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HomeMy WebLinkAbout0475 OLD JAIL LANE - Health .475 OLD JAIL LANE, BARNSTABLE A=277-025 , . 9 , W I , , o TOWN OF BARNSTABLE ° LOCATION q )5- 0(d nc0,\ ,are SEWAGE VILLAGE'ak_ b l e ASSESSOR'S MAP&_LOT a i 7 %5 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 30� e,--Acc-s (size)f-13.SS�X/�.d� a� NO.OF BEDROOMS �6^ BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility pt, Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ` fi Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o clu f % �,m / Feet Furnished by a Q.(„ � T L V Pi1` .. 'C�'`�� 7p o�� 0 C� _ . � � �. y�� \ h ��, � 5y `� • l No. Fee Fee /V0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for 33i.5poea.Y �bpztent Construction Vermtt Application for a Permit to Construct( ) Repair(24 Upgrade( ) Abandon( ) WComplete System ❑Individual Components Location Address or Lot No. t0S drld Owner's Name,Address,and Tel.No. L �7.z/��il Msxh.Ne y Assessor's Map/parcel 2_.7 7 Z 6i(1n3pJe S,4yt� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ��� �N&e— ct�Jr P4S 7 SA-,IP Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building J,'-7/Z AAr," 41• No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ,J S q— 0 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /5-60 Type of S.A.S. Description of Soil—�/�/.� 5:�-r 2. Y a Nature of Repairs or Alterations(Answer when applicable) /(�T�/'s�c:� c1 r 47'17z. 7",O7V/t Ze..- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal h. Signe Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 200(0—as-2 Date Issued V —/ `U No. wt0 �.� Fee /00 t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ll_`� { a PUBLIC.-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpprication for Migpogaf 4p5tem Cou.gtruction Permit Application for a Permit to Construct( ) Repair(X). Upgrade.( .) Abandon( ) ZComplete System ❑Individual Components Location Address or Lot No. !s i/,W ✓A/ L4 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Z 7 7 Z f �C.ro,S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. >''oxy92 f4-el/dA/E 6Z64/ 0'33 2/ 7 7 Pis Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building S'�74/QA�,•�y No.of Persons Showers( ) Cafeteria( ) Other Fixtures �3 Design Flow(min.required) ��b gpd Design flow provided 5 5 ,q.. O gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /. -b0 Type of S.A.S. -) fa3Z Z, Description of Soil f�-e 014/) 16. S.S r Y 0•.2S Y-) { Nature of Repairs or Alterations(Answer when applicable) A -�'11Ilk d-P_ S4-w it fAe/C /2Q 01-4 c � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ' accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date 6 ��ae Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued (a U ——————————————————————————————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage _Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) Abandoned( )byo e/c� J�! tom+�� J--2 C at L/75-- old ��ig:;z 4 L,r!-Q has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. D)� Z dated A Installer so✓S .�r ell J lei!i/� JP LAvC Designer 046 - #bedrooms Approved design flow 5:32 gpd The issuance of this permits all/not dd construed as a guarantee that the system/w 1,1 -T o' \felsigned. Date /A �� iD Inspector ———————————————————————————————————————————— No. 2WEi- 2 Sa Fee loo - -z THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Migpogar 6pgtem Con21ruction Permit Permission is hereby granted to Construct ( ) Repair (.Y ) Upgrade ( ) Abandon ( ) System located at 1171- O'/(y ✓'Ar &4 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. n Provided: Construction must be completed within three years of the date of--- Date (� — (� Approved by � • Town of Barnstable' Regulatory Services ' Thomas F.Geiler,Director * snxivsr•sus ' a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: 54 Designer: Installer:. Address: . NL qAM Address: 1 On ��'D r L was issued a�_ � permit to install a (date) (installer) septic system . (address) based on a design drawn by . V,'5 dated r-/,f e)& ,Q a to do (designer) l-certify that the septic system referenced above was installed substantially according to the deign, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. — =- I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State.