HomeMy WebLinkAbout0120 GREELY AVENUE - Health 120 Greely Avenue - -
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A= 245-016 -001
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No. O Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
4 /1 ftplitation for Misposal �pBtrm Construction Permit
Applicati rt for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System 21n5iidual Components
Location Address or Lot No./�49 y: Owner's Name,Address,and TelN/o.�
Assessor's Map/Parcel � 6 - 7�'" ' ' ./r� Mq_-s c.NW/ /E
Installer e,Address,and Te.No. 1L Designer's Name,Add ss,anel.N��
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.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank e of S.A.S.
P
Description of Soil
Nature of Repairs or Alterations(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 a Environmental Code and not to place the sys em in operation until a Certificate of
Compliance has been issued by this Board f ealth.
Signed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. ( Date Issued !�0 �i
IrW
ZAr
No. (T O ,. �i > .:i ` Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes si
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
'ZO A 01pplitation for Misoosal 6pstrut Construction i3Prmit
xM-e- �licatifor a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System � n'I dividual Componentsl4 ✓
Location Address or Lot No./0? YE: Owner's Name,Address,and Tel.No. ////�(r '
Assessor's Map/Parcel � S .
Installers Name,Addres,and TefrNo. , Designer's Name,Add ess,and el_Nc. 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
I
Design Flow(min.required)i gpd Design flow provided gpd
Plan Date O/ Number of sheets Revision Date
Title
Size of Septic Tank 1 e of S.A.S.
r
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) G
Date last inspected:
t 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 sys em in operation until a Certificate of
Compliance has been issued by this Board f ealth.
Signed Date 10 Z0 zo
Application Approved by �' Daie 1401
Application Disapproved by Date
for the following reasons
Permit No. (7 1tj �j�Ij Date Issued ! /.-
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFFY,that the On-site Sewage Disposal system Constructed ) Re aired(gradedAbandoned(
)by G�C�1 k1 ,� ,
at 120 has been constructed in accordance
with the provisions of Title 5 4the for Disposal System Construction Permit No. 6 dated ° 122,
Installer lam'P20MI14- 60(Wi5r Designer040/yp
#bedrooms Approved design flow A gpd
The issuance of this�ermil shall not be construed as a guarantee that the system wil i'func`tiony�as designbd.
Date (t L� (� Inspector /�(J j,,.i { ) S
No. ( � � Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Mispo$al 6peitem Construction permit
Permission is hereby granted to Construct( ) Repair Upgrade(Y ) Abandon( )
System located at l {� �!
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 be completed within three years of the date of this permit.
Date Approved by /`'
Town of Barnstable v
P�OFIHE Tpk� Regulatory Services
Richard V. Scali, Interim Director
« QAMSTABLE. Y
"M. �0� Public Health Division
'E1639.. Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer &Designer Certification Form
Date: 10 Sewage Permit# '36t Assessor's Map\Parcel 01Y 6
Designer: 1 J Installer: � Dl�
Address: Address: I 1
On 'Vow At, `jw1 was issued a permit to install a
dat ) (installer)
septic system at 1—�b based on a design drawn by
(address)
14 �. �" l � !g dated /® 13 1
(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 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 cert that the system referenced above was constructed in co njiance with the terms
of th AA approval letters (if applicable) aF 114
4ss\=.
DAVID `y r
_..( 5jle s Si Ntnsorl ature) i'
\0 No.1066 a o-,
FGIsTe?,
(Designer's Signature) (Affix Desi twj_ i�Kmp Here)
PLEASE RETURN TO BARNSTABLE 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 P# 07
� Department of Regulatory Services
. ILIAM"M a Public Health Division DatMASI
e 02
200 Main Street,Hyannis MA 02601
o rua°
Date Scheduled Time Fee Pd. (/(/•(/(/ `'
I•��
Soil Suitability Assessment for Sew e Disposal re•
Performed B—IDN10 E�7- A Witnessed By:
LOCATI N&GENERAL INFORMATION 4.=9
Location Address Owner's Name r
V �' P•�V' Address YV
�� y
Assessor's Map/Parcel � �/�� �1 Engineer's Name (yl �Y(4c
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 ft Property Line ft- Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
Parent material(geologic) Depth to Bedrock
Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
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
C PERCOLATION TEST Date Time
Observation
Hole# Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6")
nPre-soak
Rate MinAnch 12 '
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole 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:\S EPTIC\PERCFORM.DOC
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)
.o``s
1
9/ 4—
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)
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)
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)
Flood Insurance Rate Mau:
Above 500 year flood boundary No Yes
Within 500 year boundary No
Within 100 year flood boundary No ({{_////Yes
Death of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pery us rial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth f n lly occurring pervi us material?
