HomeMy WebLinkAbout0021 MIDPINE RD - Health Bamstable,
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No. Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in w.Mute,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yef
Zipplitation for bispo8AY *pstem Construction Permit
Application for a Permit to Construct( ) Repair(J< Upgrade( )t Abandon( ) ❑Complete System [Individual Components
Location Address or Lot No..?J lgldl Q• )e Al-/ Owner's Name,Address,and Tel.No. .SU� O&Q/
Assessor's Map/Parcel 3So% C Umft7ae J PO
at�.3
Installer's Name, ddress and el.No. $j��-'77/- �/ j j Designer's ame,Ad ress,and Tel.No. 57a-
C'�rk�It- C'n ss>�r�x. i'on aco v. x awn nv_e re riAct 3q /da/1) st-.
� e
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) 330 gpd Design flow provided 3 gpd
Plan Date Inrna, -33� ao0 Number of sheets Revision Date
Title ?i 4--xi ui
Size of Septic Tank p/— �XiS�ir� � 'j°p Type of S.A.S.
Description of Soil p g
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 C and t to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. /
MFJ��/
DateApplication Approved byDate
Application Disapproved by2/1 Date
for the following reasons
Permit No. Date Issued
AO 20K�
NO. r^ J / Fee �L
t THE COMMONWEALTHOF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION TOWN OF)BARNSTABLE, MASSACHUSETTS
2pplitation for Disposal 6pstem Construction Permit
Application for a Permit to Construct>( ) Repair 00 Upgrade( ) don'( ❑Complete System Individual Components
Location Address or Lot No.a?/ /�t�%� 3, � jt, Owner's Name,Address,and Tel.No. S-
Assessor's Map/Parcel 3s)/,25- C'vmn�a�uc�� r ,� ,on t1�1,2�8,_.. t c7 •"e3���r 7/ ' .
!fit i t� rr)a.ca3�
Installer's Name,Address,and Tel.No. .J`US3 77/ g3 Designer's Warne,Address,and Tel.No.
iZx^E-v low C'�n s � to+� ,sT�c Pc• x 7 '>�n��L 2 EJY 1+fie-@,irk Y+S 3ci 1--k sf
!U t ins "1 I S tM'A Ua<,qOp "*A / r•C '
Type of Building:
Dwelling No.of Bedrooms Lot Size 3(1 D.;L sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided gpd f
Plan Date �n,rr , a3. olUl7 Number of sheets Revision Date
A y
Title 7,j-I ._ - a e n r+ -A.;q N A,,;
Size of Septic Tank - c s i ram; Ir i».�.r C Type of S.A.S.4�cz>/�I�� Ala" Y1,04V 74 /Q1 X a�
Description of Soil "5 tP `''xF P l o<
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 dispo: system iii
accordance with the provisions of Title 5 of the Environmental Code aft to place the system in'op ation until a Certificate
Compliance has been issued by this Board of Health. ,
n
Date
Application Approved by �f�! s'� U! ; 1i �Xf -,/f Af Date
�'✓ - / �r 11 v v r
Application Disapproved by / ,l Date
for the following reasons
4
Permit No. / 41 TV Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( V Upgraded( )
Abandoned( )by [�r I_`,�pa f:t<c (1�r�5�-rr ' 1 el 1: C i
at o7 t rJ Avr( ._ 1 U m )Q ey, has been cons�•ucted in a r �ce
with the provisions of Title 5 and the for Disposal 4'stem Construction Permit No. ��dated
(��j, (� k'_, ' - l / `
Installer 30r� :)1,-,Tt. (ir1S Ct.Yin��1 ,_1 ��L Designer timac^WiI ( �t � ��r- &s►1Ql I
#bedrooms 3 Approved design flow gpd
The issuance of this permit shall not be c;nstrued as a guarantee that the system will • ncas deli ed.
Date Q 7 Inspector
—: -----------.------'------- ------ ----------------------------------------------------------------------- --- -
No. / 17— 1 Fee
l THE COMMONWEALTH OF MASSACHUSETTS }
PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS
bisposal *pstem ConstrUttlon Permit
Permission is hereby granted to Construct( ) Repair''(, Upgrade( ) Abandon( )
System located at �iC( ,,, Y1-/• (�,; ,T_ � �
- f
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
f
Title 5 and the following local provisions or special conditions.
Provided:Construct i 1n must be�o leted within three years of the date of this permit.
Date A 7 �1 1 7 Approved by
TOWN OF BARNSTABLE
LOCATION �-A �'� 1-1>8 s4 t, 1 SEWAGE# O(I-64C)
VILLAGE C L o ASSESSOR'S MAP&PARCEL 3:
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) L NGN— (size) ASK (�•� X�
NO.OF BEDROOMS � °� «Q flw-v 6,J
OWNER
PERMIT DATE: i-3—1 COMPLIANCE DATE:
Separation Distance Between the: BB
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility d— Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) N Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY / CaP[ VstiryrsvirK
Try,
'AW 5T.,
s fy
.,4` Y
Town of Barnstable
I"M E Regulatory, Services
Thomas F.Geiler,Director
* BnMAS& -Public Health Division
Mass. '
s63p• ♦0�
'°PEn rnn+" T6mas McKean',Director
200 Main Street,Hyannis,NIA.02601
Office: 508-8624644 Fax: 508-790-6304
Installer&BDesig Laer Certification Form
Date: �-V Sewage Permait# '� Assessor's Map\Parcel 3 D R 5
Designer: �n(w svmw N 1W, installer: lU
Address: TM � ./Iv Address: Y5 1 a
On I l NAb lU was issued a permit to install a
( ate) (installer
septic system at based on a design drawn by
(address)
l .� . knrr dated �b,
(desigrtdo -
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 se
pt' s e )but in accordance with State&Local Regulations. Plan revision or
certi as-b y designer to follow.
