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HomeMy WebLinkAbout0010 HOLLY LANE - Health 10 'Holly ,Lane Barnstable -3 " A - 33.6. 034 rill �=�,•�-: r- ., _ ma`s �• ��• i' 1 ..,. � •r :. „, `. �':iy x mot':,.` i 3 r " n _ r y e. , w r Y _ • e • , ' ti r _ - o , e o - a TOWN OF BARNSTABLE �� - 1S��� ° LOCATION l dJ �T� C< Z SEWAGE # S�`� d� ' VILLAGE ASSESSOR'S MAP & LOT 3 3 - 0- D; 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /J/U lc.. LEACHING FACILITY: (type) (size) 7,S— NO.OF BEDROOMS BUILDER OQO R av-0I MP- �C.., 0-` L� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 S S� TOWN OF BARNSTABLE �-'_ LOCATION L SEWAGE #j�PX3 r" V?�LAGE . ASSESSOR'S MAP &LOT.336-03i INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /SW CAL 1 � LEACHING FACILITY: (type) V.0 C41 (size) NO.OF BEDROOM BUILDER OR R u ��e PERMITDA .COMPLIANCE DATE: u L Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 3 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 /)Aov &-f A 000 SI No. 30 ++ Fee 4.. THE COMMONWEALTH OF MASSACHUSETTS Earered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for 30ioponl *p,5tem Cotwtruction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) O Complete System ClIndividual Components Location Address or Lot No. `D ®/J� lam, Owner's Name,Address and Tel.No. Assessor's Map/Parcel "Z 3 �—o 2 Installer's Name,Address,and Tel.No. K (X Designer's Nagie,Address and Tel.No. 1 POV to Type of Building: Dwelling No.of Bedrooms Lot Lot Sizesq.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 12,01 Number of sheets Revision Date Title u� Size of Septic Tank 'N!s Type of S.A.S. �� Description of Soil 1'7 3_XA_V. S"3X Z 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' B of ealth. / 9 h Signe Date l Application Approved by Date Application Disapproved for the following reasons r4 Permit No. so 15 Date Issued ^ --------------------------------------- _ O ' b No. /'°Yl r 3Q _ `" ,.''la ee �3L/ THE COMMONWEALTH OF MASSACHUSETTS `VEniered in computer: t ., es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Miopogar *p5tem O n truction Permit' a Application for a Permit to Construct( . )Repair(✓)Upgrade( )Abandon( ) ❑Complete System Adividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel t6l- Installer's Name,Address,and Tel.No. !X Designer's Name,Address and Tel.No. G�7i 9 d q1 Type of Building: s Dwelling No.of Bedrooms, Lot SizeyZsq.ft. Garbage Grinder(/�Q Other Type of Building_ iOeCiONo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow NW SS 0 gallons per day. Calculated daily flow �` �1�5 J gallons. 4' Plan Date 8/7�6//,9 3 Number of sheets Revision Date Title 15/ Al C TC //2 Size of Septic Tank P.f'i. >` s Type of S.A.S. S— ®d 9"e M Description of Soil, 417 S_XX. fF_3,' 2 i 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'slued ay, B.gr of -eallth. Signed Date /i/'/l�51 Application Approved by Date D L/9 Application Disapproved for the following reasons Permit No. G� `-so Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - Q,7er±ificate of Compliance THIS IS TO CEWr that the On-site Sewa$@ Disposal System Constructed( )Repaired ( Upgraded( ) l Abandoned( )by at fG' /�D �/ l"!,�` !�' L/ has been construct�(�d in jj'accordance with,the provisions of Title 5 and the for Disposal System Construction Permit No. a6 tl` '�(Ir1 dated fn! I (U v/,n nstaller Designer "'� 3 The issuance of s pe 't shall not be construed as a guarantee that the s Istem w'! f nction a�designed. Date t-1U Inspector {n V( No. rw `i Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Xi5po5af bpgtem Con2lruction Permit s Permission is hereby granted to Construct( )Repair(t/�Upgrade( )Abandon(� ) System located at /Z� �D 7/c/ 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 ust be completed within three years of the d too:this]pe � Date: 10 ! U Approved by