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HomeMy WebLinkAbout0050 CONNERS ROAD - Health 50 CONNERS ROAD Centerville A= 251 -025 S M E A D" KEEPING YOU ORGANIZED No. 12534 2-153LOR SNABLE FORES MIN.RECYCLED INITIATIVE CONTENT10% CoMad Fiber Sourcing POST-CONSUMER® www.tfipropramorp 5"Im MADE IN USA GET ORGANIZED AT SIVIMCOM 0 No. � (� � � _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Misposal 6pstrm (Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(�bandon( ) Complete System ❑Individual Components Location Address or Lot No. N.= kA Owner's Name,Address,and Tel.Nob(-2 dJ^ 1 Assessor's Map/Parcel a S( OQ:S- Installer's Name,Address,and Tel.No.�� �Sp� Designer's Name,Address,and Tel.No.`s 7 i `3!3- 4,1 71 rA C.�1 O S A TJ Type of Building: Dwelling No.of Bedrooms Lot Size •c Y e' 1A iv­&94�. Garbage Grinder( ) Other Type of Building j No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min(((.'.required) �3� gpd Design flow provided ��3 � gpd Plan Date Number of sheets ( Revision Date S�(r^ sjoe�L�l Title Size of Septic Tank C64 Type of S.A.S. �.}{� ��;A� �=��� .r•Q� Description of Soil Nature of Repairs or Alterations(Answer when applicable) ( p 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 of Health. Si Date ,J Application Approved by Date Application Disapproved by Date for the following reasons Permit No. vEJ p Date Issued No. �f C� i F �a �:. Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for 33isposal *pstem�ConstrUrtion permit Application for a Permit to Construct pp ( ) , Repairer.� ) aUpgrade(v�Abandon( ) ©Complete System ❑Individual Components Location Address or Lot No. 5C7 C zs•+.+'� -� p1C, Owner's Name,Address,and Tel.No.6(v'f qx�— 1 —e-( C 4^--49.•� Assessor's Map/Parcel p q( �co rs �CCA e- C—>_ Installer's Name,Address,and Tel.No i-IC7*<QS$' Designer's Name,Address,and Tel.No 4-v C -4l VV.-A-, L\'j�-Cr•�. �ASic . R�J„Q� _- Type of Building: ' Dwelling No.of Bedrooms Lot Size e�� �41 �qA Garbage Grinder( ) t Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 'Z �? gpd Design flow provided '�� "� l,/ gpd Plan : Date Cf�r' (' ( < 4,f✓ Number of sheets ( Revision Date S'/,(, c, t Title Size of Septic Tank ��d � Type of S.A.S. i c�r 14 ey_6.c.Q1 Description of Soil Nature of Repairs or Alterations(Answer when applieable). ,x. \ C Ei'�t(1 v�� S�g-�*`���� �6 C(n d4lhA V /- b,a C, zn( `.� C'� C_(M.t,.., Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ,�---� Signeil'"....' > \ � / � �-�.._. ,�� Date Application Approved by R Date Application Disapproved by Date 'for the following reasons y Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compriante THIS IS TO CERTIFY,that the On--site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by� a ►\ �}�CSc�, J" 1` x��C, .� at CSC � r. >^ ,� <n�* t eal l has been constructed in accordance - a. . . with the provisions of Title 5 and the for Disposal System Construction Permit NO /g 1$ dated Li 1 Installer �a •y �� > ,,�.�, , Designer 1 #bedrooms Approved design flow 4 ¢, ! ,, gpd- ,The issuance of this permit/shall not be construed as a guarantee that the system will function�as designed. ��� Date {�/ Inspector-1— N � _ ! - v ?-Ito --- No. Fee- - - - - ---- ------------- ----- - - - - - _ h - -- , y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Cons trULti!�UVermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( ) System located at 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 bbe/completed within three years of the date of this permit. Date �� / / % �I Q Approved by Town of Barnstable Departitnont of Regulatory Services i F Public Health Division Date MASS. f� 200 Main Street,Hyannis MA 02601 rFll►,AK<� s Date Scheduled- �� Tuna Fee Pd ._' X • • • 4x� Sul ity Assessment for S ge Drs osa t Performed-By: Witnessed B r�l a r on7 LO TION&.GENERAL INFORMATION 1=atlon Address Owner's Namo- (, Address �L . Assessor's Map/Parcel: NEW CONSTRUCTION REPAIR Tel hbno# �-. 1 d Land Use �� /�� glopas(96) surthco Stones Distances from: Open Water Body 1 ) ft Possible Wet .' 1t �i ft Drinking Water yy> ft Drainage Way E I �� g Y ft Property Line _, ft Other f1 SKETCHC(Street name,dimensions of lot,exact locations of test holes&para tests,locate wetlands-in proximity to holes) Parent material colp�/u� .V V �_ 4 1 _ r (8o ° Depth t0�edroalt� Depth to Groundwater. Standing Water In Hole: Weeping*01TI Pit Fnaa Estimated Seasonal High Groundwater DETERMINATION FOR SEASONALIEGD WATER TABLE Method Used: Do th Observed standing In obs.hole: In, Depth to still mottles De�th to weeping from side of obs,bola: In, aroundwater Adjuattnunt lndox Wall- Rcading Dato:, Index Wall lmval Adl,1kotor,,_ _Adj.eroundwater-Loyal,.,_, ERCOLAT1ONTEST D 1ite__ -- - — Observation _ _. - _ - Hole# Time at 9" Depth of Para 3 n Theto at 6" Start Pro-soak Time @ End Pro-soak Rate Min./Inoh Situ Sul tablllty Assessment: Sltd Pesscd_ Sitp Failed: Additional Testing Noodcd(YIN) Original: Public Health Division Observation Halo Data To Be Completed on Back— ' ***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:\SBPTIWERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Sall Texture Sdil Color Sol[• Other Surface(In.) (USDA) (Muneell) Mottling (Stnuature,Stanat,Boulders. o isistency.96'l3rival) DEEP OBSERVATION HOLL LOG Hole# Depth from Sall Horizon Soll Texture Sol]Color Sall Other Surface(In.) (USDA) (Muneell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Sall ftorizon Soil Texture Sail Color Sall Other Surface.(In.) (USDA) _(Muneell) Mottling (Structure,Stones,Boulders, Consistency. 4-4t. DEEP OBSERVATION HOLE LOG Hole# l Depth from Sail Horizon Sall Texture Solt Color S1311 Other Surface(In.) (USDA) (Muneell) Mottling (Structure,Stones;Boulders, Consistency, i Flood Insurance Rate Map:. Above 500 yearlood boundary No v Yes ;____ Within 500 year boundary No Yea!r • Within 100 year flood boundary No. Yes,,,,.,,... pepth of Naturalli occurrine Pervious Material Does at least four feet of naturally occurring porvious tnatotial exist in all areas observed thrpughout the area proposed for the soil absorption system? -s If not,what is the depth of haturally occurring pervious material? Cer'ti.--ficati-°,te n approved by the. n ' I certify that ate)I have passed the soil evaluator examination De ar ent ion and that the above analysis was performed by ma consistent with . P . the required tr x to a erience described in 110 CMR 15.017 o EAR 4 a Signature Y• `" Datts� • ' A � � �GFFC1S7gP , Q;\SBpTICU?R1tCPORM.DOC Town of Barnstable Regulatory Services Richard V. Scali,Interim Director * BARNSTABLE, v� MASS. Public Health Division �Fn►�'° Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: -Fb-- V -, 1i Sewage Permit#0<3\?