H OF Mf=SSq
DANIEL& yam
(Installer's Signature) o oiaLa ,
QT IL Cn
No.46502
t /
(`0 ASS/O EH�'\
esigner's Signature) I (Affix De?iWWVStamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC'. HEALTH DIVISION: CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic/Designer Certification Form 3-26-04.doc
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PPR-21-2017 00:21 From: To:15083E2c-080 pa—ae:1/1
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TOWN OV BARNSTABLE
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LOCATION .X4 {"+"'''t h ego t.d s i� SEWAGE#
VILi<A(3E8„ A. �—ASSESSOR'S MAP 8c PARCEL -qs� _
INSTALLER'S NAMS&PHONE NO. 3q9' _
oP'i'IC TANK cAyAc ay c-<f
. L1rAC:HTNNO FACILITY: �— � , t
NO,OF BEDROOMS
•— Cw�ed cgrer�.a) i i
OWNER" _tl s !rt Ls"' I
PERMIT DATE: I —t 7 COMPLIANCE DATE:
I
Separation Distance Bcthvicen the:
Maximum Adjusted Groundwater'Pabtb to the Bottom of Leaching Facility ���Feet
j
Private Watar Supply Well and Leaching Facility of any was exist on �
site or within 200('cct of!caching facility) F-t Fcct i I
Edgc of Wetland and LcarWng Facility(if any wetlands exist within
300 feet oP lutwhing facil_it ) J _ P Feet
j FURNISHED BY �� - �
I
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�'o J-4 meh
y� De pa rtiumt of RegWatoAy.Ser vases m
4111,i Public Realih.Dxvxslon Date
rA 200 Main Street,Hyannis MA 02601
Date Soheduled D True Fee Pdt. /04 d0
C
Soil Suitability Assess ent fo ° So e isposal
1'erFormed By:Lee `lic\AC\� Witnessed By: �/•; ��,
Location Address 1 / ,/ I /� Owner's Nance
Assessor's Map/Parent: unglucer's Name
NEW CONSTRUMOIAj REPAIR T//ellephone#
Land Use: [°.S� Slopes W. ���(/�b 5urlace Stones.
r Distances from: Open WaterBody R Possible Wet-Area Drink[ng Water•Well& _tt
Drainage Way .property Line Other ft.
SI TCH.1(Skeet name,dimensions of lot,exact locations of test holes&porn tests;locate wetlands-tn proxirnity Wholes)
ao
• s
�' •L,
\ /h
Parent material(geolog[c) exl l a"e�� Depth tQ I3edr4clt Zido ,
Depth-toGrouudwater SlandingWaterinHole: 31160C,_1 WaepingfrotzlPltFnce•
Estimated Scaso--nal high Groundwater w
._Method Used: n�.11 .t�,AA.M„F`.l'N JC�JJC4-l��,C.A1:9,�.1."i_�q�.sAA�A.A. ➢'V�JC��.I�X rJd,��..li,(.I[;(. •
i� _
Depth Observed standing in obs.hole: -_ _—Iu, .:Deptla�,ts?•ss?l1 xa74ttl at. itt,
Dagth to wcepingfmm side of obs,hole: lar, t3rtlundwaterAdJudkmt nk— f`r• i
Index Well# kZcading l7akc: index Well lav4l ._, Ac�j, haor,,.,,...,_.,,...AdJ,9migidwPorLaval
PERCOLATION TEST We 10.0-0
Observation �J
Hole# ..lis ; 'liirita•at,St" _, ., ._... .. ..,�_.
Depth of Pere. 7'� ` 71maAt 6"
start Pre-soak Time @ lo:&? 'Pima(9".6°) - _--
End Pre-soapy
Rate Mindluch
_ - _ Si6e Snitabii!!y,Asaessment: Situ 1?assrii � < Sit,„Failed: _..Add[tlonal Testing Needed�t'!1`I) � ._ . __ --
Original: Public Health Dlvisloa Observaa1lon Holp,Data To Br,Completed on Back-- - ---
m*411 f pereolaado�n test is to be conducted wit�W 100' of Weta.ndp you must first notify the
Barnstable Conseyvntion Division at-least one(1) week prior to beginning.
