HomeMy WebLinkAbout0086 BAY LANE - Health --"86 Bay Lane
Centerville
A = 186 - 036 - 001
SMEAD
No.2-153LOR
UPC 12534
smaad.eom • Mado in USA
OIFOF rrE SR FWGM
TOWN OF BARNSTABLE
LOCATION CP� �4,1 ZIX'� SEWAGE
VILLAGE �'� � ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY Z®9®
LEACHING FACILITY: (type) Cclr 4"74P_`t (size) �•� ��
NO. OF BEDROOMS
OWNER '`��
PERMIT DATE: s�s°t COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 00e Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) ��—Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) �� Feet
FURNISHED BY
im
gay LA
No. ✓ I Fee 01/ba-
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
9ppliLation for MispoBal 6pstem Construction Vermit
Application for a Permit to Construct( ) Repair(�pgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No. P61-4F41Y Z/I- «A!P7 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel /cP 6-0--'e 0000O/ v � � '14L�17�z
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
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) � gpd Design flow providedy gpd
Plan Date ��/�- / Number of sheets •9 Revision Date
Title
Size of Septic Tank G� �.0'���� /O®O, Type of S.A.S.
Description of Soil .P 401 A✓
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board alth.
S' a Date
Application Approved by Date /5 d1V 1
Application Disapproved b Date
for the following reasons
Permit No. Date Issued
No. / � / 1D _ y Y Feeff�w
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ftplicatlon for Misposal *pstem (Construction Permit
Application for a Permit to Construct.(,) Repair(46 Upgrade( ) Abandon( ) ❑Complete System [Individual Components
Location Address or Lot No. l/y Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel / Or'471?/ �"4/ 4--
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
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) 3.7*49
,✓ gpd Design flow provided !� gpd
Plan Date Number of sheets ✓ Revision Date
Title
Size of Septic Tank �X/.!'T�-VdG /00 O, Type of S.A.S.G O�/Gct �T� G.'�141007',ee4OFT
Description of Soil ��� d��A'.✓
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board alth.
SS'' ed Date
Application Approved by ` Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
TH E COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Upgraded( )
Abandoned( )by •��Q�/�y� � j y C
at P K- eef y L J'' C�/'�r� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. I5" 16` dated (e j15j?,01 S
Installer 11T !J% E'4trO_19y Designer. d/g7 46
#bedrooms 3 Approved design flow-� 9 gpd
The issuance o this 'ermit shall not be construed as a guarantee that the system wi:1 funcJtio as desihned. 0
Date �� Z Z 1 } Inspector 1 / 7V, J I�
-------------------------------------------------------------------------------------------------------------------- ------- 0
QQ
No. �� � V�j Fee, 166
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction permit
Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( )
System located at JD r
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date ((! ,/ 5 -zo/5�- Approved by
r
JUN/23/2015/TUE 09:35 AM FAX No. P. 001
Town of Barnstable
y°pYnero � Regulatory Services
Richard V, Scali, Interim Director
RARNSTABIA
1619.
a��r Public Health Division
�o rn�►+ Thomas McKean,Director
200 Main Street,Hyannis,IVTA 02601
Office: 508-862-4644 Fax: �03-790-6304
Installer &Desiagner C�-e-r�tifieation Form
Date: Z�J Sewage Permit#'1'0�%" `�6Assessor's MapTarcel
Designer: . Put Installer: I ,v gm '
Address: t§A VJA Address:
On 6 was issued a permit to install a
(date) (insta ler)
septic system at 1j b Wi NM� LJ,based on a desi4 drawn by
1�. � !� ,,�y (`address)
- ,04 01q Ad dated
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
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. Plaa revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
were found satisfactory,
I certify that the system referenced above was constructed with the terms
of the RA approval letters (if applicable) C�A OF `cT
DAVID
i! €MASON f T'
(Installer's Signature) }
`,, crs•r���
'x ;'Ji` Al
Z�((D fgn gynature) (Affix Desi ' w p Here)
PLEASE RETURN TO BARiNSTABLE PUBLIC 1dEALTH DMSION, CERTIFICATE
OF CO'NEPLIANCE 'VyILL NOT BE ISSUED UNTIL BOTH TMS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU. - -
QASepticlDesianer Ccrtitication Form Rev 3-14-13.doe
Town of Barnstable P#
Department of Regulatory Services J
t�►xrrareera Public Health Division Date 5
�. MA83 =P
�A n6;y 200 Main Street,Hyannis MA 02601
' PfD M!d A F—m
Date Scheduled_ '.B Time Fee Pd.
