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Home My WebLink About0057 LONGFELLOW DRIVE - Health 57 Longfellow ®rive 188-028 Centerville a �ft (AaUPC 12534 No.2 ORst� HASTINGS.MN F Town of Barnstable. Department of Regulatory Services / • Public Health Division Date e$ 200 Main Street.Hyannis MA 02601 Date Scheduled Time Fee Pd. Suitability Assessment or Sewage Disposal Soil 5 t3' f Performed By: Witnessed By: NI i.o rr nr� LOCATION & GENERAL INFORMATIOl�j, location Address . <'7 �/ y Owner's Name'' lebw K�v � . Address Assessor's Map/Piircel: �'�®� Engineer's Name NEW CONSTRUI ,WN REPAIR i Telephone# Land Use C' f1 — Slopes(%) Surface Stones O 00 ft Drinking Water Well --_ Lift Distances from: Open Water Body 7 � ft Possible Wet Area_____ — y 100 ft Property Line � O ft Other ft Drainage Way , SKETCH:(street name,dimensions bf lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) EMG7�-50ti. Ay �8. o' 3 .20; ' G.2960. D�t o. Z. iP-1 6� 3 aoIa'ry DOGLuNG 0 (► A Parent material(geoI 'c +rnGra ou�% as� Ili Depth to Bedrock �a r ogt ) Depth to Groundwater. Standing Water in Hole:*, enrJnif(Ilii f Weeping from Pit Face Estimated Seasonal iHigh Groundwater K/'A D�TERMIN TION FOR SEASONAL HIGHv r A'1 L' TA L�+e Method Used: % ± In. _in. Depth to soli mottles: Depth dbterved standing in nobs.hole in ©roundwater Adjusttttent . Depth toiweeping from side of obs.hole. A efor,..,. A�,dmuedwiw Level Index Well# Reading Date index Well level — Date 'Pludee_.._. PERCOLATION TEST � . Observation r� i Tithe at 9" �--- Hole# Lt s�i Time at 0' ... _�_. ..... Depth of Perc t Time(91,41 Start Pre-soak Time.( L00 -- -- End Pre-soak 1200 � Rite MinJlnch Site Suitability AsscissmenC Site Additional Testing Needed(YIN)_.�lSa___. Passed Site Failed OrigivaL•.Public He*lth Division Observation Hole Data To Be Completed on Back 00' of wetland, ***If percolali0n test is to be conducted within 1 b yengin ning- st notify the Barnstable Caservation Division at least one(1)wedc prior to DEEP OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent Gravel) 0-to" III I?" E -M Lbamj S. 10j9_ s�� Norm. Il" - -3G11 13 F-M 1. tm S. t10If- �(�I 3l.'' 1(�f l / 1" eati.m &nj to J1 S/ lU,v L Ifo r o 0 vrAno L�c C, M-C Sand to 16L 6Iq N,me, 5°).Gr-A,16 Lc*G 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) c�- sly it -M Loam S. Lo fL �1� ane_ G E M I.w S• to It- 5/ or ):0 _ 31 N i3 (-.M �� S. toN,,� 3g"-7p`' �� ICI Ism Sand to Q � I�lont- 4A 130" CL M-C SA j I® J(L 61 OL Gc-a,,el Loose DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent Oravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C n isten t Flood Insurance Rate May: Above 500 year flood boundary No_ Yes _-__— Within 500 year boundary No Yes Within 100 year flood boundary No l! Yes Depth of Naturally Occurrint_Pervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? �a P P If not,what is the depth of naturally occurring pervious material? Certification I certify that on o L (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 train* g,expertise and experience described in M CMR 15.017. Signature n Date ' OS Q:=P17CVERCFORM.DOC TOWN OF BARNSTABLe� LOCATIONS f' /�� SEWAGE S21/ VILLAGE_ A 14:7*7�' ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.. J. CRAIG MEDEIROS 7$ L T mim ST_ M HYANNIS, A 0260 SEPTIC TANK CAPACITY LEACHING FACILITY:(type)�/ ,�o � adG ("size) /peat •l NO. OF BEDROOMS PRIVATE WELL PUBL ATER BUILDER OR OWNER �J` ✓ c�L'�� <L DATE PERMIT ISSUED: q xz/ DATE COMPLIANCE ISSUED: s VARIANCE GRANTED: Yes No . i / f elo d2,fis°°° V �G ezed i rr No... .F_-�?�� Fmc...'A.0...... .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �- OF......................................................................I.....------------. Appliratinn for Disposal Works Tnnutrtution Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair �n Individual Sewage Disposal Systemat: -...................•••-•••...................................................... •- • ----- - �✓ ...............•-------------- aLoc dress -- -" r o. - .. O ner Add /� '�� ----------------- Installer Address Type of ilding Size Lot-___-•---•.----•-_._--------Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .._....... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons 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 ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date------------. -------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-._-__-_--.-_---_____.-. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------................. •. ---------- -•-••.._......-•----•••••••----------------••----•-•------•--•-•.......----•-•--••--••-•-•...--•-•-•--••--•--................ ODescription of Soil ------••-•-•-------------••-•----------------------------------._-------------------------------•-----------•-------.