HomeMy WebLinkAbout0037 LIAM LANE - Health 37. Liam. Lane
C mtervillen% -
A 167 k 016 003
i �Town of Barnstable P# , 7
' $ Department of Regulatory Services
,sue.
s Public Health Division Date
� 163y ��u 200 Main Street,Hyannis MA 02601
O�Ep Mitt
Date Scheduled Time Fee Pd.
Soil Suitability Assessment for Se age Dis osal
Performed By: v�'� Witnessed By: 1`r
LOCATION& GENERAL INFORMATION
Location Address 7 4- � � Owner's Name "
•7 Cw_ } Iktc Address •u�sJ
Assessor's Map/Parcel: / t� % Engineer's Name
NEW CONSTRUCTION REPAIR Telephone#
Land Use- Slopes(%) Z- S� Surface Stones D
Distances from: Open Water Body L ft Possible Wet Area SJ o ft Drinking Water Well ft
Drainage Way J ft Property Line L) ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands proximity to holes)
F
t, it
M
�0
psi I s10 ',.o
� F
4�
w Y
1t-t.0Z.
Parent material(geologic) Depth to Bedrock.
Depth to Groundwater. Standing Water in Hole: W A— Weeping from Pit Face
Estimated Seasonal High Groundwater < �L ��►�J
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Obs rved tandi g m o s.hole: in. Depth to soil mottles: In.
Depth to weeping from side of obs.hole: __- m In. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level�, Ad).factor, Adj.Groundwater bevel,
PERCOLATION TEST Bate, Thne..�
Observation
Hole# __r Time at 9"
I
Depth of Perc �& b')C Time at 6"
Start Pre-soak Time @ i d t u 'lime(9"-6")
End Pre-soak I V,I o+Y,,J `Zdt C.�ua�ty 1 0 ti,dlj
Rate MinJlnch L Z'Z vu So+.Y(•t r't�+�`t-' `�
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Obsemition Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conseirvation Division at least one(1)week prior to beginning.
Q:\SEPTICIPERCFORM.DOC
i
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenz% ravel
I$ Rio it pia J
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil ther
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Qp_nsistencL%
`G b� d Z,>' b l (0
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color. Soil Other
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders.
C nsi tent Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consi ten
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 ..i (date)I have passed the soil evaluator examination approved by the
Department of Envlro mental 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
Q:\SEPTIC°PERCFORM.DOC
*3 7
LOCATION SEWAGE PERMIT NO.
VILLAGE
INST LLE S, NAME ADDRESS
5UILDEIII OR OWNER
DATE PERMIT ISSYEO _��
DATE COMPLIANCE ISSUED
U\
LCT")
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH Aa f
3;4..JR.410-(J -"/A I"
OF...............I
/-----_---_---- .............
Appliration for Uhipoiial Works Tontitrurtion Prrutit 00-3
Application is hereby e f r a Permit to ruct 'Or or Repair an Individual Sewage Disposal
System at; 37 '
.............. .0-77t ........... .... .. . ...................... ................ ------- .....................................
....
s Aw
07E d s .................ar.,-t No.,,....5._Ljr,�......
............................... 6.. iogt C
___Gwner Address
..................................
..........................................Z.-_t S............. ........................
Installer Address
Type of Building Size Lot...... ...Sq. feet
U .........3..........................Expansion Attic Garbage Grinder Vl�o
Dwelling—No. of Bedrooms... (Po
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Other fixtures-------------------------------- -
W Design Flow........................ .......gallons per person per day. Total daily flow................ 3_3_0............gallons.
P4 Septic Tank—Liquid*capacity.1 allons Length................ Width........_....... Diameter._...._......... Depth......_..._.....
Disposal Trench—No..................... Width...._........._..... Total Length.................... Total leaching area....................sq. f t.
Seepage Pit No..................... Diameter--_--___-___-___-__- Depth below inlet................_._. Total leaching area..................sq. f t.
Z Other Distribution box (IV Dosing tank (
Performed by......................t;T ......P-10""I Date_..._.... _ --------
Percolation Test Results -----------1-1
Test Pit No. 1.&�_ $..minutes per inch Depth of Test Pit_______/..nZ.... Depth to ground water....
nInviinutesper inch Depth of Test Pit.................... Depth to ground water......e O!ZZV
�T4 Test Pit No. 2.......WA
7L
0 ..... ...1Z- --- ----------------------------
... .......i ... -
------ ......................................................
Description of Soil................................. ---- -----Z.,....... 4
W ...............................................................................................f v-1-2... ... ....... ........................
U V
............................... ........................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TL I Ti LZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu d by he board of health................. -Z Sign ............. . .. . .. ............
Sign .....
ApplicationApproved B ., ...-, g,........... .......................................................................... ....F/. ..........
Dis
Date
'is
Application r e for he following reasons:................................................................................................................
............................. ...... ..............................................................I...............................................................................................
