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HomeMy WebLinkAbout0754 OAK STREET (CENT./W.BARN) - Health 754 Oak Street , W. Barnstable A = 215-002 4 1 i 1 No. 4210 1/3 ,BLU i ESSELTE 10% O 0 0 0 �-00 No. ------- Fee-------�- -5-------- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion ArVell Con5truct ion A9ermit �ERII� Application is hereby made for a permit to Construct Alter or Repair ( )an individual Well at: OAA L--15 f --- Location - Address Assessors Map/and Parcel Owner Address ---------- Installer - Driller Ad ress Type of Building Dwelling ------------------- Other - Type of Building-----------—------------------ No. of Type of Well Capacity---------------------- -- - - ---— Purpose of Well------ �'ik � �^ _ Agreement: The undersigned agrees to install the aforidescribed 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 until a Certificate .of Compliance has been issued by the Board of Health. 44�� / - - -7- Signed- —------- date Application Approved By ------------------------ date Application Disapproved for the following reasons: —------------------------------------ --------------- —--------------------------------------------- date Permit No.o"Aoa Issued- q -7 ........... ----------- date ------------------ - -- ----------------------------------I----- - - - ---------------------- ----- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed Altered or Repaired by--------ra- -----------------------A Csr ----------------------------------------------- Installer ------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Proteqkn 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----------------------------------------------------------------------- tiI aoo$' '- 6w 7— No.-------------------- Fee OF HEALTH TOWN OF BARNSTABLE ZIpplication-*rVell Congtruction Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: 0 A Ic 6 f Location — Address Assessors Map and Parcel . ----- --�?�a/_�R 1,_�_�_l��/-�v'I✓_--------- -- -- Owner Address ------ _ =� �' - ------—---------- --- d- ---Ai----/ ' . 14%1 - J'- Installer — Driller Address Type of Building l Dwelling !�d Gl -- - ----------------- Other - Type of Building ---------- No. of Persons------------------------- --__________ Type of Well- --- ---------T---( , n- ------------------ 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 until a Certificate .of Compliance has been issued by the Board of Health. Signed — _ `-� ------- U--- date Application Approved By -- ------ ---- --- ----— --- — -------------- date Application Disapproved for the following reasons:----------------------------------------______________________—________—_________ ------------------------------------ ----------------------------------------------------------------------------- ----------- NN date 1 V 4 Permit No. -- (��- - --O- --- ----------- Issued--- -- - ----------- — -= date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF'` BARNSTABLE C ertif irate ®f Compliance �-�Imo L 17 C-*--y' THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) bY- ------ 1------A��ram' �r •--- -- - - - - ------------------------ Installer at------- SN --------------------------------- hasbeen installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protec j Regulation as described lie•-application for Well Construction Pergiit No. - Dated-- 7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------- — -- ----------------- -- Inspector------------------------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE dc��- Seri CongtructionPermit Na. ------------------- Fee-------------- OLPermission is hereby granted----- - -------— ----- - - ------------------------ ---------- -- to Construct ( ), A er ( Ijep�>r ( ) I ividual Well at: Street as shown on the application for a Well Construction Permit No. ------------------------------ - ------------------------------------------ Dated -- � __ ---------- - ----------------------------------------- ,0 B and of Health DATE----------------------------------- ---— ai SENDER. I also wish to receive the ■Complete items 1 and/or 2 for additional services. m ■Complete items 3,4a,and 4b. following services(for an H ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. �. d ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date .. C delivered. Consult postmaster for fee. °� � 'd v 3.Article Addressed to: 4a.Article Number d E Gv s�G ej �/ ype 9°' 4b.Service Type �° �C�;�� ❑ Registered Certified I W / ❑ Express Mail ❑ Insured 5 (M f ❑ Return Re ceK Mr&Mdise ❑ COD a7.Date of ode 0 pz 0 F5.Rec Ived B�:( rint Name) G 8.Addre s' s d equested c I¢ W IC 67(,vt J and fe f 6. gnatu . (A dresses or n0 0 N y x C� o I t PS Form 3811 December 1994 1 1 +t ++ Domestic Return Recel t UNITED STATES POSTAL SERVICE First-Class Mail � Postage&Fees Paid USPS i Permit No.G-10 I • Print your name, address, and ZIP Code in this box • , i i Board of Town of BamSMIS P O. Box 534 t Hyannis, Massachusetts o2601 f f i I� f I i Iq -Z 203 498 862 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See rev e G St & u r Post ce,State, ode i Postage $ Certified Fee Special Delivery Fee f Restricted Delivery Fee u') Return Receipt Showing to Whom&Date Delivered Rehm Receipt Showing to Whom, Date,&Addressee's Address 0 TOTAL Postage&Fees $ CO Postmark or Date CD a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return Raddress leaving the receipt attached, and present the article at a post office service i window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) cc return address of the article,date,detach,and retain the receipt,and mail the article. Lo 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the _ i gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article n I RETURN RECEIPT REQUESTED adjacent to the number. I 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O addressee,endorse RESTRICTED DELIVERY on the front of the article. O V) 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. �} 6. Save this receipt and present it if you make an inquiry. 102595-97-8-0145 �� EVE Town of Barnstable = Department of Health, Safety, and Environmental Services >3„RNSTA ems. MASS. Public Health Division .P A98 i639. 1� Eo�A 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health October 8, 1997 Wayne B. and Susan K. McGann 754 Oak Street West Barnstable, MA 02668 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 754 Oak Street, West Barnstable, MA was inspected on June 18, 1997 by John Graci, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The main cesspool was past the effective depth of leaching. The system was in hydraulic failure. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within sixty (60) days of receipt of this notice. You are also directed to bring the septic system into compliance within ninety (90) days of receipt of this order letter by installing a replacement leaching facility. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE OARD OF HEALTH omas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable • Department of Health, Safety, and Environmental Services ► BARNSI'ABM �' M&%. Public Health Division 1639• ATFpt1+a 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: DATE: ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at(�� �� was inspected on IR 414,117 by ::an n 4rc+ 6 , a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE.5 (310 CMR 15.00) due to the following: n� `\ 5 hAa;� C 0,�(ion( �� )eP LA 11 "Tim Sv►s W4'S f.�� rG�11 c ( l�rt . c You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 n days of receipt of this notice. �0)S'fi You are also directed to bring the septic system into compliance within ) days of � receipt of this order letter. 1 You are further direc-ed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health gVudtM&61.\Utk5Wu Commonwealth of MassaChusetts John Grad Executive Office of ErMrorvr> nfai Affairs D.E.P. Title V Septic Inspector Department of P.O. Box 2119 Environmental Protection Teaticket,MA 02536 -6813 � Q4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO RM ' RLC IVE �vo PART A CERTIFICATION J U N 2 3 1997 N 764 Oak St.W. Barnstable Address of Owner.: TOWN OFBARNSTABLE Property Address: �y Date of Inspection:e15197 (If different) HEALTH DEPT C Name of Inspector:John Graci Wayne McGann Company Name,Address and Telephone Number: 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes This inspection is based on criteria defined In Title V Conditionals P Sse code 310 CMR 15.303.My findings are of how the system is Y performing at the time of the Inspection.My Inspection does _ Needs Furthe Ev ation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the X Fails septic system and any of its components useful life. Inspector's Signature: . Date: 6118197 The Syp m Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: _I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion ' of the replacement or repair, passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.) _ The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 t r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 754 Oak SL1N.Barnstable Owner: Wayne McGann Date of Inspection:615197 _ Sewage