- `c Assessor's Map\Parcel Designer: ��L 1 � L— Installer: Address: Vey M &K Address: k:zs\Icva On �, -r7-- was-issued a permit to install a d te) (installer) septic system at 5 © N NE R_'� R D - based on a design drawn by (address) E LAN 1 CFNJ_F I -dated � 1 6— REV (designer) 1 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. Plan 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 in compliance with the terms of the I\A approval letters (if applicable) H OF Mgs��y 9 HARRY G\ • n ler's Signure) � EARL Signature) a 0 LANTERY, JR. H A 'p No.26575 p 6�ST ( e 'gn 's 1 ture) (Affi Stamp Here) PLEASE RETURN TO BA STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc TOWN OF BARNSTABLE LOCATIONS( 3 SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO -���qp�r- -' ��snt} �/yz SEPTIC TANK CAPACITY LEACHING FACILITY:( e) �,r S�C�.-�- (size) NO.OF BEDROOMS OWNERS PERMIT DATE: �® COMPLIANCE DATE: 07�( 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 l 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 7V,�5�,A �; O(�1` �.1/ ` r `�"�n��"� gyp. w - T Y _ �u s oV M k� V 1 tb, XLL # 1, _ _ �. C GCO Eta ---&, S IS .�, i ��� 2 FY t dAT GRAt)E _- 1r1 i rt 01 C�iL . i f � N. �A•. ,•pV C , � .. .. ,., a .,. "•Y p '` I : r` 0�� r d _ L` _ l .....__«.• _.-_.._ ,. r 4 LJE�i fit... >� — I , e e g i , a =rr cpt CR - 0-3 d .,.P 1J Ta i � �. _ .. U I ! _ c t CT , , � ... tl. i � F y \ J l�i ti Y^, /r r b 1 L'+=- t2tS3 t n _ i .. x s � 1 GCS _ NOTES: � 1.'-Disposal System be constructed in • r •pto u ed strict accordance with Commonwealth of � Mass. Environmental Code—Title V. p d p * � ST I. 2. This i for the sole purpose f n f i t h s plan s e e p pone o construction o a septic system. , v s , I 3. r o call Dig-Safe 72 hours r beginning fexcavation. Contracto t e ou s prior to beg g o I 4. Pump existing it fill with sand andabandoned._ u p e st g P t . _ 5: 'In 11 1 a{. H 10 ' plastic i i t n off{ per Title V. Install a ,500 g , past crept c tank with ees and gas baffle , , < . 5. f h i fpipe • - . Contractor to field check invert o .under he .lower patio. d r C. x - s x d • _ r R mark Ideck—elev. 7 ench a k is surface of lower patio under 62.0. x ! a r� e .'AP f 8 N 2 r h is 51 025 a the Town of Barnstable. { - a S # , d D k 9. Locus is served b Town w r I t ... e a.e . to } i T 1 _ 10. he fan view is based on survey B r" e & Kellogg, RS land recorded p s ey by ea s gg, C� Y _ Barnstable R f D in ! F : e o Deed Ian bk. 89 page 53. ,Y { , } �1 a t v t gg 1 Install h G 1 - 1. l sta { a 500 gallon plastic um chamber with a Myers model ME3 1 2 � g P pump Y / P g ( , 9" .cast iron effluent ` um with an SRA lift out rail system. See attached specs. 4 pump Y , I: t gyp .... E. r (XJ 12. Set the floats: , e e a . ON float F i n. o is oat � O F float 11R a d the ALARM float 25 , t F i t ` t , t __ 4_ ,L t } 1 materials rLV. �65r0. . ; 3. Remove all impervious 5 around S.A.S.S S to a : :.. l - -. .. : : : J :.. .+.' .. te.•r+++� -.:. , . 3 1 t 14. llse 5x8'xz H O leachchambers with �: of / to 1 / . double washed stone on a n 4 ` sides and on ends with filter fabric on to r�\ fjf � g _ rode loam an i , -1�. G d seed all disturbed urb d:areas., t e ear. w . t S s y i d 1 , I t . r t , tm y _.._.. h § qs pp tiF '41 \ a ..�,._ .. -. .. .OT mv y w. _ o I � I t , , w , r , a a 6 . HAR RY 4 _ . Y EARL u j A E t GIB 0 ,r H 7 d a : t S N E d �, AL , L� t I , r m 67 _ i0 P / F _ry i2 'L i `� Licit a� .4 ,. • J 6 E r a . , .�MnSA S G E D / Cry t H �i t rr r U t P , 31�l�L�iRQ � 5 � I . Y { Ain a I:. . .. L y w ..__ . .c F .. , 7_ _p 5 .<6 {{ ` 77... IMP ': 7 a�. ,.., �. I� it_. �' t . . y^ �, :. a 3g y $ I , x , L C CT i .�� E•. �T, g pp+ ,y+y�[�.y� 14, ; ..a !yam`. ,. '�,.. , ., _-... ! PUl`�l C A , { < .... . .•, 4. S'kY v � , _ r .. �i }� �} p���^y G ; ;: ire - t,,,� •_.��''4 i �,r' ^- : t 4. - .. S ON ( R w fir 'V.�" _ � A !' r _ µ ! p �C '�Jac J F 4,13- !4 ! �. -. ..,... a .._ Fit 1.� f z