TOWN OF BARNSTABLE �- LOCATION AQ SEWAGE #-1,9 C/-,?C79 VILLAG ASSESSORS MAP & LOT 3b-0 • INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY e L LEACHING FAClLrrY: (type) J�rd 64 -J (wl ' (size) NO.OF BEDROOM BUILDER OR R 2 u ,-ea PERMITDATE: COMPLIANCE DATE: k u Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching.facility) Feet Furnished by Z)w-y &—e 6sj,w•-tr 000 y- -J7b 10 E. yd rh• ' Ad OCT-08-2004 07 :28 AM DOWN CAPE ENGINEERING 508 362 9880 P. 01 Y. Town of Barnstable Regulatory Services Thomas F. Geiler,Director iW Mug l Public Health Division 019. .O Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508.862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Zl Sewage Permit# �� .-✓a Assessor's Map�Parcel -33�A4' Designer: • 1::U Installer: _JI A G/ Address: 41"S (�-t Address: 7 �✓' -Z�l�/5�e"//� On ���T�IOIT/�l'DdfS was issued a permit to install a (date) 11 II --(installer) septic system at , -i+V ` (--i based on a design drawn by (addr ss) nu.v J .dated (,e b-Z-10`h ��-r!• (designer) �— 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. 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. �4SH of rtiq (Installer's Signature) ARNE N OJALA CIVIL No, 30792 (De i er s Signature) (Affix �,c00ftp Here) PLEA E R 'FURN TQ BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE QF QaMP LANCE Ma ,L NOT BE ISSUED UNTIL BOTH THIS FORW&NJ2 AS-BUILT CARD ARE R CEIVED BY THE BARNSTABLE PUBLIr,HEALTH DIVISION. THANK YOUR Q:Flealth/Septic/Designer Certification Form 3-26-04.doc �•33`� 113 TROY WILLIAMS �� $ SEPTIC INSPECTIONS f REjyEO Certified by MA Department of Environmental Protection �� 6 1997 (508) 385-1500 s F po, 19 Hummel Drive M*0F#MA0T South Dennis, MA 02660 8 Commonwealth of Massachusetts �O Executive Office of Environmental Affairs s Department of �* Environmental Protection WHILam F.Weld Govwnor Trudy Coxe Argoo Paul Cellucel sea-Lry is CwMmor David B.Struhs Cornminbner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address /Q r/v L 1 vI C If %�+ N.� a y v, to Address of Owner. Date of Inspection: 3 ��� 7 f/; / (If different) X G Name of Inspecto 6 S b Company Name,Address 4T'elephone 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 Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature:-------- ignature: /f. �� Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within/thirty(30)days of completing this inspection. 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 as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B1 SYSTEM CONDITIONALLY PASSES: Ally 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 way 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 yonforming septic tank as approved by the Board of Health. (revised 11/03/9)) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner. L e L c Date of Inspection: 3 /S /J BI SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or 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 levelled 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: /V//' , 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 I9 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 160 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 9) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / o 1-1t' Owner. CO L� / Date of Inspection: 115 D] SYSTEM FAILS: AIM 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 failure. determine what will be necessary to correct the Backup of sewage into 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 SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or cloggedSAS or cesspool.pool 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 obstructed pipe(s). Number 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. 