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HomeMy WebLinkAbout0170 INDIAN TRAIL - Health 170 INDIAN TRAIL BARNSTABLE . x� x�` �xt: c e - -• 5q ga' �.. .. -..+y ) -r,,'.,� � r�4 � � e.d" r�.r'. � ���: - F - a ! � ,Bpi , � � �, is • . � �, ��. + a „ F a' A v + : . i R ,e , ^ L a. , 4 s -'�a^ n � �, J , ', R id y .i tI "e•}.. 31 •11 .- J:i r. _ .. G a .n�♦ c41 ' u 0 ♦ YI ai - y ,i , F a n t 1 • r I + : • +f e y•� � .' � .' ,, a .j TOWN OF/BARNSTABLE '✓;?CATION / °7® 49" cs l t�-A, / �Ara� SEWAGE #-,�200& �= VII.LAGE � � ASSESSOR'S MAP & LOT VILLAGE-4 �3� INSTALLER'S NAME&PHONE NO. o rvC f +f oN SEPTIC TANK CAPACITY LEACHING FACILITY: (type) #A i'& A f 4ize) 07 R NO. OF BEDROOMS BUILDER OR OWNER u 0.� 6u t ve L` PERMITDATE: Z3 U COMPLIANCE DATE: Ozo 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 r o tOvS� r `I 30 use sl a . r 1 � 34 �- � No. Z ;,, _ a, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Atlt hration for ;Diqool 6pgtem COttgtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ./7a s �d i %"�9 P Ow 's Name,Address d Tel.No. *^# UtdQ , -?� C���;'ve Assessor's Map/Par 1 /J Instal is N e,,�Addrej�, ``''d Tel. o. : Designer's Name,Address d Tel No �,tq��T'ru c � Dal _La'C fb 0 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(04 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 jo gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 4T1 er cj Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction anddmaitenance of the afore described on-site sewage disposal system in accordance with the prgistle f EnvironCode and not to place the system in operation until Certifi- cate of Compliance has b of alt Sign -o Date �� Application Approved by Date jZZ71ho Application Disapproved for the following rea ns Permit No. ­UjU (-3 Z Date Issued -' _ -7 Z - �No. !,a 1 �.�r..�*`-�� Fee 5 �✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes _ PUBLIC HEALTH DIVISION -TOWN OF�BiARNSTABLE,. MASSACHUSETTS '. ZIpprication for ]DigPogaf *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. , /%U _ R,u r,A i Own_ 's Name,Address and Tel.No. Assessor's Map/Parcel 'Installer's Name,Addre,ss,,�d Tel �o. _ ",ar, Designer's,Name,Address and Tel No At I/c o i Type of Building: , Dwelling No.of Bedrooms 5�� Lot Size sq.ftr" Garbage Grinder(0q Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures E t Design Flower gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title o' Size of Septic Tank Type of S.A.S. - --4"46 Description of Soil to x Nature of Repairs or Alterations(Answer when applicable) Date last inspected: rr I Agreement: 1 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 f Environme t Code and not to place the system in operation until Certif,- cate of Compliance has b essued by of alt - Sign / Qtiv'�3--o Date .✓ �. 0 4 Application Approved by / 0 Date s—/'Z1 0 Application Disapproved for the following reas ns fi Permit No. 'u►U 1- 3 1 Z Date Issued :. ' THE COMMONWEALTH OF MASSACHUSETTS \BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERT , t t re, n-siVl ewage Osposal Systems Constructed( >Repaired ( /�)Upgraded( ) Abandoned( v # c u a.c� - a 9 at 7� LA- '1 rA sr t✓ A4 A,4- has been constructed in accordance with the proAsions o Title 5 and the for Disposal System Construction Permit No.�_ �j" S Z` dated S" Z J Installer s A rati sI r v 0( o N T.0 r Designer ) �1 The issuanc of thi pet s a not be construed as a uarantee that the s st 11 fun n esi ned. Date f '!�L� 6/�V7,0-v �Inspector y g No. ) —3/Z- Fee _ y s' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Migogar *pgtem Congtruction Permit Permission is hereby granted to Construct )Repair(V)Upgrade( )Abandon( ) System located at 1 70 l A c ks %r�a,I o oof- ,ff/1101f r!70 L 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 thi it. 6� Date: S/Z'3 Approved by 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) -aJI, Zr-A.S6 t , hereby certify that the application for disposal works construction permit signed b me dated v�� P g Y B concerning the property located at 7 Olecv(/ meets all of the following criteria: All This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. v• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. V• There are no wetlands within 100 feet of the proposed septic system v There are no private wells within 150 feet of the proposed septic system v• There is no increase in flow and/or change in use proposed v There are no variances requested or needed. j/• 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:Frunptor 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(1.4)feet above the maximum adjusted' groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation (using GIS information) .B B) G.W. Elevation +the MAX. High G.W. Adjustment . = �O DIFFERENCE_ WEEK A and t SIGN DATE. [Please Sketch prop, e Ian Sf 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. q:health Folder:cent t ZJ 1 d C - s AV tl L p` c,, 0 k4, C'Z 1• ) C gcuoK ' 6�3 ti 0> r , �' - � 1{ �ev tt�R1i'FR 9 t t d�a.r -ktr r k't ^.: r`- 'k• ' x.. � f *, '.may _ +' s-L vYi' TOWN OF BARNSTABLE LOCATION.:/ 7V - V A ss ( tr r BAr,`@SL4SEWAGE # loZ VILLAGE ASSESSOR'S MAP & LOT 336 _/3- `INSTALLER'S NAME&PHONE NO. o rvC T-+ .oN SEPTIC TANK CAPACITY LEACHINGACII.ITY: .(type) elf t +i�9 t` 6,H (size) ;o R �. NO,OF BEDROOMS B'iJILDER'.:OROWNERa v� ! PERMITDATE:_ S D/ COMPLIANCE DATE. y 0 .. Separation Distance Between the:: ` Maximum Adjusted Groundwater.'Table and Bottom of Leaching Facility. Feet Private Water:Supply Well :and Leaching.FaciLty (If any wells exist on site or within 200 feet of leaching facility). Feet .; Edge of Wedand`and Leaching Facility(If any wetlands exist within'300:feet of leaching facility) Feet ! Furnished by. I ►� Dx j - � 34, 31 q/' .. 1 - Cr q �� TROY WILLIAMS MAY 7 1996 SEPTIC INSPECTIONS HEALTH DEPT. Certified by MA Department of Environmental Protection 760-1819 40 Old Bass River Road South Dennis,MA 02660 Chop oV Commonwealth of Massachusetts Executive Office of Environmental Affairs Department ®f ' Environmental Protection William F.Weld Trudy Cox* GoNrrw - .seavtwy Arw Paul Celluccl David B.Struhs LL Govwnor ConvrAsslocw SUBSURFACE SEWAG DtISPOSAL SYSTEM INSPECTION FORM t PART A _ CERTIFICATION Property Addreas- 76 Zad w ti ( Address of Owner. f�a.'i /�-� zf c✓"` �`^ Date of Inspeotton S�3�y(, (If different) Name of Inspect.,-7—J.t, w, Company Name,Address dnd Telephone Number. Se-c o.b)✓c.. da 6'(y 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: __IL resaes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspectors 9ignatt}w 5— / /� Date 1-3 // 6 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 r, B, C,or D: A] 'SYSTEM PASSES: V 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 evahiated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. ° Indicate yea, no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain w4.not) The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exhItration,.or tank failure is i-minent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / 7 d 1fn�.u in Owner. Date of Inspection: Bl SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distnibution 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 Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface 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. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Addreea 7 6 Owner. / Date of Ins f ~" 14 portion: D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage 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 clogged SAS or cesspool. — Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. — Required pumping more than 4 times in the last year NOT due to clogged or 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: The following 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) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: — the system is within 400 feet of a surface drinking water supply — the system is within 200 feet of a tributary to a surface