r
Soil Suitability A sessment for Sewa�'eYisposal
Performed By: 6 Witnessed By: J Ulf ^. r �
r LOCATION& GENERAL INFORMATION _
Location Address�U ���/ �✓ Owner's Name�_ToX/✓ 4—A/ �
Gar ' + Address
a N
Assessor's Map/Parcel `��0 S o/ a/ Engineer's Namee4e! r L� ��
NEW CONSTRUCTION REPAIR Telephone#
V
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body ft. Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
Parent material(geologic) Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DE 1 ERMINi A T ION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In, Depth to soil mottles: In,
Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor m4 Adj,Groundwater Level s
_..
PERCOLATION TEST Date . Time..
s Observation I
Hole# Time at 9" _
Depth of Perc 3Z V Time at 6" �+
Start Pre-soak Time @ Time(9".6")
End Pre-soak
Rate Min./Iuch
`Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
r
***If percolation test is to be conducted within 100' of wetland,you must first notify the,
Barnstable Conservation Division at least one(1) week prior to beginning. \
Q:\SEPTIC\PERCFORM.DOC V
i
DICJ EP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,,Boulders.
onsistency.%"Gravel)
-
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsisten %Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Cnite c O
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders,
ons' to
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes.1/__-
Within 500 year boundary No
Within 100 year flood boundary No.__ Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perv'ouaterial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring per ious material?
Certification
I certify that on �� (date)I have passed the soil evaluator examination approved by the
Department of Envir mental Protection and that the above analysis was performed by me consistent with .
the required training,ex rtise d experience described in 10 CMR 15.017.
Sign" J _ Date Z
Q:\$EFTIC\PERCFORM.DOC
Lb CAT10 ` o SEWAG PERMIT NO.
VF L L AG E
IN ST A LA It'S NA 6 ADDRESS
O
d_
i UILDE R OR�7 OWNER
DATE PERMIT ISSUED /448zo�p/
DAT E COMPLIANCE ISSUED !d/9��
r7 ® ✓
TO APPROVAL DF
0ARNSTAOU CONSERVATION__. �No.............. _....., .
COMMISSION F ms............._............_
J - THE COMMONWEALTH OF MASSACHUSETTS
//
BOARD OF HEALTH4 ....... ..
,
r
Appliration for Biipngal Worko Tomarurtion Famit
Application is hereby made for a Permit to Construct /or Repair ( ) an Individual Sewage Disposal
OSystem at: J
................... .: .. —�- = ..... c �+. , ...................................... _..1....-- -
" � c io - r ss or I.ot N' .................
- --- - ......................... nzi/� ----...................---
Installer Address
d Type of Building Size Lot...�� ���....Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building ............... No. of ersons.................._..______. Showers — Cafeteria
a YP g ------------- P ( ) ( )
Q' Other fixtures ____________________________
W Design Flow................. ��-?515.................. per person per day. Total daily flow.................. ��___..._........_._gallons.
WSeptic Tank—Liquid capacity. _gallons Length.&_�_. Width 4'499_. Diameter................ Depth..`':-_U"_
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No...........i--------- Diameter........�.�__..._. Depth below inlet_....._A........ Total leaching area.._�44...sq. ft.
Z Other Distribution box Dos,i,nn�g,tank ( � '
Percolation Test Results Performed by.l] M...1,,>.._14�f�.......,s� 5_�. . Date.......��.?�.71 ..............
Test Pit No. I...... .-----minutes per inch Depth of Test Pit.......VV....... Depth to ground water.... .................
Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
-----------------------------------•-•-•- ------•-------•-•-----•-------------------------•------- ---•-----------------------------
O Description of Soil tsL JLfyC`IaiJi ------------------------ ------------------------------•----•-------------------------
x
----------------------------------------------•----------------------------------------•-------------------------•---------------------------------------------------•-----••-----•--------•----•--_....