Certification �p
I certify that on l (date)I have passed the sod evaluator examination approved by the
Department of Enviro en otection and that the above analysis was perfo ed me consistent with
the re ' training,expert'e d e scribed in 310 CMR 15.017. t
Signatur Date 1b r
\SEPTIC\PER F RM.D Q C O OC
AsBuilt Page 1 of 1
TOWN OF B"NSTABLE
LOCATION yX6 SEWAGE#
VILLAGE Ce►+.i e f�•� ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY �,(ZnQ_
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS_
OWNER D !`lam �d�.2 '•
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility Of any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility, any�vetlands-exist w''
300 feet of leaching facil'ty}' Feet
FURNISHED BY
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TOWN OF BARNSTABLE
LOCATIO /w SEWAGE#�9 e StIA
VILLAG ASSESSOR'S MAP&PARCE :�r' '-00 t
Cl/
INSTALLER'S NAME&PHONE N �� , ✓r�J�f-S/� ��'�
SEPTIC TANK CAPACITY /l=
LEACHING FACILITY:(type)5, j 1V • el,14^ size), -!�-.y
NO.OF BEDROOMS A
OWNER /! -
oe
PERMIT DATE: COMPLIANCE DATE: )I
Separation Distance Betwe'n 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 `uL\ L'A9#—UA�
Rq
TOWN OF BARNSTABLE
LOCATION ' RJ� SEWAGE#
VILLAGE C—,P—,A f v,W ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY ,S®®
LEACHING FACILITY:(type) (size) Ar
NO.OF BEDROOMS2
OWNER 0%J
PERMIT DATE: 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) o Feet
FURNISHED BY
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ASSESSORS MAP : z��
- TEST HOLE LOGS
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1) 'I he inslalla(iorl shall coloij ►villt 'I,itle V and "fawn of
�dr-4��C.11uard of
l� �
FLOOD ZONE: A--/v-T ffP,�G�I SO I L EVALUATOrt : �0,VIn -j , Y`'� L.`,? i I lealth Itegula(ions.
' WI TNESS : T 2) 'Ifhe installer shall verily the location ol'ulililies, sewer iiiveiis and septic
� REFERENCE: _��'�'a� 73a�_ 2/863 � � "
_ _ _ : '._ _ �__.. DATE:__
iM; l components prior to installation and setting base elevalions.
G-/- 7-7FlEP,> -PZ-x5-1 }�' fir.. 35 PERCOLATION Rh iE: G Z 1 11.. , 3) All gravity septic piping to be 4 inch Scb ,10 I'VC at 1/8" per loot. 'I be first
two lect out of(lie d-box to the ieaching shall be level.
!� ��- Y, �,��);'i� � 1/ Z2�.� 'r _ 4) two
plan is no( to be utilized for property line delerntinalion nor arty other
TH- I 111-2 purpose other than the proposed system installation.
S) All septic components roust meet'fitle V specifications.
`b l l _ Ibt 10 G) Parking shall not be constructed over II 10 septic components.
Egyp' t 7) The property is bounded by property corners and property Bites.
�' 1 �' �✓ ,t b q� 8) 'Hie property owner sliall review design considerations to approve of total
LOCAT 1014 MAP design flow and number of bedrooms to be considered for design. Receipt
%.�j►4�� of payment for the plan and installation based on the plan shall be deemed
N U approval of(lie design flow by (lie owner.
� 9 'fhe existing leaching or cesspools shall be pumped and filled will t
. � ) g g 1 I I t material
/ per Title V abandonment procedures. 'I'Itose within the proposed SAS shall
be removed along with contaminated soil and replaced with clean sand per
ZZ `,� �c� l'itle V specs.
-I ,/, ,' ( '� �-/ 1a� I `a\ 1 10)System components to be 10 feet from water line. Sewer !roes crossing the
water Ittte shall be sleeved wills 4 inch SC11 10 PVC with ends grouted if
1 C
/ '^ t`
_., applicable. 'I'lre proposed SAS is being installed below the water service
r• line. 'I'be line is to be sleeved as aforementioned and maintained in place.
S E P T I �. SYSTEM DES I GN 1 l) If a garbage grinder exists it is to be removed and is the responsibility of(he
owner to ensure such.
FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such
exists.
l3)'1'i�e installer shall vetif the location, c tian(it and elevation of life sewer
p. �� BEDROOMS AT I ID GAL/DAY/BEDROOM - �� GAL/DAY y � 1 � Y
fines exiting the dwelling prtur to the install,
,; /� ` ,, ,° e�isr. ► /� 14)'I'his plait is representative only that a system can fit on a property meeting
SEPT I Q TANK Title V requirements.
GAL/DAY x 2 DAYS - GAL
USE IG GALLON SEPT I C TANK `�4
► ot)
0 SOIL i\BSORPTI OH SYSTEM
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31 TE AND SEWAGE PLAN
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DAV I D. B . MASON RS DATE: 10 I
s DUC ENV I RONMENrf-AL DESIGNS
b m AST SANDWICH . MA
E II
DATE HEALTH AGENT
( 508 ) 833- 2177