --------------- --- - - —- — - ------------------------------------------- date Permit No. — ------------------------------ Issued - -a date i BOARD OF HEALTH TOWN OF BARNSTAB LE Certificate ®f Comb lance THIS IS TO CERTIFY, at the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by -—- =" v - �------------— -— - -- - --------------------------- - --------- --�� — —-Inst ller at - cl - --- - S - ----3---------- --S-S----------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ` w-- ---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 BARNSTAB LE Ivell Cootruft ion Permit � 1� = y5- No. -----------=--- ----- Fee-=----=------------ Permission is hereby grante --- —________—______— _ ------------------------ ------------------------------------------------ to Construct (Alter ( ), or Repair ( ) an Individual Well t: -.. ----------------- ---------------------------------- Street as shown on the application for a Well Construction Permit No.-— — — -y—�— -- —------- Dated— -- — "— - — - - - - - - -- - -- �C---------------------------------------------- �Board of Health - -gam DATE---------------------------- ---------------- -------------------------- It , TOWN OF BARNSTABLE LOCATION /J'J �� �!✓o SEWAGE# �� `VILLAGE Af ASSESSOR'S MAP&PARCEL. INSTALLER'S NAME&PHONE NO. �dG �7i"X SEPTIC TANK CAPACITY leoo LEACHING FACILITY. (type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: 2 f± — j T COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) � � Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f - Feet FURNISHED BY /J a c, ©'T'�{'' y`` Y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Bisposal 6psteria ConstrUttiou VPrmit Application for a Permit to Construct( ) Repair OQ - Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. f A i%( f1_ Owner's Name,Address,and Tel.No. L✓�4✓N'� '� �� r.e H 47-�✓ Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 9-Z-#-A0l<i y Designer's Name,Address,and Tel.No. 6 e"rc:rG« P*w%4 4-w Ltsvr c a -2-n,c- J`d G C—6" -F4..t /3 o x G 6 a ZsZ 3 ��� y v o �'�' 7 J r o- a41 14-- P?f 2-17.7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.8. Garbage Grinder( ) Other Type of Building FA I e `,q r r .f(Z No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) j p gpd Design flow provided 3 3Z gpd Plan Date L/- Zg- /3 Number of sheets / Revision Date /1/er1V/ Z Title Size of Septic Tank loo o Type of S.A.S. .f16o,tie-%,u /WG 3 6 C *tr l&,r- Description of Soil zed ,014 v" Nature of Repairs or Alterations(Answer when applicable) %�0��-r-c /e 4e 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 by this Board of Health. Signed Date / � Application Approved by Date 57-0 Z Application Disapproved by Date for the following reasons Permit No. �G Date Issued No. qW 3 '�� C, J ni Fee 1 THE COMMONWEALTH OF MASSACHUSETTS Entered irk computer: PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes appliratiq 6pstem Construction 3permit Application for a Permit to Construct( ) Repair(M, Upgrade( ) Abandon( ) ❑Complete System Xndividual Components Location Address or Lot No. 7 M/%/ I'Al e Owner's Name,Address,and Tel.No. k/13 - tr 7�r� �a�✓ Assessor's Map/Parcel Installer's Name,Address,and Tel.No. ?mot :q E//,'J Designer's Name,Address,and Tel.No. 6vs cl e lW Sin i4-4—e r4..,CG Z~c- Od c / /Sox 46S fi7.1cl -fct- 025Z3 F'op 1 900 6�AJ7 P*14- OF'3f Z./7� Type of Building: y '3/-7 Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building _T, j r {.P A�y„ .'/ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 Q gpd Design flow provided 3 3Z gpd Plan Date Z - /3 Number of sheets Revision Date lVd�/.0 I Title Size of Septic Tank PX/;i'/-5 lnaO Type of S.A.S. /es_r j;r /�/ //r� 36 ' Description of Soil Te.At j Nature of Repairs or Alterations(Answer when applicable) � J/4'4c ,G,�/ /� y, Gv, !w ii/2 <-j Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in t accordance with the provisions of Title 5 of the Environmental Code and not to place the system in ope_adLon until a Certificate of Compliance has been issued by this Board of Health. r Signed Date S`—Z� / ,5 Application Approved by r Date S' 01 tom' l 7 Application Disapproved by Date for the following reasons Permit No. �G Date Issued --------------------- - ---------------------------------------------------------- ------ ------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(06 Upgraded( ) Abandoned( )by �r� �/,`S /J✓f ,flfa,?I--0— at In 1pi i/l LAwG IA-e p //i•.V_ has been con tructed in accordance with the provisions �pof Title 5 and the for Disposal System Construction Permit No.9013— L dated Installer /��'G.e-?�i-I e, s Designer e/�C. tic., tri #bedrooms J Approved design flow gpd The issuance of this permit sh 11 no be construed as a guarantee that the system it'fu d signed. Date Inspector No. C11-G I ^ 'U �l - Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair w Upgrade( ) Abandon( ) System located at 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 must be completed within three years of the date of this permit. Date �7 '� �� Approved by Town of Barnstable �tME 1, Regulatory Services Thomas F. Geiler, Director ` MAW ` Public Health Division -°rFD19 `� Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: ���b '�3 Sewage Permit# 7Xt -1 Y Assessor's Map/Parcel �- Installer&Designer Certification Form Designer: Installer: Address: Address: ct [A Illzl On 2,1"l 3 ��i 1 F/uA� was issued a permit to install a (date) (installer) septic system at 1 �w 1� �� �'�I ��ed on a design drawn by �,�A (address) W IV �/• �'"l� ,Qb dated '2-16— (designer) 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 u '-rions. Plan revision or certified as-built by designer to follow. Stripout (if r- acted and the soils were found satisfactory. OF Mess\� DAVID b B. C (Installer's Signature) MASON � No.1066 ��r IST q "3esi. er s Signature) i V PLEASE RETURN TO BARNSTABLE PUBL._ — f E OF COMPLIANCE WILL NOT BE ISSUED UN i il, rsv i ri i riia k URM AND AS- BUILT CARD ARE RECEIVED BY THE BARNI STABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoft'ice fonns',designercertitication fonn.doc s Town of Barnstable Pm- Department of Regulatory Services BAMSTABI.B : Public Health Division Date D zo 200 Main Street,Hyannis MA 02601 Date Schedule Time Fee Pd. Soil Suitability Assessment for Se e Dis�rosal o Performed By: y � w�. �/""I Witnessed By: LOCATION&GENERAL INFORMATION Location Address Owner's Name -Address- �• q,7" ,.- —•- — - t Assessor's Map/Parcel: Engineer's A� 5 � En ineer's Name G� .M7• �v� ; \ NEW CONSTRUCTION PAIR Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body It Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of tot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) r �I ti Parent material(geologic) Depth to Bedrock Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles:_—in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time__ Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time u, VVV���� Time(9"-6") End Pre-soak Rate MinAnch 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:\SEPTIC\-PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. - Consistency.%Gravel) f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel Flood Insurance Rate Map: Above 500 year flood boundary No��e, Yes Within 500 year boundary No Within 100 year Flood boundary No Yes_ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perv1 us r t ial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is thW lly occurring pervi us material? *414 CertificationI certify that on (date)I have passed the soil evaluator examination approved by the Department of Eotection an that the above analysis was perfon ed by i e consistent with the re re expertise e ri e •es ribed in 310 CMR 15.017. Signatur Date Z� �� 5 Q:\SEPTIC\PERCFORM.DOC - AkA .9 WL L (TOWN OF BARNSTABLE q Lo jATION W,jI6"w 5lro-e-7 SEWAGE #q�4 *2'5- VILLAGE We J? ISAAnSlA LtQ- ASSESSOR'S MAP & LOT �,���,'. C)L/Z INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1600 w lea LEACHING FACILITYAtype) Le,,c l\ A -1 (size) 1000 24[/oyt NO. OF BEDROOMS `t' PRIVATE WELL OR PUBLIC WATER pt2�40C BUILDER OR OWNER M610 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: � VARIANCE GRANTED: Yes No �. 