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HomeMy WebLinkAbout0237 BUCKSKIN PATH - Health 237 BUCKSKIN PATH, CENTERVILLE A = �Il_ I JJ� =J�a�CVCtE��o2m UPC 12534 0 �� No.2 1�3LOR NASTINGS, UN No: vU Fee `/ 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSAC.HUSETTS Zipprication for ;h6poof *p5tem Congtruction Permit Application for a Permit to Construct(1/fRepair( )Upgrade( )Aban n( ) El Complete System ❑Individual Components Location Address or Lot No. a / r wne A-Name,Addressand Tel.No. Assessor's Map/Parcel /�O#(+ ✓• [®A 7-'-`r31 i �l��� 23 CkSKr-1V?� Installer's Name,Address,and fel.No. -Designer's Name,Address and Tel.No. �J, /u rh 6-E� fog -f;9-!741 Q Type of Building: Dwelling No.of Bedrooms Lot Size !f sq. ft. Garbage Grinder(+�) Other Type of Building R65' , No.of Persons Showers(L) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 6 f p gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answfr e applica le) d cU /— 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 issued by this Board of ealth. Signe Date /Z' ��4 Application Approved by Date Application Disapproved or the following reas s Permit No. Date Issued DEEP OBSERVATION HOLE LOG Hole## Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistent %Gravel .DEEP Q$SERVAT�ON HOSE LO+G Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. C nsistenc %Gravel -T . ............ ............ DEE .... P OB...... .SERVATION HOLE LOG Hale Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistent %Gravel DEEP OBSERVATION ROL LOG I fvle# y Depth from Soil Honzor� Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistent %Gravel Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes Depth of Naturally 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 (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 training,expertise and experience described in 310 CMR 15.017. Signature Date Town of Barnstable P# Department of Health,Safety,and Environmental Services o�'THE Public Health Division Date Q 367 Main Street,Hyannis MA 02601 BAMMBM Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: LO+CATION.&GENERALINFORMATION. .. Location Address Owit ner's Name.. 2-3� 3v�kskJtil7�l t orWt/f-S �l. tf �o�tJ Address 207 3 VC.KSjGn7W(h Assessor's Map/Parcel: /7/Az a Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way It Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) w _ z Le t LL _ x rae-w a!te oed A_ �x i T/N(s /oa�d wy�sk,J1� �3 ZZ° Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater ......I..I...I................_...........................................................................,..................,.....................,..................,......................................................... f1TERlNATIjOI EORSEASOAt;D '4? A 'ER TiI3E . .............::; _....... .............................. . ... ........... ...... .. ... ...... ......................... _....._.. . ...... ......................... ..X.. ..... .. . ..... .. .. ................ . ._.. .. .. .. .............. .................................................................................................................................................................................................................................. 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____ Adj.Groundwater Level_ . 'ERCOT�ATION:TEST. Oats I tme Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant �. No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS - Zipprication for -Mioozat &p.5tem Cowaructiori Permit Application for a Permit to Construct( Rep ai, )Upgr#( )Aband n( ) ❑Complete System ❑Individual Components Location Address or Lot No. /.0 7 5/ caner Name,Address -and Tel.�No. Ljgp ,. �,.1 Assessor's Map/Parcel 7 � •�N� �+ � �3�f �7/l3 Ce✓iteevd& Installer's Name,Address,and T61.