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HomeMy WebLinkAbout0291 WOODSIDE ROAD - Health 291 WOODSIDE WEST BARNSTABLE A = 152 026 • i o a ° YOU WISH TO OPEN A BUSINESS? For Your, Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must fiat obtain the necessary signatures on this form at 200 h1ain St., Hyanni5. l ake [lie completed form to the FmN.n Clerk's Office, 1 st. FL, 367 Hain St., Hyanniti, lv{A 02601 (Town Hall) and,get they Ui.is,noss Certificate that is required by law. ,. DATE: 14 Fill in please: '? APPLICANT'S YOUR NAME/S: h l B BUSINESS YOUR HOME ADDRESS: 2 rja 5 c " = TELEPHONE # Home Telephone Number t.rJ NAME OF CORPORATION: T�S NAME OF NEW BUSINESS TYPE OF BUSINESS k 1 w k? %-2-i„j I IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS 'Z 1 W O b'D 5 ,�C 1Zc� l ����s���ioL�gp PARCEL NUMBER / (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is'intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING C MISSIO ER' OFFICE This indivi b ea inf m anyperrint re uirements that pertain to this type of busines7,AUST COMPLY WITH HOME \ _ E OCCUPAIfI(7t� Au€horize e** RULES AND REGULATIONS. FAILURE TO v COMM ENCU COMPLY MAY RESULT IN FINIPA 2. BOARD OF HEALTH This individual has been Mmt of the permit requirements that pertain,to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: YOU WISH TO OPEN A BUSINESS? p For'Your Information: Business certificates [cost$30.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town [which you:must do by M.G.L.-it does not give you permission to operate.] Business Certificates are available at the Town Clerk's Office, 1"FL, 367 Main Street, Hyannis, MA 02601 [Town Hall] DATE: / /O Fill in please: APPLICANT'S YOUR NAME/S: r✓ ��? •�.c BUSINESS YOUR HOME ADDRESS: 'd- zc% �j PRE CF TELEPHONE # Home Telephone Number L / P V . NAME OF CORPORATION: , NAME OF NEW BUSINESS Tf)P ,C/r;fr,��1,r ,�!�✓ TYPE OF-BUSINESS A61-n P. sir, v IS THIS A HOME OCCUPATION? . YES NO ` ADDRESS OF BUSINESS MAP/PARCEL NUMBER ` J� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 2®I] Main St. _ [corner of Yarmouth Rd. & Main Street] to make sure you have the appropriate permits and licenses required.to legally operate your business in this town. 1. BUILDING,COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature**. COMMENTS: 2. BOARD OF HEALTH ,.� This individual has bee f rmed of the er it requirements that pertain to this type of business. �thorized Signature* GUST COMPLY VViTI i ALL COMMENTS: HAZARDOUS MATERIALS REGULATIONS 3. CONSUMER AFFAIRS LIC[ ENSING AUTHORITY) This individual has been informed of the kcensing requirements that pertain to this type of business. Authorized Signature** - COMMENTS: Hazardous Materials Inventory Sheet Checklist q/ Date Ph sical Street Address-Check database to ensure it exists Working Phone Number ctual Amounts -( ie. gas being used to fuel machines, thinner to i clean brushes all count as hazardous materials-no blanks) Storage Information -location of storage, how long is storage for? Jf none, note that. Disposal Information -where and who? If none, note.-,that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures. they are doing. Notes need to be left to explain what you discussed with them. Date: lj lJo TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS:_, A�it/��► �' BUSINESS LOCATION: �/ �'��✓STMI/— I)-7A INVENTORY MAILING ADDRESS: `�- w i' TOTAL AM OUNT: TELEPHONE NUMBER: CONTACT PERSON:,I.L�A�/ 5 �p i ✓� EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous,waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxec or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED jMisc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers h4 �� (including bleach) !!�, Spot removers & cleaning fluids (dry cleaners) 77 _. Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS --- Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for �Dfigpoml *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) D Complete System ❑Individual Components Location Address or Lot No. t LJ S[ ✓� Owner's Name,Address and Tel.No. �Gv_Qa.wf (v Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. / e— Legr Type of Building: Dwelling No.of Bedrooms�� Lot Size e�O sq.ft. Garbage Grinder( ) Other Type of Building Yee_:5 No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ( G n r Type of S.A.S. u he Description of Soil I -e S I^� 1'e (` I K `e 1^"^ 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 Certifi- cate of Compliance has been issued y thi oard o alth. Signed Date O Application Approved by Jr Date r�—//— Application Disapproved for the following reasons Permit No. ZZIVv' Date Issued 9!