backup'orbreakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced. obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1} SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public.water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogends equal or less than 5 ppm. .3) OTHER D] SYSTEM FAILS: X I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. X SAS is in hydraulic failure. (revised 11115195) 2 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 754 Oak St W.Bamstable Owner: Wayne McGann Date of Inspection:615197 D] SYSTEM FAILS(continued) Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or.ohstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: . The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) 3 i_ I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 754 Oak St.W.Barnstable Owner: Wayne McGann Date of Inspection:615197 Check if the following have been done: X Pumping information was requested of the owner,occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. NaAs.built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 754 Oak SL W.Bamstable Owner: Wayne McGann Date of Inspection:615197 FLOW CONDITIONS RESIDENTIAL: Design flow: 0 gallons Number of bedrooms: 4 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available: nla Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: n1a Last date of occupancy: n1a OTHER:(Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Last pumped two years ago. System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n1a TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system X Single cesspool X Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) X Other(explain) 2 extra overflows APPROXIMATE AGE of all components,date installed(if known)and source information: 1030 with new pit installed in 1986 Sewage odors detected when arriving at the site: (yes or no) No (revised 11it5195) ` 5 L i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 754 Oak SL W.Bamstable Owner: Wayne McGann Date of Inspection:615197 SEPTIC TANK: (locate on site plan) Depth below grade: n1a Material of construction:_concreate_metal_FRP_other(explain) Dimensions: n1a Sludge depth:n1a Distance from top of sludge to bottom of outlet tee or baffle: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance form bottom of scum to bottom of outlet tee or baffle: n1a Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) n1a GREASE TRAP: (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:nla Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle:n1a Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Na (revised 11115/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 754 oak SL W.Bamstable Owner: Wayne McGann Date of Inspection:615197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n1a Material of construction:_concrete_metal_FRP_other(explain) Dimensions: n1a Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: n1a Comments: (condition of inlet tee, condition of alarm and float switches,etc.) n1a DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: rda Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) nla PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) Na (revised 11115195) i 7 i x SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 754 0ak SL W.Bamstable Owner: Wayne McGann Date of Inspection:6/5197 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Na Type: leaching pits, number: 1,000 gallon leach pit leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number, length: Na leaching fields,number, dimensions:Na overflow cesspool,number:2 block cesspools Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The overflow pits are frill.Sas Is In hydraulic failure Pits are past the effective depty of leaching CESSPOOLS:X (locate on site plan) Number and configuration: one Depth-top of liquid to inlet invert:4' Depth of solids layer: 2• Depth of scum layer: 3' Dimensions of cesspool: 6•x6' Materials of construction: block Indication of groundwater: none Na inflow(cesspool must be pumped as part of inspection) Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Main cesspool is past the effective depth of leaching System is in hydraulic failure PRIVY: (locate on site plan) Materials of construction: Na Dimensions: n1a Depth of solids: n1a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Na (revised 11115195) I $ l- J P a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 754 oak St.W.Barnstable Owner: Wayne McGann Date of Inspection'615197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' o � Ili b� DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 11115/95) 9 Z Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for &9;pogar *pztem Con!5truction Permit Application for a Permit to Construct( )Repair( )Upgrade(d)Abandon( ) 'L Complete System El Individual Components Location Address or Lot No. ��(� CIQ,�s� Owner's N e,Address and Tel.No. Assessor's Map/Parcel �Ql� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 71- 9-3e'Z 2- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(''e�v Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 11' gallons per day. Calculated daily flow -el-�6_17 gallons. Plan Date Number of sheets ! Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) T/Ale- -27— u.YeXO 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 Certifi- cate of Compliance has been issued thr Bo d o Health. ���g��� Signed Date Application Approved b Date Application Disapproved for the following reasons Permit No. 47 Date Issued No. � �/ 1 �� r� Fee. / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,,-MASSACHUSETTS 2pprication for Migoml *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(✓Abandon( ) T Complete System ❑Individual Components Locati6n Address or Lot No. �5,-,f D� 57- Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7/- Type of Building: f/ Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( � Other Type of Building g?eVn6f ell^ No. of Persons Showers( ) Cafeteria Other Fixtures ,. Design Flow / gallons per day. Calculated daily flow $��� gallons. Plan Date—t �7 Number of sheets Revision Date Title r Size of Septic Tank 1f O Type of S.A.S. i� Description of Soil >� Nature of Repairs or Alterations(Answer when applicable) 72Z'le 27 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore describedon-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 Certifi- cate of Compliance has been issued b this Bo d o ealth. / Signed �' W Date �lz/o:� Application Approved b ¢ Date 1 Application Disapproved for the following reasons f Permit No. � --•--. r Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(A- Abandoned( )by / r79 at z T, 5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Ji1�% Designer 5 y ✓ jN� The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date '1 g Inspector No. ail 1 qQ 2�7 �� Fee cl-c� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migool *p!5tem Con!5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( /Abandon( ' ) System located at 75'-V dQ/c r57 z#di',a>.5>`�6�. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru ion must be completed within three years of the date of this permit. Date: Approved by c __ ` ► TOWN OF BARNSTABLE LAC; TION 7SN O�/G s7` SEWAGE # / >'y 7 VE.,T°,AGE 8!!!'I9✓ ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. lrl,-24 G'®eUk", SEPTIC TANK CAPACITY /rUO 6:46 LEACHING FACILITY: (type) -�'�"�c�'��°� J (size) P NO.OF BEDROOMS r BUILDER O OWNE PERMTTDATE: q/F/f797 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Sf Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) t Feet Edge of Wetland and Leaching Facility(If any wetlands exist r I� within 300 feet of leaching facility) Feet Furnished by a7j-y R` r Poo 13 gl i b 'I'l- y ,�a• gas a3-13,2: aa��3J b ASS-ESSOR'S MAP N0. PARCEL N SEWAGE PERMIT NQ. `. IRS VI LAGE�' I N S T A LLER'S NAME i ADDRESS BUILDER- OR OWNER 4 DATE PERMIT ISSUED Y` DATE COMPLIANCE ISSUED o• 0 � ` a F R; o` e V L=�r p No.... 5.�.(..� Fizz....1...�g..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH .......... L'/ vf..........OF.............s . /1� '/'/ woVe.................................. Appliration for Disposal Works Tonotrnrtion Funfit Application is hereby made for a Permit to Construct ( ) or Repair ( L,- an Individual Sewage Disposal System at: _ :...-•-------- ----- ---------------------- _----------- .................. .Local' -..Ad 1 s or Lot No. 0 ---Val ................ ............................................. .� O ner Address M Installer Address Q7i Type of Building Size Lot------------------_--_----Sq. feet V Dwelling-kNo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 4 Other—Type T e of Building No. of persons............................ Showers � YP g ------•--------------------- P ( ).-- Cafeteria-( ) d Other fixtures .----•--•---------------------------------------------••-•••......-•••--. ----- ------------------- *._••.... ------ w Design Flow............................................gallons per person per day. Total daily flow................................_........_..gallons. WSeptic Tank—Liquid capacity............gallons 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 tank ( ) Percolation Test Results Performed by.......................................................................... Date.........:.............................. Test Pit No. 1................mmutes per inch Depth of Test Pit.................... Depth to ground water........................ P� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................--.. ...........................•-••••-••••••--••-••......-••--•-•--•••••-••---......-•-•-........--•....••-•-•-•-••-•••--•---••...-•---•-••••••-••=---•---...... O - Description of Soil..............C-1------------------- 4✓ Y U ............................................... .C�'_------------------.....--------..k..............--------••--•........--•----•••--•••••--•-•-•--.................................. •----•---------------••------•-•-•-••--•---•----•-•----------•-•--•---•--........_..--=.....-----•-•---••-•-•••• ...................... ..................... U Nature of Repairs or Alterations—Answer when applicable..-_:_...d..".. 'f Jy_ �, ..-_-_.-._ :__:____.. -------------------------•--•---............----------•----------------•--.....-------••---•----...-----•--•-•----------------------------•-•--------.....--------------------------••-•------.....•••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'LU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a'Certificate of Compliance has be issu2r the oard of health. Signe .... ' ` Date Application Approved By..............••-••-=z•••--... ......... Date Application Disapproved for the following reasons:----•-------....-••-•-•-•---•-•••..............................................•-------••-•-••••.....•--•-...... -•-•-•-•.............................•-....--------------------•-•-......-------••-............----------••-••••••--•-••-•--•-•-••••----••-••--•--•••-•---•-••-•••••••••••-•--••••••••--•••••----•-•••=- Date PermitNo.. .. .. .......... -----------•--------... Issued-....................................................... Date -� r f Fps.....`.._6.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH ...........................................OF.................. 0� ✓ +�✓............................. Appliratiou for Diiipoti al Works Toustrurtiuu 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( 4-),'!�n Individual Sewage Disposal System at: : ..:�'!``•....-'��'`�-.-............... -----------------------------------•........ ......................................... ------------- e Locato Ad —or Lot No. .. �'i� r �'��� �:�t._. _ �+, t�°? ----•-•-•-------------------------------------- r*^' Address a �i. + '/r✓ .�---------- •-•------•-----------------------------•----------•••----------•-•-_-----------__--••.....•••--- Installer Address Type of Building�,i Size Lot............................Sq. feet U Dwelling"NO. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `-4 Other—T e of Building No. of persons....................:....... Showers — Cafeteria 0.1 Other fixtures .........................--------------------- W Design Flow..............0................._...........gallons per person per day. Total daily flow...................-........................gallons. WSeptic Tank—Liquid capacity............gallons Length.......... Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................._. Total Length.................... Total leaching area.__.................sq. ft. Seepage Pit No..............6...... 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-__-__-_-__-___--_---- ....-----•-•--------------------------------------------------------------------•-•---•---•-•---•--------•-----. ----•-----_-•--••....• •__------ ODescription of Soil-------------e"n...--•-•-•---••--• ,V ......-----•-------•-------------------------------......-------------------------------•---••---...-----•------ V ............. -•-......--- -----••------------------•--••-•-..........•••... UW ...............------------------------------------------------------- ------------•---•----•••-------•----- ........... --------------------------------------------------------•........... Nature of Repairs or Alterations=Answer when applicable...-___.✓------�° >......�4........_.�� � ���_��!__.._.__.. ..........-.......................-....................................... ------------•-•--......-----...-------•-------------------•-----•----...-------------•--------------------------•---.....•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 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 the oard of health. Signed' -•-----,-����!....'�-f�-��',✓ --:----=--•--• ----'��" �-�-��--_ Date Application Approved B `® Date Application Disapproved for the following reasons---------------•----------•-•-----------••--••-•-------•---••------------------•----------------------........•. •-•--•-•-•-•-•-•----•--•............•---•...