Q:15EPTICIPERCPQl2M.DOC
nb�� Vs
t
LOG 9
a Dcptli from Sail Horizon Soil.Texture ShcI Color Soil.. 0tltcr
Surface(in.} , (USDA) (Mungrll) Mottling (Strmturc,Stones';Boulders,
o i`tcn,y.�'Critvci)
UZ
EMWAIIONRMI LOG '
Depth from SOIL Horizon Sail Texture Soll Color Sall Othar
SurPacc(in.) (USDA) (Munsell) Mottling (5tracture,Stones,Boulders.
onsis on 'Pb Grave
a YA s`z
ID EEP 01BBE .�1'.�.'ION ROLE L0 G
Depthfrom Soll.Horizon SoilTexturn Sail Color Soil Othcr'
Surface(in.) (USDA) (Munsoll) Mottling (Structgn,Stones,Boulders.
Co i to o G 0
Depth from Soil Hoelzon Soil Tcxturc Soil Color Soli 0thrr
Surface(in.) (USDA) (Munsell) Mottling (5fsactara,Stow,Bouldam,
Ca i tan 6
F10od Insane,-Rate lM—am
Above 500•year Sood boundary No_ Yes
Within 500 yoarboundnry. No�x Yes
Within 100 year flood boundary Na '__. Yes •„_
Demth.of atnraft OccelrrinaTervions&1aterfal
Does at least four feet of naturally occurring per•vio atonal exist iti all arods obge r'ved thrpughout the
area proposed fbr the sail absorption systeml
If not,what is the depth of haturaily occurring pervious Material.7
C;�ei^�tiiixcatio�n o'
x certify that on (date)r have passed fhe soil evaluator examination approved.by the
Department of Env` nm ntal Proteetlon and that°the above analysis was perfornned by me consistent with .
the required training,expartise_and experience described in�10 ClVIR 15.017-
Signature �, / Date V /
THE COMMONWEALTH.OF MASSACHUSETTS
BOARD OF HEALTH
glApplication is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal-
ystem at:
Location-Address or Lot No.
Owner Address
10
Z Other Distribution box Dosing tank
Percolation Test Results Performed by--- Z_ 3
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TLITAU 5 of the State Sanitary Code— he u dersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is e y a d =11--..
Signed... ------- ........................................ A...Date..............
Application Approved By..... ..........&� ................................. ------- ......
Date
'--'--+---
Date
Pezoz� '.
' Date
' 1
-'---'-'-----'''--'-'---
Y
No •sc- —�f Off` Fps........t.�r
THE COMMONWEALTH OF MASSACHUSETTS
" BOARD OF HEALTH
.......... ...........OF.....
Appliration for Eliipnstti Work.5 Tanstrurtinn ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at
....
/`!lUl�iN6�.....!G°A� G'uM�i.4. ?�r.�f' - -• LoT `/"---•----------------------------------•----•-•-----
Location-Address _ or Lot No
......Fee 1` -�f'r4��c•�: ----------------•--•-----•- .....���_q -
.............
Wa Owner Address n,p`�
--------------•
Installer Address
U Type of Building Size Lot,3Z1.7 Z- -------Sq. feet -�
Dwelling—No. of Bedrooms............:l...........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.._..__...........__........ Showers ( ) — Cafeteria ( )
Otherfixtures --------------------------•---------------------------'----•
W Design Flow..................5�.......--........__gallons per person per day. Total daily flow...................11.................gallons.
WSeptic Tank—Liquid capacity?�� ..gallons Length-_8 G_"..... Width__I� Diameter---------------- Depth._5 449"._
x Disposal Trench—No. .................... Width......_............. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.........../-------- Diameter........1A...... Depth below inlet........6."...... Total leaching area.z6.7......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by._.Ld!! !?�..._C:.. -L •______________ Date. f.'��L.._ ..�.����J_
Test Pit No. 1..�-4�_....minutes per inch Depth of Test Pit....!�_........ Depth to ground water.___-�--------------
Test Pit No. 2..!5�..........minutes per inch Depth of Test Pit.................... Depth to ground water........................
R+ ---•----•-------------------------------•---- -- •••. ---••...-----•......----•.......--•--•--••.......................
O Description of Soil.........A.-'-7Z'� Wooplo�4 ...,5 ? -,SaiC. j C_'q's
W
x ••---•----••----------------•--------------•---------------•---••---•---•---•-•-----•-•-----•----•-----••---•-----•-----•------•--•---••------------•-------•----------•--......•----••--•-•---•-•......
U. Nature of Repairs or Alterations—Answer when applicable................................................................................................
--------------------------------•-------•-•-•-------•--------------------------------------•--•--------------•-----------------------•-------------------•-- ...........................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T ITLL 5 of the State Sanitary Code—Th undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu th Ztf
h th.
�
Signed ..... . ----.... -------------------------_
Application Approved By............. Date
.n ------••-•--------------•--•--...---••.. aAra ------
- Date
Application Disapproved for the following reasons-...................................=..........................................................................
-•-------••......................•----------•------...------....-•----------•--------------•-----•----------------.......•----•----•--•----•-------•----••--•-••-••--•----•---------•-------•••-•-----•.
Date
Permit No..............'�s:::.__r'--'._ ��:�:------- Issued......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS '
BOARD OF HEALTH
..............77;�w.v.........OF........
_e. ..�� zq.,g.. c.`.........................
