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HomeMy WebLinkAbout0025 PEN LANE - Health 25 Pen Lane Centerville A = 193 - 201 /// S M E A D No.2-153LOR UPC 12534 smsad.com • Made In USA 4� OjIN9t 115®N 11iS i00D11CT l!E FI Of11ESFIPNOCOAI WMIIM� TOWN OF BARNSTABLE LOCATION 2,5- PL& &g=- SEWAGE# VILLAGE r,-Wra-rvd11_ ASSESSOR'S MAP&PARCEL!y3 401 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 100/) LEACHING FACILITY:(type) 2-.SSU 0 L�,*WjgrV (size) 2,s X 13 NO.OF BEDROOMS 3 OWNER J a/T ��rDENTGIi' 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), -gG Feet FURNISHED BY V � ,G 6 �i e I(, el9c�� y D, . .3 No. v�O K Fee COL'` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplitation for Disposal �&pstrm Construttiun Permit Application for a Permit to Construct( ) Repair V_.�—Upgrade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,?$ pl,N 1-4l ;- O ner'sName,Address,and Tel.No. Assessor's Map/Parcel O I taller Name,Address d Tel.No.�j O$ y20--9' 4f 8 f Designer's Name,Address,and Tel.No.j"D$- Ze ^O$_q�j/ ✓ Ue is lallp , I if WAI Mw-sToh.s fir!/s geo ECff �v�� �v/oev Type of Building: Dwelling No.of Bedrooms Lot Size /& Z& sq.ft. Garbage Grinder( ) Other Type of Building 5,tA[,,O— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)) 'C 3� gpd Design flow provided 330, gpd Plan Date 2 r �7 "(7 Number of sheets Revision Date Title r Size of Septic Tank f( 1006 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �,r/�j l'/ l4GU/" !�/e> 5, 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. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ao 65 7� Date Issued �'�Xj- 1 �►w No. v I "' Fee (01), — ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ..' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair,(/)-Upgrade(,,,,�bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z ,f P!�/1/ L4N/: Owner's Name,Address,and Tel.No. Juvlrh C�rp�Nr�v� Assessor's Map/Parcel _ O CG /? V! I taller's Name, ddress a d Tel.No.j aO-y2a-f�3� Designer's Name,Address,and Tel.No. f OS ?G ':;OS q9 7ost!Py 0,, % p�rb. , V. R'l �sis�-�1T W Mrs Tali S ml%/s 1 ,660 i=c°oy j9,av1j 1' 6 ,q O a14 Type of Building: Dwelling No.of Bedrooms 'j' Lot Size -1 sq.ft. Garbage Grinder( ) Other Type of Building 5,1,4 �� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �j�? `. `- gpd . Design flow provided gpd Plan Date �j (� (�j Number of sheets Revision Date Title Size of Septic Tank 4900 Type of S.A.S. �� � 0 —2 �00 0,01 (eile l Description of Soil 4 Nature of Repairs or Alterations(Answer when applicable) T.415 r.411 '!4Cli/ /rice /� AXw; ,5 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. Signed Date Application Approved by Date Application Disapproved by Date ' for the following reasons Permit No. aot!5 Date Issued �j '� 6 --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(L} Upgraded(4--)• Abandoned( )by �p S Cf�`j �-G l3r�rrUs° at S~ �`il/ ps// �FIVT;/'1/!11/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�,j�� � O dated S Y Installer ,1D-5exd4 0" &4rn'a-5 Designer gG Q T-'ck #bedrooms 3 Approved design flow r v gpd The issuance of this permit shall not be construed as a guarantee that the system willn dd9jLP d. f Date s J ( Inspector 1 �— CJ ------------\\------------------------------------------------------------------------------------------=---------------------------------- No. r,t 0 (,�` (-tA Fee (t�� C/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(4,,• Upgrade( 4ey' Abandon( ) System located at Q r 6:-- 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. <- �y - r� n, Dater Approved by THIS IS A LEGEND COLOR SEPTIC COMPONENTS PLAN IES EXISTING USE COLOR PLAN ONLY -vK > GAL WATER LINE L�11 V FOR INSTALLATION �`'m SEPTIC TANK NE FULL DETAIL IS BEST OAS LINE LA VIEWED IN FULL COLOR OVERHEAD WIRE EXISTING . LEACH PIT/ 90 UTILITY CESSPOOL POLE 91 DISTRIBUTION BOX +, TEST PIT O 9(3` �O ON LOT 72 12j�a ft 91 o f t AREA = 16261 sf+— 91 ti PLAN BOOK 312 PAGE 14 ` -a G ASSR MAP 193 Pa 201 rn M ti 00 )s ME OAK 1 Z M1 IMA\ GRADING ( CID • 90 0 PROPOSED C S \ a J � a 15 in '16. OAK _ EXISTING CONTOUR / —_ 1 pgLE GIs D l j \ a epyN� AT�� O� 2 O12 in AK ELEVATION 15 in in 92. 