HomeMy WebLinkAbout0009 CYPRESS POINT - Health 9. Cypress Point
A= 349-086 "
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a c7f V/-
r1` TOWN OF BARNSTABLE
LOCATION fin SEWAGE# i700 C'—36to
VILLAGE �,,� e ASSESSOR'S MAP&PARCEL: 341oi -44 cac
INSTALLER'S NAME&PHON
SEPTIC TANK CAPACITY \ �Q
LEACHING FACILITY.(type) p1 rc- 5 o 3 (size) 1
NO.OF BEDROOMS
OWNER --rm o- _
PERMIT DATE:OI - 17-,Q0DOI COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility t�3 1 N feet
Private Water Supply Well and Leaching Facility(if any wells exist
on site or within 200 feet of leaching facility) iJ A, feet.
Edge of Wetland and Leaching Facility(if any wetlands exist t
within 300 feet of leaching facility). t Pk feet
FURNISHED BY
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No. 4 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
apphtation for ais aY 6pstem'Construction i3ermit
Application for a Permit to Construct( ) Repair , ) Upgrade M Abandon( ) ❑Complete System Individual Comp
one is
Location Address or Lot No. Owner's Name,Address,and Tel.No.
/,.�
Assessor's Map/Parcel �V F ��'� $pQNc�mg`� -TAV"A 1
Installer's Name,Address,and Tel.No.�3ocu5'j're%Z 4, Rey Designer's Name,Address,and Tel.No.
Bak 6 6 9 3.4-iDwrc 4 os re.7 AfSe -& f
z o/o A?7 Z/77
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) d gpd Design flow provided SQ$4 gpd
Plan Date Number of sheets / Revision Date Al CA.1-e
Title
Size of Septic Tank .l'/S7 /000 Type of S.A.S. 7 4.-,c
Description of Soil Se-e- ^47
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by •S . Date '/7_0 Gj
Application Disapproved by Date
for the following reasons
Permit No. 2-4 Spa, Date Issued `"f 7— 200q
A
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No.
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Fee du
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
i
ftPhration for ]Bis sat 6pstem Construction Permit
Application for a Permit to Construct( ) Repair "Upgradeoe) Abandon( ) ❑Complete System 0 Individual Components
Location Address or Lot No. Owner'Name,Address,and Tel.No.
C.4) �f Pee% jooia rt T D . e-
Assessor's Map/Parcel 31y�y / �'� g pQNS-c��c.� :rA..,, c
Installer's Name,Address,and Tel.No. f,,,14--y Designer's Name,Address,and Tel.No.
�3vX 6 6 9 T.n��—.ce--r oa r6 �' talc �,.l� ;
t—Z)J �'�.6 a ono P�es-7 SA.��U-icy �'33 z�77
Type of Building: /J
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) At d gpd Design flow provided -5-4 ft4 gpd
Plan Date /o--6 9 Number of sheets / Revision Date /V c w.0
Title
Size of Septic Tank -Ph',57 loco TypeofS.A.S. 4vc S�) ��tR�,r�C�"� �✓���S�a^��
Description of Soil Se— /01.4 7
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction"and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. }
Signed r Date p-/76 19
Application Approved bydm=�i1 .S Date "/7-Off
Application Disapproved by Date
for the following reasons
Permit No.Zo<2�j- So(p Date Issued 09 -/7- 4-001
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance .�
THIS IS TO CCERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(" ) Upgraded(k)
Abandoned( )by lJckiSGie./C� �"A ,tj�,.z� SC rcir� e ►re
at --%r.�,%✓���.�—.�/.rd/L. r �Q// has been constructed in accordance
with the provisions of Title 5 and the for Disposal Systetn���onstruction Permit Nfi'� _'dated
Installer /3avSlc?e- /d/ J,th! Ceiy« 4 Designer /)/ Cvr �i
#bedrooms 7 Approved design S6 y gpd
The issuance of this pe. it sh'll not be construed as a guarantee that the system will functi n as designe\, .