12G V�'j' 0 `` 0, - � g � � i � o � 1 � ' c�, ' O o � ! �, � l � � r _, ' � ���� �,!� No.../- /--- `/s VF ..�.- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE a C Appliration for Biopoottl Work,i Tonotrnrtion Permit Application is hereby made for a Permit to Construct ( ) or Repair (jVQ) an Individual Sewage Disposal System at:// ,,�//J�� L t Addreiss' /�� jL��:�% or Lot No. .... ClL7G1.......... .... /6l !�!✓..................... ......•. ......... ......................................................... W Owner Address a .............•-•/.lJ .... G ,Sf �E -------------------------------- ,f .�i� tpft r . Installer Address Type of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms.___--_---_�__------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitylPQv_galIons Length----R-------- Width....5 __..... Diameter....------------ Depth.__ _____---- x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. I................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........................ R: ----------------- •------------------------------------------------ •-------------------- •-•------•--------- *------------•----•------- ------------- ODescription of Soil................................................. -----------------------------------------------------•---------------------•------•--•------•----•••-••----•-----••... V ....---••--••-•-----------------•••-•-----•••----•-•---•--•••----••-•-••----•--•-•---•••--•••••---•--•----•-•-----------...... ........................................................--•--•-------•-- W .....................................•----------•-----------------------------------•-----------------..:_._.. •-• • x (; U Nature of Repairs or Alterations—A swer when pplicable)---- - �7- n��.................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 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 Compli has bee issued by.the board of health. 1 Signed -. . -C.c.s. --.:.... ............................... ZZ.72.'' 4 bate Application Approved------------- 'D-- ...---- (�--- Date Application Disapproved for the 00,1owing.reasons- ------------------------------------------------------------------------------------------------------------------------------------- ............................................................................................................. - Permit No. .......... ..L.�.........7/ Issued ----... ..�.. ."..��................. Date ....................e...... f �5_ THE COMMONWEALTH OF MASSACHUSETTS YY BOARD OF HEALTH TOWN OF BARNSTABLE A liratiori for Big o�ttl Workii Torititrurtiori P�� � � rnttt Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at• 5. ��c1 .../!l��...........J 1�.D�. S� �,ea1� 9'............................................................... Lati n i�ddress or Lot No. W Owner Address --•• ................................ --•- ------------••--- Installer Address- Type of Building Size Lot...........................Sq. feet IJ Dwelling—No. of Bedrooms Bedrooms--- Garbage- nsion Attic Grinder aOther—Type of Building ............................ No. of persons ( -_ Showers Cafeteria ( )d Other fixtures --------------------------------------------------------------------------------------- ------------------------------------------------•--••-_-•---- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity.M�U_galIons Length----k'...... Width... -.--.- Diameter.-.--.-.----_-. Depth... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-� Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I----------------minutes per inch Depth of Test Pit------___•--_---_- Depth to ground water........................ 444 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R. ---------------------------------------•------------------------•-•------------.....•--••---._...•--...................................................O Description of Soil...................................................................................................................................................................•--•• x U UW --•-••----------------- ------------------•...........••...._..••--••-•-•---•--------•-••-••-------•--------�--- t _ --- .................... Nature of Repairs or Alterations—Answer when applicable.... . :C.`� .............. .... -....................................... l- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 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 Complia.rs-e has been issued by the board of health. Signed .. . c Q.....�U-CJ)-��...........................................................- - --�r�-. Dace Application Approved B rollow"ing ? < y.- PP PP Y te ApplicationDisapproved for the reafonf: ---------------------- ------------------------------------------------------------------------------------------------------------- i e/ Date Permit No. ..........# /.......... e-,.)---------------- Issued ....... .7_ ................. -- Date ----------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (�Ertifi ate of TOMIAtianre THIS IS TO CERT'IF_Y, That the-Individual Sewage Disposal System constructed ( ) or Repaired ( X ) by -------------------------- -----------------t A.4.1..........4�_0..0_ _.[Z- ----------------------------------------------------......------------------------------------------------------------ Installer at .......�� 1'1!1'1... .✓1 .............. . >.._.. ,'j ►. 5---- a.,�.... �J1z ----------- -----------......------------------------------- has been installed in accordance wilthe provisions of TITLE 5 ( The State Environmental Code as described in the application Disposal lication for Works Construction Permit No- ------ ...�'. - . dated ./..s`'.-.7 �y � ... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... .--- -� ..✓- --- -------------------------------_. Inspector --------��.........-7-.:------------- ----------- ----- -------------_-------- �J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No TOWN OF BARNSTABLE �� ..7/5 FEE... }... Dispersal. orko Toriitrurtiori ".erutit Lo Permission is hereby granted---- ...... n S_2(. to Construct ( ) or Repair ()<-) an Individual Sewage Disposal System-) at No... �_a,� �� �:�1 _ _ it_�RI t{.1 . ,6<I2st_a,_��'�m4'.. ..............••----........ Street q as shown on the application for Disposal Works Construction Permit No. Dated... ----- �Boaril of Health ---------- DATE............. -�---•---- ------- �J/ FORM 36508 HOBBS R WARREN.INC.,PUBLISHERS Z OFERTI FY 'C'Nr1T THE FOOMOFi lohl Sldo►aN. Or,l is L acn rho ON THE 1RQUNV•Rr'�'. NdW(� ri:;; \ \ 7JJfr'�tt rJ�'l FJPfU 'r7IRT i 4QMFO12A15 '1+M� ? NING+•' c•cc:lNb !.<7WA' f TIIF 'TOWN' OP.. l$,�I�N.CT!3 '� IjUl ��l• a IN ` t�lN�►r C 011I"TR u C'r6'idgntr7 TO YtIE Rptj 4 9 0.. S'v'RY si_ ., ,' (_�� `� Fri/ \ .. r:�•. i_ .•'.•',. it ^ {: \ Sip 1' i--*•— .; 2a� R.." �„• IA r^� . yalem /p�►� \ O� fi` r..,S I„ I 1.0. SEPTIC s ;��.41:•) IS 100.WU614 THE T{CL� / RSI.SF `i ,^ Nl'% :•�X�A1�Si0N ` ,� �i Z�. 'l. �' ti�r.�'f117►• 11 14 Ft Ar, ho 4,1 3. AIL, (T-D / \ Ira%' ' .'-q.;w, :�•:• -- ���.t..•Is.l.. i.?.. ?M � y`�,:7/}y/', 00. co iv LIf NE 1 �A_,Ar PRO FIL.0 SC Al.1:' HO�Iz�V 'lt'1': -'a4.�..x WE S T BARNS. . PAN`/ ► ,; l '01 ° �I �41 T p CF.L 0 'LAND'ASSI40WN ON, A ' _.`t"E5 IT.. BEIUG THE SAME. PIER a "••. E A DA -D JUN o� a c• :... IY- "tATA PLAN FOR HAROLD. C. MCxAy T t,. TC C ,AC ; I=.SI 1973 B,,/ .CROV�-E.t.L ¢ TAY1.nIR. . , ,,« s` • �:, MARCH z1,1977.TA At SCALE*. I 50 3" ?