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ASSESSORgfAlo. 'a PARCEL Qp Aploo�
LOCAT N Zn - SEWAGE PERMIT No.
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VILLAG
I N S T A LLER'S NAME A ADDRESS
B U I L D E R OR OWNER
' 4 DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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No._ ._..._..---- t; Fes ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
w.0...................OF.....a,'t 3l 4.6f�..........................................
Appliratiou for Uhipoii l Worke Tnntrnrtinn Prruat
Application is hereby made for a Permit to Construct (>() or Repair ( ) an Individual Sewage Disposal
System at:
................_........_..................................................................... ............ ..............................................................
Locafionj ddress ) -� or Lot No.
---.....C4?r�/ P..��a: _ ,, .---6-e.11.4e_"s'2S� 1 z2zk rl •:`�_....4 G ------•------••------------------•-----•--
a ner tl / r,,. 9 Address
............. ---•--`--•. "_...... ��� r��? f .h/. :....-•------•--..•---•-•------•----•----------•-•--....
Installer Address
Type of Building Size Lot__90_7_Q_z_.0....Sq. feet
U Dwelling—No. of Bedrooms.......... __________________ _____Expansion Attic (4) Garbage Grinder
Other—Type of Building _______________ No. of persons____________________________ Showers — Cafeteria
Other fixtures _________________________________ _
W Design Flow................................._ter_ __gallons per person per day. Total daily flow.................. .'IE1__0___.___.___..gallons.
WSeptic Tank—Liquid capacityld.C4__gallons Length Diameter________________ Depth_S_�'q__-
x Disposal Trench—No_____________________ Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No........,"_________ Diameter...../0---______ Depth below inlet__S.4_7__.!. Total leaching area._S./4_____sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.c(TI_.CA._&9ru>K
Test Pit No. 1_____?:_______minutes per inch Depth of Test Pit--- l3___. Depth to ground water____ . 'fit of �4
(r4 Test Pit No. 2................minutes per inch Depth of Test Pit__:_-/_.Z_`____ Depth to ground water_ ..........
a0 7'/--'- v-6 �� ktua�.l 2z�_.�,`.�.4Zu .. r.C�__ ne .` a c Fl j.4 ��.b�"._!'ern....--•-----•---... S��R6t td
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Description of Soil_. x) -- cancl'y-- _I I�fkk_-dab_ 7sn �__►Y11 cA-Fyl¢___5.ctnd_______________________ A.LLYN_
vTP Z J_L? �.'J_L�aa /c airr�_ '_''4$.__ rn�.. lcan� _. Iz e� l�_Qfs"=. .� -•--=•-•-- •------------ � ._.•wILSO.. y
No.30216
------------------- - '�
GIST
V Nature of Repairs or A terations—Answer when applicable__ ._ -__8 c//.a_ ......................................
Agreement: v�G
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with/,e_4-r_T
the provisions of TITS 5 of the State Sanitary C de— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issue b t e boa
Signe -•- •-- .4,ealth.
- -- -----••---•...-----•-
/ ate
Application Approved By......... •- •--•• -• -••---•••----- ---••---------•----•--• ---•f --- -
D t
Application Disapproved for the following reasons________________________________________________
............:.....y_;...._....__..._._______._.____..._.__________________.._.___.__.______._._._.____._.................................................................................................
/ �� Date
(/:�__Permit No. . ....I....-----..................... Issued_.__.._.........------------
Date ._
1 �
THE COMMONWEALTH OF MASSACHUSETTS
ABOARD OF HEALTH
ti
-•----. .................~4.:::......OF.......
/"R.c ?T9.t1...�'..._......
Appliration for Bhip ial Workg Toutitrurtivit ramit
Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal
System at
................_.....__.......... --•-••........Q x-...1 ' ....... ----•------------..........------....
Location-Address or Lot No. '
r _fa�izt iSc ......................................... ----- L9/.c ._1;5 c l-.t.19e1_1.----•-••---•----------------..............
r Owner Address
W ......................................................
Installer Installer Address
Type of Building Size Lot...00t.70Z_-...Sq. feet
U Dwelling—No. of Bedrooms............ ----------------------Expansion Attic Garbage Grinder (A 4
Pk Other—Type of Building -------------•_-__--__--_.__ No. of persons............................ Showers ( ) — Cafeteria ( )
QI Other fixtures .._................. . . .
Design Flow..............................5'a�_ allons per person per day. Total daily flow.............___..._
W g --- g P P P� �Y• Y N '�-•--- ............gallons.
