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Home My WebLink About0058 MIZZENTOP LANE - Health 58 Mizzentop Lane Centerville A=247-047 I sill A/I UPC 17534 No.2_COR lWoosO 1sASTINOS.UN t TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGg�Z&ZTt'�(/>%G-. ASSESSO 'S MAP&PARCEL oZ —7— INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Ili., ,LEACHING FACILITY:(type), d�'Cv _ (size) �.�� NO.OF BEDR OMS OWNER/7/'4r &)XW-- / - a 'Lv 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) Feet FURNISHED BY y �y i10 VaD t`�I J �t. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered inc pr PUBLIC HEALTH DIVISION -TOWN Of BARNSTABLE, MASSACHUSETTS Yes �4pliCation for Bisposal *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/P arc eI�Y 1-w-ZZe-ti 7v P La_��_K—It �� / $� 1,j i LZeA-r6 ° gA I staller's e,A res and Tel.No. Designer's Name Address,and Tel.No. 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)S">A gpd Design flow provided gpd Plan Date VA Ad-// Number of sheets / Revision Date Title Size of Septic Tank Type of S.A.S. 4,05 40-- C Description of Soil Nature of Repairs or Alterations(Answer when applicable) X eA) t" Date last inspected: Agreement: The undersigned agrees to ensure the con ruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E ironment Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar He th. gn d Date £�<. Application Approved by Date Application Disapproved by Date for the following reasons Permit No, o Date Issued No. I E Fee THE .-MMONWEALTH OF MASSACHUSETTS v�red ui c p c: Yes UBLIC HEALTH DIVISION -TOWWOF BARNSTABLE, MASSACHUSETTS � ltlYication for MisooBaf 0strut Construction Permit i Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.,, 41 Owner's Name,Address,and Tel.No. Assessor's Map/Paicel 3-8',1/>7Z?e IV 00 ' pl C CG.C!/ j e� /^9 �c�°�'Tcs p 94 , Installer's Name,Address,and Tel.No. Designer's Name,Address,and`Tel.No. yckl ri`G�f^p/,Aeo1 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)S>1 p gpd Design flow provided gpd Plan Date y/�A // Number of sheets / Revision Date Title t Size of Septic Tank /-Ag=o -,f4 C Type of S.A.S. /T 445 41-C 39 R, Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the cons ruction and maintenance of the afore described on-site sewage disposal system in accordance withY the provisions of Title 5 of the Er ironmenta Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar He h. gn Date Application Approved by PX' Date Application Disapproved by Date for the following reasons 06 Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Repaired(✓) Upgraded( ) Abandoned( )by at !"7 Z-CA,, 7G i� - has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d ted Installer�� Designer #bedrooms 3 Approved design flow and The issuance of thi pe rit shall not be construed as a guarantee that the system will fu r ;on designed. �� Date Inspector ----- � ---------------- --------------------------------------------------------------------------------------------- No. Fee-; �' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Re air ) U grade( 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:Cons c ion ust be completed within three years of the date of this permit. C' Date Approved by Town of Barnstable Regulatory Services Thomas F.Geiler,Director lA1tN5FiLBF;E, + Public Health Division t639. `0@ gTFpa Thomas McKean,Director - 200 fain Street,Hyannis,MA 02601 Office:.508-862-4644- -Fax: 508-790-6304 Installer &Designer Certification Form Date: 111 zo I T Designer: Installer: Address: . f5A-4 OIJ 16H Address: On _ 649A)Wlwas issued a perink to install a (d e) (installer) septic system at (� ��" based on a design drawn by �)IOP M , (address) W �TiJ� _ dated (designer) :certify that the septic system referenced above was installed substantially accord.ng 'tee Elie design, which may include minor approved changes such as lateral telocatioai of the i tr button box and/or septic tank. . I certif}r that the septic system referenced above was instalei v�nth'. a}or,changes ( :e, greater thaw 10' lateral relocati6rs of the SAS or-any vertical rd'1ooation of any component.of the septic`,systern)but in accordance with State&L6ca1;I2egflations. Plan revision o-r certified as-bait by designer to`follow. �, tH O DAVID Mqs (Installe s Signature) t'i ON �+ d 1066" .. �Q►ST£A�:.. Sq ,TAR�P� ID er s Signature) (Af 's Stain .Here fix . P�. er: PLEASE RETURN TO l6AR N$Zi PYJBLI'C.HEALTH:DIVISIOP[:'CERTINC TE OF., COM]P'LIANCE WHO 'N® ' E'= SSITED. { N7CIL "BOTH THiS°FARM BLTiLT CA ARE RECEI AEI?B'�t_TBE:B. STABLE PUBLEAIs [DIV]tSI6N THANK YOIJ: Q:Y�ealtfi/SeFtic/Desib er Certification Four, t' Town of Barnstable P# / ?.2 y' Department of Regulatory Services B, : Public Health„AR& Division DateZ/L i6s9 200 Main Street,Hyannis MA 02601 ED MIKt�, Y Date Scheduled 3/:2 3 1/ Time Fee Pd. Soil Suitability Assessm nt for Sewage Performed By: � ! �"Witnessed By: rXV wLisposal LOCATION& G Location Address NERAL INFORMATION, j 2e� n cAA e- Owner's Name' ] LL-- CQ I��, / Address Assessor's Map/Parcel:11— Q`1 7 / Engineer's Name�/.