drinking water supply — the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area GWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address 1 7(� �� !, �.Pz, ' Owner. y Date of Iispection; Check if the following have been done: ` _JZPumping information was requested of the owner, occupant,and Board of Health. None 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. ZAs 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. ZThe system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System, have been located on the site. ZThe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffies or tees, material of construction,dimensions, depth of liquid, depth of sludge,depth of scum. ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. VI The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (.revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 O �' Owner. h Try I Date of Inspeotloa: F' �-z < <✓C- S/3 y6 RESIDENTIAL FLOW CONDITIONS &w:.3 3 0 ¢au�na Number of bedrooms: 3 Number of current residents: 02 Garbage gar(yes or no):_o lAkundr9 connected to system(yes or no):Y, S Seasonal use(yes or no): i " Water meter readings, if available: (��j`d(<' " Q, ,gy_q lqo Lest date of occupancy:--! �-C, COMMERCIAL/INDUSTRIAL; /A///3 Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: /\/� yJ✓ ✓�'1,7• h H / Q✓y I w h �•i C..�r 6�-r s. �/L ia. 7 !�-.�l �`/u 1 System Pumped as part of inspection: (yes or no) A10 If yes,volume pumped: -------gallons Reason for pumping. TY7EF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known) and source of information: `�% s• /�c.,/1 g/�3/� Sewage odors detected when arriving at the site: (yes or no) �Q (revised 11/03/95) 6 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Addresx / ? 0 _71-11(:Q-l.`✓; / Owner. dl Date of Inspection: �'�Z-7 / S/3 /S6 SEPTIC TANK (locate on site plan) Depth below grader � Material of construction: Vconcrete_metal_FRP—other(explain) ` Dimensions: Sludge depth:_�3— Distance from to p of sludge to bottom of outlet tee or bathe: 02 � Scum thickness: Distance from top of scum to top of outlet tee or baffle: 6 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.) 9V�—TL- �.� `�, �� o Svc c - �. e'v o./ t�t- �- l.�Crc c/ a( r or�.Ct✓. ✓ c ca S o f y!c-e !.a GREASE TRAP:.&/l� (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.) .p (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM/ INFORMATION(oontinued) Prop.rty Addm= p —Z:� t C. Owner. u Inspection: DateofI r/3 TIGHT OR HOLDING TANK: Nli4 (locate on site plan) Depth below grade: Material of constriction:_concrete_metal_FRp_other(ezplam) Dimensions: Capacity:- gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) / Depth of liquid level above outlet invert: /—U t. Comments: (note if level and distribution is equal, evidence of so/lids carryover, evidence /o_f leakage into or out of box,etc.) ek PUMP CHAMBER:/Y (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 SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: Owner. Date of Inspection: ��'f C�'a �r/1 /3 SOIL ABSORPTION SYSTEM (SAS):, (bcate an site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching Pits, number:±&.- C /k 6 �"L leaching chambers, number- leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetat'on,etc.) V' 5: F CESSPOOLS: (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 groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) i PRIVY: (locate on site plan) Materials of construction: Dimensions. Depth of solids: Comments: (note oondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: �� Date of Inspection: s-/J rs6 SKETCH OF SEWAGE DISPOSAL SYSTEM: Indude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' oZ l l , 36 0' ao X r 1000 1.4/0 1, DEPTH TO GROUNDWATER - Depth to groundwater: feet adjusted high groundwater levf! method of determ•ination or approximation: ,�,� /6 ,� w' • -. c {..� � H A w rn,-�-,ram- ✓,,.,a� �a r7z / ��..e��i /4 J' '. 