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. El LARGE SYSTEM FAILS: /v /// follow The ing criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) health and safety and the environment because one or more of the following condrtio the system is a significant threat to public conditions ex : 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 H of a public water supply well) The owner or operator of any such system shall bring the system and facilit y into full compliance with the groundwater treatment program requirements of 31, CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address Owner. L 1. Date of Inspeotton: ,3 /S /5 7 Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. , one of the system components have been pumped for at least two weeks 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. A(2As built plans have been obtained and examined. Note if they are not available with N/A. V The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. j - All system components, excluding the Soil Absorption System, have been located on the site. 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. 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. ZThe facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. P (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Addre" d /`f L Owner. Date of Inspection: X5 /y RESIDENTIAL: FLOW CONDITIONS Design fiow: 15 mallona Number of bedrooms:- Number of current residents: Garbage grinder(yes or no):_�i;S Laundry connected to system(yea or no): `�L S - Seasonal use(yes or no):_/\(O Water meter readings, if available: Oj =- 7 7 Last date of occu • U COMMERCIAL/INDUSTRIAL• IVIA Type of establishment: Design flow:______gallons/day Grease trap present: (yea or no)_ Industrial Waste Holding Tank present: (yea or no)_ Non-sanitary waste discharg<,d to the Title 5 system: (yea or no) Water meter readings, if available: Iaat date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMP1ING RECORDS and source of information: S /nt � � K.c UWInGv ystem pumped as part of inspection. (yes or no) N­ If yea, volume pumped gaLons Reason for pumping: •T PE qF SYSTEM —� Septic soil absorption system Single cesspool Overflow cesspool Privy Shared syTtem (yea or no) (if yea, attach previous inspection records, if any) Other (explain) APPROXIMATE/tGE:all com,7nents, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) AtO (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /. SYSTEM INFORMATION(continued) Property Addreaa: a / L Ln . Owner. L�L Date of Inspection: 31S 17 7 SEPTIC TANI{:__Ie/ (locate on site plan) Depth below / Material of construction: concrete_metal_Flip_other(explain) Dimensions:_ 03 x `7 " X GcT u c.� Sludge depth.--�2— /g- �. Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness: N ON Distance from top of scum to top of outlet tee or baffle: Al" S c. v 1ti, Distance from bottom of scum to bottom,of outlet tee or baffle:_A/U -5 Comments: (recommendation for pump condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 7 h 7't j < <—.s r d .--/4 F A h A V6 c !ram S c> i-, OC2 1 U i S U G or i �K. L �6 NS GREASE TRAP: ly'49 (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 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.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �. .,� / /f SYSTEM INFORMATION(continued) Property Address: ' / t Owner. L e t Date of Inspection: /.S / TIGHT OR HOLDING TANK: /'Vll� (locate on site plan) Depth below grade: Material of constriction:--concrete_metal_FRP—other(explain) - Dimensions: Capacity: rallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: I4 (locate on site plan) Depth of liquid level above outlet invert: Comments: //�� / (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) L!f5 p lot H OF 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.) (revised 11/03/95) 7 SUBSURFACE SEWAG E DISPOSAL SYSTEM INS PECTION ECTION FORM PART C SYSTEM INFORMATION(continued) Property Addnww