Tatifiratr of Toutplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (4,1 or Repaired ( )
by............ .....-•---.....-•-••-••...................•------••----------•---•-•-••••••.--•-------- ------•----------------------••---------••---
Installer
has been installed in accordance with the provisions of TI T 2, r of he State Sanitary Code as described in the
application for Disposal Works Construction Permit No................. .:..:=�: "._. dated__... _- __•-_-________
-'��/f�8-- .
v�. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A ANTEE THATIHE
Y_ SYSTEM WILL FUNCTION SATISFACTORY.
gel
DATE.:... ."` e "` Inspector......... .:.... . }
........ .................................. ...._.....-•----•... •-•••---
THE 1 COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
SW /...........OF...... �� ,�. ...................:.............................................No..�.... ........ a
FEs:.. ..........
Disposal Workv Tonstrudion ramit
Permission is hereby granted...........V.e,: t?f 'n •--••-------------------------------•-----.......--------••------......-•-..
to Construct (t.,f orRepair ( ) an Individual Sewage Disposal System z
at7No.----- ------- :. :. ]
Street
as shown on the application for'Disposal Works Construction Permit No-------------•------"Dated....
� r� �''�----•-
........................ --•• •.."•.,
Board of Health
DATE........�411 --• ----•...••--•.........•--•....._-----
FORM 1255 A. M. SULKIN, INC., BOSTON
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® .OF HEALTH
.................OF........ � ..
ApplirFatiun for lliupus al Works Tons rnrtiun Vantit
Application is hereby made for a Permit to Construct ( ) or Repair (t/ an Individual Sewage Disposal
System at:
....�,.1�....�1.�fJ.�".l�l! :... ��. ------------------------------------------- ---- ----------------------------------------------
___
_ Location-A.4dfess or Lot No.
...'�Q /_.-....�F��fa'�u�.�----•----•......................
Owner Address
...✓.C-0 .........4 .......................................... ...•------••------------------........----•----•--...........----.......---------------------•----
Installer Address
U Type of Building
Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a Other—Type g ------•-•------------------• P ( ) — Cafeteria ( )
Otherfixtures .----•---------------------------•--------------------.•---•---•-•--•--•------•----•-•---••-••••••----•---•------------••-------....-------•--•----•--
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons
.
WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter----_--.------ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.........--..--..... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date-------------------
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-..--.-.--.-..--_----...
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....--..................
04 ..................................................
-------------
•••........
-------------•--------•------
•--•-------•-----...----------
-......
..------------
•--
0 Description of Soil........................................................................................................................................................................
x
U ..........................---•---......................................................................................................................................................................
W
x ••-----••-••--------------------•--•--------------•----•------------------•-•--••••.....-•------••-----------••-------------•-••---•--------••--•---••-----•----•----------•--••--------------......----
- U Nature of Repairs or Alterations—Answer when applicable........*Aallli---.-----------/0-0-.Q....-..�-,4Z..... g1......
Agreement
�vfE-----------------------------------
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI.L 5 of the State Sanitary Code— undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss the h
Sign ..... .. . . . ....... ...L.. _ . . -• .................... .... ..��.'
Date
ApplicationApproved By................................ _ . --•- .................................................. --•---------------------...............
Date
Application Disapproved for,the following a ons:........................................................................................-••-••--•-===---------
--...Date----------•---
' Permit No.--••-•-----•----•-....--.---- -•---.. Issued-------------------
.. ., '. .........-•-------- - .._......---•----•-----------
Date
4y
I
}
.....•... syy
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
AR
- ---...:OF......... ..:..: u
,2� lirtt Ilan fur ispnstal Works Tonstrudiun ramit
Application is hereby.made for a Permit to Construct { ) .or Repair (L. ) an Individual Sewage Disposal s
r.,
System at
_......-••-----•------••. .............. ..........................................
.... .......--
�, ' Location-A dress No.
------
or Lot
.......................................... - ----------------••-----•-•------......---......:.-----------•----•-••---•••-•-....:_.....----
W Owner
3Address
lwa....a.. 0
Installer Address
Type of Building Size Lot......---------------------Sq. feet
1-1 Dwelling—No. of Bedrooms_____________________________...............Expansion Attic Garbage Grinder ( )
Other—T e of Building a Ty g _________ .______ No. of persons____________________________ Showers ( ) — Cafeteria
Other fixtures .:--•-•••-•--- - - - '. }
.......................................
W Design Flow...............................__............gallons per person per day. Total daily flow..................
...........................gallons.
WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter................. Depth................
x Disposal Trench—No.....................'Width Width____________________ Total Length_________.._._______ Total leaching area------------,.......sq. ft.
Seepage Pit No...................... Diameter....................... Depth below inlet—.___..._____..... Total leaching area..............: _sq:ft.
Z Other Distribution box ( )-.' Dosing tank ( ) r
Percolation Test Results Performed by................... =--= ------------ = Date
Test Pit No. I________________minutes per inch Depth of 'Test Pit_ ..._._.,............. Depth to ground water........................
Lrq Test Pit.No. 2................minutes per inch Depth of Test Pit_......... _ ___ Depth to ground water________________________
a
O y=.
Description of:Soil---•---- •-_.... •---•-----•....-••-....:
x ...................................-
W
UN ture of Re airs or Alterations—Answer when applicable - .............420 &, L $.