44 �� <'cy OAK PINE - PROPOSED SOIL °o OF FoUtADN-° `sue T OAK ABSORPTION C,o OAK SYSTEM \ —SEE DETAIL 90 ON BACK 105.81 ft 89 EIS E VA TIONS a9 PLAN ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS (BOTTOM OF PIPE) EXPRESSED IN DECIMAL FEET SCALE: I 1(1 20 f t SEPTIC TANK IN EXISTING Ggpg o 20 40 SEPTIC TANK OUT 87.10 G R D-BOX IN 86.80 OT 6 Io 20 D—BOX OUT 86.63 OWED PRINT ON 8-112 x 14 in PAPER LEACHING SYSTEM IN 86.50 FOR PROPER SCALE BOTTOM OF LEACHING 84.50 THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING PLACEMENT OF ADDITIONS, SHEDS, FENCES OR SWIMMING POOLS,OWNER. CENTERVILLE. MA SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR, STREET hm4 Of _ s� OAK LOCUS o �DAVIDSs9C'yoJ, �P`�DAVID.SS9 SEWAGE DISPOSAL CyG ",JOJ� ` v PEN o s SYSTEM PLAN NE � � D. �`, I � -TO SERVE EXISTING DWELLING v N LA �+ COUGHANOWR v uo COUGHANOWR A No..1093 No. 461 JUDITH A. "rc gPPR o CARPENTER O ? SCALE ~ l� 1 `�� OWNER(S) OF RECORD `1 " s rr P� EV 25 PEN LANE ^� Ot0 STgOF Apo L��O 155 Geo Ryder Rd S PROPEENT EDRTY DRI ESSE. MA q0 Chothom, MA 02633 AUGUST AND STAMPED FOR SURVEYOR'S CERTIFICATION REFER TO 'PLOT PLAM DATED DOV1dCOU®HOtfTtOILCOITI DATE: APRIL 15. 2015 L 0 c U 5 MAP ON FILE WITH78HEI BARNSTABLE BUILDINGYDEPAORTMENT.OW 1R RL5 1508 364-0894 PG.1/2 JOBS ETE-3897 �a p 2 p DATE: APRIL 14. 2015 �p �p SODL� TEST LOG PERC* 14669 S GN �A��q , �.���`�Ng SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE 0461 DESIGN FLOW: 3 BEDROOMS X. 110 GPD = 330 GPD WITNESSED BY: DAVID STANTON. HEALTH DEPT. SEPTIC TANK, 330 GPD:X 2 DAYS = 660 GALLONS TEST PIT ] NNORC ORTOU68 WATER E NOUNIINCH E C SOILS RE USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL CONDITION. IF NOT,.INSTALL ELEVATIOM SOIL USDA SOIL SOIL COLOR SOIL OTHER: NEW 1500 GALLON SEPTIC TANK.. ORIZON TEXTURE (MUNSELL) MOTTLES 90.50Ap . SANDY LOAM 10 YR 3/2 NONE FRIABLE DISTRIBUTION ROX: INSTALL UNIT DEPICTED BELOW: Bw LOAMY SAND 10 YR 5/6 NONE LOOSE SOIL ABSORBTION SYSTEM: 87.50 THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE C MEDIUM $AND 10 YR 5/4 NONE LOOSE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES. 78.50. PER INCH = .0.74 GALLONS PER DAY PER SQUARE FOOT. TEST PIT 1 NO GROUNDWATER ENCOUNTERED THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY 2 MINANCH IN C SOILS DEPICTED BELOW CAN. LEACH: ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER INCHES HORIZON TEXTURE (MUNSELL) MOTTLES BOTTOM AREA = (24 x 12.5) = 300 sq: ft. 89:95 0-6, Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE _ + + + = 6-34. Bw LOAMY SAND 10 YR 5/6 NONE LOOSE TOTAL AREA = 446 sq.. ft. 87,12 FLOW CAPACITY = 0.74 x 446 = 330.04 gal/day 34=144 G MEDIUM SAND 10 YR 5/4 NONE LOOSE INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED 77.95 BELOW. FLOW CAPACITY = 930.04 gclldoy :WHICH EXCEEDS THE 330 gal/cloy REQUIRED FOR A THREE BEDROOM DESIGN. IEW TO BE PUMPED DRY AT TIME OF INSTALLATIONXAMINED FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. o' �• • �' REPLACE WITH A NEW DRYWELL 24.0 ft 1 in 1500 GALLON TANK UNIT TAPER IF CRACKED. ROTTED co OR OTHERWISE M` COMPROMISED. Y Un O c U? CO (V w N 0 4ia I NOT TO.Lo STONE SCALE 3.5 ft 8.5 ft 8.5 ft 3.5 ft 8 ft-6 \Q _ /„ 500 GALLON DRYWELL DIMENSIONS & DETAIL INSTALL ONE INSPECTION INLET OUTLET ^ RISER TO WITHIN. THREE COVER COVER USE INCHES OF FINAL GRADE H-10 & INDICATE LOCATION 57-0. ON AS-BUILT 0,3 IN DROP UNIT r FLOW LINE FROM /0 !n = p1D; 33. . BUILDING 14 TO pTp, in 1n D-BOX a 0$07 48 in Oppp. LIQUID GAS LEVEL BAFFLE /02 �n �. __..