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HomeMy WebLinkAbout0087 BREZNER LANE - Health 87 Brezner Lane Centerville A = 230 - 016 Aff ram UPC 12534 .2-153LQR . TOWN OF BARNSTABLE +i LOCATION 'f 're! hp r Lo SEWAGE# �OOlo- VILLAGE� ��,g�ASSESSOR'SMAP&PARCEL ^01Cn INSTALLERS NAME&PHONE NO. +- Son SEPTIC TANK CAPACITY LEACHING FACILITY:(type) g (size) 30 X-1© XD. NO.OF BEDROOMS OWNER J&kA / PERMIT DATE: O tp COMPLIANCE DATE: {O 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 within 300 feet of leaching facility) Feet FURNISHED BY I I+ Ott - - - �� Al Roo 14 w V� � �{ No. ` Fee COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS Application for 3Digo!ga1 *pztem CCow6truction Permit Application for a Permit to Construct( )Repair(A)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.S-7?Q2X)R r Q� ``--__ Owner's Name,Address and Tel-No. L-ey Kv- ► L%ckitM Assessor's Map/Parcel �;j© <a—? '$�ZY1 Inst��a�ller Name,Address, �'and Teel.pN�o.�_�� De�sign��e�, dQg�ss�an�d Tel.No.CtjpQ�)�(D%"9.��- p Sok��D W Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow. gallons. Plan Date LA I i to )OU Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S.3-30 's, 3o X 1 X;. Description of Soil Nature�of Repairs or Alterations(Answer when applicable) O 1 vLn5AWiOO Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been . u ph Health. Si ed Date 91 C) Application Approved b Date Application Disapproved for the following reasons Permit No. al Date Issued sltr ` No. !` — --" a Fee HEICOMMONWEALTH OF MASSACHUSETTS Entered in computer: lies PUBLIC.HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for -Mi$�Ogaf *pgtewCOn$truction Permit Application for a Permit to Construct( )Repair t(A)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.V brtzrv- - ^, Owner's Name,Address and Tel.No. art Kv> W,Lcexi �i�-1l-" Assessor's Map/Parcel . �` — i cal t(__ , ?i� �. .YYlca. • . Installer's Name,Address,and T 1,No. Designer's Name,Address and Tel.No.(500j)Z)(0D\—A9�. . kq�,p tYGk ()r 1 �rl�� '1 1 V4 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 3' gallons per day. Calculated daily flow gallons. Plan Date I-) I o(p Number of sheets Revision Date Title Size of Sepfic:Tank I r-NQO Type of S.A.S.3-30!}Q e, 7�,O�X 10/X A Description of Soil: Nature of Repairs or Alterations(Answer when applicable)OV11 1 I C RA4,,rVn;)1 i s on mL Yi 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 Certifi- cate of Compliance has been is.s ed_ th' and o. Health. Si ed Date 14 /&5/,q/` Application Approved b Daie Application Disapproved for the following reasons Permit No. f Date Issued �J -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS J) Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( ;!()Upgraded( ) Abandoned( )by I)1A sop, ro c- at A 7 Br e-r FA -'z jn i I Q, 01-a has been constructe rin acc° ance with the'tprovisions of Title 5 and the for Disposal System Construction Permit No. ' E° /&44 dated L- d'J`G InstallerT\n P6C) -11 Designer The issuance of this p t hall not be strued as a guarantee that the system wil un f o as esigned. Date � � _ Inspector �JCJf9 O �--------------------------- __. No. Fee � . .. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogar *pgtem Construction Permit Permission is hereby,,grantteed to Construct( )Repair( )Upgrade( )Abandon( ) System locaied at �`7 .7jf P2'Y��;(` E Q CAA it , Alm , 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 conditions. Provided: Construction must a completed within three years of the datb�v this pe t, Date:__�� Approved May 02 06 11 : 13a P. 1 _ Town of -Barnstable Regulatory Services- Thomas F.Geiler,Director • wi�+sitiA�ati Public Health Division p A a Thomas McKean,Director 200 M:trn Street,Hyartaats,NA 02601 Office:.508-862-4644 Vax: 508-790-63C4 Installer & Desip-ner Certification Form Date: 05- Designer: 112stall.cr: v<?i( r -' So►� �] Address. 0 ��) �`�. � Address: Q, S � ThQ6 4 1 was issued a peranit to install a (date) (installer) septic system at 'i Q :L ��►� based on a design drawn.by (address) t dated __9 ( 1� 6 (designer) $ certify that the septic system referenced above was installed substantially ac(;atdu% to the design, which assay 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 chamges (i.e. " greater than 10' lattzal relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulzations. Plan revision or certified as-built by designer to follow. 31, q v (fast e S S1gFtatllTo) fail p,r 7 rO,0, a/ (Designer's Signature) (Affix Des1 ier's Stamp'liere) PLEASE RETURN TO_BAIRNSTAJf3D .Ir1 PUBLIC HEALTH DIVISION. CJCl2T1111CA: E OF Ct7l!/APLYANCE WILL N(Y.r BE ISSUED UNTIL BOTH -TRIS FORM At l) AS- BU:IL T CARD ARE RFCFIWD BY THE AARtNS"Ck DILE PUBLIC If F:A.LTL[ l)Z-- VTsCO—N. THAN KY Q: f ic:rlCh'Scpticll7{rigncr cerntication Form l Zor k— TOWN OF BARNSTABLE LOCATION SEWAGE# Zs _ I , .VILLAGE �' Q'1�'��� 3 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) 1 NO. OF BEDROOMS OWNER dr 'I $ ;� PERMIT DATE: g � � 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 within 300 feet of leaching facility) Feet FURNISHED BY i ✓,aJ i i,'d 1 10 �. O o ,f �,6 I Town of Barnstable P# - °� Department of Regulatory Services 4. • Public Health Division Date I!/-R1 L 3 200 Main Street,Hyannis MA 02601 !_ l Date Scheduled Time Fee Pd- 1 po Foil Suitability Assessment for Sewage Disposal Performed By: �,���0-� 'v` ' ""'►� -S. : Witnessed By: ��� LOCATION & GENERAL INFORMATION Location Address'.g ��2/ � N� Owner's Name KATttt,gi�-A �1� �a Address q /7 gP��� LA Assessor's Mapffl4mel: 230/��6 Engineer's Name J NEW CONSTRUMON REPAIR I Telephone# sJCr6 36 Z- 2-� ZZ Land Use (� -�f�1'L Slopes Surface Stones (� ? 00 ft Drinking Water Well �ft Distances from: Open Water Body�—ft Possible Wet Area brainage Way ft. Property Line Other ft SKETCH:(street name,dimensious`of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) (to toy i i Parent material(geologic)4 — Depth to Bedrock �- ,-- Depth to Groundwater. Standing Water in Hole:' i Weeping from Pit Pace Estimated Seasonal 1jigh Groundwater i DtTERIVIIN TION FOR SEASONAL HIGH WATi';R TALE Method Used: _in. Depth to loll tnottlos: In. Depth db�erved standing in obs.hole: — p }�, Depth toiweeping from side of obs.hole: in, Groundwater Adjustment AO,Actor.,,. AdJ,CroundwaterLaval.,.,,m Index Well# Reading Date: index Well level - �ERCOLATION TEST' . Date .Time . Observation 1 . Time at 9"; -�=-- Hole# Depth of Perc 5�.. Time at b"Time(9" Start Pre-soak Time.