Agreel#'ent.
The undersigned agrees to install the aforedescribed Individual Sewage,Disposal System in accordance with
the pra- isions of TITLE. 5,of the State Sanitary.Code f T undersigned further agrees not to;place,the system in
operation.until a Certificate of Compliance has been_iss�e�,b the of h
r
rt Sig :-. -
1 ;` . Date
licat on A 'r A owed;B --_
PP PP. . . Y -
Apphcation Disapproved for the following o :_. Date
.........................................--• --- ---
Date
Permit No... Issued
Date
THE COMMLONWEALTH.�OF,.MASSACHUSETTST;'
k
BOARD .OF HEALTH' s
-
�d ..................OF:....
Tntifirate of TIt2ttphattrp
THIS IS TO CERTIFY, That the Individual Sewage D46sal System constructed ( ) -or Repaired t(t1 )
-•--- ------------------------------•--•----•._...... --- •-----•--
Installer
has been installed in accordance with the provisions of TITLE 5 of The`State Sanitary Code as described in the
`
application for Disposal,Works Construction.Permit No.__.___ -5-1b_._t_.......... dated � -_--•
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
-r` SYSTEM WILL FUNCTION SATISFACTORY. _.
DATE............... ...............--•-• ---------------------- Inspector...---.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD - OF HEALTH
RON
DIspialia1,' orks Tanstrurtion Phrmit,
Permission is hereby granted _ •? --------•-------•.............
...
to Construct ( ) or Repair (�✓') an Individual Sewage Disposal System i
at No.........
` '`i17 trl _
----••--
Street 1I
as shown on the application for Disposal Works Construction: Permit Ng.5__,f�6_7_
p B`ootealth
DATE.... --- t"' I.1 .. -----------------------
FORM 1255 A..'M. SULKIN, INC., BOSTON - ,
// APPLICATION FOR PERCOLATION TEST AND OBSI:RVA`1'I0N PITS
LOCATION ��UT Q�/� /DP/✓V•� _ NO. 17_ !i _�j
VILLAGE w/yl/T1AC�lJI U �� _ DATE
APPLICANT� C_ FEE 33"
ADDRESS TELEPHONE NO. (Non-refundable) '
ENGINEER E��l/A/Zo /CFGG�Si TELEPHONE NO. Z 2 (,
DATE SCHEDULED� 4,,o/Z/L
(Applicant' s signature)
- - , . . . . . o . o . . . o . o . . . . . . . . . . . 000 . 00 . . . . . . . . . . . . . . . . ... . . o . . . . . . . . . . o. o . . . . . . . . . . . . .
SOIL LOG
SUB-DIVISION NAME �(�/r7/!?ACt�I/1/� /�,y7-ter DATE 4121e j 9S—TIME Ou
EXPANSION A A: YES NO Ep�/gp E/ ENGINEER
TOWN WATERTPRIVATE WELI. N)� Co tjL BOARD OF HEALTH
DIfY6 � -� EXCAVATOR
SKETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes )
NOTES :
/`1 i1"PI
Pr°,,
7o.z3
i .
PERCOLATION RATE:
TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION:
1 1
2 ' /nioom C o,� 2
/v/_5)
4 _ �oclC 4
5 5
.7d / 6
7 l=IA49 . 7
8
9 SToti/E 9
10 10
12 10
12 12
13 13
14 14
15 15
16 16
SUITABLE FOR :SUB-SURFACE. .SEWAGE:':'. ':LEACHING FIELD LEACHING PITS__
. ' .: 'LEACHING TRENCHES
UNSUITABLE FOR SUB-SURFACE SEWAGE . REASONS :
NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL; COMPLETED Its ENTIRETYDY P . E, AND RETURNED TO BOARD OF HEALTH
COPY; RETAINED BY APPLICANT
D �
3¢70
1 �
of
Sy't
47''
iep71, (prta�A
N' 0 77W
43'! v/sf L oT Al 10.5'
box
��r oa25S49,y—,.1
/R 0/0nz.v�
1 1
7oI Z-3
�o
CERTIFIED PLOT PLAN
LOCATION Bi�/ST� LE �C�!HHAQvi�,
DATE oe
PLAN REFERENCE . ./3G37N4 �oT�/bS
/-��D• .ems ca.?D�D /N T�/3G /419-
i
. . . . . . . . . . . . . . . . . . . . . ' a�' •RAJ
E.
CERTIFY THAT THE L37!ST �a..UD� No.ECG Ed 't
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND2a500
AS SHOWN HEREON AND THAT IT CONFORMS TO THE .=�• CitF�.,.;=^%,'
SETBACK REQUIREMENTS OF THE TOWN OF
. . .. WHEN CONSTRUCTED.
DATE TGy.Z3i''j•9S
REGISTERED LAND SURVEYOR V 1441,q 7 F. .sw/,o- /9& e-Z> �
TOP OF FOUNDATION
CONCRETE COVER
CONCRETE COVERS
4.1 CAST 1RON r
OR SCHEDULE 482 MAX. � � 12"MAX.
4°SCHEDULE 40 PV.C.(ONLY)
P.V.C. PIPE PIPE- MIN. LEACH
PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT
?'° �snuG• PRECAST
J LEACHING
o INVERT ar.