&Local.Regulations. Plan revision:or certified as-built by designer to follow. OP4f DAVIT �y (Installer's Signature) &` cGn MASON M v No:1066,q `s '$Ti l sgN4AH1�d (Design 's Signature) (Affix e gnez's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION 'O {'RTIFICATE OF COMP .IANCE Yffil NOT BE ISSUED UNTIL BOTH TIHS FORN.I AND: -: BUILT A- DARE RECEIVED BY THE.B RNSTABLE PtTB]GIC IB ALTH DI' fj:)I�T: THANK YOU. Q:Healtb/Septic/Designer Certification Form- F, f - Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I W)9 � I hereby certify that the engineered pl an signed by me dated Jpl!m� ,concerning the property located at `d`""W A! meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet,.above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: F A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation /%5,V+adjustment for high G,W DIFFERENCE BETWEEN A and B (Z 00 SIGNED , DATE: � 10 NOTICE Based upon the above information, a repair permit.will be issued for 'bedrooms maximum. No additional bedrooms`ai`e authorized in the future,without:engineered septic system plans. gASeptic\percexemp.doc uy� 20.1 u:p efe aranon of clans and Specitications T-rare, le V . j5kCH e M,,,-C,ti The plans and specifications for every on-site system shall be prepared as follows: (1) Every system shall be designed by a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not'design a system designed to discharge more than 2,000 gallons per day pursuant to 310 CMR 15.203. Any other agent of the owner,may prepare plans for the repair of a system.designed to discharge not more than than 2,000 gallons per day pursuant to 310 CMR 15.203 provided they are reviewed by a Massachusetts Registered Sanitarian and approved by the approving authority; Q (2) Every plan submitted for approval must be dated and bear the stamp and signature of \ the designer, 9U (3) Every plan for a new system or plan for the upgrade or expansion of an existing system i 1� which requires a variance to a property line setback distance,'must.also reference a plan which bears the stamp and signature of a Massachusetts. Licensed Land Surveyor.in accordance with M.&L.c: 112, § 81D; (4) Every plan for a system shall be of suitable scale(ones 40 feet or f wer for plot Tans and one inch =420 feet or fewer for details of sys em c ponen ) and shall incl de 4� 1? / J depiction o : S (. ��g'/ w'�(„ Cot���fc�'IP (a) the legal boundaries of the facility to be served; (b) the holder and location of any easements appurtenant to or which could impact the system; W the location of the all dwelling(s)or building(s)existin an propQsgd n the facility and:identification of those to be served b the s stem; a�l�l C� '(d) -the"incation of existing or proposed impervious areas, including driveways an 9 parking areas; I (e) location and dimensions of the system (including reserve area); �. (f). -system design calculations,including design daily sewage flow, septic tank capacity / (required and provided); soil absorption system capacity (required and'provided); and S O )! _whether system is designed for garbage grinder; (g) North arrow and existing and proposed contours; ��^� ' W . location and'log of deep'observation hole tests including the date of test,existin �' 'fJJ grade elevations marked on each test, and the names of the representative of the '4`� ��St approving authority and soil evaluator; (i) location and results of percolation tests including the sate of test and the names of 'the representative of the approving authority and soil evaluator, W name and certification number of the Soil Evaluator of record; (k) location of every water supply,public and private, (�A( 1. within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply wells, O �^ 0 2. within 250 feet of the proposed system location in the case;of tubular public 9 J water supply wells, and / 3. within 150 feet of the.proposed system location in the case of private water V supply wells; location of any surface waters of the Commonwealth, rivers, bordering vegetated wetlands, salt marshes, inland or coastal banks, regulatory floodway, velocity zone, surface water supplies,tributaries to surface water supplies,certified vernal pools,private water supplies or suction lines, gravel packed or tubular public water supply wells, subsurface drains, leaching catch basins, or dry