G; Septic Tank—Liquid'capacity.0.0,d_gallons Length.1D--A... Width._.T_4Z.- Diameter--___- --w.. Depth..�_"y..
Disposal Trench—No..................... Width....../............ Total Length.................... leaching area....................sq. ft.
__
Seepage Pit No---------a-------- Diameter------10. ..... Depth below inlet....SA_Z____ Total leachirg area----:T14....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by..Ca►arc__Lei•Su�t�,�?..�Gonssl ri'h=....... Date_._:!2.S.'
a Test Pit No. I......a......minutes per inch Depth of Test Pit---- Depth to ground water- QF •y
i6j� •�'.
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit_._"-/Z.�... Depth to ground wat �, ........... s
............... �g -
�I a n w
SIEFI04--
Description of Soil__. SetncliyT��'-(obi-��ifa�A�tt��._1121sta-F►Lo__�a ................. Q - _._ALLYR----
WILSON
`� �----------------------
f��n 71 .o `No.30216
--=✓�Id-.�.��artc-At1ar,✓,fiac-aSn -�r ,�o.Er6l�--------------------- n,-� .......
UNature of Repairs r A erations—Answer when applicable___u. .yb_..8!'.�ja�_______________________________
sS%ONAL
Agreement: ot
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance Witb
--�
the provisions of rt iZ rr i I.5.E' 5 of the State Sanitary C de—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beenlissued b the board of,health.
Signed y =it ........ ��-r"'f...
................................pate
Application Approved B !z�.~�— rp/_.__ _j ' .�.._
/ f Date
Application Disapproved for the following reasons:..............................................................................................................
--------------•------------•-•------•-------•---------------•--------------------.•....----•-------------••••-•••--•-•---•••-•--•-•-•---••-•----••••-•--•--------------•-•-----•••------•--••••••-----•-
Date
PermitNo.......F---Z--------/•'--------------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............................................................,
�prfifiratr of, flu t�rli �tr�e
THI IS TO CERTIFY, That the Individual Sewage Disposal System constru•tc,gd ( � r Repaired ( )
by. ... . L/ /~ Installer ..._.. �" •._.....----- .. ..................
at. f
has been installed in accordance with the provisi is Of r' 1 5 of The State Sanitary Code as described in the
application for Disposai Works Construction Permit No....U,E_ _..-__1� ............ dated_...__.?_ fir._ ....................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A G ARANTEE THAT THE
SYSTEM WILL FUN ION SATISFACTORY.
DATE.................. ._/ . .............................. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
�~ BOARD OF HEALTH _
NO. r.... Y�E ........................
apaoal Morkii Tomitr ion-- rratit ,
Permission is hereby granted.__ y.....................
to Construct r Repair ( ) an Individual Sewage`bisposal Syst
.-
' Street N
as shown on the application for Disposal Works Construction Permit No.... /..'._��Dated.'._ -----.�.-..
________________________ __--._-._...................................._..........
Board of Health
DATE..... 11.►...... , ..................... ........
FORM 1255 HO'BBS & WARREN. INC.. PUBLISHERS
Thi o 805 Date: December 20 '1985
+Eog°Number: Bottle_.# � r
BA BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT
a SUPERIOR COURT HOUSE
v BARNSTABLE. MASSACHUSETTS 02630
Ase DRINKING WATER LABORATORY ANALYSIS PHONE: 362_2511
i t. . . Ext.'337
Client: GaryA Houser ' ' Collector: Davi°d` E'. Cahppell
Mailing Address: ' P: 0. Box 534. '' Affiliation: well driller
Barnstable, MA 02630 Time & Date of
`Collectiori: 12/19/85 11:30 a.m.
Telephone:. Type of Supply: well
Sample Location: Old Jail Lane Well Depth: 93'
W. Barnstable, MA Date of Analysis: 12/19/85 12:00 Noon "
`PARAMETER•' SAMPLE RESULT RECOMMENDED 'LIMITS
Total Coliform Bacteria/100 ml[ 0 0
pH
i
Conductivit ` (micromhos/cm) 500.0'
Iron ( m) 0.3
Ni trate4i tro en ( m) 10.0
Sodium ( m) 20.0
I . X Water sample meets the recommended limits for drinking of all above tested parameters.
II . Based only on results of the parameters. tested for this sample, the water is
suitable 'for drinking but may 'present` the problems checked below:
A. ' ' Water sample- has higher than- average levels of Nitrate. Future monitoring 'is
recommended -(2-3 times per year) to establish any upward trends.