` o EL. 4!•00... INVERT INVERT e . ; PIT OR
SEPTIC TANK .¢6 DIST.
EL. •. . . . . . EL'4c,2� • ; j= EQUIV.
,.e INVERT BOX
e; EL.4?,.�5... /000. .... GAL. INVERT �: �� �'a.
EL RO:`z INVERT w W a. :►; 3/4��T0 I I/2
G�X/S77it/6 EL. ':!3 U.
� �: , . WASHED
I STONE
° ° /B Z °• NZ.34.ig
I — - W DIA.
• , , — /o DIA----► ��..rt
PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM niorzF--. wr77-ie o/=
iNsriYu.�►-now• of
NO SCALE PiT P"VlbUS
WA S
p oQS�eV�a .4.
8 �� f3orm -j
SOIL LOG WITNESSED BY :
DATE 3,114r TIME. !;.00 '7 A'7 �?�!�'`� . BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 �= ,e4Z &v G ENGINEER
ELEV-4A.,P. . . ELEV. .. ..
V 7'o/Z/NO 8/2o S
s�B DESIGN DATA :
p�Ks NUMBER OF BEDROOMS /. . . . . . .
nl' 4z 4o,zo TOTAL ESTIMATED FLOW . . //o GALLONS/DAY
BOTTOM LEACHING AREA 7B Sd. . SO.FT. /PITlCSC,PD
/BB,So
�D SIDE LEACHING AREA . . . . . . . . SQ.FT./ PIT/377C.p?D
o
S�N�S GARBAGE DISPOSAL .IVoN .(50 /o AREA INCREASE)
TOTAL LEACHING AREA . . L67 QP. . SQ.FT
L?2., ZC,Zo
PERCOLATION RATE MIN/INCH
LEACHING AREA PER PERCOLATION RATE . Z.. SQ.FT/C.P.P,
No WATER'ENCOUNTERED
NUMBER OF LEACHING PITS .D.!ti! •Pi� h/inc,/
APPROVED . . . . . . . . . . . . . BOARD OF HEALTH • �'r'v`' / "" o� STONE' vN 19z-L
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DATE . . . . . . . . . .
AGENT OR INSPECTOR
wvl" OF
nypj n� o S L a
T E. AL y
` ELLEY
J
PETITIONER
L O CA T ON ,�..PE Rf NQ.
V I L L A C Erg--=
I H S T A LLER'S NAME ADDRESS
1 ZeZO
Q U 1 L D E R OR OWNER
DATE PERMIT ISSUED
DATE COIRPLIANCE ISSUED
i
t
�3
6
50
THE-COMMONWEALTH OF MASSACHUSETTS
0, E®AR® OF HEA TH
�S _. .... ... ._... .OF......r�l./.. _...
Appliration fur Uiipoiittt Works Towitrurtion Vrruift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst
__-(0,4 ..... ..
II l• ....
onddres o` L t
.. ............
Owner
Address
W ULel.....---.4.1w. .Sr1z_c -t._-.---_----------_--
Installer Address
Q Type of Build' Size Lot__.-_--_•___________________Sq. feet
U Dwelling—No. of Bedrooms---------
�------------------_-----Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building -----------------_------__ No. of persons..-_-_-_-.------_-_-.-.--.-- Showers ( ) — Cafeteria ( )
a' Other fixtures --------
W Design Flow__________________�G`-- Ilons per person per day. Total daily flow-__.. gallons.
9 Septic
x Disposal Trench Liquid
capacit __ ----_`�gdth. Len. gth-.'ta Len width.°---- otal leaching area-- Depth----------------
Disposal ft.
Seepage Pit No. Diameter4 � �...�e be oTiler -____ ._. tot 1 leaching area sq. it.
Z Other Distribution box ( ) Dosing tank ( ) & , d / 7_5 -,—'4f —
aPercolation Test Results Performed by-------------------------- --•---------•-••---- --------------------------- Date............ --------------------------
,� Test Pit No. 1................minutes per inch Depth of Test Pit-_---__--__-______. Depth to ground water..-.----.--_---._..-----
f� Test Pit No. 2----------------minutes per inch Depth of Test Pit..... . ........... Depth to ground water......_.__..------------
a ..................................... ----• -•-••-.....
---•--------•......---
Description of Soil , _
U - ------------------------- = ----------- -------------------------------------------------------------------------
W i�- - ---- - ----------- -
---------------=- -------------- --------------------------------------------------------------------------------------------------------•---------- ......................
0 Nature of Repairs or Alterations—Answer when applicable..----------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i the boar of ealth.
Signed:. : --- 9-7 ------------------------ ------------ -------------------
- Date
Application Approved By----- . .......... •------- -- - --- - --- ----- � - �..
15a
Application Disapproved for the following reasons:---•---•---•.................•--•--•---------...............----•-------•-----........-----.....--------------
- -------------------- •-/..._...Date
PermitNo......................................................... Ste{-----•------------------•-------•---- Issued-------/------------------- --------� -
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD qF HEA TH
�_4oL ' .OF........ . :-.......
, ppliration -for Diipuiitt1 Morbi Tomitrurtion Vrruift
Application is.hereby_, made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal.