9 TOWN OF BARNSTABLE cATION 17 017I&L 61 SEWAGE # *7 AlVILLAGE �&.e`� S • ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. X L K SEPTIC TANK CAPACITY LEACHING FACIL=: (type) Asize) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: "2 /a �� 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 8qt 4 ,,, ; •'� v TOWN OF`BARNSTABLE LOCATION LOT 1% INDIAN TRAIL ROAD SEWAGE # 87-382 VILLAGE BARNSTABLE ASSESSOR'S MAP & LOT 1 36 4/3-0-x INSTALLER'S NAME & PHONE NO.BCK 778=0444 SEPTIC TANK CAPACITY 1000 GST D-BOX 1000 GLP LEACHING FACILITY:(type) LEACH PIT (size) 1000 GALLON NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER PUBLIC BUILDER OR OWNER PAUL FITZGERALD DATE PERMIT ISSUED: 7/28/87 DATE COMPLIANCE ISSUED: t 5 / VARIANCE GRANTED: Yes No r � s -- AD I Fxs............ ...... THE COMMONWEALTH OF MASSACHUSETTS �. f BOARD OF HEALTH �> ........oF.......... ... ... Appliratilan f nr Vispniittl Works Tnnstrnrtiun -permit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Systemat ........ ..... . ............................._ , Til l (�rJ ea�.J:_�6z�-tGV:t I IIP ocati.. ..._._...»..»»»_l 1.�o.3 .... .................................••••......r-Lot No..................................._..... . �� Owner Address a ............................... ••............. ••••••••-•--......••........ .... .......•-•-.........--........•................ ... ......... ...... Installer Address G� r Type of Building Size Lot.._1Q.Z 1 � feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building .. No. of persons........................ Showers a YP g .........:..:............. P ( ) — Cafeteria QOther fixtures ....................................... ....................................................................................................... W Design Flow.................. LO........_.....gallon's per n pfr qay. Total daily`flow-----..-.-7ZZP: ............Olons, WSeptic Tank—Liquid'capacitAOW...gallons Length.SKJ; ..:. Widt1�:,. ... Diameter................ Depth.._,, x Disposal Trench—No..................... Width..................:. Total Length.................... Total leaching area...............:....sq. ft. 3 Seepage Pit No.._.....k........... Diameter.......1.0...... Depth below inlet........CQ:...... Total leaching area.ZC='1.,Asq, ft. Other Distribution box Dosing tank ( " ) p _ .' a Percolation Test Results Performed by........) ....� .. �..t:l..�YJ...... Date.... .�Zf� ............ Test Pit No. 1...._...�.mmutes per inch Depth of Test Pit...L�b_. __ Depth to ground water. . Lit Test Pit No. 2...�--�minutes per Inch Depth of Test Pit.... �,.4.... Depth to ground water-._.•.................. atr . -- Z_... ............ O Description of Soil...1._.._.Q.-'. ---•-•-�-•---�._.. -----�.-_�s°.�......�....._. _.......�r..»...... 36. lZn"sty - --.. ` "..-1�p`�..'Sc ... u t� ms 6-F Lt6Y U Nature of Repairs or Alterations—Answer when app ica le.....,.-�Q( Q : _.C. P4 :.---............ .............••----•---•--......:.-------•-•--•--•-•-------•---•--------.........---•..:..:.....--•---.....--•-•---------------------•--------_•-•-----•---------•---------------:..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'AI'ALZ, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hadben.issued.by the board.of!1ilt'h: Signed. .. ......C.:.. 5 :.. ��r d...� .. .... ••• Application Approved By.... .._..: 5.1 .-••-•• - 1.._......... Date Application Disapproved for the folio .'n reasons:................ ��-�� +� �IEER MUST SiaP;'p!�l - ��r�rv�la .....---•-- .......»..»» .i= qVc-rr i%v K1t1Ii� CERTIFY IN WRIT-,;,'° .........................••-•-....................-•--...................... z......••• •......... ... s ................................... ,.�:?Fil)ANC� •�IN STlDae Permit No.. ..t�. .:.. �......................».... , Issued. PLAN: ......•----....•...........