P�
Date � �"� y� Inspector. �y Vw•
�-t�� �tP ----
No. --------------------------•-----•---------Fee----- ------
�-
THE COMMONWEALTH OF MASSACHUSETTS
"- PUBLIC HEALTH DIVISION,-BARNSTABLE,MASSACHUSETTS
Misposal bpstem Construction Permit
Permission is hereby granted to Construct( ) Repair(vr Upgrade(k-) Abandon( )
System located at 13.3
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— 2-001 Approved b �S
PP Y
r
xr
Town of B arnst a ble. '
h�P zHE Regulatory Services
,.. Thomas F. Geller, Director
iABNSFABLE, ' _
a Public Health Division
AFo � Thomas McKean,Director
200 Nlain Street,Hyannis,MA,02601
Office:.508-8624644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: ADM
Designer:_7)"12 ci Installer: UL,C�
Address: . CAA MA A Vyita.4 Address:
to 5!�7 log C I- DTI 5 T
On �aUSF� was issued a permit to install a~`
(date) 9 ress(�ta p ,
septic system at_ r ( � ";V�VU1 ur/based on a design drawn by
(address)
dated }
(designer)
1 certify that the septic system referenced'above was installed substantially according'to
' 11- 6 design, wbich may include minor approved:changes such as later6i relocation of the
distribution box and/or septic tank.
I cerWAhat the septic system referenced.above was installed with"major,changes (i;e,
greater than 10' lateral relocationof the SAS or any vertical ieioaation of any component
of the sepiid.,pystem)but in accordance with State &Local;Regulations. Plan revision or
certified as-built by designer to follow.
�H OFM
ffirs . 2 =�1AVID• �.:c+
t er s Signature) 6. yN
., h9ASON m
No.*046
s'�NlTAR�P�
(D er s Signature) (Aff�xs a er's$tamp Here)
PLEASE RETURN TO BARN TABLE'PUBLIC.HEALTH DIVISION. RTIFIC TE
OF COMPLIANCE WII.L NOT:BE sSUED UNTIL 'BOTH:--TgIS FORM " `_
BUILT CARD ARE RECEIVED B. ;THE.BAI2NSTABLE PUBLIC'HEkUil DIVXSION
THANK YOU.
Q: HealtWept c/Designer Certification Fora ,
Town of Barnstable r# �tY
Department of Regulatory Services
Public Health Di
ARN
>� vision Date ! ?
0.5g6 200 Main Street,Hyannis MA b2601
Date Scheduled �. .. •,,
Time .; u
D Fee Pd.
r.
Soil Suitability Assessment for.Se ge zsposal
Performed By: Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address (p Owner's Name /4--4—
V ✓� blX. Address
Assessor's Map/Parcel: 3 yg-o (o . 66 rl ?S Engineer's Name
C -ell yr
NEW CONSTRUCTION REPAIR Telephone# a
V
Land Use � �D (Tl
Slopes(go) Surface Stones
Distances from: Open Water Body ft Possible Wet Area
ft. Drinking Water Well ft
Drainage.Way ft Property Line ft Other
ft
SKETCH:(Street name,dimensions of lot.-exact.locations of test holes&,perc'tests,locate wetlands in proximity to holes)
_ Parent material /(geologic) Depth to Bedrock .,I
Depth to Groundwater Standing Water in Hole'
1 Weeping Prom Pit Face)
Estimated Seasonal High Groundwatert .
'DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles:
Depth to weeping from side of obs.;hole: In, Groundwater Adjustment ft.
Index Well# Reading Date: _ Index Well level Adj,factor Adj.flroundwater Level ,
Observation PERCOLATION TEST -Date.____-_,_, Thne,.,�,—
.' - � ITime
.
Hole# '!ime at 9"
Depth of Perc Time at G`
Start Pre-soak Time Time(4"•6'--')
r
End Pre-soak
Rate MinJlnch
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:\,S EPTICUPERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon
P onzon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
on i tent vel
Z 1
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,% ravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Muusell) Mottling (Structure,Stones,Boulders.
rnnzivton vel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munseli) Mottling (Structure,Stones,Boulders,
Consistency, I
Flood Insurance Rate Map:
Above 500 year flood boundary No
Within 500 year boundary Noy
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? L116
—15
er
If not,what is the depth of naturally occurring p sous material? &VA
Certification
/ q
I certify that on / (date)I have passed the soil evaluator examination approved by the M
Department of•Envir mental Protection and that the above analysis was performed by me consistent with .
the required training,experti and ex er' nce described in 310 CMR 15.017.