B: 'the water may shorten the useful life of the Phouse's plumeirly.r�
C. Water may present aesthetic problems (taste, odor, staining), dUe- to
D. Water sample has high levels of sodium. Persons on low sodium diets should
consult their doctor.
III. Due to one or more of the reasons checked- below, this water sample is unfit for
human consumption: . °A. High Bacteria B. High Nitrates
REMARKS:
Department shall not endorse any statements,
interpretations or conclusions made by anyone
R, else concerning these results without written axweK.
CC: Barnstable Board of Health .
CC: ;
d orat y Dir r
1 /7/85
l C
,1.
D Y
Explanation of Test'Results V
lo
Total Coliform Bacteria +
Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become "
contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero
indicates that your water supply is safe and approved for human consumption. A total coliform count.of greater than
zero is most often the result of accidental contamination of the sample bottle through improper sampling methods.
For this reason, it would be advisable to retest any well water that is not approved.—
pH
pH is the measure of acidity or alkalinityof the water:On the pH scale,the number 7 is neutral,less than 7 is acidic
and more than 7 is-alkaline. The pH of water on Cape Cod tends to be acidic,in the'range of 5:0 to 6.5. -
Conductivity
Conductivity,is a measure of the dissolved salts in solution. Amounts in excess of 500,micr?mhos/cm are generally
considered unacceptable and'may have a laxative effect upon users. �'
Iron
The presence of iron in water in concentration of .3 ppm or greater may-' give the water a bittersweet astringent,. w
taste, cause an unpleasant odor,'often gives the water a brownish color and cause staining of laundry and-porcelain.
The average concentration of iron in Cape Cod's water is .2 .6 ppm.'Although the presence of iron, in water may
cause the problems listed above, it is not considered deleterious to health. Iron may be'removed-by-use of an iron
removal system.
Nitrate-nitrogen r , , t 3 ��} 'a ^!•r
The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 40 ppm.
Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to form
potentially carcinogenic nitrosamines. Contamination-sources include fertilizers, cesspools and industrial wastes.
Copper J ; ,X J '�
Due to the acidic nature of the water.on Cape.Cod', copper tends t%o leach,from pipes. This,normally does not
present a health 'hazard; however, concentrations in excess of 1.0 ppm-may cause a metallic taste and/or a
bluish-green stain on porcelain fixtures. _
Sodium
A concentration of sodium over.20 ppm is only of concern to people who are on'a low sodium diet. If the .water.
supply has more than 20 ppm sodium, it is,up,to the people whosare on*such a diet to find another source of drinking
water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm
indicate-ttiatithleretrnayrbe7fd ean!`watbt�or water getting into the well.-- - -
F2#,7::Yi:)eillr: �t1L) rys:iF.7s,.7,?:') ja �.�'J+l?• it ' [71i C i{i ii
eNt w4';.'ryno 'kd; s37Jm a::;t:it; (i.:) IQ
e 1r m4thw 3oo4tiW xt44sam f';wAt sale
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- SOIL TEST PIT DATA. " INDICATES INDICATES SEPTIC TANK DETAIL: ! " . = _._ DISTRIBUTION BOX DETAIL: LEACHING PIT DETAIL:
PERC. -5-- OBSERVED NOT TO SCALE NOT TO SCALE NOT TO SCALE
rvo I)AIE
TEST GROUNDWATER
-.- -,. T :- -LOAMB SEED -I IZ/�
NO ES SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BE CAST IRON OR __/ '�� _ NO. OF OUTLETS: _ MANHOLE COVER LOAM
PAVEMENT
TP TP TP NOTES - / H GRADE
/ � :� TP REINFORCED CONCRETE. T_ BROUGHT TO FINIS I �-
SCHE0. 40 PVC. TEES TO BE CENTERED UNDER T
GRD. EL. -__-._-__-.- MANHOLE COVER. L__. .__-___
GIRD. EL. �y-4_ GRD. EL. __ GIRD. EL. 9 •`� SEPTIC TANK TO WITHSTAND H-IO LOADING r- - �'- `--- I. DIST. BOX TO WITHSTAND H-IO LOADING 2 MIN OF I/B
,,/ UNLESS UNDER PAVEMENT, DRIVES OR
GW. EL. _�-r�— GW. EL. �_ GW. EL._// Q• GW. EL. TRAVELED WAYS,WHEREIN H-20 LOADING I I UNLESS UNDER PAVEMENT, DRIVES OR TO 1/2" 12°MIN. FILL Z
.0 /�cC� /Air/ 4 — ''
C1'' q SHALL APPLY. j J PRECAST I TRAVELED WAYS WHEREIN H-20 LOADING WASHED /
DIST ( I SHALL APPLY. STONE a ice.