__ rr y.,. ...... CROSS SECTION VIEW 6 In STONE BASE IF NEW INSTALL AN APPROVED GEOTEXTILE SEPARATION BETWEEN INLET & OUTLET FABRIC OVER STONE TEES NO LESS THAN LIQUID DEPTH CROSS SECTION VIEW ■ 3/4 in TO ■ 24 in ■ 3/4 in TO DISTRI : UTION = OX i8 I-1/2 in GRAVEL ■ EFFEC IVE: 1-1/2 in GRAVEL •• •• ►s 46. in 58 in 750 in 12 in -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE MIN STARTING WORK: --� -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM FROM 5 REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC N TANK b b SAS O CODE (310 CMR 16). Q ^ INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 6 In STONE�BASE -ECO-TECH:ENVIRONMENTAL RECOMMENDS THE INSTALLATION t� E OF LOW FLOW FIXTURES & APPLIANCES, AND PERIODIC PUMPING OF THE SEPTIC TANK. ?� /q Z CROSS SECTION VIEW S -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. l Oo p O U L C TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE ....CH. 4o PVC . EL 92.44 += 6 In OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN 90.25 -BOX 3' USE H-20 MAX : EXIST IIVC9 TEE 87.25 EXISTING loco GALLON ooa a o0o a 000000ggo PRECASToo NK 87.10 oo$oQIER" SEPTIC TA6 In DRYWELL oaoaaaoo 86.63 EXISTING SEE DETAIL ON BACK STONE SOIL ABSORPTION + 86.80 BASE 86.50 w 1 Sr a 1 w SYSTEM -SEE DETAIL o ExlsrlNc 22 ft 5-I2 fr ON BACK 84.50 NO GROUNDWATER BELOW MOTTLING OBSERVED 77.95 SEWAGE DISPOSAL SYSTEM PLAN 25 PEN LANE CENTERVILLE. MA APRIL 15 2015 ETE-3897 PG 2/2 Town of Barnstable Regulatory Services Richard V. Stalli,Interim Director DA STABM S. Public Health Division 039. ri,onias McKcan,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Desif,,ner Certification Form Date: —CA, u, Zl}[; Sewage 11ermit#),OZL5--/-3e Assessor's Nlap\Parcel LN < Designer: Dmu'iA CooOirmewrt Installer: QIM,44 '-0 Address: 5 C3 ed 0 Address: C lilt 0-t On kAtt,17 was issued a permit to install a (dite) installer) septic systern at E� Pell Lq m c based on a design drawn by (address) V C1 4 0 L V I-- date(] C?, (designer) P-` 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 tile distribution box and/or septie tank. Strip out (if required),was inspected and, the.soils were found satisfactory. I certify that the septic system referenced above was installed with nukjor changes (i.e. greater than I W 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 certify that the system referenced above was construct liance with the ternis of the RA approval letters (if applicable) Or f'ASC, sri DAVID COUGHANOWR 0 No. 1093 ST m IrAr 4N VS- (Designer's Signature) (Affix Dei7M' Y— tanip here) PLE,ASE RETURN TO BARNSTABLE PUBLIC HEALTH .01NISION. CERTLFJCATE OF COMPLIANCE WILI, NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE, BARNSTABLEVUBLIC REAL THDIVISION. THANK YOU. wScrticwesiper Certificalim Form Rev 8-111-11doc No. a�7! l / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPliLation for Nsposal Opstem (Construttion VP>Cm t Application for a Permit to Construct( ) Repair(k Upgrade( ) Abandon( ) ❑Complete System 4 Individual Components Location Address or Lot No.55 dAP'A1 CAKE-;1:( fjs Rb Owner's Name,Address,and Tel.No. Cdt utt- PAL>t_ MQ -M Assessor'sMap/Parcel 032 p5 36e tltwDLG popo> R4yaz6iu,,. m to Installer's Name,Address,and Tel.No. 4 -_q77-- $$'7l Designer's Name,Address,and Tel.No. (14 ftW 6 60jTWOls� L.�. t�l& 1— ;5-r Type of Building: I/ Dwelling No.of Bedrooms /V 4— 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) -17P97*L .- sc H-t D D--60Y, 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 Signed Date 57 v;Lo'aa 5 Application Approved by Date S' —/ S Application Disapproved by Date ' for the following reasons Permit No. d'O! S— IC4 Date Issued 5 No. y Fee E THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes., PUBLIC HEALTH DIVISION - TOWROF BARNSTABLE, MASSACHUSETTS 'ftpllcatlon for 30isposal *pstrm CottstrUctlon J3E TIt a Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System 4 Individual Components Location Address or Lot No. 5 OAP iO Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 032 D,S—{ 3oo vt4l-DDLc- Aook-,C kAuEPW(u- A Installer's Name,Address,and Tel.No. 50Q-q7?