Signature Date
QASBP"rl0PERCFORM.DOC
#,i yeee f I f" O(o, ,- TOWN OF BARNSTABLE
LOCATIO r SEWAGE # 2x
VILLAGE (0",,,,Njj ASSESSOR'S MAP 6z LOT 7
INSTALLER'S NAME & PHONE NO.Wfi
SEPTIC TANK CAPACITY ./ A//GVJ
LEACHING FACILITY:(type) ar_ (size)
7
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ,6�/
BUILDER OR O NE 9FtioS .
DATE PERMIT ISSUED: '���
I
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
E- .
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qi
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076
No. Fee
�,7 . Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes ,_
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS p
application for Migpo!gal *p�tem Construction Vermit
Application for a Permit to Construct( ;pair( )Upgrade Abandon( ) ❑Complete System ❑Individual Components
Location Address pr Lot No. Owner's Name,Address and Tel.No.
t33 t,J`vr Goat A.d . CtJv`^rvT •,q. if/I/L G�a(/O S
Assessor's Ma eC LA �'
Installer's Name,Address,and Tel.No. °p-3b 2.1*2-3 Designer's Name,Address and Tel.No.
C;uio r3+ta t t!.a�►t Gc++
Type of Building: ,
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(/A4
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3�� gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1 O W t;...k Type of S.A.S. .✓LS q
Description of Soil L>VP� �<<, TJ{S 010000
k
Nature of Repairs or Alterations(Answer when applicable) Cilft'`I✓ 4 A t
H W
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 by ' o d of ealthi'
Signed `. =�/ .. Date
Application Approved by Q Date J�_
Application Disapproved for the following reasons
Permit No. %®,�" �� Date Issued _ ' 2G-G
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
he,
1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Yication for i oar p t'em Construction Permit
Application for a Pernut to Construct Repair( )Upgrade t, )Abandon( ) ❑Complete System ❑Individual Components
Location Address pr Lot No. Owner's Name,Address and Tel.No.
1 3 t 1 ,,s�` eLCr . C ,^ 5 I �-"',
Assessor's Ma /P cel L_6-1— Gr f✓ rlJ)
3�
Installer's Name,Address,and Tel.No. �' �' 3 ,Z ti Designer's Name,Address and Tel.No.
L GGic f-jA.c
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 gallons per day. Calculated daily flow gallons.
Plan Date �, Number of sheets Revision Date
Title
Size of Septic Tank I O w-j L._ \ i c 0,q Type of S.A.S.
Description.of Soil &U CAJ. 4`['$ + 14' Z),�;Uj-j
Nature of Repairs or Alterations(Answer when applicable) -Z ' c- 4
4<<i' ' to i.J �' Fi t /�ci 7> �' v et/ f�'i P��.oAl n/
Date last inspected: �...
Agreement: f
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-
„t .
Cate of Compliance has been issued by tjiis Board of Health �a
Signed __ �c.:J 4.t Y. Date .-5
Application Approved 0 µ Dateti25�- ZA'-Za5C
Application Disapproved for the following reasons
Permit No,.,V,0,,:;/- zz Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTSel
130fiSTABLE, MASSACHUSETTS wad 1�
/thOn-site
rtificate of Compliance
THIS IS TO CERTIFY,that Sewage Disposal System Constructed( )Repaired( )Upgraded(1<1
Abandoned( )by Z%2 i I.
at 2 !L//1- has been constructed in accordance
with the provisions of Title 5 .and the f r Disposal System Cons ction Pe /A 7&:' dated, 7Z-41
Installer Designer
The issuance of ttii e 'Ashall notl'be construed as a guarantee that the system 1 funct' as �igned.
Date_ f �j'kl G / i Inspector
--------- ------- —f----------------
Fee
Sy
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lwi!60aar *pgtem Construction Permit
Permission is hereby granted to Construct j Repair( )Upgrade( )Abandon( )
System located at / s G'�r'/ r �� tl t.0.1
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: Construction must be completed within three years of the date of thjSVrmit.
Date: ✓ �'' Approved
i
116/99
NOTICE: This Form Is T613e Used For the.Repair Of Failed
Septic y S stems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL; ,�
WORKS CONSTRUCTION PERMI'�('WITHOUT DESIGNED PLANS}
�.