— ft— ?,OTro TOWNIE OF BARNSTABLE LOCATION SEWAGE # VILLAGE` t—�.�/ ~ � ASSESSOR'S MAP & LOT ��=' 2 INSTALLER'S:NAME&PHONE NO. SEPTIC TANK^CAPACITY LEACHING FACILITY: (type) I I`� USE (size) NO. OF BEDROOMS BUILDER OR OWNER f { PERMIT DATE: — 1 I COMPLL4NCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet I 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 i within 300 feet of leaching facility) Feet Furnished by. i 0, No. � _ , , ..Fee '7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zipprication for-*Mi5pozal *pOtem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7 W OCI)CV51 E' Owner's Name,Address and Tel.No. �< Ass is Map/Parcel ( 2 • ��� � .S'2 1 , Installer's�Name,Address,and Tel.No. Designer's Name,Address and Tel.No. e of Buildin • F ,l Type g• Dwelling No.of Bedrooms J Lot Size r t er fsq.ft. v Garbage Grinder( ) Other Type of Building 5 No.of'Persons, Showers( ) Cafeteria( ) Other Fixtures d ' kj t } 1 Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets i I` Revision Date ,J Title Size of Septic Tank 1 �-' �C� M Type oftS.A.S. L- I "L N r lid y r Description of Soil 'E S 'e y' .J *t'U} 1^ "t 40 r. ' Nature of Repairs or Alterations(Answer when applicable) r Y Date last inspected:. Agreement: The undersigned agrees to ensure the coristructi band 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 y!Toardrealth. Signed Date 'Application Approved by Date Application Disapproved for the following reasons - Permit No. Zer-PV Date Issued a- 7 r-q0 --=------------` - --- ----- r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO GERTtYtthat the On-sit e, 'Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( ).by 1 �T 1 g at Z W si 1� a &4-n S a ki/ has been con ted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7.dwj-q 7 I datedstru2/t ?&,rD Installer Designer + The issuance f: 'sip t hra11}�of be construed as a guarantee that the .y .te t 1 fundti•n as d sig ,� Date (/ _ Inspector / �� -� --«�--- /—�^--------------------------------- No. ( Fee -- THE COMMONWEALTH OF MASSACHUSETTS 1 PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi5p0al *p5tem Construction Permit Permission is hereby g�ranted to Construct( •)Repair( )Upgrade( Abandon n( ) System located at G 9/ �Vc o c1/) 4� Q. , �i✓. �i�..�, lot1 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:Consr// must be completed within three years of the date of this e . it. Date: �_Z4 710 Approved by, 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. r CERTIFICATION OF SKETCH AND APPLICATION FOR A bISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) r 1. e i t-! , hereby certify that the application for disposal works construction permit signed by me dated ( ( O p , concerning the property located at ( l ci o o 23 S(C5l r meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted ,groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX.High G.W.Adjustment. _ DIFFERENCE BETWEEN A and B SIGNED : DATE: 75 — 6 0 [Please Sketch proposed plan of syste back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert f No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippficatiou for i0isposal 6pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade(vrAbandon( ) 1p omplete System ❑Individual Components Location Address or Lot No. ` :5. Owner's Name,,address,and Tel.No. s Assessor's Map/Parcel 5 Z)C{, Installer's NameyAddress,and Tel.No. Designer's Name,Address,and Tel.No.5-,:=)V 36C:�-331 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) <7'�j gpd Design flow provided 3C-f gpd Plan Date fY\A G, Q VcOu Number of sheets Revision Date Title StjZVa?, Size of Septic Tank k ©0 Type of S.A.S. Description of Soil ` �n Nature of Repairs or Alterations(Answweer when applicable) �—\/—L.✓v�5 i �jy J 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 He ed Date AN Application Approved by Date 0919 Application Disapproved by Date for the following reasons v Permit No. / Date Issued --------------------- v3 hcdxy. .. y v. ... 