-••---• nets 362-4541 926 main street rt 6A ' yarmouthport mass. 02675 down cope enbV1aeer1174f civil engineers& land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys August 18, 1987 site planning Board of Health sewage system Town of Barnstable designs 367 Main Street Hyannis, MA 02601 4, inspections Gentlemen: , On August 14, 1987; Down Cape Engineering inspected the permits septic system on Lot #11, Indian Trail Road, Cummaquid. 'The consiruction complies with the Massachusetts Environmental Code Title V, the Barnstable Health Regulations, and conforms to Down Cape Engineering's plan 1#80-039A, dated January 27, 1987, prepared for Paul Fitzgerald. Respectfully; Arne H. Ojala, P.E., R.L.S. Inspected by: Arne H. Ojala AHO:amg No-1............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...-I...OW..0­....0........ . ....................................................... ApPliration for Disposal Works Tonstrudion famit Application is hereby made for a Permit,to Construct or Repair an Individual Sewage Disposal System at: ........................................ ....................................................... .................... LOC.6011 or Lot No. ck-la A-t-0 .............. .......................................................................................... Address ------------ ------------------------------------------------..................... ......................i lnstaller;`' Address —7 Type of Building Size Lot.9(12).`...� Sq. feet U 7� ........ ....... j Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No.- of persons.......____...._..._.__.___. Showers Cafeteria Otherfixtures ............................ "..!n................................................... ........ .( ...). Design Flow..................1.......(.a............gallons per,person" - per day. Total daily flow....'_------____------- ............gallons. Septic Tank—Liquid*capaciiy�00(_gallons Lengtl�., Width`-�-LA t)" 4 ...... Diameter________________ Depth_...........- ... Disposal Trench—No..................... Width....._._....._._._.:Total Length......_.....__._._._Total leaching area....................sq. ft. Seepage.Pit No..___... ........... Diameter....._1.0...... Depth below inlet........6 Total leaching area-:ZZ ..Lsq. ft. Z Other Distribution box. Dosing tank Performed by........ ........ ............ 'Percolation Test Results ............................................... Date.... Test Pit No. I...2�__�.-..minutes per inch , Depth of Test Pit__.!___ ....... Depth to ground v6raterA�..L)..A!__:...__. 44 Test Pit No. 2....�:7.minutes per inch Depth of Test Pit.___:!A"... Depth to ground water.Ku.....WC ........ .......... -.............. ........................ -----L-T ......;P;......................... -rop 0 Description of Soil_.. --------- .............:?�...... ...................................... ob, ................... ................... ................................................... -------------------------------------- 'P...... e_� I UW ................................................. ....It...... OF CL ,(.......... Z7 ................ ................................ ......... U Nature of Repairs or AAlterations -Answer when applicable_.__. ..... .. .. ..... .................. . ;................................. ................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T LZZ 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 hellth. Signed. ......... 9 --------------i..................i..... .......................... / / Date .....................Application Approved By.... .................0........................................ ........................0................ Date Application Disapproved for the follozvi,n_j reasons:.........0.......0.................0...... ......................... ........................................ ..........................................................0....... ..................................................................................0..................0........0................... Date PermitNo......................................................... Issued.......