•---••-•--------••-••-•-•-----...•••••--•--•----••••-•----•...-•-•-••--•••-•--•-•-------•--•••••-•-••••------•----•-----•-••-••-----------•--•--•._........-- Date Permit No.. - . Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALTH ............�,.°..............OF..... 4 .? a !` .................... Wrrtif irFatr of (1 ompliFana THIS IS)TVERTIFY, Thavthe Individual Swage Dispel System constructed ( ) or Repaired (A- Cr •-•------------•------•••..................•...... pee at. .............................. •-•••---....-.�-- _.._.. P has been installed in accordance with the provisions of TITIZ 5 f The State Sanitary Code as descr'bed in the application for Disposal Works Construction Permit No.__E ...... ........... dated_..J:G2. _/_ ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONS I FACTORY. DATE.......................................... ..... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ✓ :r,T ej ..,.... r` r 1 .......................• FEE........__-_............ Dis-pos al.' urkii Touptratdwit airrutit Permission is hereby granted-. .......... to Construct( ) or Repair ( ;,I an rIndividual Sewage Dispo�l System;; � /z/ _•__.. ....._ ...._1__ ............................. Street as shown on the application for Disposal Works Construction Permit No..l~ '_ ���____ Dated... . ... ...... �� DATE... •--•---------------------••----•---------•---- Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS _ I r TOP Of FOtfP1DAT10N 20 FT. MNWUM FROM CELLAR SOIL TEST DATE OF SOIL TEST ELEV. �� ' 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE CLEAN SAND SOIL TEST DONE BY 26ELISER ENGLUEEMIG � ;r CONCRETE WITNESSED BY COVERS LOAM AND SEED 4' SCHEDULE 40 PVC PIPE OBSERVATION HOLE 1 EL€V.a OBSERVATON HOLE 2 ELEV— MIN. PITCH 1/8` PER FT. 2" L4YER OF PERCOLATION RATE MIN./INCH AT INCHES 1/8" T.3 1/Y DEPTH HORIZ TEXTiiRE COLOR MOT?. OTHER DEt P_TH HOR� TEXTURE COLOR MO 'f. OTHER r WASHED STONE VENT ! I 4' CAST IRON PIPE NOT REQUIRED (OR EQUA6, MIM MUM ___ 1 a ! PITCH 1/4 PER FT. 2 1 CU. FT. OF I i CONCRETE ANCHOR r FLOW UNE a _ 100 a ELEV. MIN. '' s r o 0 0 __{ 4, I r V a t 0 10. s I I ELEV. ELEV. - >> GAS „ e SUMP ELEV. , BAFFLE ELEV. DISTRIBUTION U D OUTLET HIGH CAPA TY INFILTRATORS WITH } BOX `' S IN AN TO BE PLACED ON FIRM BASE) 4 14 TO BE WATER TESTED ,r- + `5 1 s INCH S 1 500 GALLON IF MORE THAN ONE OUTLET TRENCH foRM,�1Tit —. _ _ . . k" 6 34 INCH S WELL WATER ENCOUNTERED AT ELEV. WATER ENCOUNTERED AT ELEV. 7 ET 29 INCH S (TO BE PLACED' ON FIRM BASE) S O(LA�B�SORP TI C.`!8 FEET 34 INCHES SEPTIC TANK IND E3/4' TO 1 1/2" INDEXSYST (SAS) WASHED STONE '* ! ADJUST LEGEND: DESIGN CALCULATIONS ! BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TAE-LE ELEV. _ 7 EXISTING SPOT ELEVATION 000 NUMBER OF BEDROOMS SEWAGE DISPOSAL SYSTEM PROFILE t OBSERVED WATER TABLE ( / / ) ELEV. GARBAGE DISPOSAL UNIT _ O EXISTING CONTOUR ----00----- - - NOT TO SCALE FINAL SPOT ELEVATION TOTAL ESTIMATED FLOW FINAL CONTOUR ( 110 GAL_/BR./DAY X _ _� BR.) GAL/DAY l SOIL TEST LOCATION REQUIRED SEPTIC TANK CAPACITY a GAL.. " UTILITY POLE -C?- ACTUAL SIZE OF SEPTIC TANK 1GAL SOIL CLASSIFICATION a `OWN WATCH ATER W 0®f � RATE _, 5 e�n s.t N ' N DESIGN PERCOL. TlON RA� +„ a, GAS LINE G — EFFLUENT LOADING RATE 0,74 GAL./DAY/S.F. _.. i EACHING AREA S©. FT. I ' LEACHING CAPACITY (AREA X RATE) �' GAL/DAY RESERVE LEACHING CAPACITY - GAL/DAY r ! NOTES; .., .- i WORKMANSHIP AND MATERIALS SHALL. CONFORM TO D.E.P, _ ALL , TITLE 5 AND THE TOWN OF RULES AND x r, REGULATIONS SUBSURFACE , REGULA NS FOR THE SUBSU ACE DISPOSAL OF SEWAGE 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO A m� WITHIN 6" OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL 8E > USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4, ANY MASONARY UNITS USED TO BRING GOVERS TO GRADE SHALL # BE MORTARED ?N 5,; RT PLACE. #, 5, Q DETEI4► 71NAPON H-A`-`, BEEN MADE AS TO COMPLIANCE WITH'; DEEDLD OR ZONING REGULATIONS. OWNER ,j APPLICANT- IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG—SAFE" AT 1-800-322—�4844 AT LEAST 72 HOURS TO COMMENCING WORK ON t - 7. NTR'ACTORISTO VERIFY GRADES AND ELEVATIONS AS WELL AS � PRIOR SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. 8. PARCEL IS IN FLOOD ZONE S. LOT IS SHOWN ON ASSESSORS MAP AS PARCEL I ,4,� , A. , f APPROVED: BOARD OF HEALTH r • 1 DATE AGENT PROPOSED SEPTIC DESIGN f { ! PROJECT LOCATION I ` r 1 i I 7 S WE'ETSER ENGINEERING 235 GREAT WESTERN ROAD � } 508-•- { SOUTH DENNIS,S, MASS. 398-�-3922 � t}2560 1 DATE _ SCALE 1 rr r t .�. L cs ., REVISED �' JOB NO _ may w`"'~•., _ _... �t ;t REVISED LOCATION MAP 3 SHE I OF l Y _.. _ 0 1997 SWEET5ER ENGINEERING