� • `. '? J►� S.R. SWEF'SER ENGIWSCR J1,.,. S17135d11. �� . 97 SEA `i RF.I•.'i . DFNN1SPOki, MASS `GLEAN; WOTF . .. -. '. • .�I.EV.�7loN5 81�Qw1�G?s�^ ARE IN �'�e'r A�o_VC _... . . WAYt IW Mlhh STrtrAm, Uty'; : . ' I-CFR-rIFY 'T14AT UNDIS7UkeAF_17 SWI, C-0NDVrI0X-,5_.-. ..S_. :~' 1zE.. , ONTP S LOT ALLOWS N 10" THIC.KNCSS F0U14D�\ • . � ... ! WALL WXrWOUT AFoo-ijWG TO ,SuPFor-r TNT �Ye W AT-S.11 C5UILD114G. e'�'•' I .....,..+ 'IsTVP T. C3gt�c' �,.��k�Y.Y. �-- ! .. R. �.:. 1'�•. isilAW.�.� 16, 077. D�Tr_• .: i— REGI�TCR1=ld E�� rl : ., _ F'R0P 10N t. GNGINE>Ee , ,••�• e `JAN THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- -- '' . .OF.............. .4 ..................... Appliration -for Utsp ial Workfi Tonutrurtion Vrrmit Application is hereby made for a Permit to Construct ( ') or Re a'Uo.e ) an Individua Segage Dispossal� , System at: '� i 60 P X Y"n S t 1 Lam( 1/lOr ..._s�..�..:.......d�__.(3 -�V. f-� '�.... ............/t .. �� ..._. ' . ................ Locatio -Address r Lot N', --.------- k; � ---------------------•---......... -------•----------------------....---.-•-- /OOwner - �Ad�dree '- .- ----•--•-- __._.��_'.��....Guy:......................... ........................ � Kr--- 3 Installer Address Q Type of Building Size Lot_.--1'�_- ,Sq. feet U Dwelling—No. of Bedrooms------------a..........................Expansion Attic ( ) Garbage Grinder (N)P aOther—Type of Building __------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ¢ ( ) ;. ` '> ,. ..`. ;. Other fixtures ---------------------•---•------------------------------.-._---.----------------------------•---•---------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic T..nk Liquid capacity/_'OOPgalions Length................ Width................ Diameter--_-_ .-....... Depth--------_------ Disposal Trench—No. _-_____--_-_----_- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.....__...-:........ Depth below nlet.. ..... _._...__ Total leaching area-------------------sq. ft. z Other Distribution ox Dosing tank ( /6 - 7-7 a Percolation Test R is Performed bY._-__N? _ .... _� Date____ ___ ______________________.. Test Pit No. ........minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ rX, Test Pit No. 2__-..-______•-__minutes per inch Depth of Test Pit____________________ Depth to ground water-__-..---_-____.____-__. >. n ,. O r,<_; T --_-----�-Y------ Description o oil- ---- - --- - -- - ------ G 5` , 1� ----_- x -, V j>t - W UNature.o_ Repairs or Alterations—Answer when applicable._----------------___-_-____-_-.---_-_----_-_--.--_-----------------------------------.-___-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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. igned.. ft..-------------------- Date, Application Approved BY-------- --- ---- ---- -- ------- "--------C,� ----•-••-- ---- --:� __.._... x Date ;Application Disapproved for the following reasons:------------------------------------=--------•------•---------••------------------•- A.....••----•--•-----•------------•--•-------•-----'-'----------•--•...................••-•-------........_............................... _. ? Date Permit No. Issued .. / � --1----=------------- Date �... --------------------------------------------- - - IN 0..................... FRs....:.1+�...rdff....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v --..--.OF....... . .-.. Appliration -for Ii,4poottl Worko Tomitrnrtion Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .....................................4 tt, ` ... = _d '" {o -�� ....... --•--_------- 01 ..___Locat�o Address r t No. caner _ tlddre M Installer ;r Address Q Type of Building Size Lot---.h 4. 40A&Sq. feet U DwellingNo. of Bedroom s_-:---__--- ._ --_.Expansion Attic Garbage Grinder A60 Other—Type of Building ---------------------------- No. of persons--------:_-•__---._---.