3 ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER f .' ►
_7?N�� STONEY CONSTRUCTION TO BE WATERTIGHT. BROUGHT TO FINISH GRADE Box r 2 PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF
PVC INLET PIPE
i on o r� to o 0 oac
i I INLET PIPE EXCEEDS 0.08 FT/FT. OR IN c c
a PUMPED SYSTEM. oQ9P�. Ctjj
tf5 ofL
2"MIN !____�� ! ❑ o o 0 0 o n ❑ NOTE GENERAL NOTES.
3 FIRST TWO FEET OF PIPE OUT OF DIST _ /l ° o� LEACHING PIT TO
ALEIEL
BOX TO 8E LAID LEVEL. O � WITHSTAND H-10 LOADING
PLAN VIEW w R o >>° o � • ❑ o 0 of oSo n o ❑ o, ,,Q� I. CONSTRUCTION OF DTHEIGSEWAGE
� UNLESS UNDER
REMOVEABLE PAVEMENT DRIVE ORNORMAL WATE w 4 3/4TO 1-1/2" ❑ A r-D c Q a o n ❑ � DISPOSAL FACILITY ONLY.COVER DOUBLE LEACHING PIT oTRAVELED WAY' WHEREIN7-1 � H-20 LOADING SHALL 2 ALL CONSTRUCTION ME7HJDS ACJD
- - _. gJ I w WASHED APPLY.zt- PROVIDE U_ STONEuMATERIALS SHALL CONFORM TO MASS.
I _ — INLET TEE w • ❑ a r� o 0 0 0 ❑ b gvOF HHEALTH EGULATIOS. BOARD
WATERTIGHT <L r (no fines
s JOINTS(tyq) I I I
7 �tf"J1 eJ�_ PRECAST 1,. ,�/ _
7 -'1 I „ 4'-0" MIN. OUTLET J ¢ ._ _ f- l SEE 1 I L . v0 Q
,I SEPTIC f LIQUID DEPTH TEE 4" INLET �INOTE 2 ''I r. I - + R� -� 3. ALL PIPES LOCATED UNDER PAVEMENT
TANK
I`' .� i -. _ 1 I - ,•� , 1 l n ❑ o 0 0 0 0 o n ❑ OR TRAVELED WAY SHALL BE
F I — — I �!1 �• 4"OUTLET � 1 � � � --1--- q5 ° D -J_
f %/✓� T. t S� /✓f j a o o SCHEDULE 40 OR EQUAL
�i-1/� S7N� L ; - - - - - - - - - - - - - --J --- --1- - - - •L------1J L--------�. — 2, ----- DIA _ �? �` 6 MIN 4 IF ENCOUNTERED, At_t_ UNSUITABLE SOIL
��; > 5 ---- • - o .� b .► - BOTTOM ON lr SHALL BE REMOVED WITHIN A +a'WIDE
f�1 /� q ao� BOTTOM ON LEVEL STABLE BASE O. _po "o �o� F- ____...._ __ -_. .. ._ _ -__.- - - SH I FACILITY
BASE
� yo. LEVEL STABLE -- /J DIA--------- # ZONE AROUND THE LEACHING
CROSS-SECTION '"3j " �-/�//:
PLAN VIEW � CROSS-SECTION VIEW AND SHALL BE REPLACED WITH CLEAN
CROSS-SECTION SAND AND GRAVEL IN ACCORDANCE WITH
TITLE. Y.
5 PROPERTY LINES SHOWN HEREON
DATE: DATE: DATE: Ps .- DATE: �, ; O
INVERT ELEVATIONS:
WERE COMPILED FROM A PLAN
e r- RECORDED Al BARNSTABLE REGISTRY
TEST BY: TEST BY: TEST BY,: TEST BY: Q 50.e) OF DEEDS IN PLAN BOOK 389 PAGE 12,
ZONE RG INVERT AT BUILDING _
L AND DOES NOT REPRESENT AN
WITNESSED BY: WITNESSED BY. - WITNESSED BY: WITNESSED BY: INVERT AT SEPTIC TANK(in)
sEreACKs
-- ACTUAL SURVEY ON THE GROUND.