---------------------
h6eby,certify that the application'for disposal works
construction permit signed by me dated ncerning the
property located at 33 �it�/I✓ r- IGQr (if/f�i
' meets all of the
following,.criteria:.,/
This failed system is connected t y to o a residential dwelling only.. There are no commercial or business
uses associated with the dwelling: "`
• The soil-is lassified as CLASS I 4fid the percolation'•rate is less than or equal to 5 minutes per inch.
There areno wetlands within 100 feet of the proposed septic system ,
There ate,no private wells within 150 feet ofthe.proposed septic system
There is no increase iA flow and/or change in use proposed .
There are no variances requested or needed. f l
a bottom of the proposed leaching facility will not be located less than five feet above.the maximum
djusted groundwater table elevation,[Adjust the groundwater table using the Frimptor method when'
applicable]
t
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(l4)feet above the maximum adjusted
groundwater table elevations 1
t s
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) r
r I
B) G.W.)elevation +the MAX.High G.W.Adjustment.,n I_= q � , • .
DIFFERENCE BETWEEN A and B Lf 0,
SIGNED DATE.
[Please Sketch proposed plan of system on 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.
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} G ✓GfJ �0t0 TOWN OF BAR-NSTA'BLE
LOCATION�J .,.. P �i
s . .
-:,--VILLAGE I)v�'
� � ASSESSORS MAP &-LOT
INSTALLER'S NAME & PHONE NO. UibS cZ 6z
SEPTIC, TANK CAPACITY
LEACHING FACsILITY:(type),(�iC��J
1 NO 'F BEDROOMS W
:O PRIVATE WELL PUBLIC: ATER
BUILDER OR'0: NE
DATE PERMIT ISSUED: '' �6":200
DATE COMPLIANCE ISSUED.
VARIANCE GRANTED: Yes: No
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LOCA IOa S,E AGE PE OMIT CIO.
VILLAGE
IgST LlE ;&�ll .ADDRESS
OR 000 ER
DATE _`FlrfttllT ISSUED
DATE COMPLIANCE ISSUED
1
a:
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N .............._....... ......................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
961 —7 7�. ........OF.......43.�- �.d'�'.%��L---ems----------------------------
4 A liration for Bhqpoiial Works Towitrurtinn ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
ner Address
......- -- - -3.........................................
Installer Address
Type of Building Size Lot_..� _ .......Sq. feet
U Dwelling—No. of Bedrooms...............7_a_.........................Expansion Attic ( ) Garbage Grinder
`4 Other—Type e of Building No. of ersons___-•_______•-_•____-__-_-__ Showers
G� YP g ---•-----------------------• P ( ) — Cafeteria ( )
Q' Other fixtures ----_•____________________________
-Design Flow...................... S............... per person_per day. Total daily flow-------------- .................gallons.
WSeptic Tank—Liquid capacity/04®.gallons Length.._.....! . Width__-4.../b__ Diameter__4-_.6...
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area____-____•_•--_.____sq. ft.
3 Seepage Pit No-------I........... Diameter.......6..._..... Depth below inlet......__ ....... Total Lching area._.?—.70...sq. ft. f
Z Other Distribution box Dosing tank /-
'~ Percolation Test Results Performed by -• .• __....� ? ..____ Date-__-35 ��
a
,.a Test Pit No. 1......I......minutes per inch Depth of Test Pit...... i` _•______- Depth.to ground water... _-_.
Test Pit No. minutes per inch Depth of Test Pit..... z Depth to ground waterCa
O Description of Soil--------•-•-• Z `S ---------------------- c �
Uc 'rS? _7?7 A G'c ----------------------- r—?_�y----------------------------------------..
W -----------------------------------------�� '�18p v s 4Rica
E
- -------------------7.. ..150 _ � ..�.V Nature of Repairs or Alterations—Answer w en _--.._•---------------------------------------•-..-____-__-__-__-.---_---•-___...._.........._..
--•----•-------------------•-•---•••-••--•---••-••-------•--------------•---------......-•--------------•-----------------------------------------•------------•-----------------•••.........._...•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
('1T;�-1i^
the provisions of :� :. . 5 of the State Sanitary Code—The undersigned urt agrees not to place the syst in
operat• n u til a erti- to of Compliance has been�iissuetheZb,, rdft,.
Sign ..._..81
14 2.