--- Showers ( ) — Cafeteria ( ) a Other fixture5...... ..................................................---------------------------------------------------------------- ------------------------------ Design Flow.............................__'``- gallons per person per day., Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/®pPgallons Length-----------------Width------------._-- Diameter-----........... Depth-.-..----_---.. x Disposal Trench—No--------------------- Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below#inlet. ... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing t- k ( "" ads+ "' f `"7 7 W .Percolation Test Results Performed by .._. ... -. _.._ ,__. __4...................... Date.. $_•._/¢...:.--------___.. Test Pit No. 1----------------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-..._._----.---.-.------ �' ,t ter- � A ��--- ---- O Description o oil w. .Z- !t'� V �r�h { ._----_� ti x ' ---- ,.. . ----- rJ ---••-•. -••-••-- -- --------- --------------------- --------- ---------------- --- W UNature of Repairs or Alterations—Answer when applicable...............:.............._---.----:.-._---.-.-_-.---::.;-.:.-------------._-..--.--_-_---- ----------------------------------------`---_----------------------------:------------------------------------------------------------------------------------------------------==------------------- i Agreement: M The undersigned agrees to install' the aforedescribe-d Individual Sewage Disposal System in accordance with the provisions of Article XI 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 healtt+E 'igned- .LeQ t------------------ •------•-••-------- Date A lication Approved B �� !�' ' :`�'---- .� PP PP Y - Date Application Disapproved for the following reasons:------------------------------------------------------------------------------------ ----------•--•---------------------------------------------------------•-•------------------------------------------------------.-----------------------------------------------------------------.----- Date PermitNo.. ................................. Issued......................-................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF-, HEALTH ..............................OF.......... . f Trrtif iratr of 0,omPliaurr zoo T S I T CER , That the Individual Sewa e Disposal `System constructed ( or Repaired by % ---•- y� aller f has been installed in accordance rth the provisions of : i XI of The State �Sanitary Code as described in the application for Disposal Works Construction Permit No. `9 ---� - _ _- dated...._. -------- _ ________________ THE ISSUANCE OF PHIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY., DATE- 7 ` � � , -4 • .....------ - . - •----- In ector----- 6�` �9 THE COMMONWEALTH;-OF MASSACHUSETTS BOARD­OF EALTH « ............ ..i� ....OF........... .!.�.......... .................................. No......................... FEE........................ DinVoiitt ' rk T trnrtion rrmit Permission s_. ereby granted ^-41 �-f---- t------------------------ ----------------------------- ----------------- to Constr ') o R a ( ) an Indi id al wage D• po 1 Sy t pt atNo. r , ........... 1 ..............� .....;, _....... ............................................ Street / as shown on the application for Disposal Works Construction P rtti No. . ...... .._ ;11ated.�11 1..2.47.Z.,_ .--- .......... wvt 77 Board of Health --------------------------------------------- DATE......... -- FORM 1255 HOBBS &-WARREN. INC.. PUBLISHERS . .� rS'.1`4 r'1F'' i•� ! , ]p CFR tF'Y THF?T -rHE' ^�,�et ;---� ��! r _.. TN 1 v^ L./�h; i S 6..®C F7''t�O. C►Pet 'fHL�'':. �I,. �, ' T!J r F'. ,rya 9N4j Th>ERr rT �JQ�rFok°m; 'Pv.''rwt . � qJN($�, .� � W 13 to e G.4?o �• s , 1 N 1AlN Cyr Co STRUcTEO ,q�v�� -r'#4 (CTi3�Re FO.h(> s � ''"" 4 } }4� "t ..,,fir a t�R'' r,\ >rs('i „ — I + + a�•ij fl d rvr1 �ti k,ry T7 �, li.t. ' y a ' 22. \ L�faTE' EGi Is 7h�cC R '� }�N13 l�'t�rOt`di, �7. tGN Y�; oil , l rig 1 g ` it a SEPTIC SySTE N1 ,gam? rq ' + r•;� ts4 �l r — -(.