V Nature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with y
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further grees not to place the s stem in
operation until a Certificate of Compliance has been i by the bo of 1 ealt ~�g
Siged-• .............•- ......7 _._C.._-1
ate
Application Approved By.----- = :-------••-••. r-----•. ......�----
Appelicatip Disapproved for i` a long reasotCs `._-- •-- ----------------------------- i/ .....
.
.a.. _/......
---------------- �fcc�--•-------------------------------------------------------------------------------------------------------•----
Date
ermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS Sy y o!<J
BOARD OF HEALTH
........1.0w.w 6AI44.................OF....... �. . ......................................
%rrtif iratr of Tuutpliatta
THIS IS TO CERTIAFY, T at the ndividual Sew Dispos System_constructed ( or Repaired ( )
bY ..:.. ��._......... ' -0 ..........................................................
In aller �T
at--•------•--•---••--•...-•------•••••1-06-r..••i•••---•-.....S ------
has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No___ _________________ __".B .s>. dated....✓w`_`.t�'7-�__...................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....-----------------••I.......•---••••...........................................
Fps:. !..�.No
THE COMMONWEALTH OF MASSACHUSETTS
,IgoB.0 XR.U...0F -HEALTH •
F... .. ......... .................... :A
n�
v
C� >! ................0F....... s L.# . 1 .. Xr..
Appliration for Bispos a1 Worko Tnnitrnrtion ramit
Application is hereby made for a Permit to Construct (;/ ) or Repair ( ) an Individual Sewage Disposal
System at:
,..... J .... .. . ....... .................... ....
..». ........... ...................................... ........
oC i - dress ,r'"/ or Lot
.........• - - •. ...-•............�...... ....... ...�.- �..... -& -)'%r '� �i -•---•.......-•------
� .--. Wn T,.l.[d'S.ttala�j----- ' e t / 4;w7/>71
�...w
a :.�. ....... ......................
Installer Address 1 _________________S q
d Type of Building Size Lot___________ feet
Dwelling—No. of Bedrooms................... ....................Expansion Attic ( ) Garbage Grinder
4a4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
( )
Q+ Other fixtures
t s -----------------------------------------'--- q�t - ...............................................................
Design Flow.................... gallons per person per day. Total daily flow.................. ____...............gallons.
WSeptic Tank—Liquid capacity._-gallons Length .•-�!.___ Width A-----'0___ Diameter________________ Depth_`^'�--•-_
x Disposal Trench—No. -------------------- Width�r.............. Total Length...........:._..... Total leaching area....................sq. ft.
Seepage Pit No...........I--------- Diameter.................... Depth below inlet.............. Total leaching area..._... '___..._sq. ft.
Other Distribution box (V1115 Dosin tank ( )
aPercolation Test Results Performed by -•-.'r�-t---E' -' --- -- �'�" Date.....
Test Pit No. 1.._. .._._ A!
a minutes per inch Depth of Test Pit___•-_ f._.____ Depth to ground water... -----•---_--_
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit................:... Depth to ground water-------.................
G4 •---------------------------•--------------�t•-•-••--•------•---••-----•-•---•--------......._...--.........................................................
ODescription of Soil-•----....----�:! 'e ` ---- 1� tt �:�..... --3�---------------------------------- ......................................................
U ----------
•------------------------------------------------------------
••-•-------------------------------------------------
---------------------
•----------------
•------
•---------
------•---------------
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 TITLt 5 of the State Sanitary Cod The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issfu.d by the bo of ealt ►�'
Si ed `✓
------
� �, ate
Application Approved By... � ::_ .. ..._ t9 ,
-
�a e
Applica n Disapproved for a to reasops. ................. -•-•-•......--•---•-•-•------------ .
------------------ --- .. a... .............................................. ..
Jy r Date
PermitNo......................=---------------------------------- Issued----------;'..............................................
Date
� t
THE COMMONWEALTH,.OF MASSACHUSETTS
BOARD OF HEALTH
.....T 4t?......................OF....... 14TM. ...�►�«►�" ...................................
Trrtifiratr of TuntpliFanrr
THIS IS TO CERTIFY, T at the ndividual Se Dispos System.constructed ( r Repaired ( )
by----------------------------------------- " $ x` ...---I ' .r�- ,........
rl
has been installed in accordance with the previsions of T "' S of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N o:__ .. dated. $ ,-,7G
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT.BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................................................................... Inspector=---------....................................................................