- 1&8 7-1 Designer's Name,Address,and Tel.No. �3�tvG EtJTbRPQt� M,46GAP6& N!� Type of Building: A/ 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 Type of S.A.S. Description of Soil f 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 Envirotimental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o l Signed Date -a-D-cAot5 Application Approved by Date S "<U Application Disapproved by Date for the following reasons Permit No. ILI5- Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On�- `ite Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by CAP E W tDC l�1VT o o K LI-L at Ss CA-P'n/ (2Au cg-MJ50a-ry t T has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Noac)1 S" Cr dated D Installer (!,dPeW(Qe cJ 1QID,Lt $ C.C.C. Designer /4 #bedrooms 1" Approved design 4 flow / gpd I , � The issuance of t s ermit shall not be construed as a guarantee that the system w 11 fu/eti�n as desip, ed. Date I Inspector iCj --------------------------------------------------------------------------------------------------------------------------------,--------- No. OG J S _ 'LI,j Fee v V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem (Construction permit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at 55 Cap iy C^ARL-CTOAJI_S l2PAZ) 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. n Provided:Construction must be completed within three years of the date of this permit. f2 Date - a b - S Approved by J J I 'fliE Town of Barnstable P#. Department of Regulatory Services Public Health Division P� Z ZD l S M Date _ �� I 7 �A ie3➢- 200 Main Street,Hyannis MA 02601 ' rft)rant A , Date Scheduled Time Fee Pd. 00 Soil Suitability Assessment for ,sew ge isposal Performed By:. VaUt t/� D, coyk'k.,nl r l%I Witnessed By: �S LOCATION& GENERAL INFORMATION Location Address �( (��h Name t Lh Owner's `�' 7 I" v�l-t ��i�p evl�er Cepjjlpp���-ervt 'te Address Z5 �a✓1 LVl CTV t-t Assessor's Map/Parcel: 3 I Z01 ' Engineer's Name tl�h r i� Coin�nctvit9l,✓r NEW CONSTRUCTION REPAIR Telephbne# v 3 G 4 0��•4- Land Use la�td Tt(4 [alv v� p Slopes(9'0) L O Surface Stones___ (� Distances from: Open Water Body t ft Possible Wet Area ©6'+ ft Drinking Water Well lob + ft Drainage Way �O t ft Property Line t ft Other ft SRETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands{n proximity to holes) 23.00' �'',► 3 lU M -T f -� Parent material(geologic) Depth to Bedrock ► `�n P Depth to Groundwater. Standing Water in Ho'l)e:_M ll� Weeping from Pit Face vile y_l Estimated Seasonal High Groundwater f S Per Gi S DET RMINATION FOR SEASONAL-HIGH WATER TABLE Method Used: MO+4 1 � Depth Observed standing in obs.hole: lb, Deptll to soil mottles: n014e© t c4 itt ! K T/' -2- Depth to weeping from side of obs.hole: [tl. GrtYtlndWnter AdJastment ft. Index Well# Reading Date- Index Well leYol a Ad,tilrtbr � a,,.l A .01'Oundwater L_ e PERCOLATION TEST bate �!4 �Jrhub t Observation Hole# /�Q Time at 9" Depth of Pere �% V i't Time at 6" G` ZO Start Pre-soak Time® V" 4_20 F��1 End Pre-soak ��77-p00 Rate Min./Inch Site Suitability Assessment: Site passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observiition 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:IS EPTIC\PERCPORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Shcl Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsistency,%'Oravel) C�- P (PA in - -3 6 w (emu 'Ah1 L-00SP —04 C, ; Zia tQ YR` 5/4- DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, /% ra 0`� ��hd� Cvq�► 0`( R 2`Z ®nP � -3� w• (���� S�y�• � YR s � t' vsP•� 4- � e Timid fp y� DEEP OBSERVATION HOLE LOG.' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. DEEP OBSERVATION DOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stotles' Boulders. Consi to \ i Flood Insurance Rate Maps Above 500 year flood boundary No— Yes Within 500 year boundary No V 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? e S If not,what is the depth of naturally occurring pervious material? Certification i I certify that on�j0v lq q� (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 requir rainin , peruse a experi nCce described in 10 CMR 15.017. r Si nature P, Date r _C7 ' 2D 15 g Q:\S.EPT1C\PP-RCF0RM.D0C r� oc � LOCATION SEWAGE PERMIT NO. _ c-*- 7 2- VI L L AG E I I N S T A LLER'S NAME' & ADDRESS B UI'LDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED g—,,?,o ot 2 NO) FEB ..' .... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH pQ� ....................OF... 1 -Appliration for Uhivagal Works Tnnarurtion Famit C Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at cation- dd ess or t ........... ............/. ... �. - 1? flti� Owe a Address a -••---•---- - -.- ......................... Installer Address go r Type of Building ? Size Lot___/j c9.4a/---•-----Sq. feet Dwelling—No. of Bedrooms.............................................Expansion Attic (i'✓� Garbage Grinder (I'� Other—Type of Building ........ No. of persons......... ............... Showers (a) — Cafeteria (✓0 aOther fixtures ---__•------------------- ........................................ W Design Flow.............I'/a•------_------------gallons per person per d) Total daily flow----------.�„,��.__�____.__...._._____gall�s. �4. ' WSeptic Tank—Liquid capaclty�4_�_.gallons Length..b...__..... Width....�...._ Diameter------S_..... llepth._S �! x . Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--.,/-------------- Diame r..._�a_.___.______. Depth below inlet......b.._........ Total lea ng ea,/O _._._sq. ft. Z Other Distribution box (� _ Dosing tank ( ) G '�' Percolation Test Results by..`_....�� ..f . . ................ Date........zh/1P.......... minutes per inch Depth of Test Pit---s:YV_-_ Depth to ground water..._. . ..Q' . a Test Pit No. 1.___..�.._.. P P - - - P �' � - G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... O Description of Soil ....... _ s ------------------------------------�---�� -- �-Lam.---� -=--------------------------- ---•----------------------...._....------- -------------•--...•. c, W -----•-•----------------•----•.......-•-•-•----•-•....••••--------------•-•----------•---•••------------•-•-••-•--------------------•--------.......................................................... 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 iITl 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. Sig - - - ......... •---- -- --------- ---�-��":`t8...... Date Application Approved By... L���._._. .... Date Application Disapproved for the following reasons:__ •--- ..__._... ..........................................•••--.......-----....•••--••---•----••..........•-•-•-•----•--•--•-•-•-•---••------••-•---••-••••---•--•--------------------•------•----------•----....-•--- Date Permit No.............•......-•----•-•••----------•---••---•----. Issued........�G•-2 d � .................. Date J Fps..... .J............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r '.i , ppliration for Disposal Works Tonoirurtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .................•--......._.........- _- ___...----.•••-•-••-----••:-•--....... .........................................` . ..... ........................-----•. Location Address or Lot o p / L J a s /! G.0 }}�Z.t/ �i/! �It Address O '� ' .............................. Installer Address Type of Building ? Size Lot....b_R�d._......Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic VVY Garbage Grinder (Alf) Other-Type of Building .. f ff .----__- No. of persons..........a-------------- Showers (.oZ) — Cafeteria (171t) P4 Other fixtures .................................. Design Flow..............h -----------..,.