Syst a �ress
- 1 = :..L tio or o No.
Owner Address
Installer Address
Q Type of Build' Size Lot_.--------------------------Sq. feet
U Dwelling No. of Bedrooms--_ ,ram" _. ___Fx ansion.Attic Garba e Grinder
per, Other—Type of Building __-________________________ No. of persons-._._.__________:___________ Showers ( ) — Cafeteria ( )
Q' Other fixtures - -----.
Q
W
Design Flo a Ions.per person per day. Total daily flow___ gallons.
WSeptic 1�" 'kLigt,ridcapctt" ___gdl'lons Length=:__: __:._.__ Width_-____. . .._. lliameter__-__-,._---___ Depth_ .__- __-__ ..
x Disposal Trench o _______________ ___ W> th__ _ Len Dotal leaching area--_--__ __ _______sq- ft.
Seepage Pit No __ _:._,.___. Diameter -:. e be o nle __:_:_ Tot 1 leachin area sq. ft. .
Otli&,Distribution box ( ) Dosing tank (' ) """" .. '.f� -.: ,. �.
Percolation Test Results 'Performed by..:,: -"---------------•------"-"-"""---------------------------"--"---- Date............. ------ -------------------
Test Pit No. 1--------------__minutes per inch ' Depth of Test Pit-------------------- Depth to ground water-.-___---______-_--___
f3, Test Pit No. 2.................minutes per inch iDepth'of Test Pit-----; Depth to ground water-------------------------
--------------------------------
• a -----_
-Descriptioil n _._ ____.. "
-------- ----- --------
-
-VW
U Nature of Repairs or Alterations.—Answer when applicable................ ____________ _ ___ 1:
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 urther agrees not to place the system in
operation until a Certificate of Compliance has been i the b ar of ealth
Signed - --------- ---- ----- -------
��. Date
Application Approved By----- ,r. . .. ......... ..... = Q ,
Application Disapproved for the following reasons__ ________________________
-------"-------------------------------"---------------------------------"---------------•-------------------------------••••---•-------•--------------------------------------------------------------
Date
Permit No. . Issued. `� 7 -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF,,4AEALTH C ,
O F...
err#ifirate of Tom' Plianrr " 4
THIS IS TO CERTIFY, That the Individual Sewage Disposal System conrstrt�etf- (,�') or Repaire )
by_/
--------
nstaller
-
has been installed in accordance w t�visions of Arti XI of The State Sanitary C de as escribe m the
application for Disposal Works Construction Permit No"__ -- :.-.•---._.. dated_--_ VANTEENATTHE
. .__
THE `ISSUANCE OF THIS CERTIFICATE SHALL RIOT BE CONSTRUED AS A GUA
SYSTEM %Y1 L FUN C tQK SATISFY '.,T.ORY.
a e TisDATL ector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... OF... ---------------
N FEE• ; ..
. llttl ., ,_(,��
Permission 's y granted:----LV--yam � `.STQ --•--------------- --"------------"--"-------•-------
- --------- ----------
to Con uc�t/ �j epatr ( ) an Individual Sew e Disposal ystem s:
at No -=1t'---4g =� - fi �•+ � � --
Street
as shown on the application for Disposal Works Construction Permit Dated__
" Board of•Health
'• • / 1 DATE:_ . ...7 r
FORM 1255 HOBBS.& WARREN. INC.. PUBLISHERS �t� r- - ,
.Y
_ 1
Cc. ,���
OFTHETo�
TOWN OF BAR.NSTABLE
i BABRSTABLS, S
y MA66. o� Board of Health
am
FROM THE OFFICE OF
y
ALL SYSTEM COMPONENTS SHALL BE
SYSTEM PROFILE NOTES Rt
LEGEND MARKED WITH MAGNETIC TAPE OR
PROVIDE MIN. 20" DIAM. WATERTIGHT
(NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 64
99— EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2 PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS NAVD 88 rw1
X 99•1 EXIST. SPOT ELEV. \ TOP FOUND. EL. 52.5 FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING
48.5' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 44.5' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
—[99]— PROPOSED CONTOUR (b
NOTE: 2" MIN. WALL o
(gg 4 - PRECAST H-10 THICKNESS REQUIRED BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS " L cu
PROPOSED SPOT EL. '�. USERS (TYP.) " PRECAST RISERS TO BE AASHO H-2Q `' Dennis
TH1 4 OSCH40 PVC MORTAR ALL H-20
6" MIN. SUMP PIPES LEVEL 1ST 2' 4 COMPONENTS ` Pond
12" MIN. INT. DIM. (TYP.) INV'S EL. 40.50 4 5. PIPE JOINTS TO BE MADE WATERTIGHT. oro EE
TEST HOLE ENDS
SIDES 41.5
EE
Po 0 0 0° . coo°°o°°° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH
14*
2� SLOPE OF GROUND TEE EXISTING TEE � ° ° ° ° M�00 0M0� MMM0 —M0�� o°°°o°°°
SEPTIC TANK EXISTING *46.0' ° ° ° ° o0000000000 00 � 000 � 0000 ° ° ° ° 310 CMR 15.000 (TITLE 5.) OokmontOr —�
000G000C0 0 WATERTEST D'BOX o >°o°o°o°o . o0000000000 oo�oaoo��000 '>
° ° ° ° oa000000��o aoo®a000�oo >°°°° °°
#1 D—BOX.** ,'o°o°o°o°o °°°°°°°° °°°°°°°°
UTILITY POLE GAS BAFFLE ::, �- FOR LEVELNESS N D�OO Do�o��o�Do BOO ��ooDOOCI�O� :°o°o°a°o 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO
40.77' 40.60' °°°°°°°° °°°°°°°° 38.5 BE USED FOR LOT LINE STAKING OR ANY OTHER
FIRE HYDRANT ° ° ° ° °°°°°°°° Route 6
r. PURPOSE.