wells; and the location of any nitrogen Vf sensitive area identified in 310 CMR 15.215 within which portions of the proposed stem are located. m) location of water lines and other subsurface utilities on the facility; (n) observed and adjusted ground-water elevation in the vicinity of the system; o)' a complete profile of the system; (p) a note on the plan listing all variances to the provisions of 310 CMR 15.000 sought in conjunction with the plan; (q) . the location and elevation of one benchmark within 50 to 75 feet of the facility which is not subject to dislocation or loss during construction on the facility; W when dosing is proposed, complete design and specification of the dosing system proposed including.but aoi limited to dosing chamber capacity (required and provided),' _pump curves and specifications, number of dosing cycles and depth per cycle; (s) when a Recirculating Sand Filter or equivalent alternative technology is required or __proposed,a complete plan and specification for the system,including a hydraulic profile; t) a locus plan.to show the location of the facility including the nearest existing street; (u) the street number and lot number, if any, of the facility; and. v) the materials of construction.and the specifications of the system. i � k , A' l§ O ` 1 ..`' .. is '.. ` •.. 1 5� 1 �` Y„ 's' ec. Ct.� �� .•fit \ .` �`""'�. . Fy N OF Mqs a �2 t7 if DBVID nG o ) a MASON m Tom, �1No.1066 �. a�srE�` I I Van X FD 3 S 2:1 i ® o 1 z ze - v2 Z45 tk OF DAVID B. _ MASON m 90. - - / ' /8TEQ'� No. ------------- Fee-- '---------------- BOARD OF HEALTH TOWN OF BARNSTABLE AppYtcat ion-for Veit Cootruct ion Permit Application is hereby,nlade for a permit to ConstTct ( ), Alter ( ), or Repair ( �n individual Well at: 0—�/ I L, N 41NS N 4[a— —--- — --- - Location — Address Assessors Map and Parcel M4Ho^'-e ___ -- 47� dj 1c.;f 4, Aar s a �Lo. ------------------ Owner - - ~---- n Address f!(_____-----------___---- Installer — Driller Address Type of Building Dwelling _— Other - Type of Building -- No. of Persons------------- ------ -- T e of Well P r, C -------- Capacity .Purpose of Well_0'2.a�C --- I — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of/Compliance has been issued by the Board of Health. Sig Tf" dateApplication Approved B — date Application Disapproved for the following reaso --------- - ------- ---- date Permit No. "—O -- Issued---- �_� ___--_ ------__ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (t'j Y--- _/ASC u n)vc l Installer at— 6f�6ff �'w� Liu has been installed in accordance with the provisions of the Town of Barnstable Board of Health rivate Well Protection Regulation as described in the application for Well Construction Permit Nom ed ---- --------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- - Inspector------------------------- No. ------------- Fee-------------------- BOARD OF HEALTHt V C TOWN OF ' BARNSTABLE App Iitation ior, eY� �on�truc conPermit Application is hereby, ade for a permit to'Cons r cty Alter ( ), or Repair ( �n individual Well at: <1)s a!� �` ti >�,N�f46 Location — Address Assessors Map and Parcel _OI NA.J/S M f� o� �' �� �'?s 610 �4 � r �.lN PGI...�S�ce Owner Address / / C rW O. / bJC / (oU �US ��PP AA It o�cyF Installer — Driller J — j-- Address Type of Building ,Dwelling Other - Type of Building------------- No. of Persons---------____—__—__—------- Type of Well (1 )0 y ---- Capacity- Purpose of Well:�o Agreement: ------- _ _--,_._ Th ndersi ned agrees install the afo-redesc�i'be individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Sig d m - —� —-- ate � \` Application Approved By ----- date Application Disapproved for the following reasons: date Permit No. o Issued ---- date BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ('I b y-- dJ/T - — ---- ----- - -- - — y Installer at___ y�S , 61� JG / LN has been installed in accordance with the provisions of the Town of Barnstable Board of Health Rrivate Well Protection Regulation as described in the application for Well Construction Permit No.W --5x ated------- ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector-- - - - - --- -=--- ------- ------------ ---- _____--------���,� __�w__,� �__a. BOARD OF HEALTH TOWN OF BARNSTABLE Veil Con5truct ion Permit Fee ------------- Permission is hereby granted to Construct ( ), Alter ( ), or Repair ( an�Individual We 1 t: No. — __ -� - 4! 