@ 3— End Pre-soak •� Rate MinJInch `Ip"-- ! ' Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed Site Failed; f) ri iaaL Public He'�lth Division Observation Hole Data To Be Completed on Back O g tt ***If percola#on test is to be conducted within 100' of wetland,you must first notify the Barnstable C4#servation Division at least one(1)wedk prior to beginning.g DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis enc %Gravel) �'t_L t" Spt►Nn (o G R 311. lV A- f r� of:•tic. 41 3�"-(26" L A� u%ai 2•S 604-6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon' Soil Texture Soil Color .Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 4 �ati �,DaM �d��-J�7i ��� F/iu�t•� l�l4Ss ym Atdl DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consiste c %Oravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. n i t n d Insurance Rate May: :p Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No X Yes Depth of Naturallv Occurring Pervious Material _ .- Does at least 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? Certification I certify that on td 5"'I (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required ining,expertise^and experience described in 310 CNM 15.017. / Signature " Date 0 Q:\,SEPTIMERCFORM.DOC Pon ASSESSORS MAP : Great TEST H 0 L E_ LOGS NOTES: i POlnt �� PARCEL : 01 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH Q\ Q, ON SOIL EVALUATOR : _)-VAN f IZ�"T- C5�. THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF - FLOOD ZONE : L. ( - 1' At tX TmABL BOARD OF HEALTH REGULATIONS. WI TNESS . 17���LD CMPc .IktS Qjp�RryS. .c i-I $ g`4Q 9 Q,qo 0 a I REFERENCE : DATE: pf-1�. q f (a c i q 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, QNF 3 to V PERCOLATION RA E /AA 1 1 Nof SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO INSTALLATION. v �p0 �" TH I �1 _ 4� ,';b 0 TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION �o v F t� I*- ig "fvt C. THwvl olo �(✓e✓ ONLY, AND SHALL NOT BE USED FOR PROPERTY "LINE D I __ _ P nibL DETERMINATION: Lo r IOy�- /'� f a �•,� THER's '/ l� -{ .�j 2 �f 3,SU 4) ALL PIPING TO BE 4" SCHEDULE 40 @ I/8 "/ FOOT. (UNLESS /r RKRo SPECIFIED OTHERWISE) LOAM L O CA T I ON MAP 10--f S} L'o p" l`� 4z.12. 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A 5 GARBAGE DISPOSAL. Ito Lam 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) .y / f 1 '71,� /I I.L C �1s t i . c ,�.� '?j j�j C ►' {M Gr� U MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON FBI o G/�'t�r Sf co- A BASE OF 6"OF CRUSHED STONE. l f I P 6 ((0 f- F -M Dvv&LIe-IN V5. IZ- � trl �� Zo r r/� 31 "I �r 7 X/ i In1G, CF- (106,L; SE'PT I C SYSTEM DES I GN U In Zi<# i wl i 1 1Sv't r= ha o w G6. FLOW ES ; I MATE (a PU� 4 _ - fit✓� �f 1 ,7 S �I:.� 3�,� "it> ►°�.�v� i lr aril 3 BEDFOOMS AT IIO GAL/DAY/BEDROOM - 330 GAL/DAY ft' (N _ . _ . . L• Q 'j I �1 T?(,• vt t `C Fitz- E�A CST, SEPTIC TANK :330 GAUDAY x 2 DAYS GA L 1 i USE 1400 GALLON 'SEPTIC TANK— NEIA) V - SOIL ABSORPTION SYSTEM t 43 X y UNIT S vi 3.R e, one JLI A Vf ' K. + 1 - X 0, SIDE AREA: 0,-�( � C ,�� � _ i ( BOTTOM AREA: 3 x t �t 0>? - Z SEPTIC SYSTEM SECTION -K, 43 e . \\ LOT 60 d�M t \ 4 0 44-\AREA = 10000 s� +- (j (� (� \ � � ptzr�sf� �cr� � �� ���; ^�►; AA IL \ Ile r- 42, f 61 V bbo �1 'UU GALL u tl. r SEPTIC TANKS [� n 7 0 k 44 C E� 141 O(` -�� BENCH MARK Y ! 0 BULKHEAD CORNER SIT E , mmm ELEVATION = 44.B8 vt l AND SEWAGE PLAN BARNSTABLE GIS DATUM = walk e_w 2y'� S me LOCAT ION : 07 r_e6 Lr9�G Sv 3S j PREPARED FOR : K�it ,rF OF D RRE o 6�• IZc) SCALE :/ DARREN M. MEYER, R.S. o. 1140 P.O. BOX 981 DATE 4/-/0` �Q-/v z $TeR� EAST SANDWICH MA 02537 3 h+lTAf�\�'� z 0q.I0-U& DATE HEALTH AGENT Ph: `503) 362-2922