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms - Lot Size f,� `uI sq.ft. Garbage Grinder(Ivd) Other Type of Building PSG-S, No.of Persons Showers( Z) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �� &-4-? gallons. Plan Date Number of sheets Revision Date Title 2 , Size of Septic Tank Type of S.A.S. i Description of Soil Nature of Repairs or Alterations(Answ r w e 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 Certifi- cate of Compliance has been issued by this Board of Flealth. , Signe;or - Date`'' Z- i- Application Approved by Date Application DisapprovedOthe llowing reasoir l x Permit No. '1 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE' ,that the On-site Sewage Disposal System Constructed( 'L)-Repaired ( )Upgraded( ) Abandoned� )by at ; _ 1 f/Z has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. _ ated 1 ""sGZ r-3 1:9- Installer Designer The issuance of this permit shall not bLq co strued as a guarantee that the sy�ste 'ill function as designed77 Date li,. Ski Inspector� ^�" No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1wi.5pogar 6VOtem Con0truction Permit Permission is hereby granted to Constfuct kptWkt An System located at or ff 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:Construc on mube mpleted within three years of the date o p rmipt. Date: Approved by _,4 -1,fK**ZF BARNSTABLE `.00ATIONXD/A0, t�G/t� / SEWAGE # R"' a VILLAGE /�%f/r 11/ / � ASSESSOR'S MAP & LOT4Z/—90 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACFTY..�//> LEACHING FACILITY: (type) 71Z /,� (size) �?-Z ",,V 5 NO.OF BEDROOMS WUM;�ER OR OWNERh �� f � LS PERMITDATE: ^' a jdT—;F,12!COMPLIANCE DATE: f '" Separation Distance Between the: / Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility y 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 13' I TOW/N O/F, BARNSTABLLE LOCATION�D /� %�r/G/LS'/ ��� 7 SEWAGE # ^ va.,LAGE �%�%L/i. iL� 5, ASSESSOR'S MAP & LOT, ,/---0;f� INSTALLER'S NAME&PHONE NO. j SEPTIC TANK CAPACITY i LEACHING FACILITY: (type) (Size) � g' i NO. OF BEDROOMS R OR OWNER PERMUDATE: �_Z&=-�COMPLIANCE DATE: Separation Distance Between the: / or FeetAdjusted Groundwater Table to the Bottom of Leaching Facility y 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__ /z, _ � o No....l. .� FizsAPPRWD ..... .t'?.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � 5- - TOWN OF BARNSTABLE Appitrnfi c for Di►i,puuai Vurks Tunutrnrtiun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ...............42`---7...... Lora'. 3dn' or Lot ................ .... ....... -------------- ---------------- _ . ..................................... Add . -'- ----------------- ------ C55 1nstaller Address QType of Building Size Lot.................... Sq. feet Dwelling—No. of Bedrooms..3....._-------------------------___Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' OthsL-fix ---------------- ----- - - - - W Design Flow...._._.--- ----------------------_-gallons per person day. Total dail flow.... ___............_.....__gallons. R; Septic Tank t Liquid capacityl(?o®gallons Length--- -------- Width... ----- Diameter................ Depth................ Disposal Trench--No. .................... Width-------------------- "Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No-----j.------------ Diameter-----/0........ Depth below inlet..... ........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................ --------------------------------- Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water----.................... LZ4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ vG -----------------------------------•-------------------------------•------•-----•-•--...............................--•---••------------.......----•---....-- 0 Description of Soil........................................................................................................................................................................ V -•• -------------------------------------- •--------------------------------------- --------------------------------------------------------------------------------------- •---------- •---------------- W -------------------------------- - --------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations Answer when applica le.-._.; 10 .S. .............................. 1 �' it ' .Z�.f--- � .............................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance ee iss/'+ b the boa of health. Signed _` ...... ... ?�-- -� Dace �® Application Approved By ............`C � ... Application Disapproved for the following rearons: ............ . ...... ............................................ ............................... ....................... .......... .......... ....................................................................... .... . ................................. . .......................--........................ ....................................... Permit No. ....... .' ..Q---------------------- Issued . ...............................................---..gce..... �ce FEs... f'....