1ra r � ��-L�------------------- - str t as sho�application forr Well Construction Permit - No.- v� i 2 Dated - -- — - o------ D Board DATE ealth __ t� r�.l ti� i `�/� Q � �' i � , i I �--� �� �� No....o 0 /_5-7 �. Fxs... 3.�_ ..... T E COMMONWEALTH OF MASSACHUSET%S BOAR® OF HEALTH ' .........OF.....A55 �%�� 47.............................. vl 7 S ppliration for UWpatial Morkri Towitrurtion Vanfit Application is hereby made for a Permit to Construct (L-_�or Repair ( ) an Individual Sewage Disposal System at: cy- L � �� ..�....� ..... �-- ' szs •.................•--..... -- - -L cation-Address or p Lot No. �P�' _. ....... .! f._h.:---••---...--•-•---------•--...... .... A44.r A/A. .................... Oy44r .7._. rAddress W ............................... Installer Address d Type of Building Size Lot.._.f/ /��:7 .Sq. feet Dwelling—No. of Bedrooms................. .......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) p' Other fixtures ............................ W Design Flow............. .....gallons per person per day. Total daily flow...........33_e.-............._.•..._gallons. WSeptic Tank—Liquid capacity toad_-_gallons Length_ �d`..... Width.'¢'P_`-__ Diameter................ Depth...-4��_-. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......1........... Diameter.......�f®__.___. Depth below inlet...... _......_... Total leaching area... ....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ���y` '-' Percolation Test Results Performed by..: i ....��f:_.! ae ._. ....._. Date_ 4..L`r ............... Test Pit No. 1.�-__n+la_minutes per inch Depth of Test Pit---�....... Depth to ground water------------------ Test Pit No. 2.!5L7b!lv..minutes per inch Depth of Test Pit...1 "... Depth to ground water........................ t� ............................................................. --••----•-------------------••--- ----•-------------..............._..........-------.----.-----.---•--..-------•---:.................._......•-•---•.--••- O Description of Soilo�-Z4 )�VovD .... `.__5'es6 --Sra `�- ash = •------------ W ----------------------- -------•-••-•--••---•---•------••-•---------•••---•-•--------••-•--•-----••--------•••-----••------------------•••---•-----------------------------•--•--••-•---•----------•--- UNature 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'TT� = p 5 of the State Sanitary Code—The un signed further agrees not to place the system in operation until a Certificate of Compliance has been ' sued by the rd of health. Signed------ 1 --------•- •---... .............................. ............................ Date Application Approved By........ .............. Date Application Disapproved for the following reasons:-------•------------------------•------------------.._...------•--------------------------...................--- -•------------------•--------•-•-•-------•------•--•-----•--....-----------------...........------....---...-•-•---•------------••-•------------•--.................................................... Date PermitNo......................................................... Issued-....................................................... No................ ..... Fizz.............................. THE COMMONWEALTH OF MASSACHUSETTS Y BOARD OF HEALTH " E��.4/ OF......��!> n/s� 1G ^.............................. ApplirFatiou for Uispwi al lgurkii Tanotrurtinn Vamit .....� k Application is hereby made for a Permit to Construct (L )�'or Repair ( ) an Individual Sewage Disposal System at: pp �GD . 11�G ZA-Ale- /J/761VSTA/34C" Z07 �8 ..........-•-•-•.............................................•--•-•-----•-•----................... --•-••------••••------•----•-...........••---•..............---------------------•...-•------_.._. L cation d/dri r Lt No. J32 � ...............................................--._......••--------••...... ................................ Owner Address W -- ----------------•..._...---•---•----.._...........------....._......----•---• Installer Address . q- � Type of Building Size Lot......./..i....ce; ... feet Dwelling—No. of Bedrooms_________________...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria QI Other fixtures ...................................................... W Design Flow.............. -'' .....................gallons per person per day. Total daily flow__.