70 �- ' No.IAJ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:. • '' Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS application for -Misposal *pstem (Construction Permit Application for a Permit to Construct( ) Repair( )'`-Upgrade(t/yAbandon( ) W4 omplete System ❑Individual Components Location Address or Lot No. � C_t),0 .5*%<± � �� Owner's Name,Address,and Tel.No._q—�q 7 �. Assessor's Map/Parcel k S c� © � � ,Q �`w� j, Installer's Name Address,and Tel.No. ,$beZ- Designer's Name,Address,and Tel.No. .55n c S2`� ..�csC r-- C*4c�r►�> iW�v�C ��--� v _CkZ.oF.S .=^C . Type of Building: '' Dwelling No.of Bedrooms Lot Size ®L{ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) ?C� gpd Design flow provided r"{ gpd Plan Date fN-\s ,� i Number of sheets Revision Date Title y Size of Septic Tanker ''<=�Cj Type of S.A.S. Cb ti Inc.a- 'Y (^.A� �+ _ ►ca Description of Soil g- , , � & Nature of Repairs or Alterations(Answer when applicable)_M 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 ,S Application Approved by ` a ""'"'Me Date Application Disapproved by �/ Date for the following reasons Permit No. / 7 `/ Date Issuedj / THE 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 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a 1 7 dated T/P/� InstallerV�,r�.� VGA ,f `esigner Va:—, n—tSQy�.ra �v`Z #bedrooms Approved design flow A gpd The issuance of this r permit shall notbe construed as a guarantee that the system will P\clionas fjdesigned. Date <i ILI I i 1 Inspector /�-t No.0Q(q— 167 Fee 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Misposal &pstem Construction Permit Permission is hereby granted to Construct( ) Repair rr( ) Upgrade( Abandon( ) System located at �� 3 �c�1iS ►� �` �1 V� �j9p,��/�, 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:Co trucction must be completed within three years of the date of this permit. Date Approved by r Town of Barnstable Regulatory Services Richard V.Scab,Interim Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: i� , Sewage Permit# Q©` \6`1 Assessor's MapWarcel EU.6 Designer: 1 i N tl l Jt^n S �'i�%L Installer: 2 q1 Address: J �j Address: uZS3--r On ,s 88� _�ZP ,� -��, � �as issued a pemut to install a (dale) (installer) - septic system at �� w o u 0s t oL �-D based on a design drawn by (address) ey� _ dated �esigner) em of4 I 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 designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters(if applicable) (Installer's Signature) ER- � ` /� No. 994�0 �." esigner's Signature) (Affix ere) PLEASE RETURN TO BARN, T BLE PUBLIC HEALTH D 'WON. OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable PT# Department of Inspectional Services �. Public Health Division µit 200 Main Street,Hyannis MA 02601 P Office: 508-862-4644 - t�F 4,w,> Date Scheduled I Tune x•- Soil Suitability Assessment for Sewage Disposal Performed By: I ' Y C./ MO Witnessed By �� ,�c/ �/, Jjivf�'i►� AFS, LOCATION& GENERAL INFORMATION Location Address: < J`�c wner's Name: ® � Owner's Address: Assessor's Map/Parcel: s ® Certified Soil Evaluators Name: rC',e%� Certified Soil Evaluators Email: New Construction or Repair: Certified Soil Evaluators Telephone# V: ® f� Land Use \ vT`/ Slopes(%) / � , ` Surface Stones �✓��")�/ Distances from: Open Water Body>2. ft Possible Wet Area > -0 U ft Drinldng Water Well�/ �✓ ft Drainage Way t? ft Property Line Oft Other ft Parent material(geologic) UDC t �° v 1 W�S Depth to Bedrock �V. Depth to Groundwater: Standing Water in Hole: N `Aa Weeping from Pit Face Xl Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL IIIGH WATER TABLE Method Used: Depth Obs 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" 11 Depth of Perc d�Gl� J/'-1 Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak n' Rate Min./Inch �' �^ N "�@JV s Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) I ' Deep Observation Hole Log Hole#: Depth from Surface Soil Horizon Soil Texture Soil Color Son Motttimg Other�' (m) (USDA) (Mansell) (Strome,Stones,Boulders, A Consistency,%Gravel p i�_ 121 i p,,,,,� jc L �j� AI 2- �3 `� 6 Deep Observation Hole Log Hole#: Depth from Surface Soil Horizon Soil Texture Son Color Soil Mottling Other (in) (USDA) (Mansell) (Shacxure,Stones,Boulders, Consistency.