.* xit 7
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING I L H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. z
(2) UNITS REQUIRED Yarmouth m '�
PRECAST H-10 ALL AROUND PRECAST STRUCTURES Q
RISERS (TYP.) OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED Campground
2'0 WITHOUT INSPECTION BY BOARD OF HEALTH AND z
:,..,..,. PERMISSION OBTAINED FROM BOARD OF HEALTH. Q
6" CRUSHED STONE OR MECHANICAL
*THE INSTALLER SHALL VERIFY THE 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING
10" 14" COMPACTION. (15.221 [2]) DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCUS MAP
LOCATIONS OF ALL UTILITIES AND ALL TEE "EXISTING TEE 0.1 *45.4' LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES
BUILDING SEWER OUTLETS AND SEPTIC TANK
#2 GAS BAFFLE 32.5' BOTTOM TH-1 PRIOR TO COMMENCEMENT OF WORK.
ELEVATIONS PRIOR TO INSTALLING ANY NO GROUNDWATER FOUND SCALE 1"=2000'f
PORTION OF SEPTIC SYSTEM 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE
REMOVED 5'_BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 350 PARCEL 25
LEACHING FACILITY.
**INSTALLER SHALL CONFIRM MINIMUM SEPTIC
TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY ( 15 % SLOPE) 12. EXISTING LEACHING FACILITIES SHALL BE PUMPED AND
FOR RE-USE. REPLACE WITH 1500 GALLON (—!—% SLOPE) REMOVED OR PUMPED AND FILLED WITH CLEAN SAND.
SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF EXIST. SEPTIC TANK #1 D-BOX 35'
NOT SUITABLE LEACHING
(AA% SLOPE) D' BOX 12' FACILITY
***INSTALLER SHALL CONFIRM D-BOX SUITABILITY EXIST. SEPTIC TANK #2 105'
FOR RE-USE.
C
MID INE OAD 47
TEST HOLE
— -- — O LOGS
SYSTEM DESIGN: " 34.70,
- 6 ,14 / ENGINEER: CRAIG J. FERRARI, SE #13871
2 • 1 3 �,
GARBAGE DISPOSER IS NOT ALLOWED a 55 WITNESS: DAVID W. STANTON RS
54 PAVED DATE: 1/10/2017
c `� _
DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD DRIVE PERC. RATE < 2 MIN/INCH\
USE A 330 GPD DESIGN FLOW a CLASS l `SOILS' P# 15246
SEPTIC TANK: 330 GPD (2) = 660 �r53 ELEV. ELEV.
USE A 1500 GAL. SEPTIC TANK \ Opt 44.5' 0" 45'
LEACHING: 53 �2 5� A A
SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD LS LS
BOTTOM 25 x 12.83 (.74) = 237 GPD
10YR 3/2 10YR, 3,/2 ,
24" 33„
TOTAL: 472 S.F. 349 GPD 51 B B
USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) EXISTING LS LS/, DWELLING � 10YR 5/8 10YR 5/8
5
WITH 4' STONE ALL AROUND o O TOF = 52.5 EXISTING 48" 40.5' 48" 41 '
GARAGE
Go
49
.. � C C
APPROVED DATE BOARD OF HEALTH MA � o#1 PERC O 49 N
FS FS
H MAR - COR BR C o
#2 O P AT HOUS - 50.1 10YR 7/4 10YR 7/4
w
O 00
7 5, 144" 3215' 144" 33'
48 APPROX.
AREA LEACHING `alb 21 4, NO GROUNDWATER ENCOUNTERED
6V 2 H1
44TITLE 5 SITE PLAN
OF
LOT 105 #21 MIDPINE ROAD
0
70 2 36,225 SF CUMMAQUID MA
7
/ PREPARED FOR
/ TOY 1AMELE
Sz-
/ DATE: JANUARY 23, 2017
Scale: 1"= 20'
����� ���HOFM,180, �oFM 0 10 20 30 40 50 FEET
DANIEL �yGN � � gssyti
o� DANIELA.
A. �s
bQ1 o OJALA OJALA 4
No.40980 CIVIL off 508-362-4541
9ye°FEss\o No.46502 I fox 508-362-9880
a¢ �FG,ISTE����`�� downcape.com
��SURGE FSS/ANAL
��G down c1#0e eadk&Fefing, inc.
civil engineers
land surveyors
l 939 Main Street ( R to 6A)
DCE # 16-424 49
DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
/ti � �-�'
16-424