__..__._'v_______ ___.__._____gallons. WSeptic Tank—Liquid capacity_1_p4!;�_.gallons Length._g__'�_"�___ Width__'`?:..._. Diameter________________ Depth__���_.'. .. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/........... Diameter........ZP_ Depth below inlet...... Total leaching area....Z�_.7...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by- lotins G : •5'6 LCG��•-__P�_•--__ Date �.�G /fel aTest Pit No. i.�__j!_Q_minutes per inch Depth of Test Pit lQ¢ + ___ Depth to ground water___________. (i Test Pit No. 2_G_!!�!e_minutes per inch Depth of Test Pit 1'44 ___. Depth to ground water......_............. a -----•--- -----•-•-•••--------•----------•--•••-•-----•....... •-•••...•...............•---"------•-----;;-------•--•-------•...... -............ .... O x Description of Soil--•0- -��_.1__)ir/�v r Gt.?/-a..'.?_.._ 1..Sv�3--Soy-t"=•-------`�-'` -..:'-�G-----••`�1� . 5i�-----•------ W •--•------•-------------------------------------...........--------------------------------------------------------- -._._....••---••---------------•-----•-•----•••--------•---•-•---•--•........------ VNature 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 .TT7 77 5.of the State Sanitary Code—The un signed further agrees not to place the system in operation until a Certificate of Compliance has bee sued by tie and of health. Z -------- -----........... ................................ ................... to Application Approved B "".-•-------........._✓",%'i. ..................---•-------•-- --•--.........../---�---...•- Date Application Disapproved for-the following reasons:.......................................................................-........................................ ...---•----------•----•------•---•-••---------------------------•••••-•-••-•--••••-------------......................•--•--------•-------•-••-----•••-•-•---••-•-•-------•-----•-----•-••--•----------- Date Permit No......................................................... Issued_....................................................... Date THE-COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........�..........-��i.......-...OF.......�-�.........=- ?`r'..,..........C................................ 'f i�rF^a#r f 'vrntpli�atta THIS IS TO CERTIFY, Tha . dual Aqe Disposal System constructed ( -)''or Repaired'.( ) y... ..............•---•...... . .. -•- - ••••----••---•---•-----------••-•••-•---------------•:..----•••-•------------ Z/+ l / Install . at----••-•••---•-••-------------•--••••-••---•-------- has been installed in accordance with the provisions of TIT ey j he State SanitaryCode as described in the application for Disposal Works Construction Permit No..-• e,C-~�� ------•---_. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL.,FUNCTION SATISFACTORY. DATE----•-----_-•------------------•••_� v, ................... Inspector....................,. r =------•-----•-................... 7?HE COMMONWEALTH,,O.F MASSACHUSETTS - BOARD OF HEALTH .... .... No......................... FEE......................... Disposaln ���in rrmi� Permissionis hereby granted.............................................................................................................................................. to Construct- Re ndi ua �a e Dis o a stem atNo..................................................... ......................................................... Street as shown on the�pplication for Disposal Works Construction Rertnit Npy-----------________ Dated____ .................................... ......................... (%' Health ----------------------------------------•-• Boar f - DATE.__...-•---.._..----•---••-•.........................:.. _______________________ ^ � FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS » N I yo ezW.. 7vp uF o 546 c I / Z.G2 ftG.f s j° L"Ag Gd' t' i AAposc''c ' f 0 u� i 1yG �Q I 0 4vS� �___ 1a' n9 ° Z5na Vti• �o°�Pir DsT --- f / sox i ' � f f i I I LO7-#7 7>^-57 AAPZ,- Z' 1 .455'u�'-s6rD Di9�-t,y CERTIFIED PLOT PLAN LOCATION (jA1?!�!STi4LE /fA55 SCALE . DATE !7sEi5!Ly!y8L PLAN REFERENCE . Tj,t=7!1a S14"w.v aaw A R4.q-Ve t :' 114 OF �o CRAfG /ZyG-. ©!?sDEr Rcf � !4 � f N tr.bt33 " A �F. �� 1 CERTIFY THAT THE C�ST�� �ti SHOWN ON THIS PLAN IS LOCATED ON THE GROUND r ry =fit" fssIo E AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REOUIREMENTS OF THE TOWN OF WHEN. CONSTRUCTED. DATE PETITIONER: —7)2/Ve /. . . . �4'°��.,,� /-!A 55 REGISTERED LAND SURVEY R, lop.