-... THE,COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ��� ��� TOWN OF BARNSTABLE Appliratinn for Diiipmial Wnrkt5 Tomitrnrtion Permit Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at Locat.ie,,i \ddreds or Lot�Np ................ �_.,;. ..5?.�t.`:._.____.__.___.______ ...________.____!.�_..: �:A•!�.._ ..._................................................. O-ner ,q /� Address { W ri\ G,{/1 1 C �._(� . r? ,`r_ t I i it-, /t ........ ......• .............. .............................................. Iustaller Address Type of Building Size Lot............................Sq. feet ... Dwelling— No. of Bedrooms_. ------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) al Other fixtures ...................................................... W Design Flow.......... ....................gallons per person per day. Total daily flow.....--;--- .�:7__..._...._.._..__._.gallons. WSeptic Tank L Liquid capacity0�?1 galIons Length---2r-------- Width..._ --------- Diameter................ Depth................ x Disposal Trench--No. .................... Width------ _.._.._...... .Total Length-------------....... Total leaching area....................sq. ft. 3 Seepage Pit No.....I............. Diameter-----1_n..._..... Depth below inlet.....ern........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------•-------------•------------------•------------•-•-•-•-•--•-----••-................................................................. 0 Description of Soil........................................................................................................................................................................ W ---------------------------------------------------------------------------•------•-•-----••- ---------------- U Nature of Repairs or Alterations—Answer when applicable ..... .--.----',tt_� "! ��__....k~ ?n��. : .�:!...........--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued�y the board of health. i Signed . ................._. l .................. . .. Y j . Dace - - Application Approved By ........... � _.. r . _........... . - .-a V 3 Dace Application Disapproved for the following reasons: ......._..... .........................- ...... .......... ...... ............................................ ....................-----------...—........_.....ate...... ........................................ Permit No. .......... .3--------:43. Issued , Date ——+—` —"————— ��THE BOARD OF HEALTH TOWN OF BARNSTABLE (11jErtifirate of (gomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ......... ..........................<j..(4"" ............. ........ .. .._... .......................... . ................_...................................... tnscauer i 3`7 -..._ :�. _... rEf...... .................................. .. .................. .............. at ......... _.........._... .. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..._...../ ..-_ �..... dated ............ I-------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. V"K_� DATE. .................�� ..-.� .................. -... ...................._._. Inspector .-------- 1111-a__J- ......._.-:................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..... �.3•_�,_ FEE......... ............ nrk� �un�#r�r#i�n �rrmi# Permission is hereby granted -------- ----P,------! :u_--------- '+-------/(--�­----------------------- --------------------------••••.......... ....._ to Construct ( ) or Repair (k)--an Individual Sewage Disposal System Street (�.� ,. ; ` __. as shown on the application for Disposal Works Construction Permit No.,.,_.Y:.__._. __ Dated.......................................... VBoard of Health DATE............... .................................. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS . �, TOWN OF.BARNSTABLE .00ATION QI4*—SEWAGE # VILLAGE -��w� ASSESSOR'S MAP & LOT �7/ flat) INSTALLER'S NAME & PHONE NO. A-lyl-e_ Cs141.17 Q.P 4-rrc SEPTIC TANK CAPACITY /� �,� ►� !!(lli�/ LEACHING FACILITY:(type) J1''�-� -C 1-� Y n (size) Gt� NO. OF BEDROOMS PRIVATE HELL OR R L BUILDER OR OWNER DATE PERMIT ISSUED:_ a Ll DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No / b , g� �,vjA !o w �� 47 ikf Q b P OF Mgssq oy 02� MICHELE CUDILO oSTRUCTURAL t�lo 34774 � O 9FGISTE�� J . . (� °FSSIONAL�G.. I XwRotq �1'E-�$!bt-/A CE--, - a a \y CLbb L-AD G t1 f rtAf -,4AJ LO CAT 1011 SEWAGE PERMIT NO. ti VILLAGE �� (( INSTALLER'S NAME i ADDRESS Fly BUILDER OR OWNER DATE PERMIT ISSUED 7Z? DATE COMPLIANCE ISSUED I r� l..