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HomeMy WebLinkAbout0076 BREZNER LANE - Health 76 Brezner Lane Centerville A=230 028 I UPC 12534 ' o.2-153LO11 9 No. 0 "� Z� Fee �D C) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, `�IASSACHUSETTS Yes ZIppYicatiou for Oi5poe;al �&V!tem Cou5tructiou Permit Application for a Permit to Construct( ) Repair,�(,0 Upgrade( ) Abandon( ) © Complete System ❑Individual Components Location Address or Lot�����r+�--� ��+ �n�e`rts�,N�e�ddres,and Tel.No. Assessor's Map/Parcel O^ O�Q�y� ,��,j �� '� Installer's Name,Address,and Tel.No.3'1 e" O-W �`""` I m Designer's Name,Address and Tel.No1�So q) ` Q S9)C Cp C�f�`a 75 333� .5� .RX i vylx P Q 1 'y LtL Pak, 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.req fired) O gpd Design flow provided 3' l� gpd Plan Date :U54_1 wee Number of sheets Revision Date Title Size of Septic Tank 16e)o Type of S.A.S. 3 " 30SC Description of Soil Nature of Repairs or Alterations(Answer when applicable)Q 1YI 1 — e V 1 Isf�O GL►L `D- 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 b his rd ealth. Si ned Date ®/ _ Application Approved,by Date Application Disapproved by: Date for the following reasons 2 Permit No. 00 6 C� Ll 0 Date Issued 213.41 No. CP I O Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTI-LDIVISION - TOWN OF BARNSTABLE, MASSACHUSETTSYes Rpplication for Ii.5po.5ar *pztem Con!6trurtton Permit Application for a Permit to Construct( ) Repair(�) Upgrade( ) Abandon( ) ® Complete System ❑Individual Components Location Address or Lot No.X Owner's Name,Address,and Tel.No. Assessor's Map/Parcel c © .- OM � � l � � o Installer's Name,Address,and Tel.No.*.•�'R Y))WJ)r t 60 Designer's Name,Address and Tel.N4so 4) 0240_Yv I — VILL 9,n Qo'f q Q I (...5oM AWI Lk .s 71 A, . 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.regpiredl O gpd Design flow provided S9 gpd / Plan Date 7 d .j 10tv Number of sheets Revision Date Title Size of Septic Tank t f e) Type of S.A.S. Description of Soil yy ' Nature oqf�Repairs or Alterations(Answer when applicable)t n I'll- lC I P001-3 7C1196A t 1 1400 C�Ckkk Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage di posal system in accordance with the provisions of Title 5 of the Envirohm'6rital Code!ananot`'to place the system in operation until a Certificate of Compliance has been issued b this Board of Health.-, ) , ✓" / ,�Si ned I Date'r 30 Application Approved by _ Date Application Disapproved by: Date for the following reasons Permit No. 00 6 3 ,V® Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance }( THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (r 1 ) Upgraded ( ) Abandoned( )by _� F, �r((�(zwbb _d" "1.C 6on at �Q f �Jkr t_o.1`1..g,. (-Qh`1! :ti Id j. , , l has been constructed accordance �/� / r ,b with the provisions of,Title 5 and the for Disposal System Construction Permit No. dated Installer K--, + I DesignerMorr i C' -ow .o-r #bedrooms . Approved design flow,_)1), r gpd The issuance of this permit shall not,be construed as a guarantee that the system will function asWesigned. Date 1 Inspecto'r'- --.-/�'— No. )w� l3 7 Fee /©U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS M4!5pont �bp!tem Construction Permit Permission is hereby granted to Construct ( ) Repair (A) Upgrade ( )/ Abandon ( ) System located at , ,E f' Y ?1f" !1 YI P 1�t}l f�` y i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condi-tiionn-s...� Provided: Construction ust be o pleted within three years of the date of this per` t: Date /3/ Approved`°by�. TOWN OF BARNSTABLE LOCATION _�� �' C Z yet L.A Ale SEWAGE#1 66 1/a VILLAGE C Pa/reg V!//2 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. .I /� W A-e p ,4416 e X s SEPTIC TANK CAPACITY /. .S"C� O LEACHING FACILITY.(type) 41 yR A rd R (size),?®Sy s - NO.OF BEDROOMS OWNER PERMIT DATE: T f,3,�J 6 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist ��ri4�in ZM fnAf of loonhinn fonilit��l ^'Pf�1 I_ � NN \ c �0 �.