Dat
PermitNo......................................................... Issue(L..................Date................................
.
5 ....•-•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Aliptiration for UWVonal Works Towitrurtion Prrutit
Application is hereby or a ermt nstruct or Repair ( ) an Individual Sewage Disposal
System at,: � n�...�...............
..............� .- l.-...-•--•........-----
Location.-Address or Lot No.
....................................
*a.l . -= 1 ..�. . .. ...............................................a�''� "
Owner Address
............................................ -------•••• ........................ ..........................
Installer Address
d Type of Building Size Lot____.t_0...f_r_f.....Sq. feet
Dwelling—No. of Bedrooms............ `___________________________Expansion Attic (kjo Garbage Grinder (1-69
aOther—Type
of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ......................................................................................................................................................
W Design Flow........................�..�_._______gallons per person per day. Total daily flow................�>_ __ ............gallons.
WSeptic Tank—Liquid capacity_i,_004allons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (IV Dosing tank ( ) �-
~' Percolation Test Results Performed.by______________________________ . *!1_ Date........... -7l. . -.-.
1 Test Pit No. 1_ _ eS.S__minutes per inch Depth of Test Pit.......L''Z__.. Depth to ground water....
(i, Test Pit No. 2_.__� `minutes per inch Depth of Test Pit......f_.._ _. Depth to ground water.... k-
x Description of Soil ...•-••-•• -t '". -= 1 -•-•••-•-•••-------••-------------••---•----•---_..
.............................. .. .n..________..__.__ ..._.__.________� _.- .. _ _ ;.�___:__ j _
c, `
W ••---•••••-•-----•-----------------------•-••---••-----•••----------••------•--•-•-•---._.._...--••--•-•-•----••------------------------•••-•-----•-•-•................................................
0 Nature of Repairs or Alterations—Answer when applicable...............................................................................................
-----------------------------•------------••----•-------•-----------•---.._._...--------.............---•----------------------------------------------------..__...._..._.._...--•••--....._•-••••--••-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ILTY 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
i � f
Application Approved BY i �I = 1 trace
Application Disappr9 d the following reasons:................................................................................................................
--.` -----•----...---•---•--••------------------------•-------..•.••..----••----•------------•---•-------•-----•---•---•--••------•-•' ---__......_
-
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH. _
1
(Intifiratr of Tontpfinnrr +.
THIS IS TO CERTI-EY, That the Individual Sewage Disposal System constructed,,(-'�) or Repaired ( )
by...- ,.). - C�, f_.. ...
Qt ------..............
-------------L..._........................... ----
P _.._ ......
Install "" ,. •
--•-------•--
has been installed in accordance with the provisions of TIFILE r The State Sanitary de as gibed in the
application for Disposal Works Construction Permit No. _ :r_�_______________ dated_---€� //...::.__.___-___._._____._____..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................8/�,� -..... -•-•---- Inspector_✓!=As:.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
a �a ..........................................OF....:...-..........T . -%,� f - .......
r-
._....
No....:................... FEEIA...............
Disposal Workii T-Fonifrurtion funfit
Permission is hereby granted...................._.-ate---"-`q- --------+� -.;-
to Construct (y)or Repair ( J an Individual Sewage Disposal System --
Street
as shown on the application for Disposal Works Construction Permit No. ._ "/"/j _ Dated_.'�.__f................,:_._.-........
----•--------------------------------•-•••-•---•-----•••-_...._
Board of Health
DATE...................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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LEGEND .; . .. _ ;
EXISTING SPOT ELEVATION',. OsO ��H OF CERTIFIED PLOT PLAN
EXISTING CONTOUR O ��a Mq 1-o7- ZS L/.4 M 1--A f
FINISHED SPOT ELEVAT,gON o AL R
FINISH&D CONTOURmo
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APPROVEDt BOARD OF ,HEA,LTH:. A 9N SE IN
CIS
DATE A®ENT ��SSJONAL��6\ SCALE, /"=So ' ®ATE 7//6 �z
1 CERTIFY THAT THE PROPOSED
E!OISTERE BUILDING SHOWN ON THIS PLAN
CIVIL LAN® ` CONFORMS TO THE ZONING LA
E OR.BY$ A. OF SARNSTA LE, -MASS.
762 MAIN STREET, Cisl vyl. J'R L'
M YAWN I 3,, AAA.J S• + SHEET.L OF 2— DATE _,REA. LAND SU V EYO1f
e77 7777777 _ _
/VOTE /F F/TNER TXE SFP7 TANK OR
20 FT. M//V• ♦EACH/iYG P/T ARE MORE TNAeV /2"BE40JN
/D PT. /��/� BRA®�� f� 24 +�/�METE� CONCRETE Cop--R
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L 0 CATION SEW A C.E: PE It MIT : NO.
pep Lim-L - T7 -
VILLAGE
INST lLE 'S NAME ADDRESS '
PRO
11UIL0EIt OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
A.