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Home My WebLink About0053 CLIFTON LANE - Health 53 CLIFTON LANE, CENTERVILLE A = 5 I i I �glmffl"no = Oy UPC 12534 No. 2�153LOR HASTINGS. UN '44 ..,r.._�..._,.�..,..kd.�..N�..ra:�.�L.-.e..,......iu-� ._-.�snr�o'�..�..., _- ... _.. .. .,�.:::aY�a.,'...��_- ._._-...n.rAG,w>...J�... . �.�. •-�..31�,�snwl�Wv....r.r. -,.. _ -. ._.... 44 ` Fee No. r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication. for Migpog *p5tem Con6truction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's e,Address and Tel. - C t � Assessor's Map/Parcel n r, f57 S► A.)-T 1, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. C� -V ��V lZ$ �� s� 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 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alteratio s(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 Certifi- cate of Compliance has been isqued by this B and Heal Signe Date �Z—/ 1/4 5 Application Approved by Date Application Disapproved for the following reason ad Permit No. Date Issued w Nn .. r _ r, N_ E tereFee ^ '� d in computer: { THE COMMONWEALTH OF MASSACHUSETTS := yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS. ; 01pprication for Miopool *pgtem Congtruction Permit _. Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. PMox L � o.Owner's Name,Address and Tel. . -� ,c �2o plp Assessor's Map/Parcel SAp, L Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3 Fs Type of Building: Dwelling No.of Bedrooms�_ Lot Size sq.ft. Garbage Grinder Other Type of Building C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature o R i f pairs or Alterations(Answer when applicable) i v.s 4k l�a e ,�u w e e% V 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§ed by this Board Health. Signe Date Application Approved by U � Date Application Disapproved for the following reason a. Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of compriante THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( yy"Upgraded( ) Abandoned( )by 14,e\�� at en constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer �/ v 1 C. The issuance of this per* s.all not be co`nistrued as a guarantee that the syste` ill function as deF ned� ` �J/ /Q 1 Date t Inspector � 1A ffrl t u t j J - -i------------------------------- No. - Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopotaf 6pgtem Conztruction Permit Permission is hereby granted to Construct( )Repair( Kul-p--grade( )Abandon( ) System located at 5_'� 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 mufstt bel�plleted within three years of the date of this,pehiut.J q Date: �-l' + Approved by � I s TOWN OF BA.RNSTA.BLE u LOCATION �, �f� 17• SEWAGE # ,7'6— VILLAGE_r_ of jej 11,116 ASSESSOR'S MAP & LOTO%I�E� INSTALLER'S NAME&PHONE NO. a t�'C C` tl-llee i SEPTIC TANK CAPACITY LEACHING FACILITY: (ty (size) NO. OF BEDROOMS BUILDER OR OWNER I PERMITDATE: COMPLIANCE DATE: /1 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet j Private Water Supply Well and Leaching Facility (If any wells exist i on site or within 200 feet of leaching facility) Feet i Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet j Furnished by ir t Ilk e � s oy 410y TOWN OF BARNSTABLE to LOCATION ,,C� i f�� l° SEWAGE # e"Y ll VILLAGE_��`T /'i�`fC° ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY LEACHING FACILITY: ( pe) �`� (size) NO. OF BEDROOMS . a BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 r JJ Town of Barnstable P# Department of Health,Safety,and Environmental Services DIME Public Health Division Date ZZ/T 367 Main Street,Hyannis MA 02601 BAMSTABM MAS& I 'prEo 39. Date Scheduled 5 Time . Fee Pd. 00 - Soil Suitability Assessment for Sewage Disposal Performed By: I\6UA I J J CAA �� S Witnessed By: POIVtUA ' "`l on4 j ......... ..........._...__. _......... ........_.,....... ...__......,....... .,....................... ...................,. . .__... .......... ........... LOCATION & GENERAL INFORMATION Location Address $ a,Z�4'1 Owner's Name : 7 4 ST5" 1�E/} 4 Address �j C�� /lJ Assessor's Map/Parcel: 247/ 15 � Engineer's Name R . , `;4d1JA NEW CONSTRUCTION REPAIR Telephone# 62o6 — 775-q 76 Land Use Ya.iZ_p Slopes 474Surface Stones Wo r Distances from: Open Water Body F ft Possible Wet Area 110 ft Drinking Water Well ft Drainage Way 4 13 _ft Property Line 10/ ft Other ft I SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ✓TME 17 i i V o� Parent material(geologic) BArv(/Abe? gQt/t?S Depth to Bedrockp Depth to Groundwater: Standing Water in Hole: 6b k Weeping from Pit Face Ill Ifl Estimated Seasonal High Groundwater 3zrl P 6 6 6r _..... .......... ........................ .......... .......... . .......... ....... ................. .............. ...... ........ DETERMINATIOl t FOR'SEASON'AL G�T't?VATEYt TADLE /:. _ . Method Used 8 0�'� ey i O .yC,p,.r. h r7 /�G l..(.P Av'/14P r Depth Observed standing in obs.hole m. Depth to soil mottles: u al Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# _ZCA Reading Date: 1_ tr Index Well level =fJZ Adj.factor_ Adj.Groundwater Level '2 PERCOLATION TEST: Date I tmebv Observation J a Hole# / Z Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ i/v Time(9"-6") End Pre-soak q.,3 J:4 0 24 6AIy d A) Rate Min./Inch Z 22nSZ-�, jw( Site Suitability Assessment: Site Passed Vol' Site Failed: Additional Testing Needed(Y/N) Al Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant r DEEP OBSERVATION HOLE LOG Hole# / Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,°o ravel D/3 '' Iq /oyr3 z d'20 /vyrs /70 /O p^S 0 DEEP;OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Tv Consistency,°o ravel S ff 0 . .DEEP<OBSERVATION I U LOG Hole#....:'. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°o ravel ..DEEP OB.SERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel Flood Insurance Rate Map / 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? 1/FS . y If not,what is the depth of naturally occurring pervious material? Certification I certify that on 4)0d, (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 ln' ,expert'se and perience described in 310 CMR 15.017. Signature cr,` Date �'/ RONALD J. CADILLAC, PLS, RS Professional Land Surveyor Registered Sanitarian P.O., Box 258, West Yarmouth, MA 02673 (508) 775-9700 HIGH GROUND-WATER CALCULATION SHEET Locus 53 C i-rt.1 N L Date of observed water S/7 99 Depth water observed below ground q 2 " Well Zone C Index well mAsh zq Reading B.Oz Month of Reading U.S.G.S.(Frimpter) djustmert"for,maximum-mundwater� Well used below(usually same r4 PcS k Vl Date of Observation 2b c19 8 of. 10 year high reading ��71 (from data below), Zone well is ink. Years highest reading & month (cross out two high readings in 10 yr span) (record next-highest reading above) 1 119 �1�1 -7, 8 G f' l L,4 (data represent distance below ground) 3 1616_ �4 7 r 4�,ci 7, i6Z 18 7 '�6T' i 5 61/-13 9-}cq Current reading ,D� _minus 8/10 yr. high 6 F = ad'ustment l.. for_Zone Well Zone Adjustment: (Frimpter Adj. Zone x ,3=(8/10 yr. Adj. Zone x)-L 45 (For locus if needed) (Frimpter Adj. Zone ),I I = (8/10 yr. Ad'. Zone y) C . � a 1 b yr1-45��3,�1 Z, Hipth' round-Water Elevation definition fr m 310CMR 15.002 a and - The elevation above which in eight out of ten consecutive years the ground water table does not rise."