� Rug 03 06 09: 39a p. 1 Town of Barnstable ti Regulatory Services Thomas F.Gcilcr,Director BA Ll$, MAM $ 0 Public Health Division v�A s6�9. a`0 ? � Thomas McKeau,Director ~ 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer• & Designer Certification Form r• Date: o G Designer: Ptf�! •� �Q Installer: Address: t'�o, 4�7G_�� Address: PO 10-4 I 6/0 Dix ze7 was issued a permit to install a (date (installer) septic system at J& E)MV46& based on a design drawn by - (address) -Dorg-e 64 •..A48YM (Z.S. elated ...._7 �• �� -- � (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=&or septic tank. I certify that the septic system referenced above was installed with major changes greater.dm 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations- )Phan revision; or certified as-built by designer to fallow. 1�..� 'gNI7Af�lAN (Designer's Signature) (A Ix Designer's Slaziip Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH H DIVISIOL. CEWFIFICATE OF COMPLIANCE WILL NOf RR ISSUED UNTIL BO TII -THIS FORM AND AS- RUILT CARD ARF,:R ECI�'.X ET)BY THE BARNSTAB)i,E PUBLIC 11 AI TT.i D1V-CSZC31�1. THANK YOU. (�:flcnitiv5cptic/Y1csi�n�r Certification k'omi I Town of Barnstable. P# 0 Department of Regulatory Services ' Public Health Division Date 200 Main Street,Hyannis MA 02601 3 �ffD trti't� Date scheduled 'Time Fee Pd. ` i I Soil Suitability Assessment for Sewage Disposal Performed By: wN Witnessed By: • 40CATION & GENERAL INFORMATION Location Address .'� C� .3! _ Owner's Name .TD�vE �y�LW CeNFL-fZV D LLCv WA %t ;J, . Address 21.7 t+0 Rg r-<�NV n LN. Assessor's Map/Parcel: ;>,36. 0 Engineer's Name D ~ NEW CONSTRUtION REPAIR Telephone#J®� 3�o2 Land Used���� Slopes(gc) 5 / Surface Stones Distances from: Open Water Body •sod ft Possible Wee Area �Sob ft Drinking Water Well 20 ft Mainage Way Zed A Property Line 7 �d ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proxitnity to holes) ft-P .0 6,� t6lj , 7/2t joy � a i i . . Parent material(geologic) 60 ITS h 1 Depth to Bedrock Depth to Groundwaker. Standing Water in Hole.' N iA ' Weeping from Pit Face r '� Estimated Seasonal iliigh Groundwater DtT- ERMINATION FOR SEASONAL HIGH WATER T"L E Method Used: Depth 04erved standingan obs.hole: _in. •Depth t0 S0II M0tfcs: Depth toiweeping from side of obs.hole: in. ©roundwater AdJulint:nt Index Well# Reading Date: Index Well level Adj.'(acFor•,,,_4. Adj.(jroundwaterl.evel.,,,,e, i PERCOLATION TEST Date TI!n�Jl IflM. Observation ( '1/ Time at 9" Hole# H ►tom Depth of Perc V y 1" —AS —5 2 Time at 6" Start Pre-soak Time.Ca) IL1 S Alt-Al j xime(9"•6") End Pre-soak Rate MinAnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original:.Public Health Division Observation Hole Data To Be Completed on Back--- ***If percola#on test is to be conducted within 100' of wetland,you must first notify the ua,-„.Crane Conservation Division at least one(1) wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sol Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis enc %Gravel r ,I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Nlottling (Structure,Stones,Boulders. _ Consistencv.%Gravel) fe 31`-12(0� C 0.Sk 0 Z.Sy DEEP OBSERVATION HOLE LOG . Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons iste c Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, �c Flood Insurance Rate May: Above 500 year flood boundary No_ Yes ., ts.i to �7 Within 500 year boundary No_�c Yes Within 100 year flood boundary No Yes e' Cl i CD _Depth of Naturally Occurring Pervious Material cDoes at feast four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? "If not,what is the depth of naturally occurring pervious material? tF Certification 0k' I certify that on I (date)I have passed the soil evaluator examination approved by the Departure tg, ntal Protection and that the above analysis was performed by me consistent.with the required trai expertise and experience described in M CMR 15.01 . Signature Date Q:\.SEPTIC\PERCFORM.DOC