•.-7o. ..: . TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS •e; 4' CAST IRON 12"MAX. PIPE (OR 4 ORANGEBURG(OR EOUIV) EQUIV.)- MIN. PIPE- MIN. LEACH PITCH 1/4"PER. PITCH 1/4"PER.FT PIT PRECAST ° LEACHING FE NVERT....L..�19, INVERT DIST. INVERT P .. w �•� PIT OR D•, SEPTIC TANK G,S7 EL`IG.-Z3. ; >_ EQUIV. o INVERT 9. GAL. INVERT BOX (,' a 0 " 7�.. L.. . .jMo INVERT , . w w p :is 3/4 TO I I/2 EL.�G..... wo WASHED D EL95�10 ,'' w w STONE 'DAD /� / � �I • •w PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM. NO SCALE SOIL LOG WITNESSED BY : ?,�,vL-` �u W.1 TIME. y:3v.A.M �'c►!vALb A.Ci`fa/� BOARD OF HEALTH DATE .. . . . . . . TEST HOLE 1 81•4-1 TEST HOLE 2 7;%",ts .C•• -• �•�? ENGINEER ELEV. . .7�'.�a. . . ELEV. .97:4�'. . s,/ z s`Q-s DESIGN DATA ' z'z. 9 3 EZ.G73o HeA. SAvo NUMBER OF BEDROOMS 4viT}l fkme C�YvtC. TOTAL ESTIMATED FLOW .330 GALLONS/DAY Ale Go„ BOTTOM LEACHING AREA 78 �? . SQ.FT. /PIT iea.s� SIDE LEACHING AREA . . . . . . . SQ.FT./ PIT MGM/�'N`�• GARBAGE DISPOSAL .!Yq?-W.(50% AREA INCREASE) TOTAL LEACHING AREA U7. . . SO.FT / „ „ PERCOLATION RATE l.N35 � ?�'+��? MIN/INCH L-2 Tj 3a L-Z, e�fv LEACHING AREA PER PERCOLATION RATE .�. SQ.FT. Nd. .WATER ENCOUNTERED NUMBER OF LEACHING PITS ./.F'/�`. !''1.-*r)V .?7v.w. . APPROVED . . . . . . BOARD OF HEALTH ?'T a� SmNI� aN AGL S�DE�'s . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . DATE . AGENT OR INSPECTOR 4-7.?H/oq/2i'.� A/4-t477,V �' SHO T c�srcc: A114-olz4vI.).A. M SS, , \`FSs/0NA1.��''� PETITIONER ;,► �'` ASSESSORS MAP N0: PARCELNO: � 1.1 if 710Fee---° �---- BOARD OF HEALTH TOWN OF BARNSTABLE Application-ftlVell Cootructionpermit Application is hereby,made for a permit to Construct ( ), Alter ( ), or Repair (�)an individual Well at: -1 r- U- — -- -------------------------- - ----- — -- P— — — Location — Address Assessors Ma and Parcel -------------- 5-------1, Owner Address ZA--- ------------------------------------------------- - -y Installer — Driller Address Type of Building Dwelling--------- ------------------------------------------- Other - Type of Building -------------------- No. of Persons------------------------------------------------------- ��_ _� Capacity Type of Well—`� --------�------------------------------ -- - - - - ----- Purpose of Well� a17L----�q=��-�-------------------- - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Cogipliance has been issued by the Board of Health. Signed -- - q - -------------------------------------- date Application Approved By - � � --------p -?-------------- -- -- ----------�Ga date Application Disapproved for the following reasons:------------------------------ ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ date Permit No. -- y �`� '� ------------------------ Issued--------�----1--��-"----- ---7�'----------- - --------------------- da BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (-I bY----------- :ti,.9 , _ ,�'L'4 ------ ------------------------------------------------------------------------------- ----------------------- Installer z-- o l� ;�' 1--�-`'— - ���., ?Q �_1��— -^ `- at--y) - -----------------------------� has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No`—/- -M—W Dated �--,*r- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ---- — - -- Inspector----------------------------------------------------------------------------- .. ♦ "Y -y. - ♦ r y �. ..oqy fYt � -. ;,.- e . '•� . 1. ,4. �. . 4 � ♦ •� �rCiM�,r,1!403 � ' tg Fee---- - ----`F- . BOARD OF HEALTH TOWN OF BARN !S�TA'BLE Application-*rlVell Cootruc.tionpermit ! 'j i....•�#F+''`st,`«'7x 3.+Ya 1... " y+4na...�+- .:.':...A, �. - ,{ ' Apphcahon Is hereby made for a permit to. Construct ( ) Alter ( ), or Repair (V)an Individual W 11 at O r: x; Location 'Address ' Asses s Map.and Parcel ---- ------------------------ Owner a A dress N - - -—- - Install r — Driller b , . A ss —^ s Type of B ilding _ x t D el --`' - Q - - - --I i .r3sa>n:�.t a a ,e— -s-. O h - T�e of u' ding--`--------- - No. of Peisons — - - - --------- Type - 's C-- Ca -------/_______ _____ _______------------- --- Purpose — --- - of 11— - -— Capacity - of Well- -----r- �'t �"��------f---------- - ------- x Agreement:• The^LLu ersi"7ied agg�''eesto tall the aforedescribed individual well in accordance with the provisions of The Town of B rnsti le Boald of Healt rivate.Well Protection Regulation.