�u 8� PI10 T- `•,L� , �r_ " tk L, �I ,r, 3 , wee w/k'sTo�F . ,; . •' �, h7 Q Q }d } 6_) I �itPAti'iioH ti 7 p �' EI W. 1 ! I r tt c ' y j yN. /�� /� � 1 I tE•S- '► duAm ye �i _�jION YA "A. PROFILE SCALE' HC417. ` > SKETCH P��� I ® ' IN nN_ ES_ �T BAR.NSTAIK,E �+ %' } -FOR F {' � 7E. -T_P1T _ BEIA[G T:NE SAIVIF. P/�R.CEi_ Ur- �ANU ASSNO IN ON _,A 3 ".;ro•cl� t _r..PlAN QR_-H.AP�OLC'_ ._t��CKAY ET AL ,DATCD DUNE r y r % " lk;,;I 19.7'3 F3�/ ;.CR0WELL TAYLC)R. �CtT• {-5 C/� E 56 I 7 t� S - L I = f MA(ZCH EI T9.77 - 7ql T STA Tr R, SW E.T`ER: S. 40 91 r . DENNIS'POkT MASSia ' .. l VLAT.I-UNS SI�oVV,N E, lz. r�RE �►J Z E T 4.00VE. _ WAYIa IN.. :Ma,k gT {} V 1_, E.R—r 1fY THAT UNDISTUR3EU SOIL. C.OND1T.1OH5` ONT► 15 ..1.07":,ALLOWS .^ 10'" THICKNESS F0U1l,lDF�TIo 1 k7err WALL. WITHOUT /1\ 7OOTIP�c? TO ;, I� PPOR'T THE c rig iz: 5 U I L D I V4 G. ' t C,k T H„16 i�7� ^D�`,r . - / �+ I�EGISTERCi i'K�I�E�,S1CNgI..EKGINEce ASSESSORS MAP : O S NOTES: TEST I101_E L G PARCEL: SOIL EVALUATUI[• 1) l lie wst:illalion sliall comply witl: 1 the V and 1 own o 3oard of FLOOD Z0lEt . 6�AL L. � __._. . _ WITNESS : Da'/ ��544pt� �S I lealllt Regulations. REFERENCE _ DATE: Lt" 1 ) 2) The installer shall verily the location of utilities, sewer inverts and septic PERCOLA'i'I UN RATE: components prior to installation and setting base elevations. 3) All gravity septic piping to be 4 inch Sch 40 I'VC at 1/8" per loot. The first two feet out of the d-box to the leaching shall be level. 711- I TH-2 4) This plan is not to be utilized for property line determination nor any other �- 'n �' purpose other than the proposed system installation. ryr I ) 5) All septic components must meet'Title V specifications. IZ IZ� 6) Parking shall not be constructed over 1110 septic components. 7) The property is bounded by property corners and property lines. r LOCATION MA ' I ► 1 $ , p l y 1� l [ 8) 7'he to pert owner shall review design considerations to approve,rove of total design flow and number of bedrooms to be considered for design. Itecei pt _ g 6 [ - -- �� of payment for the Ian and installation based on the Ian shall be deemed � _, , p Y P P C� OTC approval of the design flow by the owner. ! j - -y _ ICI � W �l �I Di - 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall a__\ Dl� �� be removed along with contaminated soil and replaced witli clean sand per I ` Title V specs. C VITA 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCI 140 PVC with ends grouted if _ - - (�N�����?J �I L � -- - applicable.. The proposed SAS is being installed below the water service — line. The line is to be sleeved as albremeutioned and maintained in lace. _ — _ ` y SEPT C SYSTEM DES I G N 71) If a garbage grinder exists it is to be removed and is the responsibility of the ( owner to ensure such. � FLOW ESTIMATE MATE I2)'1'he installer is to take caution in excavation around the gas line if such exists,' BEDROOMS AT (�� GAL/DAY/BEDR00IA Q, GAL/DAY 13)`l'he installer shulLveril'y the location, quantity and elevation of the sewer lines exiting the dwelling "rior to the installation. SEPT iC TAtJIC ) plan I Y y property 6 14 'Phis lands representative out that a system can fit on a meeting -� 1 'title V requirements. GAL/DAY x 2 DAYS �o0 GAL 1, q \ � I Q Cf / 4, USE 1000 GALLON SEPTIC TANK Klgr�) e I t%4pe2 q ,F . 2 � �-L ABSo Pfi�f ON SYSTEM _ T - IF 16 60,,�OC kk SP e-, D - w E-Ta �VA M5 ' � p V►p `3fv X /r 1h'GFx F 6� ST a ` - SEPTjj C SYSTEM ' SECTION IVA4e/ y5 5L t t�I b pu n ]��t3AL 2�,t� I 31,16'xS.b� SEPT I C TANKiz_il & :I---A — ( lt- ��G 0 ) S 1 TE AND S EVJAGE PLAN LO„A 1 10�4 --_* q flu- l-� PREPARED -FOR :, SCALE :441 uj DAVID B . MASON 'S uArE: 0 DBC ENV I ROHMEIJt1•AL DES I G143 b r (:AST SANDWICH . MA y DATE HEALTH AGENT ( 508 ) 833- 2177 e