--------......._.._..........._.................. DaW ----------- THE COMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEALTH ........................................ OF..................................................................................... (Irdifirate of Toutphiturr THIS`IS 70 CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by................ ...................................o............. 47)11'04,1411-1 ......... installer at.......Li.., A .................... . ........................0.......-7--------------------------------------------!�!­,Z;;�............. ................................................................... has been installed in accordance with the provisions of TIT-LE, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit NoS ­�------_Z ....... dated....... ............ ---- - -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF................................................................. ............. Fzz...No.......................... ...... ----------- Raposal-Vorks Tonstrudwn famit Permission is hereby granted----'--- 1 ivt--•--•....e,V;;�.................................................................................. to Construct or Repair (N an Individual Sewage Disposal Systgh7 at No._._.. .............................................................. ..................................................................... �treet Permit .............. _�Dated....6:�._ as shown on the application for Disposal Works Construction R No!. l ... ............................... W4 I tAM ....................................................................................................... Board of Health c DATE............ ............................................................. SECTION SEWAGE \ " ` '- ��fJG�M Q�{C: . [�P 0� �Ot.t'~l�l�ArT(DN El- . 3�x 64 ��,. �� • - 'I CO —SEPTIC TANK — 1 -., ., - �O. O BOX �j� =LEACH° PI� .. TOP F FDN l.�•.�P.f..(MSU* —"2"OFIIBTO Ih" G'XI�lTl1.�(� r WASHED STONE. 1 • 1 (�I I GOtI�'1Qitl 1, ,, l<, C 3 0 I �1 - I IN•' 2(IBeO�T �✓I�t?t2S �!1�� �'r0 grc. oUlJG OUT• IN• _ 44.il`f SEPTIC 419 Z TANK 1�-u-=L 'rI� ELEV. ELEV. ELEV. \4 ELEV. ELEV. ELEV. : p� Q Ib ,�•r \ r .\ 2. :. WASHEDSTONE 1 i , CtiSZ .CD TEST HOLE LOG p f S5 TEST BY a k P� �, ,�I� f� s `[' M ILEA J S3 TEST GATE Z I Z WITNESS . . r DESIGN BEDROOM HOUSE ' I T.H. s 1 T.H. 2 ' ELEV. 53.9j ELEV. NO 1- 3<0l� Top anln Sup, bm, PERC RATE MIN/(N. DISPOSER Dig R ( I r��afi SD,�j / FLOW RATE I ((� (GAL./DAY)/ h SILT 5b..ly ti^ 8,�o SEPTIC TANK .a w(7N t3a�lvs —, RFQ'D SEPTIC TANK SIZE LEACH FACILITY 4 j GLE.Aa.1 Z' 6 I '�I .Z i 1� Mr✓�tt1M SIDE WALLh- - (Z,S) _ G/D. LCD� sAl.►D I BOTTOM G/D. �. 4 I TOTAL �r1Z �' R i USE: LEACHING �_ 1yl E EGThI� DI4M x LoI Ft=��Tl VI P` _ /'5 ESIGNIIIG ENGIN ER MUST SUi' WATER ENCOUNTERED } I ��`\ ` \`\\ 7, L)j� VV , ;TALLATiON AND CERTIFY..I1J I �\:• -IE SYSTEM WAS INSTALLED IN NOTES: (UNLESS OTHERWISE NOTED) :I �ry� 7r" "tip TC PLAN. I.DATUM(MSL)=TAKEN FROM-�fl (6_t,1�1t S ___.-.QUADRANGLE MAP ' 2.MUNICIPAL WATER ----'AVAILABLE &%JD �STlt,4c--2 I �\ 3.PIPE PITCH:IA"PER FOOT 4.DESIGN LOADING FOR ALL PRE CAST UNITS:AASHO• i -44 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1) FT. I I� 6.PIPE JOINTS SHALL BE MADE WATER TIGHT ARNE )I. I SITE PLAN STATE CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. `� OJALA STATE ENVIRONMENTAL CODE TITLES 1� "d 8 HISPt,At�l R7RPROR75FD I-lOP.k. C*JU?A1i74--k-IOIJI-D `,v�g��7, � I I ktk Of Locus: L�7 �j it1Dl�l T�.�.Il� o K10f I� USF—D FOR ,�^ LI►J e '::sT KI I r �� '�°s G(.(M M II 10 M �- 1.AL.L UI�I✓I.IITA?-,0E- MhoI'Tee-I�, �'-r'4FiC�\1 �. .10At\i0 'TZ (O LENGINEER IO _ -- _ �i�GM.b1�U17 �d�� ��� G i�lT� Llf%'JL � ..� �• REF: I�ttYJIU �gE`ID. p �I rtT�l�>✓2A�D (D` -©U'NQ (.t%A�I�E+(I•!C-7 APt;A 1 �HOI,�f f\( Or[ Pt�N ° down. cane engineeffing ®234 I • , PREPARED FOR: C I` f CIVIL ENGINEERS _ SURVEYORS .. . ryEp -v.vY BOARD OF HEALTH M� MaW SL SCALE IH. 46I 1 Z B7 oa _ CONTOURS (EXISTING)............. APPROVED DATE ��K-�JG✓��� MA SC L (PROPOSED)-o-o-o�-. . DATE 22>0 0� �`