----.__gallons per person per day. Total daily flow ............`0----------__-- gallons. WSeptic Tank=Liquid capacity/_Oj.gallons Length-_,_f _.. Width.... �........ Diameter__-___t:__'__- Depth...S.�''..... x Disposal Trench—No..................... Width................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...../------------_ Diame_ r___.f___...-_._... Depth below inlet....... ....... Total leac ng ea.J6-0e .....sq. ft. Z Other Distribution box (,� . Dosing tank ( ) /` 7 1 Z / f w r Percolation Test Results by--------- }�f/ter .,,+strc " 'r� --• Date..------- .......... `4 Test Pit No. 1.....-�-----minutes per inch Depth of Test Pit...l Depth to ground water..... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--_________------_.-_-_ ODescription of Soil....: ••------•---•----• a..... ------------------ --------•.t-. ---------------------------------- (xj -` '- Lr- '--.I���!ii _. %tri?:f L„--------------•--------•------.....-------- W -----•--------------------------------------------------------------------------------- ---•--•---------------------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... __ _________y..__..___._..............._..._...............-----._-_.---------.----.-...--_-----.-.-.._...._.....______.__._....................................._..__................._.........._. Agreement: TIjq%undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T?TlE 5 of the StateSanitary Code; The undersigned further agrees not to place the system in operation u til a Certificate of Compliance has been issued by the board of health. F:. s r/ Date Application Approved By......!✓= � � V� `�1�� •----- � Date Application Disapproved for the following reasons:.............................................-................................................................... +. "' Date ' r PermitNo-------------------------------------------------------- Issued_................... Date ,.,: THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH .........../.��1_1�.�...............oF...... ij !s r9J?/.. ,................................... �rr#ifirtt�le ,af�'�iant��taanrr -'THIS IS TO CERTIFY, That the Individildl`Sewage Disposal System constructed ( i) or Repaired ( ) by----------------------� iJi. ..........ems-t'---. -- ------------- ---------------------•---------•-•-------- - -------.----------------------------_------•--------- Installer x. has been installed in accordance with the provisions of T "' r' 5 Qf ITI'Re State Sanitary Code as described in the T «- - ;s applicatilion for Disposal Works Construction Permit No........................................ da.ted_...F-_.--/7_`.7�--'___-------- T4E ISSUANCE OF THIS CERTIFICATEt SHALL k®T',EEtCONSTRUE9 AS A GUARANTEE THAT THE SYSTEM 1alssl}}ILL tFUNCTIONj;SATiSFACTORY. DATE........L:"`.si�Q.."`_ ................. Inspector-•-- ....t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH b ---�- j N :. FEE.... .'.............. Dispooll Wr(rki Atra ion rrani# Permission is hereby granted ... �.-------• ..................--•-••--•----•----•.................................................. to Construct ( ) or Repair ( ) an Individual Sewage Di osal System at No.-----. `-- _...y f �1 ._ !-J -•-•-C-� ..........!.. ... Street as shown on the applicatiori`f_or Disposal..Works Construction mit .__..__ Dated.__ ........-•--_-.... ^f v, , Board of Healt DATE-----•-------f-----.�� 1�' s;',rz •--------------------•--•--...•----- .. z FORM 1255 HOBBS & WARREN, INC,'PUBLISHERS l � / Y 77q's7- C)/rs 00, i L o ?' . � z / - 90So, -, 98 �p/:D ' a ' A) F/IV E j GOT L) ` ,eaf� 7 M si9wo 73. .61 te (,0 89. /44 I 0 .E'vcoc�,c,Ti�'2Ec> s .' ` TE57r- ' NOLE 77 PER , T'O A/IV RECORDS w � DA TE G o -ice 711 J . ,. SC!-ALE' j•, �- .• TO IVA/ VX3 T E R. /s /,f:9 V/-? % L P B L E //VS P. M / /V//"I U /"! OUIL. 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