Owner. / Date of Inspection: SOIL ABSORPTION SYSTEM (SAS),_k1'*" (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pit&, number:,.0 2. S leaching chambers, number._ leaching galleries, number. leaching trenches, number,length: leaching fields, number, dimensions: over1low cesspool, number: Comments: (n condition of soil signs of hydraulic failure level of n S Po ding, condition of vegetatiom,etc.) CESSPOOLS: LA M (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of gr(nndwater: inIIow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: ti1� (locate on site plan) Materials of construction: De Dimensions: Depth of solids: , Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised J 1/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (contlnued) Property Address: Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: indude Get to at least two permanent references landmarks or benchmarks locate all wells within 100' L /7t 3 /ooU . h 7S `X � ` Lec��L-, r' � DEPTH TO GROUNDWATER Depth to groundwater: feet - 1 y adjusted high groundwater lend method of determination or approximation: J w cam„ r•„ 9 r (/ Permit Number: Date:. Completed by: �' `�'ti-+ HIGH GROUND-WATER LEVEL COMPUTATION Site Location: l /7 a H Lot No. Owner: Address: Contractor: Address: Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: u2 O Appropriate index well.................................................... OWater-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 213) j determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water 1 level at site (STEP 11 ........................................ / No.... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD v9F HEA ��lG / ... OF.......P. ........... ......... . Appliratinn -for. 4%ipofittt Nvrkii C ow4rurtion Vamit Application is herebypade for a Permit to Construct ( ) or Repair (n Individual Sewage Disposal pSystem at: _ D /, Locatio Addre or o No,- -- ............ ......-•"-"-"••"'-• .......... ----- -----•-----------•--------•------ Owner t ddress a C Installer Address Q Type of Buildi VSize Lot............................Sq. feet U Dwelling No. Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) p`L-, Other—Type of Building ............................ No. of persons_-_-_---::-___--__-_---_- Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------- -------- W Design Flow.:............................:.... .. . Ions per person per day.TotaLdaily--flow,..----.-----.------.-----------------------gallons. WSeptic Tank Liquid capacity- -eons Leng ----------•----. Width Diameter Depth Dis osal Trench— o. --__--_---_�-. Wi h..... ... ... ... talT�e th-___ tal leachingarea--.-_--___:_.__-•--s . ft. x P � , 7.� q /� th below inlet ��otat leaclriii Seepage Pit No.__,l______________ Diameter_.- plg area..-_-.-_-.---_-_sq. ft. Z Other DistribuTion box ( ) Dosing tank ( ) 0-1 Percolation Test Results Performed by-------------------------------------------------------------------------- Date..............----------------_------- Test Pit No. I................minutes per inch Depth of "lest Pit.................... Depth to ground water.-.-_--.._-----._-.----- �14 Test Pit No. 2..:.............minutes per inch epth of Test Pit.................... Depth to ground wate ----------------------- R. ---------------------------- ------------------------------- Description of Soil-------- -------- `— - W --•-••-•-•---•----• ---------------------------------------------------------------------------------------------------------- x ------------------------- --------------------------------------•---•----------...........•-----•----- U Nature of Repairs or Alterations—Answer when applicable. -- :. ._. AV 6 ----------------------------------•--------------------- Agreement: " The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in 'operation until a Certificate of Compliance has been issued by the board of health. igned -•------•----•-- -.. .