----- U •-------•-----•------------------------------------•--•--•-•---• ------•-•------------------••-----------------•----------------------------------------•---•----•------•------•----------- ------------------------....................................... .................................................. -- -- --------- - Nature of e airs or Alter tions—Answer when a licab e__._._. � U P PP - -� `�.?-`' �� Agreement: &�---..---.--•.-----••.•_-•--....--•..................•---- ---. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TJITA 1E 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. rr Signed. .. ---•--•. -----• 10.�1 Date Application Approved By............... ................................. .......... . 3'--F1E_ Date Application Disapproved for the following reasons:-------•------•--•-------------•----------------------.._..---•-•-----------------------------------•----•------ --------------------------•--•----•--•--•-----------•------------....-----------•----------•-------....--I--•...•--•--•-•--••-----•-•----••--•---•--------•-•----------•-••----•--•----••---•---•••---_.. � v� Date Permit No.---. .._...'---------v� Issued_....................................................... Date 'a'd• � r-r/ v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ""'..----.....OF.......a...`^r............... Alip irafiun for Biupuual Works Tuntitrurtion tirrutit Application is hereby made for a Permit to Construct ( ) or Repair (..,"ran Individual Sewage Disposal System a..j_� --------------- --------------- ----- ............................................. ----• ------•----•--------------•• ----- ---- Coca' dress �-- Lot No. ✓ _ A O/},(ner fN� �/ � Addr\ess_�� 7'�.�jj�� ........... .. ...(--•-•. .....• C--`_-_5.-------•----...---•----..........--'.....Y�� ....-----�..----a=----------------------.. .:....!..rf. -`---------...----------------- Installer Address PQ d Type of B ilding Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria p 1 Other fixtures ............................... . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons 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 ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per Inch Depth of Test Pit---................. Depth to ground water..-.--.-------__.._--.-. fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----__.......-_._.-_--- 9 ----- --- Description of Soil.......... r. . __ . .__r.�r.: x W ............----------- ----•------------•-•-••--•••-••-•----------••--••--• .......................................•------•.......... ........................................ U Nature of epairs or Alter tions—Answer when applicable.---_---. .- y - -��.-1-�!�_-1--.....1:?-_?_�-��. . ..:............. E: ( { !k; --------------------------------------------------------------------•------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. Signed. .---.._.. ......... ---../.___..!�'_'_.. -----",`'�.'........._ ��,1 . •--•-- - Date Application Approved B _. _' .........9 ... _ <,�_____ Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- .....................•-••...•--•-....-----••---••--••••••---•-•-------•-------•-•-------•--•--••-....--•---••-•--•-----•••---••-----------•----•••••-•••--•-••-••--•----••--••-••------•-•-----......-- � Date PermitNo.....-T�---a-------- � f......................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...u-�- .................OF...... /....:. ............... ................................................ Qrrtifiratr of Toutpliatirr Ti, S is C/ER.TIFY hat the Individual Sewage Disposal System constructed ( ) or Repaired ( } by = --------------- �—Ftfs�er _ -------------------------------------------------- has been installed in accordance with the provisions of TI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------- 5_.Y.1_....... dated........:....................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................... ....................... Inspector............................ ...... ----------------------.......--•-•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �- — No...� FEE_;—) -...... iu�ruu 1 rku Tonu#ruriion amit Permission is hereby granted. .... ......•` Tf.._. J/.r.� e. !?. „..- ---•----•-----------•...................••-............................. to Const t ( ) or Repa' a Individual._<7777 J� Disposal Sys>;e}n —,f - /E � Greet S Cas shown on the application for Disposal Works Constructio ermit No..�� ::,./r�_ Dated.......................................... -•---•.........._-•--••-•-------•- ------•------••-••......-•--••.....••--•- ^ �(G Board f Health DATE................. -..1. Y. .................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ..