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HomeMy WebLinkAbout0567 OLD CRAIGVILLE ROAD - Health r 567 Old Craigville Road Centerville A= 226 - 185 Sllll J�QEc�cLEo� O _z yi UPC 12543 Now 53LOR HASTINGS. MN No. Fee )6� ry THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mi5po5aY *pgtem COtt.5truction Permit Application for a Permit to Construct( ) Repair(�) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address Tel.No. s sor's ap/Parceli Eck OT MA- gc�g, �5. 3116 41 Installer's Name,Address,and Tel.N .�JD� Designer's Name,Address and Tel.No. a� ex- Qo, 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) rj Q gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) L* y-4 c pan m1Fs, 5&4c, 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 Healt Si ed Date : —0 /Q8 6 Application Approved by Dateto / Q,%, Application Disapproved by: Date for the following reasons Permit No. Cj Date Issued I J No. . r'1cn\s 16 Fee ,d0 � -5 , -- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: T PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes s Z(pprication for Mi5po5ar 6p.5tem Cow5truction Iermit Application for a Permit to Construct ) Repair O Upgrade( ) Abandon O ❑ Complete System ❑Individual Components �- Location Address or Lot No. t ( Owner's Name,Address,and Tel.No. 5ee7 0 LZI t5v tc, rA &/Ve ,,J ( / \yen m i 1 1� Tr4cr. stn7 dtcl C.Mk-v Asses sore's Map/Parcel� c��_1 QS 16 or- , go$ 75 333 Installer's Name,Address, n Tel.Nq.20 n Designer's Name,Address and Tel.No. a;?Jg'Yt 2).eA vvrYW cfu t� �O r-t'2 s'1 ►?'wq"- 1�0 Qo%,Zix Type of Building: Dwelling No.of Bedrooms 5 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min,required) rj r-)© gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil #i 1 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 the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health.. Sign I(/� Date 10 SD-$ 1n4 Application Approved by Date 7co `Application Disapproved by: Date for the following reasons Permit No. Q00 � ,'''; �" Date Issued �� 5 — 3 ————————— ———————————————.——————————————————— 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 S P ._ -o,r.C)�n %yaA scg 1-, at !;;I zi i A c w nI j 1 0r, c-A. , (Apo has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No. ej S 41 9- dated Installer s��n �n Designer Do,C=e4 1 a 84"r #bedrooms Apprqi4cd design flow .rJ'�O gpd The issuance of this 0 t h I not be c strued as a guarantee that the s stem wil ctio as sig ed Date �� Inspect No. Fee Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 11i5poot *p$tem Construction Permit Permission is hereby granted to Construct ( ) 1 Repair ( x) Upgrade ( ). Abandon ( ) System located at v PG7 K)U4 C i'A oT n t--� f�, If and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this s p t. Date �?