-----•-•--•--•--------- Application Approved B -- - te Application Disapproved for the following reasons:------------------------------------------------- ----•-------------------- --•..............•--••------------•-•••------•--••--------------•---•---------•-••-•--•-'-•-----•--••-...............-----••---------•-••-•-•. -------- •---- ------- ------•---•-------------------•--- Permit No......................................................... Issued... -- --•-- Date...... ----_----------------------- ------------- --- No.. a2 `....".... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD Qf HEALTH . - OF........ f. .. ......... .. �-- ----------- Application -fur Biipuiittl Oorkfi Towitrurtion Prrutit 4-11 Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal S1st at: KC_ f�: 'dL_I... ..._ '� ��r `% fC' ,- _ t' r - z Y :A "� - 1 ,4� ._.t...Locatio�nAa dre , !��" )oNo � !r Owner sddress Installer Address UType of Building- V Size Lot-_------------------------Sq. feet Dwelling6�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p0-4 Other—Type of Building ............................ No. of persons_-_-.------------..-------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------•--•----------------------•-- --------- -------------------------------------------------------------- ------ W Design Flow...................................>.-.----g�allons per person p'er day. Total daily flow.........................................---gallons. WSeptic Tank)-Liquid capacity- dons Length..... .......... Width... Diameter Diameter--.-.__-._.-.-- Depth................ Disposal Trench—No. .................... Vl/idth_-.......__...._ T tal Len th--... `"9.....:. T tal leaching area....--.._.._..._-_-_sq. ft. x r + � ,,< r�e f a"i 1 Seepage Pit No-------------------- Diameter..C=%�`.��_...-._ Depth below inlet....=-_.___..._.-.:. Total leaching area------------------ ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------- ----------------------------------------------------- Date..------------------------------------- Test Pit No. 1................minutes per inch Depth of "Pest Pit....-..-_.-._._-_-- Depth to ground water...-.-------..-._..---. �14 Test Pit No. 'I................minutesper inch Depth of Test Pit.................... Depth to ground/wate _........_.......______. ------ ' .DDescription of Soil--_--- ----- '� "` � �_�'�"�'�'' �a = � "�,�� ���� T�`---- &�--� -------- x ` �. Vy -----------------------------------------------------------------------------------•------------------ W ------------ ------- ------------------------------------------------------------------------------------ '-`-'' -- - '-------- U Nature of Repairs or Alterations—Answer when applicable..._._ 3_f r� � ••�ro- � �_.. - � '''------ - ------ A�Xl ----•------ -•--� ----• -- ------- ----- - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary-Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. igned � � ��''/f Dale/---••-- Application Approved BY =_-v' = ---- ------- i X ttt ate Application Disapproved for the following reasons----------------------------------------------------- •-•-•-••---------------•---•-----------•-•-•--••- ---------------------------------------------------------------------------------------------------------.......------------------------------------------------.......------------------------------••-- Date PermitNo......................................................... Issued........................................................ Date ram" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF,-FIEALTH x .. ...O F.......... . .. .... ... .. . � Trrtifiratr of 0AImpliaurr T Imo$ I TO CE�RTIh ;"That the Individual Sewage Disposal System constructed ( or Repaired ( ) o f a" Y •. •........... , Istaller *' has been installed in accordVice with the pr sions of :Article XI of The State Sanitary Co--------Z,tvv�_n----i.............. d as described in the application for Disposal Works Construction Permit No............. --: ------- dated... ---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE6 AS A GUARA TEE THAT THE SYSTEM W ` FUN TION SATISFACTORY. Inspector .DATE----- ..t. --- ----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ,f BOARD OF,--A EALTH— No.-- -^ - FEE,.-. --------- �i���,��t�� �rkY, ���,�tr�trti�$t �rr�nit Permission is hereby granted. sR •�'" ;�f ! ------------------------------------------------------------ atct Construct ( ) or Repair ( )�an Indi�duid g� p r we e Dis anal dS tem 1 l dew, ., t -street, ....... 1. as shown on the application for Disposal Wo' �s Construction P it No. . '._.... Dated_-.-1 . '1../ -'Z- _. � t = I. ord etih DATE------ ' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF. BARNSTABLE V ,UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS . (.' ASSESSORS MAP. N0. PARCEL NO. 0".3 ` ADDRESS'' i® rac LP VILLAGE CONTACT PERSON PHONE NUMBER `� 9 LOCATION OF TANKS: CAPACITY:. TYPE.OF FUEL AGE: TYPE: LEAK dt� oev-r o t+oavp —. �OR CHEMICAL DETECTION : . : SYSTEM' .� . -TVXA.A&W . DATE OF PURCHASE OF.. EACH: 1. 2. 3. 4. 5. DATE'OF: FIRE DEPARTMENT` PERMIT:. TESTING CERTIFICATION SUBMITTED: . .PASSED DID NOT PASS PLEASE PROVIDE A SKETCH .SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. k =ANK- TA�Y- HOLLY , �t,E'lylV 3 1 1 GBrd,. /IrQQt01(J N* ` Owdon Pe Nelson Nelson Coal do Ail CcopwwO Iwo 180 Iyanough Road WannUp,Piss o 02601 :. Nelsons ibnoving.CAW oomweation on the Laing of d 27thp I oontaoted John Veterina about his availabili to eowmte f eatahouee four• t datian end a 2000 gale oil honk a r new h io Quid Ho]1y �0 Y: He hesitantly admitted the he vould prefer' that .t find someone else to do the Jobo He'indicated that a,tire depa rtaeat penrndt Vvuldl be needed 7.. (which he wouIA grant)# and the installation Would have to.be made by,a. '.' wed oil: heating M8330L sad th3 top of the tank Would have to be at leas 18p (preferably 940 balmgrcuW e ; At ym eaggestlonp I then ontact" thi'AM 0690pool OpffImpyo and IA the absent® of.It a, Thom why you recoma endetp I spoke with his peon» n��:lira. Ralbdneol� who esid •they � illteorABted in doing .the eeeaavn-. tion ks and Mould like to; ineptat the location before iWdng a.commit. ment4: ;II have a tentative date with Messrs ' Robinson and Thom for this --purpose at Tonic Road i�� Q> Uo This to contingent � a __ _ �� upon � Beim able to drive x to the daps on July 5thp and I�l1..o hMm the appaintro- ment by Phone On 17 Wrivslo If you-cr your representative could be present at the,same. time it would indeed be mat helpfulo : lin try to „ phone you Wino th to sea if this ng .Will be convendent for YOUP What lid Me to do is Mall the 2000 gale tank underground and the daubla piping to the inside of the basement walls but lea" the .heating.system operating four the time being o>n its p�rre� owt 27 galo tank supply& '&sn Utwp then all the plumbing ohangee in thevftw circula- ting system we =Tleteo- the new oil supply lines cM be extended to the ba-zepry and.the old supply tank removed." 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Jql"*. �✓ I it e I li C 3 I �•�!-- -- ---- -— --- - I • •. - II it � I I I u 4 d L' F' II • i,,I THYS.:Ib.�.pa�[.-5es11;44 W6,L.. U • ,, :.-=v �: '—_ I .. _ I (�•�*I�G�WZIT dVLIMGr L N I— _ - • I , - �1 Cf.> P �.' �iy`I Q •. " TOP FNDN. AT EL. 48.05' SYSTEM PROFILE TEST HOLE LEGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO ENGINEER: ARNE H. OJALA, PE MINIMUM ,75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 46.0' - 47.0' WITNESS: 5AM WHITE, IRS * 46.5' RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 7/10/03 /LOCUS FOR FIRST 2' 3' MAX. 10 MIN. INCH PROPOSED 1500 PERC. RATE = 45.35' GALLON SEPTIC 45.1' 44.0' CLASS II SOILS p# 10,528 .I. ►+aLY TANK (H- 10 ) GAS 43.8�' �M 44.0' .. .