` INVERT AT SEPTIC TANK(out) 07 . b
Q " .y 6 TOPOGRAPHIC SURVEY BY TRANSIT 9
PERC. RATE: PERC, FRONT .30 �.
RATE: PERC. RATE: PERC. RATE. p� �� � �
c =. MIN./INCH __._. - MIN./INCH - - MIN./INCH MIN./INCH SIDE 15' ,�0 �I , INVERT AT DIST. BOX(in) �`� STADIA METHOD
REAR /5" `� � � o � INVERT AT DIET. BOX(out)
0� ,� �� INVERT AT LEACHING PIT rd�•�l
�, n rn
DA UM. E I °D 't BOTTOM OF LEACHING PIT
loll 1 ` U.S.G S. MAXIMUM GROUND
VERTICAL DATUM: WATER ELEVATION
s "~ °` `�08 -- " =�' , ` m OBSERVED GROUNDWATER
;,� / `� g g
BENCHMARK USED , .,�. 3 207
.�=%�" ma's/
s
f i
LOT /7 / DOP '
LOT l6 .• __. cr
i
1
750
6,
00
120-00,
DESIGN CRITERIA.:
LOT 19 _ ,� / �I �,. t DESIGN FLOW:
Je r y ~ — —
\ '� ` j ° 55 _BEDROOMS AT /:! G.P.B./D HOG.P.D. -
LOT 18 - — - --
r' 90,702� SF \ ..-' �� / r' - v T(�P O F�&Y'( E T) fir J r1
t
.•^' t \ ` �' ELEV.V.68_39'
` 79 / Group
r / , ell � \ ` � � f � _ ' j � 19 _.- REQUIRED SEPTIC TANK:
The B
-... r, ,
SEPTIC TANK PROVIDED: _ GAL.
Cape Cod Survey Consultants
�, / / �4 ( ./ 1 . '";.: p► 53 SIZE OF LEACHING FACILITY REQUIRED:
ff
J a `� \ / f 9� ' I -�" 4� i r _ -- ro
Ir`N PERC. RATE: _ _ _-_ MINJNCH 3261 Main Street
2
0• i
� � r'' �-•" --% � / � q'' / � r ,,- _-' I � r;= , � ._, ._ -- - - `-.—i - - _ - Route 6A
f 94 yr i `_ �` \ '`*`' / I �' ,, �/, .. - _- - - - Barnstable Village MA
02630
�, ti✓ `� �'' ,b \l -- ' ' �, , �` f r, �, �J f �f --- _ -- - -- - 617 362 8133
in
\ Vy
G - -
I ,` l✓ l -- SIZE OF LEACHING FACILITY PROVIDED:
F'"T"7' `� �r ~` pc+� d 2 r I ` , i'ROJECT TITLE
;
+ � ,; WA TER L/NE
q
W - SEWAGE DISPOSAL
}t PROPOSED CONTOURS ,
EXISTING CONTOURS Cw<�,�..i r
.74 SYSTEM DESIGN
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o - — - BARNSTABLE, MA.
1.4
c loll,
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LOCUS PLAN:
7f 5
,
° f / /# �' ` PRf PARED FOR
1 / ! / � 1 ` V' "' - __-• l �
� y¢ f / I � GARY ROUSER a
� l \ - .. f l / 1 / PROFESSIONAL LAND SURVEYOR DATE '` .4 �� JOSEPH BELLEROSE
S 75
6 _
,
im (� DATE. 12/ 3/85
0.00
yvtLS
✓ ` 4/..38' / _ 7 /3 29 '`4 '\ '� of COMP/DESIGN G G.M.
2 " \ — -- -
I S 64 r / \ `�,c}' „��?/� Q CHECK: S.A.W.
PLAN VIEW r 6 - G.G.M.
--- -
rJ RAW N
__ FIELD: D.J,B./ T.J.Y.
SCALE: 1" = 20� PROFESSIONAL ENGINEER-CIVIL DATE
UNDERGROUND UTILITIES WERE COMPILED FROM AVAILABLE , FILE NO:
_ —
RECORD PLANS OF UTILITY COMPANIES AND PUBLIC AGENCIES _ _ }, - _ -''' _ _._ ------ — -
�
AND ARE APPROXIMATE ONLY. BEFORE DESIGN AND CONSTRUC- 0 10 20 40 6o F F F I scaLE� I" = 2,083'±
DWG NO: 1042 SHEET
JOB NO 03-1684-00' 1 OF I
TION CALL DIG SAFE' I - $00 - 322 -4844 . '