>� � Approved by j Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, rr i'V l P/ Ilhereby certify that the engineered plan signed by me dated �5 , concerning the property located at 5-6-? Q L� 02A1 4 V I LL—C RD, meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. . • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 6 B) G.W. Elevation +adjustment for high G.W. DIFFERENCE BETWEEN A and B $. SIGNED . DATE: NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc TOWN-bF BARNSTABLE 6 Go 1 ! 7 d L /� C ��1! �LOCATION ( l L Le SEAGE #W , U t.✓ VILLAdtt °�7At ' ° � '� ASSESSOR'S MAP & LOT QJ INSTALLER'S NAME&PHONE NO._ el d A C.© E DQ S SEPTIC TANK CAPACITY l d—rJ n LEACHING FACILITY: (type) L e A C /�!-' A'/e 1-47 (size) NO. OF BEDROOMS " BUILDER 0 OWNE p PERMITDATE: Q 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 Wetlarid and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnii4dby ,tr A fi. ` r3 � 1 � i Town of Barnstable Regulatory Services Thomas F. Geiler,Director + snxxsTAB6E. + 9HASM& Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Offce:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: I r 2- 0, Designer: ba r��� �"/ J vl�/��� gn / Installer: Address: . Q. 9 � Address: PC) P),Q J 02S3 On /Q,,- 1 wl was issued a permit to install a (date) // (installer) /T— se tic system at S� 7 6/V CA416'0 1t�4 based on a design drawn by (address) ✓y�✓i " "� ; `(� -G�dated q dJ (designer) r 1-certify that the septic system referenced above was installed substantially accordingto the design, which may include minor approved changes such as lateral relocation of f he distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (Le, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Locaj—Regulations. Plan revision or certified as-built by designer to follow. OFs . o RR � 1 � `�- (Installer's Signature) ipl � \ Isrs ��6 s�NITAR11 d� (Designer's Signature) Affix Designer's Stamp 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:Health/Septic/Designer Certification Form - TEST PIT � PERC. TEST RED LIL Y POND GW ADJUSTMENTa INDEX WELL: MIW- 29 EXISTING ti t �' `� • '.� ED LANDS ZONE: B # GRADE # 2 �F 1lVI-' LEVEL G.9 O - EL. 99.3 EL. 99.2 - O" ADJ. 1 .2' 9" - 98.55 -w- -A� 98.G2 - 7" "4` w LOAMY SAND I OYR 3/2 FLOOD ZONE: 250001 - 0008 - D JULY 2, 1992 31 - - - 9G.72 LOAMY SAND 9G70 - - - 30 ZONE B . AF'N 2 26 185 I OYR 5/8 D E51 GN - 389829 ±5F 1 _ C-- 100.O' SINGLE FAMILY DWELLING W/ 5 BEDROOMS -95.22 94.79- NO GARBAGE DISPOSAL DAILY FLOW= 5 X I 10 = 550 G.P.D. _i MEDIUM SAND SEPTIC TANK(VOL. REQ'D) �2 2.54Y7/4 550 G.P.D. X 200% = I100 GALS \ USE 1,500 GAL.TANK-NEW \ 12G"- 88.7 88.7 - 120 LEACHING AREA(S.A.S.) OB5. GW @ 1 20" (EL. 89.3) OB5. GW @ 1 19" (EL. 89.29) USE 37.5 X 20 X G" LEACHING FIELD \ ADJ. GW (90.50) ADJ. GW (90.49) 37.5 X 20 X 0.74 = 555 GPD OK z \ z TESTED : AUGUST 14, 2005 < 550 GPD REQ'D c,a N N �961 N 501L EVAL: D. MEYER I 0 o I / 100.0' o Epp CLA55 1 501L5 LTAR = 0.74 GPD/ft^2 \ - NOTE5: 6\ s 1 . DISPOSAL SYSTEM TO BE CONSTRUCTED IN STRICT ACCORDANCE WITH COMMONWEALTH OF MASSACHUSETTS ENVIRONMENTAL CODE -TITLE V. BENCHMARK: 5TAKE/TACK I �\ \ 2. ASSESSORS PARCEL NUMBER (APN) : MAP 22G - PC. 185 ELEVATION = 100.00 `yc� \ h GAPAGE 3. CONTRACTOR TO CALL DIG-SAFE 72 HOURS PRIOR TO BEGINING CONSTRUCTION AND/OR EXCAVATION. (ASSUMED DATUM) \ 4. EXISTING CESSPOOLS TO BE PUMPED AND FILLED WITH SAND, AND ABANDONED. '.J 5': CONTRACTOR TO Ff>=CD CHECKlNVERTOF EXf5TING TANK G. PUMP SEPTIC TANK, CHECK T'5 AND INSTALL GAS BAFFLE No. 5G 7. TH15 PLAN DOES NOT, IN ANY WAY, REPRESENT AN ACCURATE, INSTRUMENT SURVEY OF THE PROPERTY, AND 15 NOT 1 112 STY. TO BE USED FOR ANY CONSTRUCTION, OTHER THAN THE ELEMENTS OF THE SEPTIC SYSTEM AS SHOWN. ,WD. FRM; / a 8. THI5 PLAN 15 NOT A RECORDABLE PLAN. T.O.F. = 99.'02' 9. BENCHMARK IS BASED ON AN ASSUMED DATUM, AS SHOWN, UNLE55 OTHERWISE SPECIFIED. 5' REMOVAL RO EL. 9G.70 OR TOP OF C LAYER � 10. SUVREYOR: HOOD SURVEY GROUP, LLC: P.O. BOX 23 I :SANDWICH, MA 02563 1 1 . SURVEY DATA FROM SUBDIVISION PLAN FOR SANDY LANE RECORDED AT BARNSTABLE PEG. OF DEEDS PLAN BOOK 2G - PAGE 131 22.0 1 111 0 0 \ rn 12. SUBDIVISION SERVED BY TOWN WATER _ _ ? 13. PLUMBING TO BE MODIFIED TO MEET OUTLET LOCATION * ELEVATION. I t 14. 5 FOOT 501L REMOVAL AROUND LEACHING TO EL. 9G.70 OR TOP OF C LAYER 4 - - ° ° ° \ - ..9� MAY BE NECESSARY DUE TO CHANGE IN GRADE p G' T"-2 p_�_ 4?� 15. NO KNOWN PRIVATE WELLS WIN 150' OF PROP. LEACHING. N G, NEW 1 ,500 1 G. NO WETLANDS WITHIN 100' OF PROP. LEACHING. GAL. TANK 5 2.0 \ 4' \ �A`11N OF MAssq 37 5' /� /� 1`�� 00' oo AR E' 10.0 , - - 160.G0' -+ . 55705'00"W _ r _ )\ E R No. 1140 EDGE OF PAVEMENT G/ST? sANITAR`PN TOP OF WALL OLD CRAIGVILLE LOAD = VENTFILTER EL. 99.02 REMOVE IMPERVIOUS MATERIAL 5'AROUND EXISTING GP,. EL. 99.20 SYSTEM TO EL. 9G.7 2%SLOPE EL. 99.0 OF cx /ex�� SEWAGE SYSTEM D ES I G N 9"MIN. COVER 2"PEASTONE EL. 96.6 EL. 97.0 ["020 TEST 5G7 OLD CRAIGVILLE ROAD K,LEVEL 2'LEVEL °BAD EL. 9G.0 EL. 96.85 I,500GAL EL. 9G.G0 �� a NEALTN AGENT APPROVAL DATE I-IYANNISPORT MA D-BOX ° °tr°�a°o °aoo 3/4"- I I/2" WI �pgoo"g� ° P.C. CONC. EL. 96.19 / FIELD GASBAFFLE �� °8°c ca'� n DOUBLE Q`bR°q� CHECK SEPTIC TANK(H- IO) G"MIN. rob�o�tr°bib °bq�b pR oa lb bqb FOR: MARY ELLEN MILLER PH: (3GO) G87-7189 o°off ,oDoo�p000�o oo EL.9G.43 �A s- °oBAoo FL. 9G.2G °So$2oBo. $oo WASHED STONE 4 °a°8% °Yo EL. 95.5 LEGEND P.O. BOX 1092 8°. ,Ro go.kltd'O S oa'8o, p9So0'8?0 BATTLEGROUND WA 98604 6"CRUSHED STONE OR COMPACTED� 37.5' I O'MIN 24 PROPOSED CONTOUR - MIN. - hood Survey group, LLC. DARREN M. MEYER, R.S. DEPTH OF LIQUID- 4' 5.0' INLET TEE DEPTH - 10" 10 EXISTING CONTOUR LAND SURVEYORS P.O. BOX 981 OUTLET TEE DEPTH- 14" ADJ: GW EL: 90.50 18 ROUTE GA EAST SANDWICH MA DRIVEWAY 02537 5ANDWICH1, MA 025G3 Ph: (50) 3G2-2922 PROFILE OF D15PO5AL SYSTEM _ sz. "c° FIRM ZONE DRAWING NOT TO SCALE) S "B" DATE: 16AU605 SCALE: 1" = 20' I' M A�G(� F DATA . Large Format Box # Doc # Image # i