A lication Approved By________
...... Date�-�l•------
Application Disapproved for the following reasons:---•--•--------------------------r-•-•-------•-------•••--••••---------- ------••-••-•---•--•-••._....._--••--
........••••••••••-•••-•----•----•-____....--•--....-•----••••-•-•--••-••...••-•--------•--__...•••--•--•---__.._...•--•-----------------------•-•---------- ......... ...............................
Date
PermitNo......................................................... Issued.......................................................
Date . .
No ------------
...........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......OF.................. ..................... ......... .....................-............................................
Ap" firation for Uh4voaul Works TotwujArtion Frrutit
Application is hereby made for a Permit to Construct ('�) or Repair an Individual Sewage Disposal
System at:
...........
.........................................i.......................... . .... ............................................ .............................
Location-Address or Lot No.
.................. � .. .........................................
....... �VOwner .............................................A..d..d.r.e..s.s
Installer ......................................................................Address
Type of Building Size Lot_-1-7.6.9.1--------Sq. feet
U Dwelling—No. of Bedrooms...............3. .........................Expansion Attic Garbage Grinder fiVO)
04 Other-Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfixtures ......................................................................................................................................................
Design Flow......................SS................gallons per person per day. Total daily flow.............�3 30.............................010iis.
P4 Septic Tank—Liquid capacity/4W..gallons Length Width.4J.b.' Diameter.-4 Depth:-&-'-
Disposal Trench—No..................... Width..................... Total Length--------_-/....... Total leaching area....................sq. ft.
Seepage Pit'No......../- ----- -------- Diameter.._...._:.__..... Depth below inlet....26a... Total leaching area..................sq. f t.
Z Other Distribution box (V) . Dosing tank ( )
Percolation Test Results Performed by----------------------C -. ,
......................................... Date--- .............
Test Pit No. I-----1:...._..minutes per inch Depth of Test Pit-___-Z,5_1--------- Depth to ground water_.05r-%J'1 .....
Test Pit No _..... .._....minutes per inch Depth of Test .... Depth to ground wate6'�!f'
7--( 4' -7y 2, //--
........... ...... ..........
.....................
0 Description of Soil........... ,
W... . ...
c.
................................ ... .............................................
------------------------------------------- ............
------------------------------------------ ... .... .................................................................
------------ -----------
U Nature of Repairs or Alterations—Answer i=piccatie'................................................................................................
...............................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TTLE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
;S g ed..........6..7....................................................... ... .....................
Application Approved By.. .. ...... . ................... . ...... .Date
Application Disapproved for the following reasons:..............................................................................................................
.......................................................:....................................................................................................I..............................................
Date
Permit No. Issued...................................t ..................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF........ V
.............................. ..............................................................................
THIS Ifs T E IFY, That the Individual Sewage Disposal System constructed ll _) or Repaired
by . ........... /..............*...... ------------------- . .... . .....................�17.....;4�...........................
s a
I 7k
at`.... ---- W..................
.................................. . . .. an
.................................................................
has been installed in accordance with the provisions Of K
fy) f T4State SitarW Co an 19 zg4scribed in the
application for Disposal Works,Construction T Permit ... ...........------------------- ......................
THE ISSUANCE OF THIS CERTIFICATE"SHALL NOT BE CONSTRUED AS A.GUARANTEE THAT THE
SYSTEM WILL.FUNCTION SATISFACTORY.
•
DATE....................... ......... ..................................... 11ispector...... .......................................
THE COMMONW�LTH OF MASSACHUSETTS
E OF,, HEALTH
,.3.. . OF.......
hex-
...... .
.......... ........ 7 FEE ..._.
in panIr idrudion Vanti
P"r issionP i I hereby granted...
-
..... ... ..........................................................................................................
f )� o epair e to ConsM*, & � ...n/I In
dividual S, wa� i Syst
..... ............. y... . ...... ...at N ......wo.�O..... Street...... ..........................2...... ...............
as shown on the application for Disposal Works Construction Ppa No .. ................
............................ .................... ......................