�Vi 6 NEW CONSTRUCTION REPAIR t/ Telephone#5'6g'- Land Use Slopes(%) Surface Stones 1 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) 0 1" ,'., 100 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: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level.- �,-, Adj.factor„- Adj,drvundwater Level, R%6J ATION TEST bate Thne Observation Hole# Time at 4" Depth of Pere Time at 6" Start Pre-soak Time @ 'lime(V-V) End Pre-soak Rate MinJlnch 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:\.SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# F�Surf�ac�e(in.) SoiI Horizon Soil Texture Soil Color Soil (USDA) (Munsell) Mottling Other (Structure Stones;Boulders. o rsistencv 96 Gr:,�Pn i 110 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. J Z onsistency %Gravel) lit D - EEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i to DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Man: Above 500 year flood boundary No Yes - W —ithin 500 year boundary No✓ Yes Within 100 year flood boundary No,... Yes - Death of Naturally Occurrins Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? -�i If not,what is the dep of naturally occurring pervious material? � Certification I certify that on Ib. (date)I have passed the soil evaluator examination approved by the Department of Envir mental Protection and that the above analysis was perfo ed by me consistent with . the required training,ex p s n experience described in 310 CMR, 15.017. SignaturJ2 Date II Q:\.SEPTICIPERCFORM.DOC ASSESSORS MAP :PARCEL : w � �� TEST HOLE LOGS NOTES: j FLOOD ZONE: --- _ - - - SO L EVALUATOR : 1) The installation shall comply with Title V and Town of Yarmouth Board of /y WITNESS : I r� Health Regulations. REFERENCE: ,�/ )-�lt,t, ,r --df- _.:P.J�1l .._/ f�'/# , -/27 DATE: 1 � � — r 2) The installer shall verify the location of utilities, sewer inverts and septic PERCOL T I0 RATS: . GW components prior to installation and setting base elevations. NI/ ,, / V60Li 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first j T - I TH-2 two feet out of the d-box to the leaching shall be level. 4 This plan is not to be utilized for property line determination nor an other LD 5 � �D d¢•-l�7 ) p p p Y Y purpose other than the proposed system installation: Lfl ,� 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. l '`uD �7 2✓ ,�✓ 7 The property is bounded b property corners and ri ert lines. ' LOCATION MAP U�' �- � ) p p Y Y p p Y p ' p Y 8) The property owner shall review design consideratioins to approve of total 5t ( ` design flow and number of bedrooms to be considered for design. Receipt C/ of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. I _7 ✓' 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall b�0 (d(0. Okla b gJ40,WJ 1EV 5b, be removed along with contaminated soil and replaced with clean sand per Title V specs. i Z1 10)System components to be 10 feet from water line. Sower lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if SEPTIC SYSTEM DESIGN applicable. The proposed SAS is being installed below the water service _ line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the FLOW ES T I MATE owner to ensure such. ' 12)The installer is to take caution in excavation around the gas line if such BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY exists. 13)The installer shall verify the location, quantity and elevation of the sewer x i SEPTIC TANK lines exiting the dwellingprior to the installation. ff ?eo GAL/DAY x 2 DAYS - b GAL USE I ' GALLON SEPTIC TANK ; ' I 10 MIV SO 1 L AB'WORP ION SYSTEM_.._ __.__�_�_. �ZN nF, SON c" , � w D -,mv �', 14c. -q- r _ d Q "rl• lT1 ( v � 1 J� '� ll.. 7- �� S TE \_?w C �a ,ram r / .. f ?j C.11��'L5 X 1►Flo -,� ,� _ '�.'� lrAK 1 - �� - °� ki SEPTIC SYSTEM SECTION .A .� - -_._—_.__--\I.'v- J. - --- to 3°��, fix► � �r�� 1� .�� _ t�`.._�� - _=�. � Y_ _ _ __ . . - h �--� 1,LLOV i Q GALo bjL7,77 = , / i`I 1 L ¢ SEPTIC TANK S 1 TE AND SEWAGE PLAN ' t LOCAT I ON : J —4 I b'? �l io � K PREPARED FOR : - C)Wr2IvI1Ak, � � -�r��.l��^ � ��V,��; 3� � � CU SCALE: l ch W DAV I D B . MASON R� DATE: ON W DBC ENVIRONMENTAL DESIGNS .J z EAST SANDWICH . MA W DATE HEALTH AGENT ( 08 ) 833- 2 177 z i i I i I