%Gravel "m "AA t o �31L f-A. Deep Observation Hole Log - Hole#: �Q Depth from Surface Soil Horizon Son Texture Son Color Soil mottling Other (in) (USDA) (Munsell) (Struclaue,Stones,Boulders, Consists %Gravel r Deep-Observation Hole Log Hole#: Depth from Surface Son Horizon Son Texture Son Color Son Mottling er (in) (USDA) NUMB) - (SMwftu%Stones,Bouldas, Consistency.%Gravel g Flood Insurance Rate May: / Above 500 year flood boundary No Yes Within 500 year boundary No / Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? v if not, what is the depth of naturally occurring pervious material?[____S Certification J� I certify that on ` b �(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection nd that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. D Signature Date SKETCH: (Or you can attach a eparate sheet)_ (Street name,dimensions of lot,exact locations of-test holes&perc tests,-locate wetlands in proximity to holes) 1 down cape engineering, inc.S1EVE SOILS ANALYSIS 291 WOODSIDE RD MARSTONS MILLS, MA DATE OF REPORT: 4/18/19 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 291 WOODSIDE ROAD, MARSTON$ MILLS LOCATION: DARREN MEYER TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 125.7 SIZE :WEIGHT RETAINED % RETAINED € % PASSED ------------- ............(sum..)..........................------------------o ................... o.............. . 1" 0.01 0.0/oi 100.0% -------------->.................................. >--------------------b-----------=----=- 3/4 1 0.01 ----0.0%1 100.0% -------------:...... ......------- ---- - -0.01 0.0%i 100.0% ........................................... ...... 3/811 0.01 _-__0.0%1 100.0% --------------......................................... ...:---------- o-------------_---o- #4 0.0 0.0 ; 100.0% --------------i......................................................,---------------------..................................... #10 5.51 4.4%`:...................................... 95.6% . #20 23.61 18.8/0: 810 --------------,..................................................... ..................................... #40 59.1. 47.Ooo , 53.Oo -------------- .....................................................:_ ............................ .. #50 I 78.6' 62.5/o E 37.5/o --------------►............................ ........,____-------------_-_y................................ #80 -103.31 __82_2%1 17.8% --------------............................. .............----------- -. ..................................... #100 115.71 92.0%' 8.0% #200 -------i.. .... .................. ...122.3'-------------97-30�- -----------2.7% -------------:.....................................................:---------------------=---------------- PAN: 124.81 100.0%1 0.0% --►- --------------- - -•-------- --------A---- -------- ------------ -- ---- -- ---- ---- - SAMPLE: 125.71 NOTE:TEST ON PASSING#4 ONLY, 1.8% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3(FINE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING #4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >97%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MIN:/IN. MATERIAL NONCOMPACTED SOIL DESCRIPTION: FINE SAND DANIELA. OJALA CIVIL Cn No.465t)2 � Q Q6TE��O Rss AL �� J u _t sA,tA TOWN OF BARNSTABLE LOCATIOO N '� ` C (�j �r�: SEWAGE# ( G VILLAGE ,�r vim, ASSESSOOR'S MAP&PARCEL ' Ua INSTALLER'S NAME&PHONE NO. c--Ac�J%<zE\-t=," '5Ekc,& dam_ SEPTIC TANK CAPACITY LEACHING FACILITY. (type) c�,� S�c'vr� (size)0S�x NO.OF BEDROOMS OWNER .. PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: e 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 facility) Feet FURNISHED BY v..,.::; t NAco f N/� " o . J 5 TOWN OFBA.RNSTABLE LOCATION SEWAGE # vELLAGE'- -J RZLASSESSOR'S MAP & LOT �^f ®2� INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACIL=: (type) (size) AIX NO.OF BEDROOMS BUILDER OR-OWNER PERMITDATE: ( I " 0 © COMPLIANCE DATE Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Watei 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 facility) Feet Fumished by- t - / L 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a.w .......... OF............ �� !!ST..h'dL_ .......... lea � Nyphratio c for Ditivagat Warh,5 Tomitrurtion Vrrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at ��'�i'f........ �. -....�1..-....4v a.........................................../2c� fv�sT....��' ��,Sf'�91�' T.... ... Location•Address ................................. or Lot DI�_......................,..........._... o. ...........:?F�a -..� ......... �r...Y::r.,rv�T......................................................... ..,.... Owner Address � .............................................Installer.......................,................. ........................,...................Address.........._..........,...............-•---- T;,pe of Building Size Lot--. .....Sq. feet Dwelling r No. of Bedrooms......,,3.................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building No. of persons............................ Showers a YP g P ( ) — Cafeteria ( ) Otherfixtures ------------------------•----------------------------.•-••------....--•----------•--•- W Design. Flow..........S.0..........................gallons per person per day. Total daily flow............................................gallons. USeptic Tank—Liquid capacity/!adl)..gallons Length................ Width................. Diameter................ Depth................ xDisposal Trench—No.........,.�...... Width................... Total Length.................... Total leaching area....................sq. ft. 5 Seepage Pit No.-.--lt.GtQ-p'7hameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,4 Test Pit No. J----------------minutes per inch Depth of Test Pit...............---.. Depth to ground water....-..._..-..---...... �Zq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....--..--............. f� --------------- -------------------------------•--------------------•-•--------------........-------.------------------••-------------------- ••------------- O Description of Soil-------------=5�'�-•--- UCH............------ EST- GE----- -�.............................. TO 1 G -------------------------------------------------------- ------ id w G ---------------------------------------- .. ,k<'A VNature 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 Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i the bo •d.of health, • cr Signed.. v� ............ lee, D r Application Approved B !. 7 6i/ PP PP Y------------ -• -----------------------------------•---•--......----- -•-- --. _4(-••-•-... .. Date Application Disapproved for the ollowiny 7S _S .........-•---•----------•--------•------------------------•-------------•...I- ---..--------------------------------------------------------------------------------- ............................ V' Date <St� PermitNo.......'f-ta-----------•.......................... Issued............------ ..................................... �� Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA . rr 4M THE COMMONWEALTH OF MASSACHUSETTS BOARD - OF HEALTH << ., OF. .._.. ., , ,_..e.:t:............................... Applirativil far lai-spolial Wark onstrurtuin Vorrmit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: __., h - ._. Pf...i........_..............•......._ .n-sr-... _, Location-Address or Lot No, ............. �.:a 4 a, .i: ..r....4.. ,, ., ;/....,........................................................ Owner Address W � .............................................installer....,...,.,..,.........,... ..,.... .....,......................,....,.......Address'........._............................-- Q Type of Building Size Lot....:::...:................Sq. feet U Dwelling—No. of Bedrooms......... ................................Expansion Attic ( ) Garbage Grinder ( ) a, Other—Type of,Building ............................ No. of persons.__..__.-•-__-------------•- Showers ( . ) — Cafeteria ( ) G>a Other fixtures ---• ••--•-• --•-...-•••-••.---• -----------------•--•-------------•------------•-•••-•-•---•-•-•--•-•-------- W Design Flow........ .+.............. ........gallons per person per day. Total daily flow............................................gallons. :.f 1:4 Septic Tank Liquid-capacity.__,... ,_gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. r Seepage Pit No.._.. :p... k_,; ?iameter.:................. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...............----------------------•-----------------------------• •... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-..-_-.-__...__________- (i Test Pit No. 2................minutes.per inch Depth of Test Pit.................... Depth to ground water........................ P ------------•-----------------------------------•-------••-••-•------------------------------------.......................................................... 0 y Description of Soil...............s" 4 =r ... Ur..-. .._.... (� is 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 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. Rtf... r f Signed_ ... .... ., ................. ...... ._..... r. c:. fr :F,��,,,�`•,ri•.-.�� •. a� _',- .., .:,,•. - a'�e DateG / ,.�>�y.. Application Approved B ................... ---•---• .....Y ---•-- •. ...................•.................................. �^ 7 Date Application Disapproved for the following reasons:................................................................................................................ -•--•---...---•--------------•--•••----••-•-------••-.._.........--••--•-•-• •-••-•-••••••-•-------...--•--•--•-----•-••-•--------•--------•--•--•--...---••--•-•------•--•--••......-----•--- -•---- Date Permit No.......... ':...., r'� Issued........................................................ Date F i. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH %".Wrtifi;ratr of Toutp iaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired by. .. -- �� = -- --- --------------- - --. - ---------------,--------------•------•---••- lu taller,,, -4 at.._ -•-•- ------...-•-- ------- -------- ------- ----•-- - --------- -------- has been installed in Accordance with the provisions of Article X1 of The State Sanitary Code as described in the • ti: - d-- -G is — application for Disposal Works Construction Permit No----- dated....... : ____.__._._.___ ___.._..._......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATEZ.. -- =. Inspector..............................................................••--..........---..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............s..: - .._..:... } a NO....:.................... FEE.. ................... - Permission is4iereby granted § -'' < --------•••.._..•-••--•-•---•-•..................••••••••......................--................. to Construct,( or Rep r ( ) a>.t tttd>vidual Sewage'Disposal System atNo.................................................................................................... --•-••......•-•-•- •...................................•.: ......•--••- t Street .z'J s:✓` F•aif 7 as s'nown on the application for Disposal Works Construction Permit No..................... Dated------_-_:......_......................... o .................................•.. /,r. f Boerd of FI�li DATE N.;':� 4_t, ......A : .. .FORM 1255 HOBS & WARREN. !NC.. PUBLISHERS LEGEND WEST BARNSTABLE PROPOSED CONTOUR ® PROPOSED SPOT GRADE r —— 98 —— EXISTING CONTOUR + 96.52 EXISTING SPOT GRADE Q� FRpq� Ok W EXISTING WATER SERVICE o TEST PIT .I m O� O ZO��\O� LOCUS N rn WELL v �50 ft FROM LOCUS MAP wE<< LOCUS INFORMATION PARCEL ID: MAP 152 PAR. 026 1 _ _ 106 TITLE REF: 6659/111 110,6 282.68' 104 102 PLAN REF: 239/137 O0 ea FLOOD ZONE: PROPERTY NOT IN FLOOD ZONE 30 SEPTIC SYSTEM _25 W, ten REPAIR PLAN _ - 1 1 / z� / o o h LOCATED AT: o , ,��� P_2 T 291 WOODSIDE ROAD -I F ' 1 WEST BARNSTABLE, MA rn s PREPARED FOR v ) D �X �o CPATIO y�� GWEN DIXON / WELL II m �t PATIO r- PROP , READY ROOTER EXC. / � r —� SEPTIC TANKANK O O T (0 o p sw;M°0ND toMAY 6, 2019 III C) 104- +Z O POOLNG m E qS EXIST. 1,000G O -- SEPTIC TANK N* OF SHE DEXISTING L ACHING LOT 26 DA N ys \ � AR r \I / AREA = 35046 sf+— Ag: � cn , �' �/ ,� /' I PLAN BOOK 239 PAGE 137 1140 OBI i'/ ASSR MAP152 PCL 26 102; - - 253.42' MEYER & SONS, INC. . - ., 96 P.O. BOX 981 100 98 Y BENCH MARK EAST SANDWICH, MA. 0253T TOP OF FOUNDATION PH: (508)360-3311 EL. 103. 19 FAX: (774)413-9468 ' BARNSTABLE GIS DATUM PLAN meyerandsonstitle5@gmail.com SCALE: 1 in = 30 ft SHEET 1 OF 2 .-J 1894 ELEV. TOP DROP FND. NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (97.0) = 103.19-11� F.G.EL: 96.50 F.G.EL: 96.0 F.G. EL: 97.0 VENT a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a• {4 X 2" OF 3/8" DOUBLE WASHED F.G.EL: 93.19 ±. 3/4" - 1-1/2" . . STONE OR FILTER FABRIC 6 ' •" DOUBLE WASHED STONE a " 4" SCH 40 PVC 10"1 ®®®®• O ®®®® 1a" s 0 S= 1% (MIN. ®®®®®®®®®®® a' TEE'S ARE TO BE . ®®®®®®®®®®® 4" SCH 40 PVC INV. 91 .25 2 EFF. DEPTH 1a®®13E3- ®® -....a'.:: INV.91 .65 ff RA I NV. 91 .08 4' 2 X 8.5' 4' GAS PROPOSED DB-3 EFFECTIVE LENGTH = 25' (� EXISTING BAFFLE DISTRIBUTION BOX ' INV. 91 .90 (H20) INV. ELEV.= 90.90 �- I-,,,.�1 p) PROPOSED 1 ,500 GALLON SEPTIC TANK of GASJ.BAFFLEBAFFLE TO BE INSTALLED ON ����` MAss9 ��� K0 B EAKOUT OUTLET TEE AS MANUFACTURED BY �`� �y U f� NOTES: o DARREN Gn ELEV.= 91 .90 1) CONTRACTOR SHALL VERIFY ALL EXISTING TUF-TITE, ZABEL, OR EQUAL E R TOP CONC. ELEV.= 91 .90 PIPE INVERTS PRIOR TO CONSTRUCTION \ 11 INV. • ~ ®® 2) TANK AND D-BOX SHALL BE SET LEVEL AND TRUE ELEV.- 9 .90 ®®®®®®®®® p ®®®®®®® TO GRADE ON A MECHANICALLY COMPACTED SIX ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN �NITAR�a� .. BOTTOM EL.= 90 ®®®®®®® 310 CMR 15.221(2) ' 3.75 5 FT. 3.75, 3) PLACE SANITARY TEE IN D-Box 4' SUITABLE S L PROV. EFFECTIVE WIDTH = 12.5' 4) INSTALL INLET & OUTLET TEES W/ APPROX. 45.9 ' TO GW GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE BOTTOM OF TESTHO EL: 84.90 SOIL ABSORPTION SYSTEM (SECTION) L t (PER BARNS GIS, APP X. GW ® EL. 39) (500 GALLON H-20 LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#: 15944 BOARD of HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: APRIL $, 2019 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: DESIGN PERCOLATION RATE: <2 MIN/IN - 310 CMR 15.405 (1) (B): WITNESS: DAVE STANTON, BARNSTABLE HEALTH PT. DAILY FLOW: 110 G.P.D. X 3 BR = 330 G.P.D. 1) A 2.10 Fr. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING GARBAGE GRINDER: NO (not designed for garbage grinder) TO BE 5.10 FT (MAX) BELOW GRADE VS REQ'D 3 Fr. (H20/VENT PROVIDED) Elev. TP-1 Depth Elev. TP-2 De 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 97.80 A 0" 96.90 SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE PROP. 1,500 GAL. SEPTIC TANK INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE LOAMY SAND A LOAMY SAND D LEACHING AREA REQUIRED: 330 DESIGN ENGINEER. 96.80 10YR 3/2 12" 95.90 tOYR 3/2 12" ( )/0.74 = 445.94 S.F. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING B FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN LOAMY SAND B LOAMY o USE TWO (2) 500 GALLON H-20 PRECAST LEACH CHAMBERS W/ 4' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. C ENGINEER BEFORE CONSTRUCTION CONTINUES. 9422 10YR s/6 43" 93.32 1oYR /s 43" STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D b�DY 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF SANDY LOAM LOAM THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 10YR 6/6 6/6 BOTTOM AREA: 25 x 12.5 = 312.5 SF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. f SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 91.30 78" 9 0.4 0 78" 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED C2 2 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. SIEVE SAMPLE FINE FINE DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 9. IT SHALL RF THE RESPONSIBIUTY OF THE CONTRACTOR TO VERIFY THE O EL 89.4 SAND SAND THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BLGiNNING 2.5Y 6/6 2.5Y 6/6 CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TIRE 5. 86.30 138" 84.90 144" PROPOSED SEPTIC SYSTEM UPGRADE PLAN 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12 THIS PLAN IS TO BE USED AND IS NOT TO BE CONS ID FORRED AEPTIC PROPERTY LINE SUSYSTEM RVEY ONLY PERC RATE <2 MI GROUNDWATER HORIZON) OBSE PER SIEVE ANALYSIS 291 W 0 0 D S I D E ROAD, W. BAR N STA B LE, MA 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. Prepared for: Dixon/Re d Rooter Exc. 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. Design and Site Plan by: SCALE DRAWN DATE 15. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED) • I, Darren M. Meyer, R.S., CSE, hereby certify that I am''currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. N.T.S. DMM 05/06/19 to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX 981 requirements of 310 CMR 15.017. 1 further certify that.l have passed the Soil Eval. Exam in October, 1999. EASTSANDWICH,MA 02537 REV DATE CHECKED SHEET NO. 508-362-2922 DMM 2 of 2