Board of Heat
DATE : ........................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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E3OA2D. Dom` ,��EAL7s=1'2EGULAT/OrVS NUMSE,2 O,� E3EDeOOMS 3
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SEPTIC TAnI� D/ST2/PU7`i0ti/• 30�C r
�l n/D LEAC/-//ivG P/T TO '13 ..0�:- GAL�DA.-
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COnlC2ETE S_T.E'En/GTH 300�pSI ' " f
' eEQ.O' LFAC<-I CAS. .33 GAL.IDA.Y
STEir-L649
20000
D2/VEYVA Y n/OT 7-0 8E LOC•A7TE.D
• O✓E.,� SYSTEM l.JNL'ESS. H- 20- - tta.'�t�' � -. _ •
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L_0,4D/,Vo /S USEZt) -
AL L Pih�S TO Z3E.Yl/.4.TE�TIGL-{T PL.AN
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TEES.CASTC.2. O�O� �•�C�15T + .,, . ��F�,�'_EuCE G:tj�'.•-/-z�, T��t�r�::a7�r� F
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ASSESSORS MAP : 3' !_..
__ _ ___ _. _ TEST HOLE_ LOG
4 PARCEL : - -
FLOOD _
ZONE : Nd� ����L1C���-� SO L EVALUATOR :. I)�yI ,�l'.,
l � The installation shalt comply with Title V and Town of Barnstable Board of
/ _ WITNESS : 7T ,A\ Ir
REFERENCE : 1:3�7`�'g f' 4' /�� DATE: l�V( l�✓ l 'ZO Health Regulations.
w1 4) _ __. ____ ___^.__ _ ____ . The installer shall verify the location of utilities, sewer inverts and septic
``�1� D �i4�L1��,C? PERCOLATION PATE: Z MI components prior to installation and setting base elevations..
�vQVC C�1R, 2 I� _ \Id • ��� li 1. •�D � ) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" (.r foot. The first
_ � Sr Y P p P g F
TH- 1 TH-2 two feet otit of the d-box to the leaching shall be level.
2 I ) This plan is not to be utilized for property line determinatio'i nor any other
� 0 to .— purpose other than the proposed system installation.
I.
to 60-Av r ) All septic components must meet Title V specifications.
Parking shaI l not be constructed over H 10 septic componei) s.
J �(�� "T'he property is bounded by properly corners and property ,:ties.L 0 C A T I ON M I'�P
�''f The property owner shall review design considerations to approve of total
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A� ���¢ �ti``1►� design flow and number of bedrooms to be considered for :sign. Receipt
Of payment for the plan and installation based on the plan., all be deemed
:approval of the design flow by the owner.
The existing leaching or cesspools shall be pumped and fil d with material
w la+h ' t per
removed a p p used SAS shall
er Title V abandonment procedures. Those within the rc
0 y , l�� 0o �' 1,S'�' blong with contaminated soil and replaced wit' clean sand per
Title V specs.
1 `� \ � -�- _. '))System components to be 10 feet from water line. Sewer 1 :es crossing the
water line shall be sleeved with 4 inch SCH 40 PVC with f ds grouted if
SEPT (: SYSTEM DE G N applicable. The proposed SAS is being installed below the water service
____ line. The line is to be sleeved as aforementioned and maintained in place.
If a garbage grinder exists it is to be removed and is the responsibility of the
FL0W EST 1 MAT owner to ensure such.
i ')The installer is to take caution in excavation around the gas line if sucrn
\ , E;EGROOMS AT IO GAL/DAY/BEDROOM -1 _GAL/DA`' exists.
and elevation of the se��cr
1'hv in;9.;,11cr sh►i1 vcrif� the location, quantity
1 , d••,elling rrior to the installation.SEP1'�C 'LANK � 1�n��s ex�+ins ,
No GAL/6AY x 2 DAYS - GAL
N ` I USE ;��)t) GALLON SEPTIC TANK
78
SOIL A33ORPTION SYSTEM
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v_ DOTTOM AREA: 3C,. x
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�°`--� '_`'S\E P T C SYSTEM SECT I ON_�q,< T(Tl Tj
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l�W ` 00
SEPTIC TANK � _
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LE
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SITE AND SEWAGE PLAN
V, LOCATION : I tlJlva FOc�T �(Zl�l�
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4 PREPARED FOR :
DAV I D B . MASON,VN,j )ATE : l0 200
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DBC ENVIRONMENTAL DESIGNS
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_._w., _.._ __._._....�.._ _ -.__ EAST SANDWICH . MA
DATE HEALTH AGENT
, R ( 506 ) 833- 2177
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