�� v000 0000 0000000o BAFFLE o 43.17' C7 CJ Cl LO m O C7 © o & ocoo 0000 000000000000 �- 6" CRUSHED STONE & MECHANICAL 0 © 0 0 AN LANE 4 COMPACTION, (15.221 [2]) MIN 2'"' ' 0 [:3 O O O � O � � a 41.17'MIN [� ELEV. DEPTH OF FLOW l Olt ' RTE 6A (-,1-% SLOPE) ( % SLOPE) 3/4 TO 1 1/2 DOUBLE WASHED ST-)NE 47.0 TEE SIZES: 23' INLET DEPTH = 10" 1 1 ' = 14 OUTLET DEPTH MIXED UNSUIT. FI7A43.0' LOCATION MAP NTS " ` *THE INSTALLER SHALL VERIFY THE 48 LOCATIONS OF ALL UTILITIES AND ALL ASSESSORS MAP 336 PARCEL 34 BUILDING SEWER OUTLETS AND ELEVATIONS 1��0 -- _ 8.17 ! 1 j ZONING DISTRICT: RF-1 PRIOR TO INSTALLING ANY PORTION OF -SEPTIC SYSTEM SILT LOAM,. uNsulr. YARD SETBACKS: 2.5Y 5/4 FRONT = 30' 96" SIDE = 15' REAR = 15' 33.0' PERC C2 FLOOD ZONE: C STONY LOAMY SAND 2.5Y 5/4 34[si� O 00 168" 33.0' NOTES: + . 6 -+33.70 NO WATER ENCOUNTERED p 33.57 1 . DATUM IS APPROXIMATE NGVD 35.55 +33.76 SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 2. MUNICIPAL WATER IS EXISTING -_' 35.6 DESIGN FLOW: _a BEDROOMS ( 110 GPD) = 550 GPD 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. #1 32.85 USE. A 550 GPD DESIGN FLOW ITS T� 10 3 �+. UESii�N LOADING 1=0K ALL PRECAST UNITS� i v BE Ai-�Sf;v H- . LAWN AREA 33.74 SEPTIC TANK: 550 GPD ( 2 ) = 1100 5. PIPE JOINTS TO BE MADE WATERTIGHT. 3 .24 33.15 LOT 15A 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 5' REMOVAL OF UNSUITABLE SOIL 65,425f SQ. FT. USE A 1500 GALLON SEPTIC TANK ENVIRONMENTAL CODE TITLE V. REQUIRED AROUND PERIMETER OF 33.12 #9 1.50f ACRES LEACHING FACILITY, DOWN TO 32.74 (REPLACE EXISTING 1000 GAL. SEPTIC TANK) 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT SUITABLE SOIL LAYER. REPLACE WITH CLEAN MED. SAND. ENGINEER 3 3 LEACHING: TO BE USED FOR ANY OTHER PURPOSE. TO INSPECT AND CERTIFY +3 9 w 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.34.71 REMOVAL. � SIDES: 2(59 + 10.83) 2 (.60) = 167 72 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 7 a 3 15 loot `'' j2. 3 ►') BOTTOM: 59 x 10.83 (.60) = 383 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED cv FROM BOARD OF HEALTH. 37 34.26 WETLAND o TOTAL: 917 S.F. 550 GPD 10. PUMP & REMOVE EXISTING LEACH PIT & SEPTIC TANK PROP. 14'x 12' 5. 8 8 +33.79 #6 USE (6) 500 GAL. LEACHING CHAMBERS (ACME OR SCREENED PORCH 36 R ALL �56 36.67 32.27 EQUAL) WITH 3' STONE AT SIDES AND 4' AT ENDS \ 3g 4 + 32.12 L G N Q TITLE 5 SITE PLAN 47D �9 35.46 # ---- 412 2 3&45 # 3 98 100.0_ PROPOSED SPOT ELEVATION OF aa.58 44 4 ffEoc a .0 3 .46 Ma 32.53 #132.01 100x0 EXISTING SPOT ELEVATION 10 HOLLY LANE 34.19 IN THE TOWN OF: 4 '�W i 100 PROPOSED CONTOUR (CUMMAQUID) BARNSTABLE EXIST. LEACH Piz +34.92 (PUMP & REMOVE) { +4 .3 34�773 I 100 EXISTING CONTOUR PREPARED FOR: JOSEP.FI AND ALICE SWEENEY 5 3 EaCiST:SWELL. 89. yy WATERLINE PROVIDE 50' OF 40 r. 6. 6 6 a PROP. DORMER ABOVE) MIL LINER AT 5' t g� DRIVEW I 30 0 30 60 90 OFF SAS IN AREA O { { 77 7 _ 40.40 40 SHOWN. TOP AT EL - { `� �11' / Ag 40.67 1 BOARD OF HEALTH 44.0', BOTTOM AT 4 i �A�' 6a `��37.20 EL. 40.0' a 23' 42.21 41I �8 MA SCALE: 1 = 30 DATE: AUGUST 26, 2003 < 7• 142.31 I 4 3 APPROVED DATE 1 REPLACE EXIST ST .81 7 1 9 REV 6/14/04 3 8. WITH 1500 GAL. •3 2 0 REV 6/22/04 (5 BR) WATERLINE MUST BE ST 4 � � 42. 5 off 508-362-a5af / +48.4 + 42.4 �42•2 fax 508 362-9880 RE-ROUTED TO BE 10' \ +42. FROM SEPTIC SYSTEM +a8.6 6. 42.86 1- - 82.07 I I ���'1HO- +1�s c � �'A FM,�ss9c COMPONENTS as a7.91 4- down cope engineering, Inc, moo ARN9 H ya � ARNE 4 05 +as.9 o OJ ' H. 8.4 +482ppMENT CIVIL ENGINEERS " CI L `� OJALA N 3 2 -6v � A No.28348 L=2-.4 172.56' LAND SURVEYORS =25.41t 03-064 HOLLY LANE 939 main st. yarmouth, ma 02675 ON* AR H. OJALA, P. .L.S.` DATE