--`' The undersigned further grees not t place the 11 in operatl�n:uritil a Certifica of Co pliance has-been sued by the Board of Health Signed / 14 --- -- X, date Application Approved By A --- -r aat ` Application Disapproved for the following reasons:----- ;lµ - ----------------------------- ---- ---------------- —__—---—______________ -- b_ __ _,______________ —--------____—____ -------- y W a +lama,. _,date s - f Permit No. - - ----------------------- Issued-----' ------�--�----- da. J0 BOARD OF HEALTH ",'` . 1 TOWN OF BARNSTABLzE. C ertif icate Of Co1nPj( aact THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (�) by---------- ---- ------------------ ---------------- ---------------, - / Installer at - — - - — - - — ----- ---- -- ---------- ------ ------------------------------ .�.. " rr has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in.tihe application for Well Construction Permit Nok-yp--! Dated------------------------ �� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL i . SYSTEM WILL FUNCTION SATISFACTORY. f. DATE--------- ——-- — — --— - -- . Inspector--------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Iell Construct ion 3permit r No. �r--- —f ---J �` Fee- Permission is hereby granted .v_..�,--- —SCC3n��,,r�L------- ------------ ------- ---------------------------------------------------- to Construct ( ), Alter ( ), or Repair (✓) an Individual Well at: N o. - - 4�-� - �`d- - c -1 r` '-- _� l� � ------------- - Street as shown on the application for a Well Construction Permit No.- ;�!�' =� � —� - -- Dated ------- ----- --- ---------- - — _ DATE--�' -- r Board of Health ' O r t Y i t 4 } 1 { i i i i �i _ 1 5L� 1 ( ASSESSORS MAPS --- 2-7 - -- - ---- TEST HOLE LOGS NOTES: PARCEL: 2 FLOOD ZONE: SOIL EVALUA OR: 9 �U 112 M�04 --- "----- WITNESS: 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE: ZC��` /// � DATE: Health Regulations. QE; (�-�,�—/f"jF ��p/ 2 PERCOLAT ION RATE: � �t , 1 t 2) The installer shall verify the location of utilities, sewer inverts and septic - l �OV- components prior to installation and setting base elevations. F.. TH- 1 TH-2 3)` All gravity septic piping to be 4 inch Sch 40 PVC at 1%8"per foot. The first g two feet out of the dbox to the leaching. LS 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. W l Z �9 5) All septic components must meet Title V specifications. / D �fl 6) Parking shall not be constructed over HI septic components. LOCATION MAP&�15) - 7) The property is bounded by property corners and property lines. �•- 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval a the owner. �- --- � PP of the design g flow b Y 9) The existing leach pits shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean washed sand per Title V l ( dv ��J, c ��� Ho tf04D. W40L specs. 10)System components to be 10 feet from water line. Sewer lines crossing the \ \ water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if I SEPTIC SYSTEM DESIGN applicable. \ \ r 11) If a garbage grinder exists it is to be removed and is the responsibility of the 1 FLOW owner to ensure such. ESTIMATE MATE i n in excavation around the as line if applicable. e o is to take caul installer 12 ThePP g BEDROOMS AT 110 GAL/DAY/BEDROOM -,$6VGAL/DAY Requested Variances; SEPTIC TANK Title V; Section 15.221(7)Requires that the top of the SAS be within 36 inches of C 1 Grade. SAS to be vented since not within 36" of grade due / \ , 'GAL/DAY x 2 DAYS - GAL To existing septic tank elevation. USE 1� GALLON SEPTIC TANK.Wwt -41VQ udr f OIL �N0F ABSORPTION SYSTEM i i l / n DAV� ��s � ��j 1��,�`- !hi��t,,,'t1�t�-fZ>v,.`� .UJ �_ a� �1��',,J .. G �- f MASON ,1 ~ v 9F0/8T y ' SIDE AREA: X i%, E f n /2Z SgN1TAp�P� BOTTOM AREA: x 1Z,2 X b r1I`�,7 t26 ob y ° / SEPTIC SYSTEM SECT I ON ►5, vur d' % D t \ - GAL ._. 130 S TII C TANK -, _ l� ��-90v"11 / M-T� it, 1,15 01 ID SITE AND SEWAGE PLAN c� 0 -�R*Hfk,ri LOCAT I ON : -,5AIL., L�&LOD pZ� � PREPARED FOR _ 'nW `. l SCALE: I DAV I D B . MA S ON DATE: DBC ENV I RONMEN�'AL DESIGNS —� EAST SANDWICH . MA B4- DATE HEALTH AGENT W b ( 508) 833-2177