Y
THE COMMONWEALTH OF MASSACHUSETTS `
BOARD OF 'HEALTH �✓�..
W. " ..... .....OF.......9Aalo-eir ...........................
T0_ .... f? ► r
N ..... ... --••--
din pan 1 nrk � n r inn rmft
Permission is hereby granted........ ............ !------- -= Griot................•-•--.................
to Construct or Repair ) an Individual S wage Dispos ystem
at No.----•-•---••.�.1 " ---V--------- -------------- Y **------. `...
---
', Street q
as shown on the application for Disposal Works Construction P 't No. _-__ _ -___ Dated...._5��. �,�!_."..............
...................
R J / Board of Heath c1 t
DATE---.........••--••...... � ._ ir- Y ... � / 2-
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS s
ASSESSORS MAP : /P>�
TEST HOLE LOGS
PARCEL: "� _--_—_��--- ------ 1) '['lie installation shall comt:)� with Title V and "Town offA(Aj%fR&oard of
FLOOD ZONE: d✓Z ��iaG✓C SOIL EVALUATOR:"
) tU1p f (lealth Regulations.
WITNESS : l I 2) The installer shall verify the location of utilities, sewer inverts and septic
REFERENCE: �Z�� DATE: J O components prior to installation and setting base elevations.
a` i�77 7`i�- �-T'► 0"'"Y 1 PERCOLATION RAT t 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per Foot. The first two feet out of the d-box to the leaching shall be level.
64\4, O a U' �b 4 This plan is not to be utilized for property line determination nor an other
TH- 1 TH-2 ) p p p Y Y
purpose other than the proposed system installation.
0Q14 l�11lb oil �(�1�Iti�(�, 5) All septic components must meet Title V specifications.
_ 6) Parking shall not be constructed over H10 septic components.
LJD 7) The property is bounded by property corners and property lines.
1 8) The property owner shall review design considerations to approve of total
design flow and number of bedrooms to be considered for design. Receipt
LOCATION MAP �t ' of payment for the plan and installation based on the Ian shall be deemed
PY p P m
approval of the design flow by the owner.
t yqd 9) The existing leaching or cesspools shall be pumped and filled with material
V per Title V abandonment procedures. Those within the proposed SAS shall
be removed along with contaminated soil and replaced with clean sand per
Le .S 34 Title V specs.
XD �•�. ` �`�j 10)System components to be 10 feet from water line. Sewer !fines crossing the
a9\` water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if
applicable. The proposed SAS is being installed below the water service
l I I line. The line is to be sleeved as aforementioned and maintained in place.
o ` SEPT I C .S Y S T E I II DES I G N 11) If a garbage grinder exists it is to be removed and is the responsibility of the
Iq� owner to ensure such.
FLOW ESTIMATE 12)The installer,is to take caution in excavation around the gas line if such
exists.
BEDROOMS AT I l'D GAL/DAY/BEDROOM -i'%� GAL/DAY 13)1"ne installer shall verify the location, quantity and elevation of the sewer
lines exiting the dwelling prior to the installation.
_ t 14)"Phis plan is representative only that a system can fit on a property meeting
SEPTIC TANK Title V requirements.
a_ s •s i ` '' O GAL/DAY x 2 DAYS - GAL
�1
USE (GOC� GALLON SEPTIC TANK �6 ----
1 (�Ateff-&—�evwioce, wr
S0TL-ABSORPT-I ON7SYSTEM__.._.-_._.
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i� �lrin b �'�,t�ti a�,���t
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SIDE AREA: )C i�Z o y
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No.1066 r y
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��.4 o g�8. SEPTIC SYSTEM SECT I ON
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SEPTIC TANK "All
SITE AND SEWAGE PLAN
LOCATION : 4'e,&
PREPARED FOR �N`f I- 1.7I1�
S ALE•
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DAV I D B . MASON ?& DATE: tZ 2alv�
_ DBC ENV I RONMEN`fAL DESIGNS
EAST SANDWICH MA
W DATE HEALTH AGENT
Z ( 5O8 ) 833- 2177
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C'''ICT TO APPROVAL OF ti
771STABLE CONSERVATION klii_l,E �,A �iC �: � � ., :.► 4 u►.11c.
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